Diagnosis Of Dermatological Diseases Research Articles

Clinical Accuracy Of Dermatologists And Nondermatologists In The Diagnosis Of Dermatological Diseases.

To compare the clinical diagnostic accuracy of dermatologists and non- dermatologists in the diagnosis of dermatological diseases. The descriptive, cross-sectional study was conducted at the Dermatopathology department of a tertiary healthcare hospital in the Punjab province of Pakistan from January 1 to December 31, 2019, and comprised biopsy specimens of patients with diseases of the skin and subcutaneous tissue. The clinical diagnoses of general surgeons, otolaryngologists, dental/maxillofacial surgeons, plastic surgeons and gynaecologists were noted and compared with those of dermatologists in the light of histopathological findings. Data was analysed using SPSS 16. Of the 386 specimens submitted, 113(29.3%) were sent by dermatologists and 273(70.7%) by non-dermatologists. Clinical diagnostic accuracy of dermatologists 92(81.4%) compared to non-dermatologists 137(50.2%) (p<0.005). The dermatologists diagnosed significantly more cases belonging to inflammatory and miscellaneous cutaneous diseases category accurately than non-dermatologists (p<0.005). Similarly, the dermatologists diagnosed significantly more cases of neoplastic disorders accurately than the non-dermatologists (p= 0.018). There was no significant difference in the clinical diagnostic accuracy of dermatologists and non-dermatologists in cases of cystic lesions (p>0.05). In the neoplastic category, no significant difference was found in the clinical accuracy of dermatologists and plastic surgeons (p=0.347). The specialised skills of dermatologists could not be matched by any other group of physicians.

A Clinico-Pathological Multidisciplinary Team Increases the Efficacy of Skin Biopsy and Reduces Clinical Risk in Dermatology.

A clinical risk is an inherent risk in healthcare processes, including skin biopsy procedures, and may lead to misdiagnoses, increased healthcare costs and potential harm to patients. Indeed, clinical and histopathological data must be integrated if we are to reduce clinical risks and improve diagnostic accuracy in the diagnosis of dermatologic diseases. Although dermopathology services used to be part of a dermatologist's duty, the recent centralization of these laboratories has caused a loss of expertise and increased both complexity and safety issues. Some countries have implemented clinical-pathological correlation programs aimed at facilitating communication between clinicians and dermatopathologists. However, Italy has regulatory and cultural barriers that make the implementation of these programs difficult. Therefore, an internal analysis was carried out to assess the efficacy and impact that skin biopsy procedures for inflammatory and neoplastic conditions have on the quality of care in our dermatology department. As the analysis evidenced a high number of descriptive pathologic reports and discordant diagnoses, a multidisciplinary group of four dermatologists, four general pathologists and one dermatopathologist was set up. Herein, we present the results of this analysis and project and describe the structure of the multidisciplinary group. We also discuss the pros and cons, possibilities and limitations of our project, including the regulatory barriers of the Italian National Health System.

Dermoscopy of Psoriasis: A Cross Sectional Study

Introduction: Dermoscopy is a non-invasive tool that aids in the diagnosis of dermatological diseases. Objectives: The study aims to evaluate the dermoscopic features of psoriasis in the skin. Materials and Methods: All patients clinically diagnosed with psoriasis were enrolled in the study. Dermoscopic findings were studied using a handheld pocket dermoscope (Dermlite DL1) with high magnification. Dermoscopic examination used both polarizing and non-polarizing lenses. Results: The age of the patients ranged from 12 years to 58 years, and the mean age of presentation was 30 years (+/-12.7 years). There were 52% females and 48% males. In dermoscopy, vascular changes were seen in 90%. Vessel arrangement was seen as uniform in 80% of the cases and non-uniform in 20%. Dotted vessels were seen in 88%, glomerular and comma-shaped vessels in 2%. In 94%, white scales were seen, followed by yellow scales in 2% and mixed types in 4%. The background color was red in 68% of cases, pink in 26%, and brownish in 6%. Pigmentary changes were observed in 16%. Follicular changes were observed in 6%. Conclusion: The present study analyzed the characteristic of dermoscopic features in psoriasis. Further studies should be conducted, including inflammatory disorders and their correlation with dermoscopic features.

Medical Student Confidence in Diagnosis of Dermatologic Diseases in Skin of Color.

PurposeTo evaluate medical student confidence in diagnosing dermatologic diseases in skin of color.MethodsA voluntary supplemental module was implemented as part of the second-year dermatology curriculum at Wayne State University School of Medicine (WSU SOM) in Detroit, Michigan. The goal of the module was to ascertain whether it may increase confidence in students with their approach to diagnosing diseases in darker skin tones.ResultsSeventy-seven of 295 students (26%) completed a “Skin of Color” optional module consisting of thirteen cases of common skin pathologies in African American patients. A pre- and post-survey performed to assess students’ confidence using a five-point Likert scale. After completing the module, medical students demonstrated a statistically significant increase in confidence in diagnosing skin pathologies in skin of color.ConclusionDermatology pre-clinical course work should include supplementary materials to increase student confidence in diagnosing skin diseases in darker skin tones.

Morphological Spectrum of Vesiculobullous Skin Lesions: An Institutional Perspective.

IntroductionA vesiculobullous lesion of the skin encompasses a group of dermatological disorders with protean clinicopathological features. They usually occur as a part of the spectrum of various infectious, inflammatory, drug-induced, genetic, and autoimmune disorders. Therefore, accurate diagnosis of these lesions is essential for appropriate management and to reduce the associated morbidity and mortality. The conventional skin punch biopsy is the mainstay in the diagnosis of dermatological diseases, especially when combined with confirmatory tests, such as direct immunofluorescence (DIF). Our study evaluated the clinicopathological spectrum of vesiculobullous lesions.MethodsWe studied 150 cases of vesiculobullous lesions at the Department of Histopathology, Liaquat National Hospital and Medical College Karachi, Pakistan. Written and informed consent was taken from the patients followed by skin punch procedure in which three biopsies were obtained, which included one biopsy from the lesion and two peri-lesional biopsies. One peri-lesional biopsy was sent in cryomatrix for DIF studies, whereas the other two were sent in formalin to follow the standard tissue-processing protocol.ResultsOur results showed that most patients belonged to the geriatric age group of more than 50 years (44.7%), and 54.7% of the patients were females. Total 74.7% of the patients had generalized lesions, followed by lower limbs (9.3%) and trunk (7.3%) involvement. Most patients were diagnosed with bullous pemphigoid (31.3%), followed by pemphigus vulgaris (27.3%), dermatitis herpetiformis (15.3%), Darier’s disease (14.7%), pemphigus foliaceus (4.7%), epidermolysis bullosa (2%), linear immunoglobulin A dermatosis (2%), paraneoplastic pemphigus (0.7%), and drug reactions (0.7%). DIF studies were applied on 60 cases, out of which complement protein C3c was the most commonly deposited protein (53.3%).ConclusionOur study emphasized the diagnostic role of skin punch biopsy in the proper evaluation of vesiculobullous skin lesions. Histopathology is the cornerstone diagnostic tool in this regard, with DIF being a useful adjunct.

Cytology in the Diagnosis of Dermatological Diseases: Tzanck Smear

Cytology in the Diagnosis of Dermatological Diseases: Tzanck Smear

Do the clinical diagnostic skills of dermatologists correlate with the histopathological gold standard?

While numerous studies have evaluated the diagnostic accuracy of dermatologists and non-dermatologists in the clinical diagnosis of dermatologic diseases, they lack comprehensive evaluation of the validity of clinical diagnosis in dermatology or an analysis of the accuracy of multiple wide-ranging diagnoses. An extensive literature review was performed for all articles assessing the validity of clinical dermatologic diagnoses compared to histopathological gold standards. This commentary will discuss [...]

A Novel Computer-Assisted Algorithmic Method for Differential Diagnosis of Dermatological Diseases

To deal with human surface locations electronically, it is essential to establish a designation method to code the sites. For the development of site designation methods and databases, dermatological textbooks, atlantes and clinical photographs were collected and reviewed. The sites were systematically named, numbered, and mapped on human models. The whole human surface was divided into 484 segments, and then assembled into 15 groups and 29 subgroups. After establishing the site designation method, we constructed a database of the sites of occurrence of dermatological diseases, and a database of age, sex, signs and symptoms. More than 700 diseases were analyzed and coded into the database. To gather information on the site of a particular disease, not only textbooks, and atlantes of dermatology, but also photographs obtained during clinical practices were reviewed, as clinical photos of patients can be more delicate than the descriptions in textbooks. The prototype of a computer assisted dermatological diagnosing system was made using site a designation method and the databases. This interactive computer program worked relatively well as a helpful guide or dermatological diagnosing tool. Further diseases are being added to the databases.

Dermatologic Diseases of the Nail Unit Other Than Psoriasis and Lichen Planus

Diseases in which involvement of the nails may be helpful in the diagnosis of dermatologic disease elsewhere include psoriasis, lichen planus, Darier's disease, alopecia areata and totalis, keratotic scabies, scleroderma, and lupus erythematosus and dermatomyositis. Dermatologic diseases in which involvement of the nail commonly occurs but is relatively nonspecific and not diagnostic include dermatitis, lichen striatus, parakeratosis pustulosa, pityriasis rubra pilaris, acrokeratosis paraneoplastica, pemphigus vulgaris, epidermolysis bullosa, porokeratosis of Mibelli, and acanthosis nigricans. These entities are described and treatments summarized as appropriate.

Capillary Microscopy in the Diagnosis of Dermatologic Diseases

Capillary Microscopy in the Diagnosis of Dermatologic Diseases