Dermatology Practice Research Articles

A Clinico-Epidemiological Study of Hyperkeratotic Palmoplantar Lesions and Its Correlation With Dermoscopy and Histopathology in a Tertiary Care Center.

Introduction Hyperkeratotic lesions on the palms and soles are one of the most frequent clinical presentations encountered in dermatological practice, with a myriad of underlying etiologies that closely resemble one another and are clinically indistinguishable. Histopathological examination is the tool used by dermatologists to arrive at a final diagnosis, butit is invasive and not feasible under all circumstances. Dermoscopy is a new age, increasingly popular, noninvasive diagnostic technique of great value that is used to diagnose underlying etiology by acting as a bridge between clinical and histopathological pictures. This study aimed to evaluate the various etiologies underlying palmoplantar hyperkeratosis and the role of dermoscopy in the diagnosis of each disease along with its ability to delineate a close differential diagnosis and ensure appropriate treatment. Materials and methods This was a hospital-based observational cross-sectional studyconducted from July 1to December 31, 2022. Consenting patients with hyperkeratotic palmoplantar lesions on clinical examinationattending the dermatology outpatient department at our tertiary care hospital were included after institutional ethical clearance was obtained. Patients with HIV, hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) infection, or a history of hyperkeratotic lesions since birth, i.e., inherited palmoplantar keratodermas, were excluded from the study. A total of 60 patients aged between 18 and 60 years who met the above criteria were included. A complete history was taken; a thoroughexaminationwas performed. Routine investigationsand tissue histology were done. Potassium hydroxide (KOH) mount and patch testing were done as and when required. Dermoscopywith DermLite DL4was performed in all cases on lesional areas, and the findings were noted. Results Palmoplantar psoriasis has been found to be the most common cause of hyperkeratosis in our study with 24 (40%) out of 60 cases, followed bychronic hand-foot eczema found in 19 (31%) cases. Dermoscopic findings that help in differentiating various etiologies arevascular findings and scaling types. Vascular findings, mainlyregularly arranged dots and globules, were more prominent in palmoplantar psoriasis. Yellow white scaling was frequently observed in hyperkeratotic hand eczema.Most of the cases corresponded with their provisional diagnoses on histopathology, butfour out of 19 histopathologically confirmed cases ofeczema showed clinical resemblance to palmoplantar psoriasis, along with dermoscopic features of psoriasis. Two out of four cases of histopathologically confirmed palmoplantar LP were clinically considered palmoplantar psoriasis and hyperkeratotic hand-foot eczema. Conclusion Although hyperkeratoses of palms and soles are a common clinical entity, the similarity between the clinical features of the underlying conditions causes a diagnostic dilemma for treating dermatologists. Dermoscopy is a noninvasive, quick, reproducible, supportive investigation in the diagnosis of these conditions that certainly aids in reaching closer to a differential diagnosis and for better delineation, but it does not avert the need for a skin biopsy. Further confirmation with histopathological examination is advisable, especially in these conditions as they show close morphological similarity. A combination of all these investigations and clinical examinations gives better diagnoses and appropriate treatment.

Enfermedades infecciosas no venéreas atendidas en consultas de Dermatología en España: resultados del estudio DIADERM

Background and objectiveThe burden of nonvenereal infections in Spanish dermatology practice has not yet been evaluated. The aim of this study was to analyze the overall weight of these infections in outpatient dermatology caseloads. Material and methodsObservational cross-sectional study of diagnoses made by a random selection of dermatologists from the Spanish Association of Dermatology and Venereology (AEDV) working in outpatient dermatology clinics. The data were obtained through the anonymous DIADERM survey. Diagnoses of infectious diseases were selected using codes from the International Classification of Diseases, Tenth Revision. After excluding sexually transmitted infections, the diagnoses were classified into 22 groups. ResultsSpanish dermatologists diagnosed an estimated 16190 (95% CI, 9338-23042) nonvenereal infections on average per week, a figure that accounted for 9.33% of the dermatology caseload. The most common diagnostic groups were nonanogenital viral warts (7475 diagnoses, 46.17% of nonvenereal infections), dermatophytosis (3336, 20.61%), and other viral infections (1592, 9.84%), which included Molluscum contagiosum infections. Nonvenereal infections were more common than noninfectious dermatologic conditions in private clinics (P<.0020) and adults (P<.00001). Patients with these infections were also more likely to be discharged than those with other conditions in both public (P<.0004) and private (P<.0002) practices. ConclusionsNonvenereal infections are frequent in dermatology. They are the third most common reason for outpatient visits, behind actinic keratosis and nonmelanoma skin cancer. By enhancing the participation of dermatologists in the management of skin infections and encouraging interactions with other specialists, we will be able to carve out a niche in an area we have scarcely ventured into to date.

Experiences and coping behaviors of patients with psoriasis: a qualitative study

BackgroundPsoriasis is a complex, chronic, lifelong inflammatory skin disease characterized by the development of erythematous, indurated, scaly, pruritic, and often painful skin plaques, and it is currently incurable. It profoundly affects psychological wellbeing and social functioning and has significant associated co-morbidities. To improve clinical approaches, understanding of the experiences of patients with psoriasis is needed.ObjectiveTo explore the experiences and coping behaviors of patients with psoriasis.MethodsA qualitative study approach was conducted. Through semi-structured interviews, 20 patients with psoriasis were recruited from general practices and specialist dermatology practices in a regional teaching hospital in Taiwan. Recorded interviews were transcribed and analyzed by content analysis.ResultsThree themes and nine subthemes were identified: (1) Symptoms distress: (a) trouble with scaling, (b) bothersome itching, and (c) complex pain experiences; (2) Psychological distress: (a) encountering discrimination and (b) feeling stigmatized; (3) Managing psoriasis: (a) coping with symptoms, (b) seeking alternative methods, (c) using biologic agents, and (d) changing thinking and coexisting with the disease.ConclusionThe experience of patients with psoriasis has significant negative impacts on their lives. The findings of this study can provide healthcare professionals with a reference for the care of patients with psoriasis.

Evidence-base for the beneficial effect of nutraceuticals in canine dermatological immune-mediated inflammatory diseases - A literature review.

Immune-mediated inflammatory diseases (IMIDs) are associated with an abnormal immune response, resulting in a disturbed homeostasis and chronic inflammation. Most canine dermatological IMIDs (cDIMIDs), such as allergies, autoimmune and immune-mediated diseases, require long-term treatment with immunosuppressive drugs with potential adverse effects. In general, nutraceuticals are thought to be safe. As a result, there is a tendency for the more frequent use of nutraceuticals in veterinary medicine. The aim of this review was to present evidence-based proof for the use of various nutraceuticals in the treatment of cDIMIDs and, where possible, to provide conclusions to guide their use in veterinary dermatological practice. A comprehensive literature search on common cDIMIDs and nutraceuticals was performed. Only peer-reviewed articles published in English and related to the study topic were included. A total of 64 eligible publications were classified in five categories based on study design and substantively assessed on additional criteria such as standardisation of diets and number of included animals. For final appraisal, classification of major, minor or no evidence was used whereby efficacy was based on clinical outcome measurements. Minor evidence for the beneficial use of several nutraceuticals, including essential fatty acids, niacinamide and probiotics, was found for treatment of specific cDIMIDs. These nutraceuticals may improve clinical signs or reduce the required dose of concurrent medication (e.g. drug-sparing effect) in some dogs. Some nutraceuticals also may be used for long-term maintenance therapy. Despite some promising findings, major evidence for the use of nutraceuticals in cDIMIDs is lacking, warranting further research.

Erythema Nodosum Associated with Terbinafine Therapy- A Case Report

Terbinafine is a commonly used anti-fungal agent in dermatological practice but not one clearly associated with erythema nodosum. There is only one published report in 2014 that described a delayed onset of erythema nodosum after cholestasis complicated terbinafine therapy. We report the case of a woman who developed erythema nodosum whilst on terbinafine therapy for onychomycosis to further consider this link and its potential implications.

Protocols on correction of signs of undifferentiated connective tissue dysplasia using hardware and injection techniques in cosmetic patients

Undifferentiated connective tissue dysplasia (UCTD) is a genetically determined condition with a progressive course characterized by defects in the fibrous structures and the basic connective tissue substance, leading to impaired formation of organs and systems, which determines the features of the associated pathology, as well as the pharmacokinetics and pharmacodynamics of drugs. In dermatological and cosmetological practice, the issue of UCTD is very topical, as individual external presentations of the connective tissue dysmorphogenesis among young people can reach 85.4%. In recent decades, a real revolution has taken place in aesthetic medicine, which is associated with the emergence of new injectable products, development of hardware, cellular and thread techniques. Every year mew methods of treatment emerge and the existing ones are improved. Statistics of the past years show that minimally invasive non-surgical interventions are becoming more and more popular in all countries, their number significantly exceeds the number of surgical operations. To date, there are 2 groups of methods aimed at collagen stimulation: hardware techniques and injection methods. The effectiveness of the use of polylactic acid drugs as the first-line drugs for the correction of UCTD in order to prevent premature ageing was evaluated in the presented clinical cases. Patients with a cosmetology profile were treated according to the complex protocols that included amino acid replacement therapy, IV therapy, contour correction with drugs containing polylactic acid and hardware techniques (microneedle RF lifting with insulated and non-insulated needles, ultrasonic SMAS lifting, ablative laser techniques, Ipl-therapy). As a result, an algorithm for managing a patient with UCTD was developed in the cosmetology practice. The provided clinical cases show that the detection of signs of UCTD can significantly improve the patient’s quality of life and prevent premature aging.

A novel automatic acne detection and severity quantification scheme using deep learning

Accurate detection and severity quantification of acne are of great significance in the precise treatment of patients. Due to the similar appearance of acne with close severity, it is challenging for dermatologists to grade acne accurately and efficiently. This study aims to propose an accurate and efficient scheme based on deep learning (DL) to assist dermatologists in acne detection and severity quantification. The proposed frame consists of two steps: the Localization deep learning (Localization-DL) model and the Class segmentation (ClassSeg) model. The first model uses the distilled lightweight convolution network as the backbone and extracts multi-scale features through a pyramid pooling module for facial region localization and distinction. The second model is a unified framework that combines a Class module to distinguish background and facial skin sub-images and a segmentation (Seg) module to perform segmentation for different classes to obtain lesion masks. The facial skin segmentation branch of the ClassSeg model is built based on a high-resolution network (HRNet) and modified by mask-aware attention, shuffle attention, and conditional channel weight block. The experiments show that the two models achieve promising results and demonstrate effectiveness in lesion detection compared to other methods. The proposed scheme shows excellent results in acne severity quantification and yields a comparable performance with dermatologists (accuracy: 0.9091 for ours, 0.9301 for SDerms, 0.8741 for IDerms, and 0.7483 for JDerms). The assessment performance also outperforms the existing approaches. This work opens new avenues for acne severity quantification and provides valuable diagnosis evidence for dermatologists in clinical practice.

Rosmarinus officinalis and Skin: Antioxidant Activity and Possible Therapeutical Role in Cutaneous Diseases

The rosemary plant, Rosmarinus officinalis L., one of the main members of the Lamiaceae family, is currently one of the most promising herbal medicines due to its pharmaceutical properties. This research aimed to evaluate the antioxidant role of Rosmarinus officinalis and its bioactive compounds on the skin, with a focus on the newly emerging molecular mechanisms involved, providing extensive scientific evidence of its anti-inflammatory, antimicrobial, wound-healing and anticancer activity in dermatological practice. The search was conducted on articles concerning in vitro and in vivo studies in both animals and humans. The results obtained confirm the antioxidant role of R. officinalis. This assumption derives the possibility of using R. officinalis or its bioactive elements for the treatment of inflammatory and infectious skin pathologies. However, although the use of rosemary in the treatment of skin diseases represents a fascinating line of research, future perspectives still require large and controlled clinical trials in order to definitively elucidate the real impact of this plant and its components in clinical practice.

Subepidermal Low-Echogenic Band-Its Utility in Clinical Practice: A Systematic Review.

High-frequency ultrasonography (HF-USG) is a relatively new imaging method that allows the evaluation in a non-invasive manner of the skin layers and skin appendages. It is a diagnostic tool with increasing usefulness in numerous dermatological pathologies. High reproducibility, non-invasiveness and short diagnostic time make this method an increasingly used tool in dermatological practice. The subepidermal low-echogenic band is a relatively newly described parameter that seems to be a marker not only of intrinsic and extrinsic skin aging, but also of inflammatory processes taking place at the skin level. This systematic review aims to evaluate the role that SLEB has in the diagnosis and monitoring of the treatment of some inflammatory and non-inflammatory dermatological conditions, as well as its utility as a disease marker.

Developing relationships with patients, staff, and industry in dermatology.

Maintaining a thriving dermatology practice requires thoughtful and intentional investment in relationships with patients, staff, and industry. Growing the patient-physician relationship involves optimizing patient satisfaction and outcomes, which can provide improved ratings and reimbursement. Cultivating an environment of employee engagement is also essential for promotion of patient satisfaction, employee satisfaction, and practice productivity. Additionally, relationships with industry require careful navigation to maximize its great potential for medical advancement and benefit for all parties. There are inherent conflicts of interest between physician motivation for improved patient outcomes and industry goals of increased profits. Successful management of these relationships can be a difficult task, but it remains important.

Growing a cosmetic practice with devices and injectables in dermatology.

Growing a cosmetic dermatology practice is an often complex and arduous task. Many factors must be considered to build and maintain a successful clinical practice. Devices and injectables are both integral components to operating a comprehensive cosmetic dermatology practice. Aesthetic physicians seeking to grow their cosmetic practice in these areas must be aware of the numerous considerations-both more obvious and more subtle-that play a role in the decision-making process, including the local market, patient demand, clinic space, and physician experience and training. This contribution is focused on the factors that should be carefully considered when one is looking to grow a cosmetic dermatology practice with devices and injectables.

Oversight of In-Office Dispensing and Samples in Dermatology.

The provision of samples and in-office dispensing of products and medications to patients are important, yet often controversial, practices in dermatology. Opinions on the practices of sampling and in-office dispensing vary greatly among dermatologists. Ultimately, there are several advantages and disadvantages associated with each practice, and common topics of discussion include ethics, costs, safety, and adherence. Many of the concerns associated with the practices of sampling and dispensing in dermatology may be mitigated by careful consideration and action by prescribers. Providers should be aware of their current practices surrounding these issues and, if utilized, methods by which these practices can be improved in order to optimize patient care. With careful consideration, it may be possible to practice sampling and dispensing of products and medications safely, ethically, and to patients' advantage as an integral part of the dermatology practice.

A Systematic Review: Landscape of Private Equity in Dermatology From Past to Present.

The primary objective of this abstract is to define the growing trend of private equity (PE) backed consolidation of dermatology practices and explore its impact on patient care. The secondary objective is to better inform dermatologists of the acquisition process as well as how practices are valued in the event of a leveraged buyout. A systematic review was conducted using PRISMA guidelines using PubMed/MEDLINE and Web of Science in July 2021. Studies included were graded using the Oxford Center for Evidence-Based Medicine 2011 Levels of Evidence.1 A total of 18 articles met the inclusion/exclusion criteria. With the current environment of low interest rates combined with increasing cost of medical operations and non-clinical administrative burdens, PE is positioned to expand exponentially in total value through leveraged buyouts of solo and small dermatology groups.2 Selling dermatologists receive payment in form of upfront cash, and equity in escrow incentivizes them to continue the growth of their clinic so that it can be consolidated into a larger portfolio of practices to be sold to another buyer in 3-7 years at a far higher valuation. Within the fragmented $8.4 billion-dollar dermatology space, PE-backed practices represent approximately 10-15% of all private practices.3-5 Dermatologists should be aware of both the risks and the rewards of acquisition by PE given the fiduciary responsibility to shareholders and their patients. J Drugs Dermatol. 2023;22(4): doi:10.36849/JDD.6892 Citation: Sung CT, Salem S, Oulee A, et al. A systematic review: Landscape of private equity in dermatology from past to present. J Drugs Dermatol. 2023;22(4):404-408. doi:10.36849/JDD.6892.

Main effects of retinol palmitate on skin structures and the technology of its use in dermatological practice

Vitamin A and its synthetic analogues are used in the treatment of numerous skin diseases. The main genomic effects of the natural form of vitamin A (retinol palmitate) are associated with its active metabolite all-trans-retinoic acid and are compensated by several restrictive mechanisms. Numerous studies have proved that retinol stimulates the proliferation of keratinocytes of the basal layer of the epidermis and endothelial cells, and also activates dermal fibroblasts to synthesize proteins of the extracellular matrix of the dermis. As a result, the thickening the epidermis, increases the mechanical strength of the skin and the hydrating ability of the dermis, angiogenesis increase. The ability of retinol to enhance the adhesion of endothelial cells and leukocytes, regulate the processes of keratinization and sebum secretion was found. Vitamin A is also a powerful antioxidant. Retinol palmitate is used as the main or auxiliary drug for the treatment of a wide range of dermatoses. The principle of application is based on clinical studies and confirmed by existing experimental data. In the treatment, the following algorithm is followed. If retinol palmitate is necessary to improve epithelialization and strengthen the epidermal barrier, medium therapeutic doses should be used. For the treatment of disorders of keratinization processes, depending on the severity of the pathological condition, medium and high therapeutic doses of the drug are used. Violation of the processes of sebum secretion and severe hyperkeratosis respond better to treatment at high therapeutic doses. It should be noted that many skins clinical manifestations mostly regress under the action of vitamin A in doses that do not lead to the appearance of signs of toxicity of the drug.

Geospatial analysis of access to dermatology care in Los Angeles County: a cross sectional study.

Geographic maldistribution of dermatologists contributes to disparities in access to dermatologic care. We aimed to investigate the geographic distribution of, and differences in wait times for medical dermatology services in Los Angeles County (LAC). We placed phone calls to 251 dermatology practices in LAC to ask for a new patient appointment for a changing mole. We found West LAC (Service Planning Area [SPA] 5) had the highest number of dermatologists and South LAC (SPA 6) had the lowest (26.1 versus 0 per 100,000 residents, P=0.01). Service Planning Area 6 has a higher non-White, uninsured, and impoverished population than SPA 5. Dermatology appointment wait times and Medicaid acceptance varied between SPAs but was not statistically significant (P=0.37 and P=0.20, respectively). Medicaid-accepting practices had a significantly longer mean wait time for an appointment than practices that did not accept Medicaid (26.1 versus 15.1 days, P=0.003). Regions with predominantly non-White, Spanish-speaking, and medically underinsured residents were found to be disproportionately lacking in dermatologists across LAC, which may contribute to impaired access to dermatology services in LAC.

Recommendations for individual comorbidity risk assessment in adult patients with psoriasis

It has long been known that chronic inflammatory systemic diseases, such as psoriasis, pose ahigh risk of developing comorbidities. In everyday clinical practice, it is therefore of particular importance to identify patients who have an individually increased risk profile. In patients with psoriasis, the comorbidity patterns "metabolic syndrome", "cardiovascular comorbidity" and "mental illness" were identified as particularly relevant in epidemiological studies depending on the duration and severity of the disease. In the everyday care of patients with psoriasis in dermatological practice, the use of an interdisciplinary checklist for risk analysis and the initiation of professional follow-up care has proven valuable. On the basis of an existing checklist, the contents were critically evaluated by an interdisciplinary group of experts and aguideline-oriented update was prepared. In the opinion of the authors, the new analysis sheet represents apracticable, factually focused and updated tool for comorbidity risk assessment in patients with moderate and severe psoriasis.

A Dual-Modality Imaging Method Based on Polarimetry and Second Harmonic Generation for Characterization and Evaluation of Skin Tissue Structures

The characterization and evaluation of skin tissue structures are crucial for dermatological applications. Recently, Mueller matrix polarimetry and second harmonic generation microscopy have been widely used in skin tissue imaging due to their unique advantages. However, the features of layered skin tissue structures are too complicated to use a single imaging modality for achieving a comprehensive evaluation. In this study, we propose a dual-modality imaging method combining Mueller matrix polarimetry and second harmonic generation microscopy for quantitative characterization of skin tissue structures. It is demonstrated that the dual-modality method can well divide the mouse tail skin tissue specimens' images into three layers of stratum corneum, epidermis, and dermis. Then, to quantitatively analyze the structural features of different skin layers, the gray level co-occurrence matrix is adopted to provide various evaluating parameters after the image segmentations. Finally, to quantitatively measure the structural differences between damaged and normal skin areas, an index named Q-Health is defined based on cosine similarity and the gray-level co-occurrence matrix parameters of imaging results. The experiments confirm the effectiveness of the dual-modality imaging parameters for skin tissue structure discrimination and assessment. It shows the potential of the proposed method for dermatological practices and lays the foundation for further, in-depth evaluation of the health status of human skin.

Treatment Patterns of Port-Wine Birthmarks With Pulsed Dye Laser Among Dermatology Practices in the United States.

Kodumudi, Vijay MD, MBA, MPH*; Geronemus, Roy G. MD†,‡; Feng, Hao MD, MHS§ Author Information

Melanoma diagnosis at a specialist dermatology practice without the use of photographic surveillance.

Photographic aides are increasingly used in melanoma surveillance. We report melanoma characteristics detected using traditional surveillance without photographic technologies. Retrospective study of melanomas diagnosed by three dermatologists at a private dermatology practice over 7 years. Patients underwent full skin examinations with dermoscopy and suspect lesions were excised or biopsied. Total body photography (TBP) and serial digital dermoscopic imaging (SDDI) were not used. Patient demographics, melanoma subtype and thickness, location, biopsy technique and keratinocyte cancers diagnosed at the same visit were recorded. Ratio of in situ to invasive melanomas was calculated. Melanoma risk factors were recorded for 69 randomly-selected patients. 492 patients were diagnosed with 615 melanomas during 579 visits. 505 (82%) were in situ (in situ to invasive ratio of 4.6:1). Of the invasive melanomas, 85.5% had a Breslow thickness <0.8 mm, 10 (9.1%) 0.8-1 mm and 6 (5.5%) >1 mm. 43.3% of in situ melanomas were lentiginous or lentigo maligna and 41.6% were superficial spreading melanomas (SSM). Of invasive melanomas, 24.3% were lentigo maligna melanoma and 59.5% were SSM. 48.4% of melanomas were diagnosed by shave procedures. Where risk factors were known, 25% were very-high-risk and 43% had a history of melanoma. Keratinocyte carcinoma was diagnosed by biopsy at 26.1% of visits. Studies using TBP and/or SDDI report in situ to invasive ratios of 0.59:1 to 2.17:1. Tradiational melanoma surveillance with immediate biopsy of suspect lesions results in high in situ to invasive ratios. Studies using photographic surveillance show lower ratios of in situ to invasive disease.

Evaluating dermatology education in Australia: Medical students' and junior doctors' perceptions.

Despite a high frequency of dermatological general practice and emergency department presentations, including serious and potentially fatal skin conditions, evidence suggests that undergraduate dermatological education remains sparse. Given this, there exists a need to gauge dermatology-relevant knowledge and skill in our new doctors. An online survey was completed by final-phase medical students and junior doctors from Australian medical schools. The survey appraised self-perceived confidence of dermatology knowledge and skills, in addition to 5 knowledge-based multiple-choice questions. Nine hundred and forty-two eligible responses were completed. Respondents reported low confidence in identifying dermatological conditions in people with skin of colour (μ=1.69), handing over to dermatology colleagues (μ=2.00) and in diagnosing and managing acute/emergency dermatology conditions (μ=1.84). In contrast, participants felt most confident in counselling sun-protective behaviours (μ=3.95) and suturing small wounds (μ=3.43). 76.4% of respondents had not undertaken any dermatology placement, and 70.9% had never been formally assessed in dermatology. Those who received dermatology placement had a significantly higher aggregated self-reported confidence (p < 0.0001) and answered significantly more MCQs correctly (p=0.0419). Those who had been formally assessed had a significantly higher self-reported confidence (p < 0.001) and answered significantly more MCQs correctly (p=0.007). Final-phase medical students and junior doctors exhibit low confidence across many dermatology competencies. Participants believed they need more dermatology education, and seldom feel prepared when exposed to dermatologic pathologies. Introduction of a standardised curriculum, formal assessments and increased clinical exposure are possible solutions.