Experience Of Dermatologists Research Articles

Effectiveness of a Dedicated Rural General Surgery Residency Track: A 13-Year Analysis of the First ACGME Designated Rural Track.

The shortage of general surgeons in rural America is well documented. The North Dakota community-based general surgery residency program initiated a unique approach to training for rural practice through a dedicated rural track. The rural track included 9 months of rotations in specialty rotations beneficial for rural practice. This study analyzed practice patterns and satisfaction of residents completing rural track training. An anonymous voluntary survey was sent to rural track graduates between 2010 and 2022 via the Qualtrics Web site. Specialty rotations completed, specialty procedures currently performing, satisfaction with rural track training, and recommended specialty rotations for future rural track graduates. Twelve of fifteen graduates (80%) responded. Eighty-three percent of respondents chose the rural track because they desired practice in rural areas and/or desired broad-spectrum surgical practice. One hundred percent of the graduates were satisfied with their training. Seventy-five percent of the graduates came from a rural background, and 75% either previously practiced or currently practice in a rural community. Procedural data demonstrated that 67% of the graduates performed endoscopy procedures, 42% performed hand procedures, and 47% performed C-sections. Rural track graduates desired more experience in urology (50%), ENT, OBGYN, and advanced endoscopy (33%). Experience in plastic surgery, GI, hand surgery, dermatology, and IR was cited as beneficial. The rural track graduates found significant value in their rural track training that benefited them in practice. Three quarters of the graduates entered rural surgery practice, performing a broad spectrum of procedures.

Imposter Syndrome in Veterinary Education? How Knowledge and Confidence Affect Treatment of Canine Atopic Dermatitis.

Anecdotal data suggest that clinicians can be confused about the indications, advantages, and disadvantages of treatment options for canine atopic dermatitis (CAD). This may be due to the varying levels of knowledge and confidence among clinicians at different stages of their training and careers. A lack of evidence-based studies of confidence when applying knowledge in veterinary education inspired this research. We surveyed 75 Royal (Dick) School of Veterinary Studies (R(D)SVS) final-year students, 34 general practitioners (GPs), 70 GPs that have undertaken continuing professional development in dermatology, 34 advanced dermatology practitioners (e.g., interns and residents), and 15 dermatology specialists using an online questionnaire with Likert-type scales for each response. Correlations between the levels of education, sources of knowledge about managing CAD, and their understanding of different treatment options were analyzed. p < .001 was deemed significant. The results revealed a significant lack of confidence among students and GPs in treating CAD. In contrast, the groups generally had a similar level of understanding of the management options. The exception to this was a lack of understanding about ciclosporin and antihistamines among students and veterinarians with less dermatology experience. Targets for intervention should therefore aim to improve confidence in clinical application rather than knowledge per se in undergraduate and post-graduate education. Improving confidence in managing CAD will improve the welfare of atopic dogs and their owners.

Defining the Care Pathway in Patients with Psoriasis and Atopic Dermatitis.

This study aims to map the clinical pathway for psoriasis and atopic dermatitis (AD) in a tertiary hospital to better understand patient needs and experiences, thereby suggesting improvements in patient-centered care. A mixed-method approach was utilised involving a literature review, a questionnaire for healthcare professionals (HCPs), and two focus groups (one with HCPs and the other with patients with psoriasis or AD). Ethical approvals were obtained, and informed consent was acquired from all participants. Patients and HCPs identified significant delays in the pre-diagnosis phase, extending up to five years for psoriasis and three years for AD, adversely affecting the timely initiation of effective treatment. In addition, there were reported difficulties in obtaining appointments during flares, a lack of dermatologic emergencies, a need to increase human resources and physical space, and a need for telematic consultations for urgent cases. Discrepancies between HCPs' perceptions and patients' experiences highlighted unmet needs, particularly in primary care settings and emergency departments. Several strengths were also identified, including satisfactory experience in dermatology, the hospital's high level of specialisation in the management of complex patients, optimal communication between services, consideration of patient preferences, and proper advice on hospital pharmacy care and administration support of treatment and adherence monitoring. The findings underscore the necessity for interventions to reduce wait times and improve treatment immediacy and effectiveness post-diagnosis. The insights from this study can direct enhancements in patient management and satisfaction for individuals with psoriasis and AD.

Light-based therapies in the treatment of alopecia.

All types of alopecia, including androgenetic alopecia, alopecia areata, and lichen planopilaris/frontal fibrosing alopecia, affect over half of men and women. Though a common dermatological experience, many patients with visible hair loss report significant psychological and social distress and, consequently seek treatment. Current existing therapeutic regimens have proven to be efficacious, though may result in various adverse effects and require lifelong use. Laser and light-based therapies have been emerging in the current literature as a safe and alternative treatment, but their utilization for treating alopecia is poorly understood. This review evaluates the existing evidence regarding the use of lasers in the treatment of various forms of alopecia. Overall, there has been promising evidence for potential alopecia treatment efficacy: low-level light therapy for androgenetic alopecia, fractional laser for androgenetic alopecia, and excimer laser for alopecia areata.

Sistem Pakar Diagnosis Penyakit Kulit Pada Anak Menggunakan Metode Certainty Factor

Technological advances in the modern era have facilitated various aspects of life, including health. Puskesmas Tanjung Ria in Jayapura, Papua, Indonesia, serves about 100 patients daily from 07:30 to 14:30. One of its main services is the diagnosis of skin diseases in children, which can be caused by genetic factors, environment, stress and parasitic infections. Research shows that there are about 20 to 30 pediatric patients with skin diseases every week. Often the treatment of skin diseases is delayed due to public understanding at the Tanjung Ria Health Center, diagnosis is carried out by a team consisting of 1 doctor and 1 assistant with a symptom-based approach. However, the main obstacles are hectic work schedules and limited resources. Available pediatricians may not have enough experience in dermatology, which can lead to suboptimal treatment. To reduce uncertainty in medical diagnosis and improve the diagnosis of skin diseases in children, the Certainty Factor (CF) method is applied in the expert system. This study proposes the development of a web-based system that uses certainty factor methods for early symptoms of skin diseases in children, in order to prevent delays in treatment. System development uses the waterfall method, which includes needs analysis, design, coding and testing with the blackbox method.

Dermatopathological Analysis of Common Skin Lesions Encountered in Cadavers

This study served as a purpose for medical students to gain experience in both dermatology and pathology, which is a common barrier that prevents first and second year medical students from refining skills that are not later taught until residency. This prompted a study to develop gross differential diagnostic skills and how to analyze histopathology slides to diagnose common skin lesions to refine skills in both clinical and histology presentation. A cadaveric case series was designed to examine multiple shave biopsies on all abnormal skin lesions observed from nine cadavers used for the first year medical students gross anatomy lab during the year 2022-2023. Biopsies were stained using hematoxylin and eosin. Histopathology slides, though initially viewed by medical students, were confirmed by a pathologist at a later time. 25 samples were taken from the 9 cadavers. The most commonly encountered lesion was macular seborrheic keratosis, with nine of the 25 (32%). Seven of the sample lesions (26.9%) were melanocytic nevus. Two sample lesions (8.0%) from the same cadaver were a superficial cutaneous cyst and one sample lesion (3.8%) from a separate cadaver indicated verruca vulgaris. Common dermatological lesions were identified among the nine cadavers used for analysis. This provided opportunities to develop and refine skills in dermatopathology. A further increase in sample size is needed to gain exposure to a larger variety of lesions and to identify common dermatological lesions grossly based on differing race, age, and gender.

Evaluating the World Health Organization's SkinNTDs App as a Training Tool for Skin Neglected Tropical Diseases in Ghana and Kenya: Cross-Sectional Study.

Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, primarily impoverished populations in low- and middle-income countries. Skin NTDs, a significant subgroup, manifest primarily as skin lesions and require extensive diagnosis and treatment resources, including trained personnel and financial backing. The World Health Organization has introduced the SkinNTDs app, a mobile health tool designed to train and be used as a decision support tool for frontline health care workers. As most digital health guidelines prioritize the thorough evaluation of mobile health interventions, it is essential to conduct a rigorous and validated assessment of this app. This study aims to assess the usability and user experience of World Health Organization SkinNTDs app (version 3) as a capacity-building tool and decision-support tool for frontline health care workers. A cross-sectional study was conducted in Ghana and Kenya. Frontline health care workers dealing with skin NTDs were recruited through snowball sampling. They used the SkinNTDs app for at least 5 days before completing a web-based survey containing demographic variables and the user version of the Mobile Application Rating Scale (uMARS), a validated scale for assessing health apps. A smaller group of participants took part in semistructured interviews and one focus group. Quantitative data were analyzed using SPSS with a 95% CI and P≤.05 for statistical significance and qualitative data using ATLAS.ti to identify attributes, cluster themes, and code various dimensions that were explored. Overall, 60 participants participated in the quantitative phase and 17 in the qualitative phase. The SkinNTDs app scored highly on the uMARS questionnaire, with an app quality mean score of 4.02 (SD 0.47) of 5, a subjective quality score of 3.82 (SD 0.61) of 5, and a perceived impact of 4.47 (SD 0.56) of 5. There was no significant association between the app quality mean score and any of the categorical variables examined, according to Pearson correlation analysis; app quality mean score vs age (P=.37), sex (P=.70), type of health worker (P=.35), country (P=.94), work context (P=.17), frequency of dealing with skin NTDs (P=.09), and dermatology experience (P=.63). Qualitative results echoed the quantitative outcomes, highlighting the ease of use, the offline functionality, and the potential utility for frontline health care workers in remote and resource-constrained settings. Areas for improvement were identified, such as enhancing the signs and symptoms section. The SkinNTDs app demonstrates notable usability and user-friendliness. The results indicate that the app could play a crucial role in improving capacity building of frontline health care workers dealing with skin NTDs. It could be improved in the future by including new features such as epidemiological context and direct contact with experts. The possibility of using the app as a diagnostic tool should be considered. RR2-10.2196/39393.

Acceptability of 'as needed' biologic therapy in psoriasis: insights from a multistakeholder mixed-methods study.

Biologic therapies have led to increasing numbers of patients with psoriasis who have clear or nearly clear skin. It is current practice to continue biologic therapy indefinitely in these patients, which contributes to a substantial long-term drug and healthcare burden. 'As needed' biologic therapy in psoriasis may address this; however, our understanding of patient and clinician perceptions of this strategy is limited. The aim of this mixed-methods study was to gain insight into the perspectives of both patients and clinicians regarding the acceptability of an 'as needed' approach to biologic therapy in psoriasis, including potential barriers and enablers to implementation in routine care. We first conducted UK-wide online scoping surveys of patients with psoriasis and dermatology clinicians to explore their views on 'as needed' biologic therapy. Using topic guides informed by these survey findings, we then carried out qualitative focus groups with patients and clinicians. Themes were identified using reflexive thematic analysis. Of 67 patients and 27 clinicians completing the scoping surveys, 67% (43 of 64 patients) and 78% (21 of 27 clinicians) supported the use of 'as needed' biologic therapy, respectively. Respondents highlighted advantages such as a reduction in healthcare burden and greater ownership of care. Challenges included logistics of 'as needed' drug provision and potential risks of disease flare and drug immunogenicity. Focus groups comprised 15 patients with psoriasis [9 female patients (60%), average disease duration 32 years (range 9-64)] and 9 dermatology clinicians [8 female clinicians (89%), average dermatology experience 20 years (range 8-33)]. Both patients and clinicians felt that an 'as needed' treatment approach will deliver a reduction in treatment burden and present an opportunity for patient-led ownership of care. Both groups highlighted the importance of ensuring ongoing access to medication and discussing the potential impact of psoriasis recurrence. Patient preferences were influenced by their lived experiences, particularly previous difficulties with medication delivery logistics and establishing disease control. Clinician perspectives were informed by personal experience of their patients adapting their own dosing schedules. Clinicians highlighted the importance of targeted patient selection for an 'as needed' approach, ongoing disease monitoring, and prompt reaccess to medications upon psoriasis recurrence. These data indicate that 'as needed' biologic therapy in psoriasis is acceptable for both patients and clinicians. Formal assessment of clinical effectiveness and cost-effectiveness is warranted to enable the real-world potential of this approach to be realized.

Experiences of Dermatologists and Patients Regarding Psoriasis and Its Connection to Psoriatic Arthritis in Saudi Arabia.

Psoriasis is a chronic, inflammatory, immune-mediated skin disease that has significant impact on a patient's quality of life, yet it remains challenging for dermatologists to successfully identify and manage. Without effective screening, diagnosis and treatments, psoriasis can potentially progress to psoriatic arthritis. A descriptive, observational cross-sectional study of Saudi Arabian dermatologists and patients with psoriasis was conducted to explore dermatologist and patient perspectives of psoriasis, including diagnosis, management, disease course and unmet needs. This study involved a quantitative questionnaire administered to 31 dermatologists and 90 patients with psoriasis at eight medical centers and was analyzed using descriptive statistics. Dermatologists and patients perceived that psoriasis treatment was initiated promptly and that follow-up visits were sufficient. Their perspectives differed in the time to diagnosis and patient reaction, symptom severity, input into treatment goals and educational needs. The dermatologists' concerns about underdiagnosed psoriasis (13%) were primarily related to patient awareness (87%), physician awareness (58%), and the absence of a regular screening program (52%). Only 31% of patients with psoriasis were highly satisfied with their psoriasis treatment, with 78% experiencing unpleasant symptoms of pain or swelling in joints indicative of psoriatic arthritis. However, only 56% of these patients reported these symptoms to their physicians. When dermatologists were made aware of this difference, referrals to a rheumatologist increased. The study highlights the importance of strengthening psoriasis management by enhancing dermatologist referral and screening practices, adopting a multidisciplinary approach to care, and improving education and resources for physicians and patients. These results can help to inform the improvement of psoriasis screening, diagnosis and treatment strategies and ensure that expectations meet treatment outcomes. Further research exploring the dermatologist and patient perspectives of the disease pathway from psoriasis to psoriatic arthritis and tailor-made treatment approaches is recommended.

NEURAL NETWORK SYSTEM FOR ANALYSIS OF UNBALANCED HETEROGENEOUS DERMATOLOGICAL DATA ON THE BASIS OF A MULTIMODAL NEURAL NETWORK

To date, skin cancer is the most frequently diagnosed form of oncopathology. Visual diagnosis of this cancer type in the early stages is difficult due to similar visual manifestations in benign and malignant types of pigmented formations, and its accuracy depends on the experience of dermatologist. Artificial intelligence technologies are able to equal and surpass accuracy of visual diagnostic methods, but there is a risk of false positive prognosis, when malignant pigmented formation may be recognized as benign. One of the possible ways to improve recognition accuracy and reduce false positive conclusions is simultaneous use of different preprocessing methods, heterogeneous data analysis, and use of modified learning loss functions to eliminate negative impact of unbalanced dermatological data. The study presents an intelligent system for unbalanced heterogeneous dermatological data analyzing based on a multimodal neural network trained using modified cross-entropy loss function. The accuracy of classification of pigmented skin lesions in 10 diagnostically significant categories in the proposed system based on the AlexNet convolutional neural network architecture reached 83.87%. Due to the emerging synergy when using various methods to improve performance quality of intelligent systems, the number of false positive forecasts of the intelligent system was reduced, and the accuracy was increased by 1.31-4.91 percentage points, depending on the convolutional neural network architecture. Implementation of the developed system as a tool for auxiliary diagnostics can reduce the consumption of financial and labor resources involved in the medical industry, as well as increase the chance of early detection of pigmentary oncopathologies.

42858 Years of dermatology experience and geographic region are associated with frequency of malignant excision relative to malignant destruction in the Medicare population

42858 Years of dermatology experience and geographic region are associated with frequency of malignant excision relative to malignant destruction in the Medicare population

Results from the Pennsylvania Dermatology PA Society 2023 Salary Survey

The Pennsylvania Dermatology PA Society, a state affiliate chapter of the Society of Dermatology Physician Assistants, conducts an annual salary survey of its membership based on self-reported W2 earnings for the previous year. The 2023 salary survey collected responses from 84 out of 346 PAs who practice dermatology as their primary specialty in the state of Pennsylvania. Results from the survey yielded insights such as respondents’ geographic location, years of experience in dermatology, compensation amount and structure, and factors they consider most important when selecting a position. The Pennsylvania Dermatology PA Society presents results from this survey to add to the existing practice data and inform evidence-based discussion on fair compensation.

DP01 Survey on the management of dysplastic naevus

Abstract Although dysplastic naevus (DN) is a frequent diagnosis, there is significant controversy on its definition and gradation and its relationship to melanoma risk. Therefore, there is no consensus over optimal management, and surveys from Australia, Canada and the USA have shown variation in clinical practice. Dysplastic naevus with involved histological margins has not been shown to progress to melanoma. To assess UK management of DN depending on the grade of atypia and reported excision margin, we circulated a questionnaire via email to dermatologists in Scotland, north Wales, Liverpool and Manchester. Seventy-two responded, of whom 46 (64%) were consultants. The cohort was generally highly experienced, with 10 (14%) responders with 1–5 years’ dermatology experience, 15 (21%) with 6–10 years, 27 (37%) with 11–20 years and 20 (28%) with &amp;gt; 20 years’ experience. Management of DN varied greatly. For mild DN excised with &amp;lt; 1-mm margin, 59 (82%) agreed that no further management was required. Opinions were divided when margins were involved in mild DN, with 14 (19%) agreeing that no further management was required, 42 (58%) choosing to re-excise and six (8%) to re-excising only any residual pigmentation. Most dermatologists reassured patients with moderately DN with margins &amp;lt; 1 mm (49, 68%); 18 (25%) preferred to re-excise. For moderate DN with involved margins, six respondents (8%) felt that no further management was necessary and 54 (75%) would re-excise. For severe DN with margins &amp;gt; 1 mm, 16 (22%) would still re-excise and six (8%) would agree management in the multidisciplinary team meeting (MDT). For severe DN with margins &amp;lt; 1 mm, 41 (57%) would re-excise and seven (10%) would agree management in the MDT. Lastly, for severe DN with involved margins, 62 (86%) would re-excise and seven (10%) would agree management in the MDT. This study has shown comparable results with those from Australia and the USA, whereby most dermatologists would re-excise moderate and severe DN with involved margins. Significant numbers indicated that they would re-excise in the case of close histological margins: this is unnecessary, and more standardized management may reduce expenditure. Limitations of the study include the usual potential sources of bias in a questionnaire survey; it should be noted that reported behaviour may differ from actual practice. However, this is the first UK study on this common clinical scenario. The move to report DN as low- or high-grade may help to reduce variation, but our survey suggests that some patients are currently undergoing unnecessary procedures.

Use of Social Media for Patient Education in Dermatology: Narrative Review.

Social media has rapidly become one of the main avenues for news and communication among those with access to technology. Nearly 60% or 4.7 billion people worldwide use social media. Different social media networks provide users with a barrage of posts, opinions, and transformations. With this noticeable uptick in physician and patient education usage of social media, exploration of the impacts of social media on patient education in dermatology is crucial. The goal of this narrative review was to evaluate existing peer-reviewed literature examining the use of social media for patient education in dermatology and to establish trends and implications. Additional attention was given to different social media sites, and potential differences in modalities of posts such as short-form videos on TikTok and Instagram Reels, long-form videos on YouTube, and infographics on Twitter, Instagram, and Facebook. PubMed, Access DermatologyDxRx, and Scopus searches of peer-reviewed publications were performed to discover articles with social media and patient education keywords in combination with other health care-relevant or dermatology-relevant keywords. Subsequently, the screening of these studies was performed by the author who has experience with education and research experience in health care, dermatology, social media, and telehealth. Ultimately, the selected articles were summarized through qualitative analysis of key points and presented for further discussion. Through this narrative review, the researcher was able to identify several publications focusing on dermatology and social media. Some common subject areas included the use of social media for the promotion of private dermatology practices, residency programs, and research journals. So long as providers, such as dermatologists, take ethical considerations into account, these platforms can provide patients with curated educational content. In addition, several publications emphasized the use of social media as a form of patient education on dermatologic conditions but also as a source of misinformation. This narrative review illuminated the use of social media as a form of patient education for dermatology, with its applications addressed across many demographics and situations. As social media platforms continue to update their algorithms, content filters, and posts, social media may become a reputable form of patient education in dermatology. Future studies and innovations should continue to explore innovations in this space, the efficacy of different modalities of posts, and longitudinal differences in patient outcomes and health literacy.

Years of dermatology experience and geographic region are associated with outlier performance of excision or destruction for nonmelanoma skin cancer

IntroductionTreatments for nonmelanoma skin cancer (NMSC) include excision (surgical removal) and destruction (cryotherapy or curettage with or without electrodesiccation) in addition to other methods. Although cure rates are similar between excision and destruction for low-risk NMSCs, excision is substantially more expensive. Performing destruction when appropriate can reduce costs while providing comparable cure rate and cosmesis.ObjectiveTo identify characteristics associated with exclusive (outlier) performance of excision or destruction for NMSC.MethodsThe study consisted of malignant excision and destruction procedures submitted by dermatologists to Medicare in 2019. Proportions of services for each method were analyzed with respect to geographic region, years of dermatology experience, median income of the practice zip code, and rural-urban commuting area (RUCA) code.ResultsFewer years of experience predicted a higher proportion of excisions (R2 = 0.7, p < .001) and higher odds of outlier excision performance. Outlier performance of excision was associated with practicing in the South, Midwest, and West, whereas outlier performance of destruction was associated with practicing in the Northeast and Midwest.ConclusionsDermatologists with less experience or in certain geographic regions performed more malignant excision relative to destruction. As the older population of dermatologists retires, the cost of care for NMSC may increase.

35126 Education to improve general medical doctors’ dermatology referrals

General hospital doctors often find it challenging to correctly diagnose and appropriately refer common benign and malignant skin lesions. A series of dermatology images of melanoma, nonmelanoma malignancies, actinic keratosis and benign lesions was presented in a quiz format to general medical doctors in a model 3 hospital. Dermatology experience, confidence in lesion recognition and decision for dermatology referral was surveyed pre-teaching. A teaching session with follow-up quiz and self-assessed confidence of lesion recognition and diagnosis was surveyed. Comparison pre and post quiz scores were analyzed. Twenty-four medical doctors ranging from intern to consultant participated in this study. 96% (n = 23) had no prior dermatology experience. Following teaching, 61% (n = 14) expressed feeling confident in their diagnosis of presented images, compared with 17% (n = 4) preteaching. The follow-up quiz showed a global 24% increase in lesion recognition. Correct referral of actinic keratosis improved from 79% to 100%, acral melanoma improved from 75% to 90%, melanoma referral improved from 77% to 93% and BCC referral improved from 88% to 100%. 91% (n = 21) found the teaching session helpful for future practice. The teaching session improved the ability to correctly identify features of common benign, premalignant and malignant skin lesions. The follow-up quiz demonstrated improvement in appropriate referrals for premalignant and malignant lesions. Regular dermatology teaching with images and self-assessment quizzes should improve the confidence of general hospital doctors to correctly recognize and refer to dermatology services. This study demonstrates the need for dermatology teaching to general medical doctors to improve the accurate diagnosis and referral of common skin lesions.

Emojis and Emoticons in Health Care and Dermatology Communication: Narrative Review.

Emoticons and emojis have become staple additions to modern-day communication. These graphical icons are now embedded in daily society through the various forms of popular social media and through users' personal electronic conversations. With ever-increasing use and inclusivity, exploration of the possible health care and dermatology applications of these tools is imperative. The goal of this narrative review was to provide and evaluate an up-to-date literature survey examining the utility of emoticons and emojis in medicine. Special attention was paid to their existing and potential uses in the field of dermatology, especially during the COVID-19 pandemic. A PubMed search of peer-reviewed publications was performed in mid-2021 to collect articles with emoticon or emoji keywords in combination with other health care-relevant or dermatology-relevant keywords. Screening of publications and described studies was performed by the authors with education and research experience in health care, dermatology, social media, and electronic communication trends. Selected articles were grouped based on common subjects for qualitative analysis and presentation for in-depth discussion. From this extensive search, researchers were able to identify a wide variety of publications detailing the use of emoticons and emojis in general health care, pediatric health care, public health, and dermatology. Key subject areas that emerged from the investigation included the ability of emoticons and emojis to improve communication within pediatric health care, enhance mood and psychological assessment or mental health screening in adults, develop interventions to improve patient medication adherence, complement novel means of public health and COVID-19 surveillance, and bolster dermatology-specific applications. This review illuminated the repurposing of emojis and emoticons for a myriad of advantageous functions in health care and public health, with applications studied in many populations and situations. Dermatology-specific uses were relatively sparse in the literature, highlighting potential opportunities for growth in future studies and practices. The importance of diversity and inclusivity has extended to emojis, with the recent introduction of skin color customization and new emojis better representing the comprehensive spectrum of users' experiences. A continuously evolving and technology-driven population creates a unique niche for emoticons and emojis to ease worldwide communication and understanding, transcending the barriers of age, language, and background. We encourage future studies and innovations to better understand and expand their utility.

General practitioners' explanation and advice on childhood eczema and factors influencing their treatment strategy: A qualitative study.

BackgroundAtopic dermatitis (AD) is common in children and the majority of children can be treated by the general practitioner (GP). Various factors can influence the GP's treatment strategy and may lead to less effective treatment. The objective is to gain insight into the treatment goal, treatment strategy, explanation and advice given by GPs when dealing with AD in children and to explore which factors play a role in the choice of pharmacological treatment.MethodsSemi‐structured interviews in primary care in the Netherlands were audio‐recorded and transcribed. All data were analysed according to the six‐steps approach of inductive thematic analysis.ResultsWe interviewed 16 GPs. Treatment goals mainly focussed on the short term. GPs discussed the importance of emollient use and emphasised emollients as the basis of treatment. We found that several factors played a role in prescribing topical corticosteroids (TCS); severity of the AD, age of the child, skin type, corticophobia among parents and GPs, experience of side effects and dermatological experience. GPs reported giving limited advice about the use of TCS and prescribed medication that is not recommended by the guideline.ConclusionVarious factors seem to influence GPs' treatment strategy for AD in children. More attention and education about the use and safety of TCS in children during GP training, continuous medical education, probably improve treatment in line with guidelines and can lead to more confidence and knowledge about TCS among GPs, which ultimately may improve the education and self‐management of patients.

Impact of trainee experience on shave biopsy specimen size.

Skin biopsies are crucial for the diagnosis of many cutaneous pathologies, yet specimen adequacy is essential for definitive diagnosis. Recent literature has noted a trend in decreasing biopsy size over time, which has created concern over implications regarding adequacy for diagnosis. This study sought to evaluate if clinician training length or type of residency training impacted the average biopsy size and sample adequacy. Dermatopathology reports for shave biopsies between January 1, 2021, and June 30, 2021, at Penn State Health were queried through PathNet, the software application for pathology reports in this health system's electronic medical record system. Biopsy dimensions, volume, diagnosis, location, clinician training level, and descriptions of evaluation of deeper sections (recuts) and superficial sampling were recorded for each biopsy. Basic statistical calculations were performed to assess the mean and standard deviation for biopsy sizes per clinician group. Differences in biopsy size between training levels were statistically significant despite qualitatively similar biopsy locations and final diagnosis categories for each clinician training group. After evaluating measures for sample adequacy, our data showed significantly smaller biopsies; however, overall frequencies were minimal. Additionally, more inadequate specimens were noted for clinician groups with the least amount of dermatology experience. The results of this study identify a correlation with decreasing biopsy size amidst increased experience in dermatology training but find no evidence to support that this trend currently threatens sample adequacy.

Dermoscopy use in primary care: a qualitative study with general practitioners

BackgroundSkin assessments constitute a significant proportion of consultations with family physicians (commonly called general practitioners or GPs in the UK), and referrals to hospital dermatology departments have risen significantly in recent years. Research has shown that dermoscopy use may help GPs to assess and triage skin lesions, including suspected skin cancers, more accurately. However, dermoscopy is used by a small minority of GPs in the UK. Previous questionnaire studies have aimed to establish in a limited way some perceptions of dermoscopy among GPs: this study aimed to explore more deeply the factors influencing the use of dermoscopy among GPs.MethodsThis was a qualitative interview study set in UK general practice. A purposive sample was taken of GPs who were established dermoscopy users, GPs who had recently adopted dermoscopy, and those who did not use dermoscopy. A total of twelve semi-structured interviews were conducted. Audio-recordings were transcribed verbatim and analysed using a thematic analysis (Braun and Clarke).ResultsGPs’ capability to use dermoscopy necessitated receiving adequate training, while previous dermatology experience and support from colleagues were also considered factors that enabled dermoscopy use. The impact of dermoscopy on patient consultations about skin complaints was generally considered to be positive, as was having an ‘in-house’ dermoscopy user within a GP practice to refer patients to. However, training in dermoscopy was not considered a priority for many GPs either due to other more pressing concerns within their practices or the perceived complexity of dermoscopy, alongside barriers such as equipment costs. Significant ethical concerns with posting patient photographs online for training and teaching purposes were also highlighted.ConclusionsBoth GPs who use dermoscopy, and those who do not, consider it to have an important role in improving skin assessments within primary care. However the need for adequate training in dermoscopy and dermatology more generally was highlighted as a key barrier to its wider use. The development of competency standards for the use of dermoscopy could allow the adequacy of training to be assessed and developed.