Hospital Dermatology Research Articles

Outpatient appointment scheduling problem considering patient selection behavior: data modeling and simulation optimization

In medical outpatient services, due to patients’ imbalanced selection for doctors of different levels and for different visiting periods, inefficiency of resource utilization and dissatisfaction of patients have become the main problems faced by hospital managers. For the first time, this research has considered patients’ preference between high-ranking professional titles of general doctor and expert doctor. Through analyzing real data of the outpatient clinic at Dalian City Dermatology Hospital, the behavioral pattern of patients’ patience limit adjusted with expected waiting time was obtained. This research also established a data-driven discrete event simulation model that takes into account walk-in patients’ time preferences, appointment patients’ no-shows and cancellations, and considers complex patient flow caused by unbalanced selection of doctor resources and patience limit of waiting time. To optimize scheduling for appointment patients with two types of doctors, this research put forward a simulation optimization framework that maximized hospital benefit and minimized patients’ dissatisfaction. At the same time, simulation budget allocation based on multi-objective optimization and genetic algorithm were combined to obtain the approximate Pareto joint capacity plan of multi-servers and a patient scheduling scheme. The simulation model was validated through a case study based on real data of outpatient service for the whole year, and the proposed optimization method can comprehensively improve performance of outpatient service scheduling system. The simulation optimization framework can provide an effective scheduling scheme for all multi-server service systems involving consumer selection and impatient behavior.

Clinical prediction and diagnosis of neurosyphilis in HIV-negative patients: a case-control study

BackgroundEarly diagnosis and treatment of neurosyphilis is of great significance for regression. There is no gold standard for the diagnosis of neurosyphilis. We did this study to explore the factors associated with the clinical diagnosis of neurosyphilis and assess their accuracy for the diagnosis of neurosyphilis.MethodsWe retrospectively reviewed 100 cases of syphilis patients who underwent lumbar puncture at a major dermatology hospital in Guangzhou, China between April 2013 and November 2016. Fifty patients who were clinically diagnosed with neurosyphilis were selected as case group. Control group consisted of 50 general syphilis patients who were matched with age and gender. The records of patients were reviewed to collect data of socio-demographic information, clinical symptom, and laboratory indicators. Multivariable logistic regression was used to explore diagnostic indictors, and ROC analysis was used to assess diagnostic accuracy.ResultsNeurological symptoms (odds ratio (OR) = 59.281, 95% CI:5.215–662.910, P = 0.001), cerebrospinal fluid (CSF) Treponema pallidum particle agglutination (TPPA) titer (OR = 1.004, 95% CI:1.002–1.006, P < 0.001), CSF protein (OR = 1.005, 95% CI:1.000–1.009, P = 0.041), and CSF white blood cell (WBC) (OR = 1.120, 95% CI:1.017–1.233, P = 0.021) were found to be statistically associated with neurosyphilis. In ROC analysis, CSF TPPA titer had a sensitivity of 90%, a specificity of 84%, and an area under curve (AUC) of 0.941.ConclusionCSF TPPA can potentially be considered as an alternative test for diagnosis of neurosyphilis. Combining with neurological symptoms, CSF protein, CSF WBC, the diagnosis would have a higher sensitivity.

Dermatology nurses view on factors related to Danish psoriasis patients’ adherence to topical drugs: a focus group study

Background Topical medications are first-line treatment for mild-to-moderate psoriasis, but adherence is low, which negatively affects patients’ outcomes and quality of life. Nurses can play a central role in patient care, particularly in improving adherence. Objectives To explore the experience of dermatology nurses with psoriasis patients’ adherence to topical drugs. Methods We conducted a semi-structured focus group study with 6 dermatology nurses and 2 dermatology nursing students. Participants were recruited from a dermatology hospital outpatient clinic. Data were analyzed by a systematic text condensation method with a phenomenological-hermeneutic approach. Results Nurses experienced that factors such as social inequality, patient-centered nursing, and patients’ quality of life can have an influence on adherence. Conclusion Optimal adherence to topical treatments is a complex exercise and is influenced by many different factors. Involving nurses when prescribing topical treatments may be beneficial since they are one of the most trustworthy professions and have a holistic view on psoriasis severity, patient preferences, health care resources available and socioeconomic factors.

Inpatient eDermatology (Teledermatology) Can Help Meet the Demand for Inpatient Skin Disease

Background: Currently, the number of inpatient dermatology providers cannot meet the overall burden of inpatient skin disease in the United States. Introduction: We seek to determine whether inpatient eDermatology can meet the need for inpatient skin disease in hospitals without access to a dermatology hospitalist. Methods: This retrospective cohort study reviewed inpatient eDermatology consults at the University of Pittsburgh eDermatology Consult Service between July 1, 2014 and June 30, 2018. This included a diverse group of 1,320 patients admitted to 10 different community hospitals. Study data were reviewed for demographics, diagnostic impressions, time to discharge, and diagnostic discordance between referring and consultant physicians. Results: Forty percent of inpatient eDermatology consults were admitted with a primary dermatologic diagnosis. Referring diagnosis most commonly was rash not otherwise specified. eDermatology consulting impressions, conversely, were specific and varied. Ninety-one percent of patients received a consultant impression by the end of day, or within 8 hours. Overall, 89.3% of patients with a referring diagnosis of "cellulitis" were given a different diagnosis by the consultant. Discussion: Although this study lacked concordance data to compare the Inpatient eDermatologist with a live Inpatient Dermatologist, overall, eDermatology consultants were able to provide rapid consult recommendations that aided patient management. Conclusions: Inpatient eDermatology appears to be an effective medium to provide dermatologic care to patients at hospitals without a dermatology presence. This delivery of health care can help prevent misdiagnosis, unnecessary costs, and inappropriate systemic therapies.

2125. Staphylococcus Species Identification by Fourier Transform Infrared (FTIR) Spectroscopic Techniques: A Cross-Lab Study

Background Staphylococcus aureus is well known to be associated with atopic dermatitis. Recent studies also report S. aureus presence in lesional skin of squamous cell carcinoma (SCC) and its precursor lesion, actinic keratosis (AK). Therefore, it is of potential clinical interest to monitor skin S. aureus colonization on AK lesions. Fourier transform infrared (FTIR) spectroscopy is a cost-effective, nondestructive, and reagent-free technique for rapid microbial identification. It is based on the use of spectral databases developed with well-characterized strains in conjunction with the application of multivariate statistical analysis to elaborate classification models. In the present cross-lab study, spectral databases containing FTIR spectra of over 1000 staphylococcal isolates obtained from reference and clinical microbiology laboratories across Canada were employed in the FTIR spectroscopic identification of Staphylococcus spp. isolated from AK, SCC and perilesional skin of patients at the Princess Alexandra Hospital Dermatology Clinic in Brisbane, Australia.MethodsFTIR spectra of 51 staphylococcal isolates from AK, SCC and perilesional skin were acquired by both attenuated total reflectance (ATR)-FTIR and transflection-FTIR spectroscopy. All isolates had been previously characterized by 16S rRNA sequencing. ATR- and transflection-FTIR spectra were recorded in triplicate from isolated colonies taken from the same agar plate. Identification of the bacteria was based on the similarities of their spectra with those in ATR- and transflection-FTIR spectral databases originating from the Canadian lab.ResultsAmong the 51 staphylococcal isolates included in this study, identification of S. aureus (n = 24) with 100% specificity and 100% sensitivity was achieved by both ATR- and transflection-FTIR spectroscopy. Overall, FTIR-based species identification was in 90.2% concordance with 16S rRNA sequencing.ConclusionThis cross-lab study demonstrates the applicability of Canadian isolate-based ATR- and transflection-FTIR spectral databases for the identification of clinical staphylococcal isolates obtained in Australia. The results support the potential utility of FTIR spectroscopic techniques to monitor skin S. aureus colonization on AK lesions.Disclosures All authors: No reported disclosures.

Frequency of neurological deficits in Sudanese lepromatic patients

Leprosy has been a major burden on humanity over thousands of years. To study the pattern of neurological manifestations among adult Sudanese leprosy patients seen in Khartoum Dermatology Hospital in the period from Feb 2018 to Jul 2018. This is a prospective cross-sectional hospital-based study. Seventy adult Sudanese leprosy patients were studied using simple, direct, standardized questionnaire including history and neurological examination. Numbness was the most common neurological symptom seen in 77.14%.Each of visual disturbance, headache and bilateral ulnar sensory impairment was detected in 7.14%. Half of the patients had upper limbs sensory nerve dysfunction while 42.86% exhibited sensory nerve dysfunction in the lower limbs. ";“Gloves and stoking";” sensory impairment was the most common finding (30%) while bilateral lateral popliteal sensory impairment was seen with the same percentage. Bilateral median and unilateral posterior tibial sensory impairment were found in 1.43% each. Unilateral radial cutaneous sensory impairment was seen in 2.86%. Approximately half (48.57%) of the patients had upper limbs motor dysfunction. Bilateral ulnar distribution motor affection was seen in 40%. A significant number (41.43%) had upper limbs muscle wasting. Impaired olfaction was the most common cranial nerve sign seen in 12.86%. Leprosy reactions were detected in 21.43%; type 2 reaction in 14.29% while type 1 reaction in 7.14%. Numbness and limbs weakness were the most common neurological symptoms in leprosy patients. “Gloves and stokes";” peripheral sensory neuropathy being the most common sensory disturbance. Ulnar and median nerves motor affection was the most common motor dysfunctions.

Clinical effects of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face

Objective: To explore the clinical effects and key techniques of expanded super-thin perforator flaps in the shoulder, neck, and chest in reconstruction of extensive burn scars in the face. Methods: From January 2008 to November 2018, 22 patients with extensive burn scars in the face were admitted to the Department of Plastic Surgery of Dongguan Kanghua Hospital and the Department of Plastic Surgery of Dermatology Hospital of Southern Medical University, with 3 males and 19 females, aged from 4 to 48 years. There were 16 cases of type Ⅱ and 6 cases of type Ⅲ in facial scars. Before the first stage of expansion surgery, Doppler blood flow survey meter or multi-slice CT was used to locate the perforator vessels. One to four expanders with rated capacity ranged from 100 to 600 mL were placed in the patients. We gave 20% to 30% of the rated capacity of expander intro-operation and common injection with 10% to 15% of the rated capacity of expander per week post-operation until the volume reached 1.5 to 2.5 times of the rated capacity of expander during the past 3 to 4 months. At the second stage of surgery, the perforators were located again before surgery with the same method. The size of defects after the excision of facial scars ranged from 6 cm×4 cm to 18 cm×16 cm. With perforators used as nutrient vessels, narrow pedicle flaps or random flaps ranging from 6 cm×6 cm to 22 cm×18 cm were elevated as rotating or advancing to reconstruct the defects. The donor sites were sutured directly. Some of the flaps needed stage Ⅲ operation for cutting the pedicle. The survival of flaps, post-operation complications, and follow-up were assessed. Results: All flaps of 22 patients survived. All the donor sites were closed simultaneously. One patient underwent an additional surgery for 5 cm×4 cm necrosis on distal part of flap caused by subcutaneous hematoma. Two patients with epidermis blister on the flaps were healed by themselves after dressing change. Due to rapid expansion, blood capillary proliferation appeared on the central part of the flap in 3 cases, after slowing down the expansion speed properly, which had no impact on flap transfer. No ischemia or venous congestion phenomenon were observed in the other flaps. During follow-up of 5 to 48 months, the flaps of patients showed no significant bloated appearance, with good complexion and texture, and even could reproduce facial fine-grained expressions naturally. Conclusions: For the reconstruction of extensive burn scars in the face, expanded super-thin perforator flaps can not only acquire large and thin flaps with high matching degree surface skin defect, but also reproduce facial fine-grained expressions. It is a simple and safe method which conforms to the facial aesthetic standard.

Air pollution and exacerbation of skin itching and sleep disturbance in Iranian atopic dermatitis patients.

For about three decades now, the number of people suffering from atopy including atopic dermatitis (AD) has been increasing in developed countries. Genetic background and environmental factors including air pollution play an effective role in its incidence. This study examined the association between air pollutants and exacerbation of AD symptoms including sleep disturbance and itching in AD patients of Tehran. In this panel study, 31 patients with AD who admitted to Razi Hospital, dermatology hospital in Tehran, entered the research. Daily information including questions on disease symptoms (sleep disturbance, itching) and duration of outdoor stay (in hours) were collected using a questionnaire. The mean 24-h concentrations of PM2.5 and PM10 pollutants were obtained from the Air Quality Control Company. The relationship between the concentrations of the pollutants and exacerbation of the disease symptoms was investigated using the GEE (Generalized Estimating Equations) model. There was a significant relationship between the concentrations of air pollutants and exacerbation of sleep disturbance and itching on the same day, before, and after adjusting the effects of the confounding variables, so that the estimated odds ratios (95% confidence interval) between PM10 and PM2.5 and exacerbation of itching were 1.06 (1.02-1.10) and 1.17 (1.07-1.28), respectively. There was a significant statistical relationship between the concentration of particulate matter (PM2.5 and PM10) and exacerbation of sleep disturbance and itching. PM2.5 showed a stronger relationship with the exacerbation of symptoms compared to PM10.

Incidence Of Psoriatic Arthritis Among Psoriatic Patients In Damietta Governorate

Background: Psoriasis is a chronic inflammatory skin disease affecting approximately 1-6% of population in the world.Aim of the work: To screen psoriatic patients for psoriatic arthritis [PsA] to improve optimal PsA management and outcome.Patients and Methods: This study included one hundred and tow patients with psoriasis recruited from the dermatology outpatient clinics in Damietta, [Al-Azhar University Hospital, Dermatology and Leprosy Hospital and El-Maasarah Hospital]. Patients should fulfill a Simple Psoriatic Arthritis Screening Questionnaire [SiPAS] to calculate the prevalence of psoriatic arthritis among psoriatic patients in Damietta.Results: The study included 42 [41.2%] females and 60 [58.8%] males with age range between 6 -88 years old with mean age 45 years old. Among the 102 included patients with psoriasis, 36 patients [35.3%] had score [≥3]; [63.9%] of them were men and [36.1%] were women with mean age 51 years old, mean age of onset of psoriasis 31 years old and mean duration of psoriasis 19.14 . [77.8%] of them had psoriatic nail lesions. On the other side, 66 patients [64.7%] had score [<3] with mean age 45.19 years old, mean age of onset of psoriasis 32 and mean duration of psoriasis 9 years.Conclusion: Early diagnosis of PsA could prevent permanent joint damage or spinal fusion and could improve long-term patient outcome. The SiPAS questionnaire can be a powerful tool to help dermatologists to quickly screen PsA during their clinical practice. The SiPAS questionnaire is able to quickly screen psoriasis patients for PsA. A SiPAS score ≥3 is an indication for referral to a rheumatologist.

Cross-sectional review of referrals to the Vancouver General Hospital Dermatology Rapid Access Clinic in 2016

Cross-sectional review of referrals to the Vancouver General Hospital Dermatology Rapid Access Clinic in 2016

Epidemiological and molecular investigation of resurgent cutaneous leishmaniasis in Sudan

ObjectivesLocal health personnel have drawn attention to an apparent increase in incidence and severity of cutaneous leishmaniasis (CL) in Sudan. The objective of this study was to investigate CL burden and surveillance. MethodsSurveillance data were compiled from the KalaCORE programme, Leishmania coordinators in Northern Kordofan and Southern Darfur, and Khartoum Dermatology Hospital. CL lesions were sampled from 14 suspected cases from Northern Kordofan and the Hospital for Tropical Diseases in Omdurman. PCR–restriction fragment length polymorphism analysis and multilocus sequencing were used to characterize the disease agent. ResultsAll sites reported substantial increases from 2014 to 2016/7, far exceeding World Health Organization case reports for 2014, consistent with a widespread outbreak. Single seasonal peak incidence was observed, except for two peaks in Southern Darfur. In Northern Kordofan, the odds ratio for CL in the 35–44 years age group was 2.6 times higher than in the >45 years age group (p<0.0001); in Southern Darfur, the OR was 2.38 greater in males than females (p<0.0001). Lesions included severe presentations, despite chemotherapy. Leishmania major was identified as the agent. ConclusionsActive surveillance is required to understand the extent of CL in Sudan, as well as training to standardize surveillance, diagnosis, reporting, and quality control. Point-of-care rapid diagnosis would be valuable. Genotyping and phenotyping are required to monitor the emergence of pathogenic strains, drug resistance, outbreaks, and changes in severity.

Appearance in acne: an often-overlooked concept.

Acne is one of the most common skin conditions affecting all age groups, especially adolescents and young adults.1 The transition into adulthood is a crucial period of development including many changes and challenges, such as professional progress, making and strengthening relationships and forming one's personal identity.2 Having visible acne impedes these developmental tasks and, in the absence of a cure, affected people must learn to live with their skin condition. Effective treatments are therefore essential. In order to measure efficacy of different treatments, well‐developed and validated patient‐reported outcome measures should be available and capture improvements from the patient's perspective.3 Being an important outcome of acne treatments, appearance should be measured in every clinical trial. What is more important for an affected patient, especially for adolescents and young adults, than how their skin, acne and acne scars look and improve? Because appearance is in the eye of the beholder, a self‐report is needed to capture this concept. There are some acne‐specific measures available, but they often overlook this subjective concept. In this issue of the BJD, Klassen et al. dared to develop a new instrument filling this gap, the ACNE‐Q.4 Addressing the concept appearance comprehensively, this measure is novel. An important criterion to ensure good quality of the development of a measure is a patient‐oriented approach. Patients as well as different healthcare providers were involved in the whole development process. Three top‐level domains with several major and minor themes emerged. Feedback of clinical experts was obtained and cognitive interviews with affected patients were conducted to assess content validity of the scales according to the COSMIN criteria.5 Modern psychometric analyses using the Rasch Measurement Theory were performed to identify items with poor fit and different measurement properties of the ACNE‐Q, such as structural validity, internal consistency, test–retest reliability and construct validity, were assessed. The study is limited to the North American population. However, a large sample size (n = 256) recruited from two countries and different settings, i.e. hospital and community dermatology clinics, was involved in the validation study. Although the ACNE‐Q is quite long, with 73 items in seven scales, it is a comprehensive and promising measure that can be used in clinical practice and research to measure appearance and appearance‐related distress and symptoms. This study lays the ground for future studies on the validation and feasibility of the ACNE‐Q.

Clinical profile of pityriasis rosea: a descriptive study from urban Karnataka

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pityriasis rosea (PR) is common, self-limited papulo-squamous dermatosis of unknown origin, which mainly appears in adolescents and young adults (10-35 years). It has a sudden onset, and in its typical presentation, the eruption is proceeded by a solitary patch termed “herald patch”, mainly located on the trunk. The objective of the study was to assess the clinical profile of pityriasis rosea.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The data was collected from patients attending the Department of Dermatology, Basaveshwar Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Gulbarga. It is a descriptive observational study. A total 79 patients suffering from pityriasis rosea who attended the outpatient department were included in the present study during the period from 2006 to 2007.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 79 patients studied, majority were from 11-20 years age group 33 (41.8%) followed by 27.8% from 21-30 years age group. The mean age of study population was found to be 21.3±6.4 years. 11% gave history of acne vulgaris, 8% each had history of atopy and drugs. Commonly observed prodromal symptoms were URTI (25.3%) and fever (17.7%). Herald patch was seen on trunk in majority of patients i.e. 36 (61%) followed by 18.6% cases on upper extremity and on neck (8.5%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study concludes that pityriasis is common in 11-20 years age group with male predominance having URTI as common prodromal symptom and typical rash.&lt;/p&gt;

Development of a new patient-reported outcome measure to evaluate treatments for acne and acne scarring: the ACNE-Q.

Psychosocial concerns represent important outcomes in studies of treatments for acne and acne scarring. Also important, but largely overlooked, is the concept of appearance. To design an acne-specific patient-reported outcome measure for acne and acne scarring. We used a mixed-methods approach. Phase I involved 21 patient interviews that were audio-recorded, transcribed and coded. Concepts were identified and developed into scales that were refined through 10 cognitive interviews and input from 16 clinical experts. Phase II involved data collection at hospital and community-based dermatology clinics in Canada and the U.S.A. Eligible participants were aged 12 years and older with acne and/or acne scars on the face, chest and/or back. Rasch Measurement Theory (RMT) analyses were performed to examine psychometric properties. Phase I led to the development of seven scales that measure appearance of facial skin, acne (face, chest and back) and acne scars, acne-specific symptoms and appearance-related distress. In phase II, 256 patients completed the ACNE-Q. RMT analysis provided evidence that the items of each scale worked together conceptually and statistically. Most participants scored within the range of measurement for each scale (81·9-93·1%). Reliability was high, with person separation index values and Cronbach alpha values > 0·90 for the appearance scales, ≥ 0·87 for appearance-related distress and ≥ 0·75 for symptoms. Worse scores on appearance scales correlated with worse symptom scores and more appearance-related distress. The ACNE-Q is a rigorously developed instrument that can be used to measure appearance and other patient-centred concerns. What's already known about this topic? Acne is a common dermatological condition that can have an important impact on psychosocial function. Current patient-reported outcome measures specific to acne focus mostly on measuring psychological and social impact. What does this study add? The ACNE-Q provides a set of independently functioning scales that measure appearance of facial, back and chest acne, acne scarring and facial skin. Additional scales measure appearance-related distress and acne symptoms. What are the clinical implications of this work? ACNE-Q provides the dermatology community with a rigorously developed patient-reported measure for acne that can be applied in clinical trials, research and patient care. The measurement of appearance by ACNE-Q scales is more comprehensive than in other instruments providing important information on appearance of their acne and/or acne scars from the patient perspective.

Nursing Care in Dermatologic Oncology: a Qualitative Study.

Nurses in hospital dermatology departments must increasingly provide care for patients with skin cancer. Although the experience of oncology nurses in numerous specialties has been widely explored, no study has focused on the experience of nurses in dermatologic oncology. We aimed to explore how nurses experience their care for patients with skin cancer. This is an inductive, exploratory study employing semi-structured interviews and focus groups with nurses, followed by thematic analysis. The study included purposive sample of 14 nurses practicing in different sectors of this dermatology department. Data were collected via two focus groups of six nurses each and 14 individual, semi-structured interviews, both using a researcher-developed interview guide. Interviews were transcribed and analyzed with thematic analysis. The most illustrative quotes were translated into English. Nurses' experiences of providing care in dermatologic oncology are organized around two themes: (1) their practices for these patients and (2) their management of emotional distress as the major issue in care, especially at night. Our results show the predominant place of relationships with patients in nurses' practices and of their emotional distress due to their closeness to the patients. Specific and original aspects have also been demonstrated with practical implications to be drawn for nurses' supportive care role: the distress engendered by the specific and harrowing experience of nurses dealing with skin cancer, which can be both seen and smelled.

Inpatient teledermatology: Current state and practice gaps

Inpatient dermatology care can be challenging for dermatologists. Currently teledermatology is widely used in the outpatient setting but is not common in the inpatient setting, although it has the potential to reduce wait times and improve access to care. To review the available literature on inpatient teledermatology, assess how teledermatology is currently being used in the inpatient setting, and recommend best practice use of inpatient teledermatology. A literature review was performed and dermatology attending physicians were surveyed at the Society for Dermatology Hospitalists annual meeting about their current use of inpatient teledermatology. The majority of attending physicians (80.8%, n = 21/26) responded that their institution uses some form of teledermatology. Approximately half of those using teledermatology used it for both inpatient and outpatient consultations (55%, n = 11/20). For institutions with inpatient teledermatology, attending physicians used teledermatology to remotely staff inpatient consultations (81.8%, n = 9/11), triage consultations (63.6%, n = 7/11), and answer curbside questions from primary teams (18.2%, n = 2/11). The limitations of this study include a limited sample size from a single meeting. Inpatient teledermatology is currently under-utilized has the potential to increase access to dermatology care and may be best used for triaging and remote staffing. Additionally, standardization of platforms and reimbursement would allow for increased use of inpatient teledermatology.

Allergic contact dermatitis caused by glucose sensors in type 1 diabetes patients.

Allergic contact dermatitis caused by glucose sensors has become an increasing problem. Contact allergies to isobornyl acrylate, colophonium, ethyl cyanoacrylate and N,N-dimethylacrylamide have been reported. However, there is a paucity of information regarding the prevalence of sensor-related dermatitis and detailed patient histories. To evaluate diabetes patients who have developed allergic contact dermatitis caused by glucose sensors. Seventy patients with suspected contact allergy to glucose sensors referred to university hospital dermatology clinics in southern Finland were patch tested with the baseline series, an isobornyl acrylate dilution series, and a number of other acrylates. Atopic constitution, contact allergies, the severity of the dermatitis and the ability to continue with the same or another type of sensor were recorded. Positive patch test reactions to isobornyl acrylate were seen in 51 of 63 (81%) Freestyle Libre users. Colophonium or its derivatives gave positive reactions in five of seven Medtronic Enlite users. The median duration of sensor use before dermatitis was 6 months. The estimated prevalences of contact allergy to sensor adhesives were 0.7% for Freestyle Libre and 0.8% for Enlite. We suggest that patients who have difficulties in finding a tolerable glucose sensor or an insulin pump should be patch tested.

Evaluation of corticosteroid use in outpatient department of dermatology of a tertiary care teaching hospital: a prospective observational study

Background: Corticosteroids are widely prescribed drugs in dermatology. Rational prescribing of steroids is important for best therapeutic outcome at lowest possible dose. A study was carried out at a tertiary care teaching hospital in order to evaluate the use of corticosteroids which provided a picture of trends in the usage of corticosteroids in dermatology at that set-up. Materials and Methods: This prospective, observational study was carried out in department of dermatology for 1 year after ethical approval. Data was analysed for parameters related to corticosteroids, their potency, WHO drug prescribing indicators, effectiveness as well as effects of corticosteroids on quality of life of patients. Statistical analysis was done using Microsoft Excel Office 365. Results: In the 223 patients, 44.84% patients belonged to 21-40 years age group. Mostcommon indication was eczema in 29.15% cases. Topical betamethasone (25.11%) and oral prednisolone (20.17%) were most frequently prescribed. 95/140 topical steroids prescribed were super highly potent. Among concomitant drugs, a majority of 38% were antihistaminics. Degree of polypharmacy showed 04 drugs in a majority (43.15%) of prescriptions. Only 6.27% drugs were prescribed by generic name. Conclusion: Corticosteroids were beneficial to a large no. of patients. Initial usage of low potency steroids topically wherever possible can be emphasized. WHO drug prescribing indicators analysis indicated the need to adhere to WHO guidelines as well as prescribing drugs by generic name. To maintain a balance between judicious use and frequent abuse with corticosteroid is important along with physician’s vigilance and patient education.

Rationale, objectives and design of PURE, a prospective registry of patients with moderate to severe chronic plaque psoriasis in Canada and Latin America

BackgroundTreatment options for the management of moderate to severe plaque psoriasis include phototherapy, oral systemic agents, and biologic therapy. Secukinumab, a fully human monoclonal antibody that selectively targets IL-17A, is the first IL-17 antagonist approved for this patient population. Long-term observational data are required for establishing the true population-based benefit-risk ratio of approved treatments. PURE is a multinational registry that will assess the real-world safety and effectiveness of secukinumab and other approved therapies in the management of patients with moderate to severe psoriasis.MethodsThis is a multinational (Canadian and Latin American), prospective, observational study of adult patients with moderate to severe psoriasis that initiate treatment with secukinumab or other approved therapies as per local standard of care. A total of 2500 patients (1250 per cohort) will be recruited in the practices of hospital and community dermatologists. Decision regarding treatment must have been reached prior to and independent of patient enrollment in the study. The study includes a 5-year follow-up with recommended assessments at Baseline, 3 and 6 months post-Baseline, and every 6 months thereafter. The primary objective of the study is safety. Secondary outcome measures relate to effectiveness (Investigator’s Global Assessment -IGA mod 2011-, Psoriasis Areas and Severity Index, Body Surface Area), patient reported outcomes (Dermatology Life Quality Index, Work Productivity and Activity Impairment Questionnaire, Hospital Anxiety and Depression Scale, Psoriasis Epidemiology Screening Tool, Psoriasis Symptom Diary, and Treatment Satisfaction Questionnaire), and healthcare resource utilization.DiscussionThis is the first observational study in Canada and Latin America assessing the real-world safety and effectiveness of secukinumab in the management of moderate to severe psoriasis. The extensive clinical, patient-reported and health economic outcomes collected will allow the comprehensive evaluation of this new treatment in comparison to other approved therapies.Trial registrationClinicalTrials.gov Identifier: NCT02786186; date of registration: May 30, 2016.

Evaluation of Serum Level of Glutathione Peroxidase Activity in Vitiligo Patients

AbstractBackground: Vitiligo is an acquired disorder with loss of epidermal melanocytes. Oxidative stress is thought to play a significant role in the pathogenesis of vitiligo. Glutathione Peroxidase (GPx) is one of the most important antioxidant enzymes.Aim of Study: To estimate serum levels of Glutathione Peroxidase activity in patients with vitiligo to assess its role in the disease activity.Patients and Methods: This study included (60) patients with vitiligo and (20) healthy individuals served as a control group. They were collected from the Outpatient Clinic of Dermatology and Venereology Department Tanta University Hospital. Serum levels of glutathione peroxidase activity were estimated in the patients and control group.Results: Serum GPx activity level showed a statistically significant increase in vitiligo patients compared to control group.Conclusion: Oxidative stress is thought to play a significant role in the pathogenesis of vitiligo represented by significantly increased GPx activity level in vitiligo patients.