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BMJ Case Reports Dec 2023A perimenopausal woman with abnormal uterine bleeding underwent an uncomplicated laparoscopic hysterectomy. Postoperatively, she developed fever, abdominal erythema and...
A perimenopausal woman with abnormal uterine bleeding underwent an uncomplicated laparoscopic hysterectomy. Postoperatively, she developed fever, abdominal erythema and pain. Imaging revealed diffuse abdominal wall skin thickening, most pronounced at the right port site with a small area concerning for developing abscess. There was high clinical suspicion for necrotising fasciitis due to rapidly progressive skin deterioration. Despite antibiotics and surgical debridement, her condition progressed. Biopsy of the inflamed tissue confirmed a diagnosis of pyoderma gangrenosum (PG), and treatment with daily prednisone led to rapid improvement of symptoms.Successful diagnosis and treatment of the patient's symptoms required multidisciplinary collaboration among gynaecology, general surgery and dermatology. PG, although a well-known condition among dermatologists, is rarely, if ever, encountered by gynaecologists, and its resemblance to conditions such as necrotising fasciitis complicates early detection and intervention. This case highlights the diagnostic and management challenges associated with PG in the gynaecological setting.
Topics: Female; Humans; Pyoderma Gangrenosum; Fasciitis, Necrotizing; Anti-Bacterial Agents; Skin; Gynecologic Surgical Procedures
PubMed: 38160031
DOI: 10.1136/bcr-2023-256676 -
Cureus May 2024Equitable health manpower distribution is essential for the successful implementation of the Universal Health Care (UHC) program by the Philippine Department of Health....
BACKGROUND
Equitable health manpower distribution is essential for the successful implementation of the Universal Health Care (UHC) program by the Philippine Department of Health. Mapping the distribution and profile of dermatologists in the Philippines can improve Filipinos' access to skin disease treatment.
METHODS
A review of the database of dermatologists from the Philippine Dermatological Society (PDS) members' directory (as of November 2023), as well as the Philippine Health Insurance Corporation (PhilHealth) database (as of July 2023), was conducted. The distribution of PDS-accredited dermatologists was analyzed by geographic location, demographic profile (age and sex), density (per 100,000 people), and the dermatologist-to-general practitioner (GP) ratio. Heatmaps illustrating the distribution of dermatologists in the Philippines and the ratio of PhilHealth-accredited PDS board-certified dermatologists to GPs were created.
RESULTS
Out of 1389 PDS board-certified dermatologists, 1345 resided in the Philippines. The majority were women (1221/1345, 90.78%), with a median age of 47 years (range: 23 to 85). More than half were practicing in the National Capital Region (NCR) (684/1345, 50.86%). The overall dermatologist density was approximately 1 per 100,000 people (1.19); it was highest for the Luzon Island group (1.54) (NCR, 4.80) and lowest for the Mindanao Island group (0.27; the Bangsamoro Autonomous Region of Muslim Mindanao or BARMM, 0.04). Less than one-third (396/1345, 29.44%) of dermatologists were PhilHealth-accredited, with a density of 0.35 dermatologists per 100,000 people. Out of 45218 PhilHealth-accredited physicians, 396 (0.88%) were dermatologists while 11748 (25.98%) were GPs. The overall dermatologist-to-GP ratio among PhilHealth-accredited physicians was 1:30; it was highest in the Luzon Island group (1:20) and lowest in the Mindanao Island group (1:118).
CONCLUSION
The Philippines lacks dermatologists in regions outside the NCR. The majority are women, and few are PhilHealth-accredited. The dermatologist-to-GP ratio among PhilHealth-accredited physicians is low. Dermatology training programs should encourage more applicants, especially men, and prioritize applicants from underserved regions.
PubMed: 38883103
DOI: 10.7759/cureus.60402 -
JAAD International Sep 2023The use of teledermatology abruptly expanded with the arrival of COVID-19. Here, we review recent studies regarding the efficacy, perception, and utilization of... (Review)
Review
BACKGROUND
The use of teledermatology abruptly expanded with the arrival of COVID-19. Here, we review recent studies regarding the efficacy, perception, and utilization of telemedicine in the pediatric population.
OBJECTIVE
To evaluate the current state of pediatric teledermatology.
METHODS
A literature search was performed using the terms "pediatric," "teledermatology," "dermatology," "telemedicine" and "telehealth" in PubMed, Scopus, Embase, and Google Scholar. 44 articles published between 2008 and 2022 were included.
RESULTS
Diagnostic concordance between pediatric teledermatologist and in-person dermatologist ranged from 70.1% to 89%. Conditions treated with pediatric teledermatology were similar to those treated in-person. The rate of in-person follow-up after an initial telemedicine appointment pre and postpandemic was 12% to 51.9% and 13.5% to 28.1%, respectively. Patient satisfaction with teledermatology was between 70% to 98% and provider satisfaction was approximately 95%. The integration of teledermatology can reduce missed appointments and wait times among pediatric patients. However, considerable technological challenges exist, particularly in underserved communities. Globally, teledermatology may expand access to care though limited literature exists regarding its use in pediatric populations.
CONCLUSION
Telemedicine is effective for the diagnosis and treatment of many dermatological conditions in children, with high patient and provider satisfaction. Implementation of teledermatology can potentially increase access to care both locally and globally, but obstacles to engagement remain.
PubMed: 37228364
DOI: 10.1016/j.jdin.2023.03.005 -
Cancers Dec 2023Myeloid neoplasms and acute leukemias include different entities that have been recently re-classified taking into account molecular and clinicopathological features.... (Review)
Review
Myeloid neoplasms and acute leukemias include different entities that have been recently re-classified taking into account molecular and clinicopathological features. The myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) category comprises a heterogeneous group of hybrid neoplastic myeloid diseases characterized by the co-occurrence of clinical and pathological features of both myelodysplastic and myeloproliferative neoplasms. The most frequent entity in this category is chronic myelomonocytic leukemia (CMML) which is, after acute myeloid leukemia (AML), the main myeloid disorder prone to develop cutaneous manifestations. Skin lesions associated with myelodysplastic and myeloproliferative neoplasms include a broad clinical, histopathological and molecular spectrum of lesions, poorly understood and without a clear-cut classification in the current medical literature. The aim of this review is to describe and classify the main clinical, histopathological and molecular patterns of cutaneous lesions in the setting of MDS/MPN in order to improve the diagnostic skills of the dermatologists, hematologists and pathologists who deal with these patients.
PubMed: 38136431
DOI: 10.3390/cancers15245888 -
Journal of the American Academy of... Aug 2023Atopic dermatitis (AD) is a chronic inflammatory skin disease that can significantly decrease quality of life. AD is commonly associated with comorbidities including... (Review)
Review
Atopic dermatitis (AD) is a chronic inflammatory skin disease that can significantly decrease quality of life. AD is commonly associated with comorbidities including ocular surface disease (OSD). Conjunctivitis is the most common OSD associated with AD and can increase in incidence with use of monoclonal antibody biologics that target the type 2 inflammatory pathway. The objective of this review is to raise awareness of comorbid OSD in AD patients that dermatologists may encounter, with a focus on conjunctivitis, and equip dermatologists to address mild ocular concerns. We provide background on the subtypes and pathogenesis of comorbid OSD in AD patients and describe OSD associated with type 2 inflammation-inhibiting AD biologics. We also discuss screening and diagnosis, recommended treatment options for dermatologists, and when to refer to an eye care specialist. This multispecialty approach aims to support the overall health of AD patients and provide optimal patient care.
Topics: Humans; Dermatitis, Atopic; Quality of Life; Eye Diseases; Conjunctivitis; Inflammation
PubMed: 36806642
DOI: 10.1016/j.jaad.2023.01.043 -
NPJ Digital Medicine Aug 2023Gregoor et al. evaluated the healthcare implications and costs of an AI-enabled mobile health app for skin cancer detection, involving 18,960 beneficiaries of a...
Gregoor et al. evaluated the healthcare implications and costs of an AI-enabled mobile health app for skin cancer detection, involving 18,960 beneficiaries of a Netherlands insurer. They report a 32% increase in claims for premalignant and malignant skin lesions among app users, largely attributed to benign skin lesions and leading to higher annual costs for app users (€64.97) compared to controls (€43.09). Cost-effectiveness analysis showed a comparable cost to dermatologist-based diagnosis alone. This editorial emphasizes the balance in AI-based dermatology between increased access and increased false positives resulting in overutilization. We suggest refining the diagnostic schemas with new referral pathways to capitalize on potential savings. We also discuss the importance of econometric analysis to evaluate the adoption of new technologies, as well as adapting payment models to mitigate the risk of overutilization inherent in AI-based diagnostics such as skin cancer detection.
PubMed: 37582856
DOI: 10.1038/s41746-023-00900-0 -
Indian Journal of Dermatology 2023The human monkeypox (mpox) virus is an orthopox virus that can be transmitted to humans. Though the disease has been endemic in Africa, the recent mpox outbreak since... (Review)
Review
The human monkeypox (mpox) virus is an orthopox virus that can be transmitted to humans. Though the disease has been endemic in Africa, the recent mpox outbreak since May 2022. We attempted to examine differences between the endemic form of mpox and the current outbreak. Review of electronic medical database with relevant keywords. The current outbreak of mpox has disproportionately impacted the gay, bisexual and other men who have sex with men (MSM) community. This is also the first time that widespread semen testing has turned up evidence of mpox viral deoxyribonucleic acid (DNA). Cases in the present outbreak are more likely to affect adults, involve the genitalia, and have no prodrome. Close diagnostic differentials include varicella and hand-foot-mouth disease. The disease is usually self-limiting; though secondary infections, anorectal pain, pharyngitis, ocular lesions and rarely, renal injury and myocarditis may occur. This review focuses primarily on the novel clinical characteristics and emerging sexual transmission route of the mpox virus, which, although unconfirmed, appears extremely likely as the route of spread. Dermatologists have an important role in this health emergency, as early diagnosis can cause a significant reduction in disease transmission.
PubMed: 38371541
DOI: 10.4103/ijd.ijd_335_23 -
Journal of Cutaneous Medicine and... Nov 2023Patient dignity is a core component of medicine and health care, yet maintaining patient dignity can be challenging in clinical settings in dermatology, specifically...
BACKGROUND
Patient dignity is a core component of medicine and health care, yet maintaining patient dignity can be challenging in clinical settings in dermatology, specifically during a total body skin examinations (TBSE) for appropriate assessment and diagnosis. A recent study evaluated patient perspectives in dermatology. The purpose of this study was to investigate current draping practices and perspectives from a physicians' perspective.
METHODS
A cross-sectional study was performed with the use of study-specific questionnaire distributed to staff dermatologists and dermatology residents across Canada.
RESULTS
A total of 117 physicians were included (84 attending dermatologists and 33 dermatology residents). Nearly all staff and resident dermatologists (90.6%) indicated that draping was important. Specific practices differed between residents and staff ( = .03). Only 3.1% of residents indicated that they did not receive any form of teaching on draping during their training compared to 21.4% of attending physicians ( = .03).
DISCUSSION
This study confirms that draping practices in dermatology are perceived as important by dermatologists, consistent with other reports emphasizing approaches to protect patient privacy and dignity. There is a shared value for draping and consistent integration of this within current practice of Canadian dermatologists. Formal and informal education incorporated in medical education and dermatology training is becoming more prominent. Major study limitations include sampling bias, convenience bias and nonresponse bias.
CONCLUSION
This is the first study to evaluate physician perspectives on draping in dermatology or other areas in medicine. Findings from this study support a focus on draping in medical education.
Topics: Humans; Dermatology; Cross-Sectional Studies; Canada; Delivery of Health Care; Physicians; Surveys and Questionnaires
PubMed: 37587832
DOI: 10.1177/12034754231191479 -
Acta Dermato-venereologica Aug 2023Parents of infants treated with beta-blockers for infantile haemangioma are often concerned about the long-term aesthetic outcome. This cross-sectional study assessed...
Parents of infants treated with beta-blockers for infantile haemangioma are often concerned about the long-term aesthetic outcome. This cross-sectional study assessed the influence on the long-term aesthetic outcome of characteristics of the infantile haemangioma, the beta-blocker treatment, and the infant. The study included 103 children aged 6-12 years, treated with beta-blockers (propranolol or atenolol) for infantile haemangioma during infancy (age at treatment initiation ≤1 year) for ≥6 months. Dermatologists and parents scored the Patient Observer Scar Assessment Scale, and the child scored a visual analogue scale. Dermatologists identified whether telangiectasia, fibrofatty tissue, and atrophic scar tissue were present. The long-term aesthetic outcome of infantile haemangioma was judged more negatively by dermatologists and parents in case of a superficial component, ulceration, older age at treatment initiation, higher cumulative dose, and/or shorter follow-up time. According to children, infantile haemangioma located on the head had better aesthetic outcome than infantile haemangioma located elsewhere. Close monitoring, particularly of infantile haemangioma with a superficial component, is essential for early initiation of treatment, and to prevent or treat ulceration. These outcome data can support parental counselling and guide treatment strategy.
Topics: Child; Infant; Humans; Cicatrix; Cross-Sectional Studies; Prognosis; Hemangioma, Capillary; Adrenergic beta-Antagonists; Esthetics
PubMed: 37649330
DOI: 10.2340/actadv.v103.5286 -
Journal of the American Academy of... Feb 2024Psoriatic arthritis (PsA) is a chronic inflammatory disease that often goes unrecognized in patients with psoriasis. As a result, patients may develop significant... (Review)
Review
Psoriatic arthritis (PsA) is a chronic inflammatory disease that often goes unrecognized in patients with psoriasis. As a result, patients may develop significant structural damage before diagnosis and initiation of adequate treatment. Dermatologists are in an unique position to identify early signs and symptoms of PsA. Here, we briefly review the pathogenesis of PsA, differences in PsA presentation within real-world dermatology practice versus rheumatology clinical trials, and imaging modalities that can be used to assess structural damage. We then discuss several ongoing controversies related to prediction, assessment, and treatment of PsA-related structural damage. Debated questions include the following: (1) Does subclinical enthesitis predict progression from psoriasis to PsA?, (2) Does methotrexate inhibit progression of structural damage?, (3) Does structural damage correlate with clinical disease activity?, and (4) Can progression from psoriasis to PsA be prevented? Evidence presented herein suggests that dermatologists, together with rheumatologists, can play important roles in the early diagnosis and treatment of PsA, thereby potentially preventing irreversible structural damage.
Topics: Humans; Arthritis, Psoriatic; Dermatologists; Psoriasis; Rheumatology
PubMed: 37852305
DOI: 10.1016/j.jaad.2023.10.021