Dermatology Outpatient Clinic Research Articles

The Prevalence of Body Dysmorphic Disorder in Outpatient Dermatology Clinics: A Systematic Review.

Body Dysmorphic Disorder (BDD) is a psychiatric condition involving a preoccupation with physical appearance disproportionate to physical findings, which are often absent altogether. Previously published data has estimated its prevalence at 11.3-11.9% approximately, across various medical specialties. No recent systematic reviews strictly related to dermatology clinics and the prevalence of BDD have been published. The goal of the review was to gather a pooled prevalence of BDD in outpatient dermatology clinics around the world and further underline the importance of its recognition and appropriate treatment. Twenty-one articles tackling BDD in outpatient cosmetic and general dermatology clinics were selected. Studies were graded based on the Newcastle-Ottawa Scale (NOS) and the Statistical Package for the Social Sciences software (SPSS) was used to a calculate a mean for the pooled prevalence, yielding a weighted mean prevalence of 12.5% among general dermatology patients and 25.01% among cosmetic dermatology patients. The mean prevalence of BDD among general dermatology patients fell within previously reported numbers. It was, however, markedly higher than previously reported in cosmetic dermatology patients, which we postulate could be due to dermatologists being at the forefront of non-invasive cosmetic procedures. As such, we conclude that given the high prevalence of BDD among dermatology patients, we highlight the importance of keeping a high index of suspicion of BDD among dermatologists, ways to uncover it in a clinical setting, and additional data showcasing the importance of psychiatric treatment of these patients for better outcomes, all while avoiding unnecessary interventions.

Evaluation of the efficacy and safety of cold laser (Diode 808 nm) therapy in the treatment of localized plaque psoriasis: clinical, dermoscopic and ultrastructural study

Background Psoriasis is a chronic, recurring, and immune-mediated inflammatory skin disease. Throughout the period of the last few decades, phototherapy has become widely used in treating stable psoriatic lesions. For the treatment of psoriasis, several light/laser therapies with distinct modes of action have been developed. Cold laser therapy might be an effective therapeutic choice for localized plaque psoriasis. Objective To assess the safety and efficacy of cold laser therapy clinically and microscopically in localized plaque psoriasis treatment. Patients and methods 40 patients with localized mild plaque psoriasis were selected from the Dermatology and Venereology outpatient clinic–Tanta University Hospitals and enrolled in the clinical trial. They were treated by cold laser 808 nm wavelength (Endolaser 422, Enraf–nonious B.V. Rotterdam, Netherlands) one session for 10 min on each plaque twice weekly separated by 2 days until clinical cure or for a maximum of 8 weeks. Evaluation was done immediately after the last session by taking the average of three blinded dermatologists of the photos, the modified Psoriasis Area and Severity Index [mPASI], dermoscopic examination, patients’ satisfaction scale and histopathological and electron microscopic examination of punch biopsy specimens taken before and after the end of treatment from psoriatic lesions in four patients only. Results There was a statistically significant clinical improvement after the end of treatment compared with before treatment as 16 patients (40%) showed excellent improvement, 8 patients (20%) showed good improvement, 9 patients (22.5%) showed mild improvement, and 7 patients (17.5%) showed poor improvement. As regard mPASI, a statistically significant decrease in mPASI was found after the end of treatment (P<0.001). Regarding dermoscopic examination, a statistically significant reduction in the percentage of patients showing dermoscopic red dots and white scales after the end of treatment (P<0.01). As regard the patients’ satisfaction scale, 82.5% of patients were satisfied from the results. Histopathological and ultrastructural evaluation revealed normalization of the psoriatic microscopic changes with cold laser. Conclusion The use of cold laser therapy for the management of localized mild plaque psoriasis is safe, tolerable, effective, and can be used as an alternative therapy for psoriasis.

Welche Faktoren beeinflussen die Teilnahme am gesetzlichen Hautkrebsscreenings in Deutschland?

Due to increasing skin cancer incidence, Germany implemented a statutory nationwide routine skin cancer screening (rSCS) in 2008. The present study aims (1) to analyze which patient factors are associated with the participation in rSCS in Germany and (2) to investigate reasons for nonparticipation. Participants and nonparticipants of rSCS (≥35years) were recruited in routine care in nine dermatological outpatient clinics. Reasons for (non)participation, knowledge about skin cancer as well as clinical and socioeconomic data were obtained. Stratified by groups, descriptive analyses and binary logistic regression analyses for associations with participation were performed. Of the 294 rSCS participants and 162 nonparticipants, 46.5% were male with a mean age of 54.5 ±12.7years. In total, 87.1% had sunburns in childhood and 47.1% used sunbeds before. Higher age, female gender, previous sunbed use, and concern for and knowledge of skin cancer were significantly associated with previous rSCS participation. Of the nonparticipants, 46% were unaware of the option for free rSCS and 40% justified their nonparticipation on the basis of feeling healthy. The reasons for nonparticipation in rSCS, such as sociodemographic characteristics and risk behavior, should be known in order to optimize rSCS programs.

Which factors influence the participation in statutory skin cancer screenings in Germany?

Due to increasing skin cancer incidence, Germany implemented a statutory nationwide routine skin cancer screening (rSCS) in 2008. The present study aims (1) to analyze which patient factors are associated with the participation in rSCS in Germany and (2) to investigate reasons for nonparticipation. Participants and nonparticipants of rSCS (≥35years) were recruited in routine care in nine dermatological outpatient clinics. Reasons for (non-)participation, knowledge about skin cancer as well as clinical and socioeconomic data were obtained. Stratified by groups, descriptive analyses and binary logistic regression analyses for associations with participation were performed. Of the 294 rSCS participants and 162 non-participants, 46.5% were male with a mean age of 54.5 ±12.7years. In total, 87.1% had sunburns in childhood and 47.1% used sunbeds before. Higher age, female gender, previous sunbed use, and concern for and knowledge of skin cancer were significantly associated with previous rSCS participation. Of the non-participants, 46% were unaware of the option for free rSCS and 40% justified their nonparticipation on the basis of feeling healthy. The reasons for nonparticipation in rSCS, such as sociodemographic characteristics and risk behavior, should be known in order to optimize rSCS programs.

Acute myeloid leukemia manifesting as pruritus: a case report

Acute myeloid leukemia (AML) is considered a rare malignancy of the stem cell precursors in the bone marrow, resulting in only 1.2% of new malignancy diagnoses in the United States. Pruritus is a frequent complaint for dermatology providers, averaging up to 54% of adult outpatient dermatologic patients. Dermatologic manifestations, specifically pruritus, are not common in AML; however, AML is a potentially lethal malignancy that should be considered. Here, the author describes a case of a male patient with no past malignancy history. He presented to the outpatient dermatology clinic with complaints of generalized pruritus for 1–2 weeks. He was diagnosed with severe anemia and subsequently AML after direct admission to local inpatient hematology/oncology specialists. This case illustrates the importance of considering malignancy, specifically leukemia and AML, as a differential in patients with generalized pruritus.

Do complaints related to vitiligo affect sexual quality of life and marital adjustment?

The authors aimed at evaluating the effect of vitiligo on female sexual function and Dyadic Adjustment in a hospital-based study as gender negatively affected the marital quality of vitiligo patients, more in women. A total of 153 patients who applied to the dermatology outpatient clinic of a tertiary university hospital were interviewed. However, 120 vitiligo patients who were married and had a sexually active partner and suitable the inclusion criteria were included in the study. It is seen that the mean score of the DAC is 43.13±5.11, and the mean score of the SQOL-F is 52.57±5.39. Vitiligo has a negative effect on a woman’s sexual life and Dyadic Adjustment. Early identification of sexual problems in vitiligo patients and planning their future course of management can aid in improving the marital adjustment and quality of life.

Integrated plasma metabolomic and cytokine analysis reveals a distinct immunometabolic signature in atopic dermatitis.

Disease models for atopic dermatitis (AD) have primarily focused on understanding underlying environmental, immunologic, and genetic etiologies. However, the role of metabolic mechanisms in AD remains understudied. To investigate the circulating blood metabolomic and cytokine profile of AD as compared to healthy control patients. This study collected plasma from 20 atopic dermatitis with moderate-to-severe itch (score of ≥5 on the itch Numeric Rating Scale and IGA score ≥3) and 24 healthy control patients. Mass-spectrometry based metabolite data were compared between AD and healthy controls. Unsupervised and supervised machine learning algorithms and univariate analysis analyzed metabolic concentrations. Metabolite enrichment and pathway analyses were performed on metabolites with significant fold change between AD and healthy control patients. To investigate the correlation between metabolites levels and cytokines, Spearman's rank correlation coefficients were calculated between metabolites and cytokines. Patients were recruited from the Johns Hopkins Itch Center and dermatology outpatient clinics in the Johns Hopkins Outpatient Center. The study included 20 atopic dermatitis patients and 24 healthy control patients. Fold changes of metabolites in AD vs healthy control plasma. In patients with AD, amino acids isoleucine, tyrosine, threonine, tryptophan, valine, methionine, and phenylalanine, the amino acid derivatives creatinine, indole-3-acrylic acid, acetyl-L-carnitine, L-carnitine, 2-hydroxycinnamic acid, N-acetylaspartic acid, and the fatty amide oleamide had greater than 2-fold decrease (all P-values<0.0001) compared to healthy controls. Enriched metabolites were involved in branched-chain amino acid (valine, leucine, and isoleucine) degradation, catecholamine biosynthesis, thyroid hormone synthesis, threonine metabolism, and branched and long-chain fatty acid metabolism. Dysregulated metabolites in AD were positively correlated cytokines TARC and MCP-4 and negatively correlated with IL-1a and CCL20. Our study characterized novel dysregulated circulating plasma metabolites and metabolic pathways that may be involved in the pathogenesis of AD. These metabolic pathways serve as potential future biomarkers and therapeutic targets in the treatment of AD.

PSYCHO-SOCIAL IMPACT AND QUALITY OF LIFE AMONG PATIENTS WITH PSORIASIS ATTENDING A TERTIARY CARE INSTITUTE IN NORTH CHENNAI

Objective: To assess the psycho-social impact of psoriasis and the quality of life (QoL) among psoriasis patients. Methods: This is a cross-sectional study with a sample size of 140 done in a dermatology outpatient clinic in a tertiary care institution in North Chennai. The dermatology life quality index (DLQI) was the primary tool for assessing QoL. Results: The study participants’ mean±SD DLQI score was 8.84±4.59. Out of 140 patients, 32.9% had severely affected QoL with a DLQI score &gt;10. About 81.4% of study participants felt embarrassed due to their skin lesions, and marital life was affected by 36.4%. Suicidal thoughts and alcohol addiction (for coping up) were found to be prevalent among 12.9% of the subjects, both of which were maladaptive coping strategies. It was found that patients with DLQI scores of 10 or more tend to cling to alcohol as a coping mechanism, and this association is statistically significant. Further, a significant association was also noted between the site of the lesion and marital life getting affected by psoriasis. (x2=9.893, p=0.042). Conclusion: Patients with psoriasis are subjected to an intricate web of physical and psycho-emotional challenges. Hence, the physician offering chronic follow-up care to those patients needs to adopt a holistic strategy to address their continuing medical and psychosocial needs.

Characterizing differences inoutpatient dermatologic care utilizationamong disaggregated Asian American subgroups.

Despite having significantly higher rates of atopic dermatitis, psoriasis, and pigmentary disorders compared to White patients, studies suggest that Asian Americans are underrepresented in outpatient dermatology clinics. In this study, we utilize the National Health Interview Survey (NHIS) and prioritize disaggregated analyses to evaluate differences between the most populous Asian American subgroups (Chinese, Filipino, Indian, and "Other") in utilization of outpatient dermatologic care. We utilized multivariable logistic regression to compare outpatient dermatologic care use between each Asian American subgroup and Non-Hispanic Whites. Out of 96,559 adults, our study included 5264 self-identified Asian American and 91,295 non-Hispanic White adults. Most Asian participants were female, had health insurance, and had incomes > 2 times above the federal poverty line. We found that, compared to 21.4% for NH whites, lifetime prevalence of total body skin exam was highest among Filipino Americans (12.3%) and lowest among Indian Americans (7%). Additionally, all Asian American subgroups had a significantly lower odd than NH Whites of ever having a total body skin exam, with Indian Americans having the lowest odds. While thebenefitofTBSEs inIndian Americansis unclear,it is possible that differing cultural perceptions about dermatologic needs,barriers to care,orimmigration status may be contributing tothe observed difference. Furthermore, the Indian diaspora encapsulates a range of skin tones, risk factors, and behaviors that maydifferentiallyinfluencedermatologic disease risk,similar totrends identified among Hispanic patients (Trepanowski et al. in J Am Acad Dermatol 88:1206-1209, 2023). Additional researchutilizingthe sevennational databasesthat have been identifiedasprovidingdisaggregated Asian racial information (Kamal et al. in J Am Acad Dermatol, 2023)maybe useful to furtherilluminate avenues for intervention.

The Relationship between Vitamin D, Body Mass Index and some Dietary Products with Acne Vulgaris; A Case-Control study in Baghdad/Iraq

Objective: To investigate the association of vitamin D level and moderate to severe acne as a primary outcome, and its association with BMI, dairy products, and chocolate consumption. Subjects and Methods: A case-control study was conducted in a dermatology outpatient clinic. Patients, diagnosed with moderate to severe acne vulgaris that warrant treatment with oral antibiotics, and had global acne grading system (GAGS) score of &gt;=19 were eligible to be selected as cases. Aged matched, with no or mild cases of acne were eligible to be selected as controls. The participant height, weight, BMI, and serum circulating 25-hydroxyvitamin D level were measured. A modified food frequency questionnaire was used for dietary history. Results: Comparing Cases (N = 101) and Control (N = 134), the mean of vitamin D level in cases were lower than that in the controls, however no statistically significant difference is observed. There were statistically insignificant differences between the studied groups regarding milk (whole, low fat, skimmed and any type of milk), cheese, yogurt, other dairy products, and chocolate consumption. However, a statistically significant disparity in weight is noted, but not in BMI. Conclusion: The results did not reveal any statistically significant associations between vitamin D level, BMI, dairy and chocolate consumption, and moderate to severe acne. However, it is important to note that this does not definitively rule out the possibility of any potential relationships or effects.

Nutrition's effect on male fertility: A retrospective study

Objective: The aim of this study was to clarify the effect of food on male fertility in a sample of Egyptian men. Background: Eating a varied and healthful diet may be an essential aspect of sustaining good overall health. However, specific vitamins and food groups may have a more substantial impact on reproductive health than others. A male's diet may affect his fertility. Method: Type of study Case control nested in a cross-sectional study It was conducted during the period from September 1st, 2021, to 1st of September 1st, 2022, in Dermatology and Andrology Outpatient Clinic in Menoufia University. Results: The results Twenty hundred and fifty-seven married men who have a regular sexual relation, eating different types of food accepting to participate in this study, the highest percentage of the participants were from urban areas, aged 30-39 years, weighed more than 90 kg, were 170-180 cm tall and had secondary education. Conclusion: Nutrition can both negatively and positively affect the quality of semen. The diet should include vegetables and fruit, fish and seafood, nuts, seeds, whole-grain and fibre-rich products, poultry, and low-fat dairy products.

Prevalence and characteristics of Epidermophyton floccosum skin infections: A 12-year retrospective study.

Epidermophyton floccosum (E. floccosum), an anthropophilic dermatophyte, is the primary causative agent of skin conditions such as tinea cruris, tinea pedis and tinea corporis. This study aimed to determine the prevalence and characteristics of E. floccosum-induced dermatophytosis, with particular emphasis on the types of infections and demographic profiles. In this retrospective study, patient records from the dermatology outpatient clinic were scrutinized, covering the timeframe from January 2009 to December 2020. Eligibility for the study required a dermatophytosis diagnosis verified by microscopic examination and fungal culture. Of the 4669 confirmed dermatophytosis cases, 82 (1.8%) were attributable to E. floccosum infection. The proportions of male and female patients with E. floccosum infections were 50.0% each. The most common presentation was tinea pedis (39.0%), followed by tinea cruris (37.8%) and tinea corporis (26.8%). The mean age at disease onset for tinea cruris was 38.7 ± 18.7 years, which was lower than that for tinea pedis (50.6 ± 14.2 years) and tinea corporis (53.5 ± 16.4 years). However, these age differences were not statistically significant. A continuous decrease in E. floccosum isolation was observed over the study period. There was a steady decline in the prevalence of E. floccosum dermatophytosis over the 12-year study period. Despite the decreasing trend, tinea cruris, tinea corporis and tinea pedis remained the predominant clinical manifestations of E. floccosum infection.

Cumulative incidence and risk factors for cutaneous squamous cell carcinoma metastases in organ transplant recipients: The Skin Care in Organ Transplant Patients in Europe-International Transplant Skin Cancer Collaborative metastases study, a prospective multicenter study

Solid organ transplant recipients (SOTRs) are believed to have an increased risk of metastatic cutaneous squamous-cell carcinoma (cSCC), but reliable data are lacking regarding the precise incidence and associated risk factors. In a prospective cohort study, including 19 specialist dermatology outpatient clinics in 15 countries, patient and tumor characteristics were collected using standardized questionnaires when SOTRs presented with a new cSCC. After a minimum of 2 years of follow-up, relevant data for all SOTRs were collected. Cumulative incidence of metastases was calculated by the Aalen-Johansen estimator. Fine and Gray models were used to assess multiple risk factors for metastases. Of 514 SOTRs who presented with 623 primary cSCCs, 37 developed metastases with a 2-year patient-based cumulative incidence of 6.2%. Risk factors for metastases included location in the head and neck area, local recurrence, size >2cm, clinical ulceration, poor differentiation grade, perineural invasion and deep invasion. A high-stage tumor that is also ulcerated showed the highest risk of metastasis, with a 2-year cumulative incidence of 46.2% (31.9% - 68.4%). SOTRs have a high risk of cSCC metastases and well-established clinical and histological risk factors have been confirmed. High-stage, ulcerated cSCCs have the highest risk of metastasis.

Facial Mimicry and Doctor-Patient Satisfaction: The Feasibility of Artificial Empathy in a Clinical Video Data.

Good nonverbal communication between doctor and patient is essential for achieving a successful and therapeutic doctor-patient relationship. Increasing evidence has shown that nonverbal communication mimicry, particularly facial mimicry, where one mirrors another's facial expressions, is linked to empathy and emotion recognition. Empathy is also the key driver of patient satisfaction. This study explores how facial expressions and facial mimicry influence doctor-patient satisfaction during a clinical encounter. We used a facial emotion recognition-based artificial empathy model to analyze 315 recorded clinical video data of doctors and patients in a dermatology outpatient clinic. The results show a significant negative correlation between patients' emotions of sadness and neutral and doctor satisfaction, but no correlation between the duration of doctors mimicking patient emotions and patient satisfaction. These findings provide valuable insights into the future design of systems that can further enhance clinician awareness to maintain communication skills in the search for better doctor-patient satisfaction.

Lack of Association of Acne Severity with Depression, Anxiety, Stress, and Eating Attitudes: A Cross-Sectional Study.

this study aimed to investigate the relationship between acne severity and depression, anxiety, stress, and negative eating attitudes in patients with acne vulgaris. This study was conducted with 81 patients with acne vulgaris who applied to the dermatology outpatient clinic of Karaman Training and Research Hospital. The patients were asked to complete a sociodemographic data form, the three-factor nutrition questionnaire (TFEQ-21), and the depression anxiety stress scale (DASS-21). Acne severity was assessed using the global acne grading system (GAGS) by an expert dermatologist. Of the 81 patients, 74.1% were female and the average age of the cohort was 22.86 years. The average body mass index of the patients was 21.78 and the GAGS average score was 24.25. Correlation tests revealed the lack of any relationship between the GAGS score and the DASS-21 and TFEQ-21 scale scores (and their subscales). The DASS-21 depression subscale was correlated with the TFEQ-21 total score, and TFEQ-21 emotional eating and TFEQ-21 uncontrolled eating scores. Additionally, a relationship was identified between the DASS21-stress subscale score and TFEQ-21 uncontrolled Eating and TFEQ-21 total score, as well as between the DASS21-anxiety scale and the TFEQ-21 total score and TFEQ-21 uncontrolled eating subscale score. Although no relationship was found between acne severity and depression, anxiety, or eating disorders, these conditions can increase the risk of eating disorders among acne patients. Therefore, it is critical to take the necessary precautions for the treatment of depression and anxiety disorders in this patient population.

Exploring the Effectiveness of Biological Therapy in Patients with Psoriasis: Body Image and Quality of Life.

Background and Objectives: Psoriasis is a chronic, long-term, incurable skin inflammatory disease characterized by the excessive proliferation of epidermal keratinocytes, dilation of blood vessels, thickening of the skin, and the formation of visible red patches of variable sizes. The impact on patients differs with the severity of the disease, leading to physiological discomfort and psychological distress, which significantly affect the quality of life. The etiology of psoriasis is not completely clear, but immune cells, including type 1 and type 17 cytokine-producing cells modulated by regulatory T cells (Tregs), play a critical role in driving the disease pathogenesis. With the ability to specifically target inflammatory markers, biologics can efficiently inhibit the spread of inflammation to achieve therapeutic effects. The goal was to explore the changes in body image and quality of life in psoriasis patients undertaking therapies with biologic agents. Materials and Methods: This study employed a quasi-experimental, single-sample, pretest-posttest design. Forty-four psoriasis patients were recruited from the dermatology outpatient clinics at two medical centers in northern Taiwan. A structured questionnaire, including demographic information, the Body Image Scale (BIS), and the Dermatology Life Quality Index (DLQI), was used as a research tool. Questionnaire assessments were conducted both before and three months after the biologic agent intervention. Statistical analyses were performed using SPSS version 22.0. Results: Our results indicated a significant difference in body image between psoriasis patients before and after intervention with biologic agents. In addition, overall quality of life (QoL) also showed significant improvements before and after biologic agent intervention. There was a positive correlation between body image and quality of life in psoriasis patients. Conclusions: The treatment for psoriasis has evolved rapidly in recent years, and biologic agents have proven to be effective therapies to improve the quality of life for psoriasis patients. Our study suggests that health-related education and psychological support can further benefit psoriasis patients to willingly and positively undertake treatment and therefore improve their positive body image and quality of life.

Comparing quality of life, anxiety, depression, sleep disturbance, and associated factors in vitiligo and alopecia areata patients.

Vitiligo and alopecia areata (AA) are two autoimmune skin diseases that affect patients' quality of life (QoL) and give rise to psychosocial complications, such as depression, negative self-image, less joyful social engagements, and low self-esteem. These two disorders have common and uncommon characteristics. Therefore, in this study, we tried to evaluate the similarities and differences in the psychological parameters including quality of life, sleep disturbance, anxiety, and depression levels between, vitiligo and AA patients. Patients with either vitiligo or AA visiting the outpatient dermatology clinic from November 2017 to December 2020 have been included in this study. Persian versions of three questionnaires including the dermatology life quality index (DLQI), hospital anxiety and depression scale (HADS), and Pittsburgh sleep quality index (PSQI), have been used to assess the QoL, sleep disturbance, anxiety, and depression levels in patients. In total, 188 patients, including 94 (50%) cases of AA and 94 (50%) patients with vitiligo, met the criteria. In AA patients, a significantly higher DLQI score was found (p-value = 0.002) compared to the vitiligo cases, which means a better QoL in vitiligo patients. Additionally, AA patients had higher scores of anxiety (P-value<0.001) and depression (p-Value<0.001). However, sleep disturbance (64.9% of AA patients vs. 59.3% of vitiligo patients; p-Value = 0.4888) was not significantly different between the two groups. Our data showed lower QoL and higher levels of anxiety and depression in AA patients compared to vitiligo cases, but no difference was seen in sleep disturbance in the PSQI-P score.

Effectiveness of adding educational video in patients with atopic dermatitis to facilitate shared decision-making

Abstract Background: Shared decision-making (SDM) is becoming more popular in various medical specialties as a core component of patient-centered care. However, patients’ lack of sufficient disease knowledge remains a barrier to implementing SDM. Objectives: This study aims to examine the effectiveness of two educational approaches for atopic dermatitis (AD) patients, a pamphlet and pamphlet plus video, using assessments of knowledge level and satisfaction. Methods: From August 2021 to February 2023, patients with AD from the dermatology outpatient clinic at Tri-Service General Hospital were included. Educational pamphlets were provided before educational videos, and patients were asked to complete an identical five-question test postpamphlet and postpamphlet plus video, respectively. A questionnaire was used to evaluate patients’ satisfaction. The two test scores were compared, and the satisfaction levels were analyzed. Results: The mean postpamphlet plus video score (94.84 ± 10.20) was significantly higher than the mean postpamphlet score (77.42 ± 17.17, P &lt; 0.001) across 62 eligible samples. Gender and age subgroups showed similar trends. In addition, most patients preferred educational pamphlet plus videos (ranging from 37.5% to 75.0% in different subgroups) compared with educational pamphlets (ranging from 0.0% to 3.85%). The educational pamphlet plus video demonstrated high satisfaction in promoting disease knowledge and treatment options for AD. Conclusion: Adding educational video is an efficient approach toward reinforcement of patients’ knowledge of AD and further facilitates the implementation of SDM in dermatology practice.

Clinicoepidemiological Spectrum of Connective Tissue Diseases in the Pediatric Population in a Tertiary Care Center in North India: A Cross-sectional Observational Study

Abstract Background: Connective tissue diseases (CTDs) are chronic in nature and carry a high risk of morbidity, disability, and mortality if not recognized and treated promptly. Data on clinical spectrum of CTDs in the pediatric age group are sparse from developing countries such as India. Objective: To study the clinicoepidemiological spectrum of CTDs in the pediatric age group. Methodology: A hospital-based, cross-sectional, observational study was undertaken over a period of 16 months from January 2021 to June 2022 in the dermatology outpatient department and pediatric rheumatology clinic in a tertiary care hospital in North India. Clinical and laboratory findings were recorded. Results: A total of 100 children diagnosed with a CTD were included in the study. The mean age was 11.11 ± 4.20 years. Out of 100 children, 55% were female and 45% were male with a male-to-female ratio of 1:1.2. Our study included 63% juvenile idiopathic arthritis, 17% systemic lupus erythematosus, 7% juvenile dermatomyositis, 6% Kawasaki disease, 3% systemic sclerosis, and 2% Henoch–Schonlein purpura and mixed CTD patients each. Mucocutaneous features commonly seen were rash (40%), oral ulcers (22%), and photosensitivity (18%). Commonly seen systemic features were joint pain (77%), followed by fever (63%). Conclusion: Mucocutaneous manifestations are frequently seen in CTDs and constitute a frequent and an early manifestation of CTD. Early recognition of CTD in the pediatric age group will help in timely initiation of treatment to prevent disabilities and mortality.

Pain type and neuropathic pain components in acute herpes zoster.

The aim of this study was to investigate the pain type (nociceptive or neuropathic) and neuropathic pain components in patients with acute herpes zoster (HZ). Patients with acute HZ referred to the outpatient Dermatology and Venereology clinic between January 2021 and January 2022 were retrospectively detected. The demographic data including gender and age, rash localization, pain severity, and neuropathic pain components were recorded. Pain severity and neuropathic pain components were evaluated using a Visual Analog Scale (VAS) and Douleur Neuropathique 4 (DN4), respectively. The study included a total of 58 patients, comprising 33 females and 25 males. Of these patients, 35 (60.3%) were found to have neuropathic pain. Itching, burning, pins and needles, and tingling were the most frequently reported neuropathic pain signs and symptoms. The proportion of female patients with neuropathic pain was found to be significantly higher than that of male patients (p=0.021). No significant differences were observed in the distribution of pain across different body sites or in the age of patients with neuropathic pain (p>0.05). Itching was significantly more common in younger patients (p=0.02). In conclusion, the study found that over half of the patients with acute HZ experienced neuropathic pain, and this was more frequently observed in female patients. Analysis of different components of neuropathic pain showed significant differences in age, gender, and site distribution. The findings of this study may have important implications for the manage-ment and treatment of acute HZ.