Medical Dermatology Research Articles

Management of pain in the inpatient and non-surgical outpatient dermatology settings: A narrative review.

Pain is frequently encountered in dermatology practice, which impairs the activities of daily living, adds to psychological morbidity, and therefore compromises the quality of life. It ranges from mild to severe in intensity across various dermatoses and requires prompt addressal and treatment. Diseases such as extensive pemphigus vulgaris and Stevens-Johnson syndrome are especially painful and require a multidisciplinary approach with the involvement of a pain specialist in their management. The main pathogenic types of pain include visceral nociceptive, somatic nociceptive, and neuropathic types, the latter two being most relevant in dermatological disorders. Somatic nociceptive pain is often seen in patients of Stevens-Johnson syndrome/ Toxic epidermal necrolysis, epidermolysis bullosa, pemphigus vulgaris, erythema nodosum, and hidradenitis suppurativa, while neuropathic pain is part of the disease process in dermatoses like leprosy, herpes zoster, and dysesthesia syndromes. Therapeutic approaches to pain management include the use of non-opioids (acetaminophen, non-steroidal anti-inflammatory agents), opioids, and non-pharmacological therapies, along with appropriate management of the underlying dermatosis. World Health Organisation (WHO) analgesic ladder remains the most commonly employed guideline for the management of pain, although treatment needs individualisation depending on the nature and severity of pain (acute/chronic), type of dermatosis, and patient factors. There is a paucity of literature pertaining to pain management in dermatology and this topic is often neglected due to a lack of awareness and knowledge of the topic. The present review aims to discuss the pain pathway, various painful conditions in the setting of medical dermatology practice, and their management along with relevant pharmacology of the commonly used analgesics.

Fellowships in Complex Medical Dermatology.

Complex medical dermatology fellowships currently are offered at 5 institutions in the United States. The decision to pursue this fellowship is individualized; however, additional training can prove to be beneficial when practicing in an environment with medically challenging patient populations.

ChatGPT versus clinician: challenging the diagnostic capabilities of artificial intelligence in dermatology.

ChatGPT is an online language-based platform designed to answer questions in a human-like way, using deep learning -technology. To examine the diagnostic capabilities of ChatGPT using real-world anonymized medical dermatology cases. Clinical information from 90 consecutive patients referred to a single dermatology emergency clinic between June and December 2022 were examined. Thirty-six patients were included. Anonymized clinical information was transcribed and input into ChatGPT 4.0 followed by the question 'What is the most likely diagnosis?' The suggested diagnosis made by ChatGPT was then compared with the diagnosis made by dermatology. After inputting clinical history and examination data obtained by a dermatologist, ChatGPT made a correct primary diagnosis 56% of the time (n = 20). Using the clinical history and cutaneous signs recorded by nonspecialists, it was able to make a correct diagnosis 39% of the time (n = 14). This was similar to the diagnostic rate of nonspecialists (36%; n = 13), but it was much lower than that of dermatologists (83%; n = 30). There was no differential offered by referring sources 28% of the time (n = 10), unlike ChatGPT, which provided a differential diagnosis 100% of the time. Qualitative analysis showed that ChatGPT offered responses with caution, often justifying its reasoning. This study illustrates that while ChatGPT has a diagnostic capability, in its current form it does not significantly improve the diagnostic yield in primary or secondary care.

Skin of Color Is Underrepresented on Instagram: Assessing South Jersey Skin Talk as an Educational Tool to Increase Awareness.

Background Instagram, a widely used social media platform with over two billion active users, has the potential to propagate dermatologic health information within the public sphere. However, there is a lack of representation of people of color (POC), making it crucial to share accurate and inclusive posts to increase awareness about dermatologic conditions. It is also necessary to address the misconceptions about skin diseases and other hereditary conditions within various ethnic groups. To combat this, a group of medical students created South Jersey Skin Talk (SJST), an initiative aimed to improve dermatologic health literacy in skin-of-color communities, particularly in underserved areas like Camden County, NJ. Using reliable sources to prevent the spread of misinformation, SJST's accessible Instagram page explains skin conditions, especially emphasizing appearances and manifestations in POC. The hypothesis being investigated bythis group is that the implementation of SJST as a community intervention is expected to improve dermatologic health literacy in POC. Methods A 13-question survey was conducted via Qualtrics (Seattle, Washington) and was distributed on social media (Instagram, Facebook, Reddit, Twitter, TikTok, and GroupMe). It remained open for eight weeks during which users 18 years or older were invited to participate. The survey was divided into four sections: demographics, Instagram usage, knowledge of dermatology, and inclusion and diversity on SJST's page. A total of 184 total responses were collected, which were compared using chi-squared analyses on Qualtrics software. Results POC felt less represented on social media compared to White respondents prior to visiting SJST on Instagram (p < 0.00001). However, after viewing SJST, 87.5% of White participants and 88% of POC reported feeling represented on the page. Additionally, both groups of respondents indicated that they felt more knowledgeable about their primary skin concern after viewing the SJST's posts. Furthermore, 86.8% of POC reported that they would feel more confident participating in a conversation with their dermatologist regarding their primary dermatologic concern. Conclusion SJST is a community outreach organization focused on improving health literacy for POC and bridging the gap in healthcare disparities between White and POC populations. The results from this survey confirm the hypothesis and illustrate that community interventions targeted at education for POC increase health literacy and patient autonomy. These results also show that there is a need for more representation and diversity in medical dermatology on social media. Further studies should be done to investigate other disparities affecting adequate representation for POC.

Is a 4 J/cm2 PpIX-Weighted Simulated Daylight (SDL-PDT) Dose Still Efficient for Photodynamic Therapy of Actinic Keratosis?

Background: Several solutions are now proposed to provide indoor illumination with so-called artificial white light or simulated daylight (SDL-PDT), resulting in an effective treatment for actinic keratosis (AK). However, the optimal PpIX-weighted light dose is still debated. Integrating the effective irradiance over the irradiation time yields the effective light dose, which is also known as the protoporphyrin IX-weighted light dose and is a key parameter for the efficacy of the treatment. Objectives: The paper aims to report the clinical outcomes of SDL-PDT when using the PpIX-weighted light dose of 4 J/cm2, in patients treated for AK lesions of the scalp or the face at our medical dermatology center (ClinicalTrials.gov NCT052036). Methods: A total of 30 patients (16 males, 14 females), with a mean age of 71.0 ± 10.2, with phototype 1 (16 patients) and phototype 2 (14 patients) with grade I-II AK were treated with a drug light interval (DLI) of 10 min and a light exposure of 35 min (Dermaris, Surgiris, Croix, France), corresponding to a PpIX-weighted light dose of 4 J/cm2. The primary endpoint was the cure rate of patients at six months post-treatment. Secondary endpoints included scores of pain, erythema, crusts, and discomfort during or/and post the treatment. Results: In total, 762 AK were treated. Six months following treatment, the cure rate of the patients was 77%. The median pain score was less than 1 out of 10 for most of the patients. Erythema was observed in all patients and lasted 3 days (±1.5 day). Crusts were seen in 28 patients. Discomfort was reported as mild or less in more than 97% of patients. Conclusions: The shortening of the PpIX-weighted light dose to 4 J/cm2, corresponding to an illumination duration of 35 min with the Dermaris, does not modify the efficacy of the SDL-PDT. This observation is in agreement with recent published data demonstrating that the light dose can be reduced. Furthermore, this clinical study confirmed that SDL-PDT is an effective and nearly painless treatment with minimal side effects for patients with AK lesions of the scalp.

A national survey comparing practice patterns and residency training satisfaction for categorical dermatology versus combined internal medicine and dermatology trained physicians.

Combined internal medicine and dermatology (med-derm) training programs were created to advance complex medical dermatology and inpatient dermatology care. A prior study demonstrated that compared to categorical dermatology residents, med-derm residents had less program satisfaction, yet indicated a stronger desire to pursue careers in academia. No follow-up data on practice patterns after training has been reported. We aimed to characterize differences in residency program satisfaction and practice patterns between physicians trained in categorical dermatology compared to med-derm residency programs. We surveyed physicians who graduated from combined med-derm programs along with their counterparts, from six institutions, that either currently or historically had a combined med-derm training, from 2008-2017. Fifty-five percent of med-derm and forty-one percent of categorical-trained physicians responded. The practice patterns between the two groups were similar. A quarter of med-derm physicians continued to provide general internal medicine services. Categorical trained physicians were significantly more satisfied with their training (P=0.03) and performed more excisions on the head/neck (P=0.02). The combined graduates had significantly greater confidence in multidisciplinary care (P=0.003), prescribed more biologic (P&lt;0.001) and non-biologic immunosuppressive agents (P=0.002), and volunteered more for the underserved patients in their communities (P=0.04). Although few differences in overall practice patterns between categorical and med-derm trained graduates were appreciated, med-derm graduates seem more comfortable with multidisciplinary care and may care for more medically complex patients requiring immunosuppression.

Assessment of knowledge and comfort prescribing common systemic medications within an academic medical dermatology clinic: a cross-sectional survey study.

We assessed dermatologists’ knowledge and comfort levels in prescribing various medications. Knowledge gaps in the management of cyclophosphamide, opioid pain controllers, intravenous immunoglobulin and newer-generation biologics were observed. Dermatologists expressed greater concern about prescribing medications that are broadly immunosuppressive with severe side-effects such as cyclophosphamide and rituximab.

Teledermatology in the provision of biologics through COVID-19 in a rural dermatology practice-A retrospective review.

COVID-19 compounded existing barriers to healthcare for rural patients. We completed a retrospective chart review of patients receiving Pharmaceutical Benefits Scheme subsidised biologics at a Modified Monash Model 3 dermatology practice during the pandemic and examined factors contributing to successful continuation of care, particularly teledermatology. Our experience is instructive in the provision of medical dermatology to regional patients.

Medical Dermatology

Australasian Journal of DermatologyVolume 64, Issue S1 p. 54-76 ABSTRACT Medical Dermatology First published: 22 May 2023 https://doi.org/10.1111/ajd.14044Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Volume64, IssueS1Special Issue: Australasian College of Dermatologists 55th Annual Scientific Meeting, Engage, Enhance, Elevate, 27–29 May 2023May 2023Pages 54-76 RelatedInformation

Integrating Precision Medicine into Medical Dermatology Clinical Practice: An Expert Consensus Panel.

Precision medicine utilizes an individual&rsquo;s genomics to improve diagnosis, prognosis, and therapy. The joint American Academy of Dermatology and National Psoriasis Foundation 2019 guidelines recognized the need to identify biomarkers that can predict the optimal biologic agent for an individual patient. This paper examines the current state of precision medicine in dermatology and how its use can improve outcomes in psoriasis. A search of PubMed/MEDLINE using the terms precision medicine, personalized medicine, biomarkers, genomics, and dermatology was performed to identify relevant publications. An expert consensus panel was then convened to assign levels of evidence to each article using strength of recommendation taxonomy and create consensus statements requiring a two-thirds supermajority for agreement utilizing a modified Delphi approach. Thirteen articles met inclusion and exclusion criteria and were assigned levels of evidence. The panel created 10 consensus statements on how precision medicine can improve patient outcomes, all of which received a unanimous (6/6) vote. Choosing a biologic medication for psoriasis often relies on patient preference, provider preference, and a trial-and-error approach. Utilizing precision medicine tests such as Mind.Px can help providers identify biomarkers unique to a patient&rsquo;s pathophysiology and choose the optimal medication through a targeted and evidence-based approach. Zakria D, Brownstone N, Armstrong AW, et al. Integrating precision medicine into medical dermatology clinical practice: an expert consensus panel. J Drugs Dermatol. 2023;22(6):588-593. doi:10.36849/JDD.7432.

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.

What do Patients Want to See on Social Media? Evidence From a Two-Year Experiment.

Dermatological information on social media is dominated by misleading and potentially harmful content from nonexperts. Literature suggests that, to address this issue, dermatologists should develop an online presence. However, the successful presence of dermatologists on social media has been criticized for focusing on cosmetic dermatology and not representing the broad spectrum of the specialty. The aim of this study was to systematically analyze which dermatological topics interest the public most, and to find out whether it is feasible for a dermatologist to become influential on social media while presenting all dermatological topics equally. The study was performed on an educational dermatology YouTube channel. The 101 videos published in a two-year period were divided into cosmetic (51 videos) and medical dermatology (50 videos). Student's t-test was conducted to determine whether there were significant differences in views. Medical dermatology videos were then classified into three categories: Acne, facial dermatoses (excluding acne) and other dermatological diseases. A Kruskal-Wallis test was used to compare these three categories and cosmetic dermatology. When comparing cosmetic and medical dermatology, no significant differences were found. When comparing the four categories, cosmetic dermatology and acne were found to generate significantly more views that other dermatological diseases. The public seems to be particularly interested in cosmetic dermatology and acne. This might make it challenging to become successful on social media while presenting a balanced portrayal of dermatology. However, focusing on popular topics can provide a real chance to be influential and protect vulnerable people from misinformation.

Features that define clinical severity of ulcerative pyoderma gangrenosum: a Delphi consensus study of experts and patients on behalf of the US Medical Dermatology Society.

Features that define clinical severity of ulcerative pyoderma gangrenosum: a Delphi consensus study of experts and patients on behalf of the US Medical Dermatology Society.

Differences in Practice Patterns and Payments for Female and Male Dermatologists: A Canadian Population-Based Study Over 3 Decades.

Canada's fee-for-service physician reimbursement system, where a set rate is provided for each service, suggests that a physician sex pay gap should not exist. However, recent evidence has questioned this presumption. To characterize trends in demographics and billing, overall and by sex, for dermatologists compared to other medical and surgical specialty groups in Ontario, Canada. Using population-based data, analysis of physician billing and clinical activity from Ontario, Canada, over 27 years (1992-2018) was performed. Multilevel regression models were used to examine unadjusted and adjusted differences in payments between females and males over time, while controlling for age, distinct patients seen, patient visits, and full-time equivalent. A total of 22 389 physicians were included in the analyses, including 381 dermatologists. The proportion of female dermatologists increased from 32% in 1992 to 46% in 2018. Dermatologists' median Ontario Health Insurance Plan (OHIP) payments were $415 340 (IQR: 285 630-566 580) in 1992 compared to $296 750 (IQR: 164 480-493 180) in 2018. Male dermatologists' OHIP payments were 20% more than their female counterparts across the entire study period. After adjusting for practice volumes, there was no significant pay gap amongst female and male dermatologists (P = .42); however, the sex pay gap remained significant for the other specialty groups (P < .001). From 1992 to 2018, dermatologists on average saw 19% fewer distinct patients per year and 15% fewer visits per patient. The overall sex pay gap within medical dermatology can be attributed to differences in practice patterns, whereas the sex pay gap remained significant in the other specialty groups.

Athena: Specialty Certificate Examination case for outpatient medical dermatology.

A twenty-year-old black woman presents to clinic with a two-year history of recurrent nodules and abscesses affecting the groins and axillae. She manages this with intermittent courses of oral antibiotics from the GP when she has a flare. She smokes 10 cigarettes per day and drinks 7 units of alcohol per week. She mentions that over the last six months she has experienced abdominal pain, diarrhoea, and fatigue. There is no recent history of foreign travel.

PS07: Service planning for delivery of specialized psychology support to medical dermatology: experience of a participatory co‐design approach at a London teaching hospital

PS07: Service planning for delivery of specialized psychology support to medical dermatology: experience of a participatory co‐design approach at a London teaching hospital

The emerging fifth epidemiologic subtype of Kaposi sarcoma in HIV-negative men who have sex with men at a tertiary care center in NYC from 2000 to 2021.

11579 Background: Kaposi sarcoma (KS) is a vascular tumor caused by human herpesvirus 8, also known as Kaposi sarcoma herpesvirus. There are 4 widely accepted distinct epidemiologic subtypes of KS: classic, endemic, iatrogenic, and epidemic (HIV-associated) forms. An emerging 5th subtype is increasingly recognized: non-epidemic KS in men who have sex with men (MSM) who are HIV-negative and have no other known causes for immunodeficiency. Objectives: To characterize a cohort of non-epidemic KS seen at the Sarcoma Medical Oncology or Dermatology Clinics at Memorial Sloan Kettering Cancer Center in New York City from 2000 to 2021 to identify risk factors, presentation, treatment course, and prognosis of these patients. Methods: Following IRB approval, a retrospective observational study was performed. Eligible patients were identified through the Electronic Health Records (EHR). The patients were characterized based on age at presentation, sex, gender identity, comorbidities, coinfections, and treatments and outcomes amongst other factors. Study data were collected and managed using REDCap electronic data capture tools. Results: Seventy-two patients were identified. The median age at time of diagnosis was 58 (range: 32-83). At initial diagnosis, 46% (33/72) of patients underwent observation, 50% (36/72) received localized treatment (i.e. excision, cryotherapy or topical therapy), and 4% (3/72) received systemic treatment with chemotherapy. The median duration of follow-up was 22 months. In follow-up, 43% (31/72) of patients had progression of disease requiring recurrent treatment: 24% (17/72) received localized treatment while 18% (13/72) received chemotherapy. Patients who received chemotherapy, predominantly pegylated liposomal doxorubicin, received treatment for a median duration of 13 months (range: 2-72 months). By the end of the follow-up period, 7 patients had died, of which 2 deaths were attributed to KS. During follow up, 10% (7/72) of patients were diagnosed with a lymphoproliferative disorder. Conclusions: This study is the largest yet, to our knowledge, to characterize the non-epidemic KS subtype in HIV-negative MSM. It is important to recognize this KS subtype to identify these individuals, who despite not having HIV are at increased risk for KS. Accurate recognition of this subtype may also allay patient concerns regarding overall prognosis, given that the majority of these patients present with indolent disease and have favorable outcomes compared to the epidemic variant of KS. Additional research is needed to understand the potential increased risk of lymphoproliferative disorders.

Engaging continuing medical education in evaluating knowledge gaps and preferences in advanced BRAF+ melanoma.

e23007 Background: Given the rapid evolution of treatments for advanced melanoma, oncology providers are challenged to stay current on evidence-based recommendations for optimal patient care. Integrating practice-based polling into continuing medical education (CME) activities is a proven way to increase engagement, address knowledge gaps, and assess attitudes on specific topics. Methods: We provided a CME activity designed to educate oncology and dermatology providers on the latest advances regarding the management of advanced BRAFmut+ melanoma. Interspersed engagement opportunities further assessed practice preferences and elucidated persisting educational needs. The CE activity was available for credit from December 31, 2020 to December 30, 2021. Results: 305 medical oncology or dermatology providers who each see an average of 25 patients with melanoma per month participated. These providers scored an average 38% on pretest topics related to the use of triple therapy and patient and/or tumor characteristics that guide clinical decision-making. Post-learning, providers scored 84%, highlighting the impact of the education on knowledge gaps. Notably, while 51% of these providers indicated that they were guessing on the pre-test, the percentage of those who were confident and correct on the post-test rose from 3% to 28%, demonstrating a rise in confidence among participants. While 50% of participants noted a positive perception of triple therapy (BRAF inhibitor + MEK inhibitor + anti-PD1) in the front-line setting, case-based polling questions showed that providers lack consensus regarding the use of combinations of treatments in other clinical scenarios. While 45% would recommend triple therapy in the first-line setting, dual checkpoint inhibitor (CPI)-based treatment is preferred after progression on a first-line CPI or dual-targeted therapy. Conclusions: CME is a useful method to address knowledge gaps regarding evolving treatment options. As data regarding the use of triple therapy for patients with BRAF+ melanoma emerges, oncology and dermatology providers will require further education on how to apply these options in practice.[Table: see text]

17th Medical Dermatology Meeting, 13 January 2022

17th Medical Dermatology Meeting, 13 January 2022

Critical review on the utilization of robotic-system point-to-point-based position actuators and laser sensors with artificial intelligence mediator in an archetypal mechatronics network for medical dermatology applications

In this article, a comprehensive overview of the classic designing of mechatronics-based robotics components like sensors and effectors in a network to solve the problems related to the medical skin of the human body with the help of an Artificial Intelligence has been carried out. Area-based artificial agent is the easiest way to deal with the skin-related diseases. In this artificial agent, we are having autonomy and flexibility to work on the area.