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Journal of the American Academy of... Jun 2023Topical corticosteroids (TCS) are commonly prescribed to treat inflammatory skin diseases, and appropriate prescription is necessary for treatment success.
BACKGROUND
Topical corticosteroids (TCS) are commonly prescribed to treat inflammatory skin diseases, and appropriate prescription is necessary for treatment success.
OBJECTIVE
To quantify differences between TCS prescribed by dermatologists at consultation and family physicians for patients treated for any skin condition.
METHODS
Using administrative health data in Ontario, we included all Ontario Drug Benefit recipients who filled at least one TCS prescription from a dermatologist at consultation and a family physician in the year prior between January 2014 and December 2019. We estimated mean differences and 95% confidence intervals in amount (in grams) and potency between the index dermatologist prescription and the highest and most recent family physician prescription amounts and potencies in the preceding year using linear mixed-effect models.
RESULTS
A total of 69,335 persons were included. The mean dermatologist amount was 34% larger than the highest amount and 54% larger than the most recent amount prescribed by family physicians. There were small but statistically significant differences in potency using established 7-category and 4-category potency classification systems.
CONCLUSIONS
Compared to family physicians, dermatologists prescribed substantially larger amounts and similarly potent TCS at consultation. Further research is needed to determine the effect of these differences on clinical outcomes.
Topics: Humans; Physicians, Family; Dermatologists; Cross-Sectional Studies; Administration, Topical; Glucocorticoids; Dermatologic Agents; Dermatitis, Atopic; Drug Prescriptions
PubMed: 36914480
DOI: 10.1016/j.jaad.2023.01.036 -
Medecine Sciences : M/S Dec 2019Therapeutic monoclonal antibodies are henceforth commonly used in the management of psoriasis but have been also used more recently in chronic spontaneous urticaria and... (Review)
Review
Therapeutic monoclonal antibodies are henceforth commonly used in the management of psoriasis but have been also used more recently in chronic spontaneous urticaria and atopic dermatitis. Three examples are developed herein: dupilumab, omalizumab and lanadelumab. The specificity of their mechanism of action results from a better understanding of the inflammatory pathways in these chronic diseases, which previously shared either the same targeted topical or systemic treatments. However, their high costs should be put into perspective with the epidemiology, the precise evaluation of the severity, the optimization of first line treatments and the long-term benefit/risk ratio.
Topics: Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Dermatitis, Atopic; Dermatologists; Humans; Immunotherapy; Psoriasis; Skin Diseases
PubMed: 31903911
DOI: 10.1051/medsci/2019201 -
American Journal of Clinical Dermatology Jul 2023The current 2022 mpox (monkeypox) outbreak has been officially recognized as a public health emergency. The mpox clinical symptoms include high fever, fatigue, chills,... (Review)
Review
The current 2022 mpox (monkeypox) outbreak has been officially recognized as a public health emergency. The mpox clinical symptoms include high fever, fatigue, chills, headache, swollen lymph nodes, muscle aches, and a disseminated painful rash. However, recent cases of mpox have shown a shift in clinical symptoms, with anogenital skin lesions emerging as the predominant feature. Due to the predominant skin manifestations of mpox, dermatologists could be crucial in detecting new mpox cases and educating frontline healthcare professionals about mpox. The mpox virus is continuously evolving and has several variants. Genome sequencing has revealed that the Clade IIb variant is responsible for the 2022 mpox outbreak. Mpox spread may occur through animal-to-human and human-to-human transmission; however, unlike coronavirus disease 2019 (COVID-19), long-range airborne transmission has not been reported. Healthcare professionals are at higher risk of becoming infected since they are usually in close contact with both the patients and potentially contaminated fomites (e.g., examination table, gowns, gloves). Both public and healthcare professionals should take preventive and avoidance measures to limit the spread. Mpox is usually self-limiting and may require only symptomatic treatment; however, it may cause severe complications in special populations such as immunocompromised individuals. For severe infection, clinicians may consider antiviral drugs (off-label), tecovirimat and brincidofovir, originally approved for smallpox treatment. Two smallpox vaccines, ACAM2000 and JYNNEOS, can be used as pre-exposure prophylaxis against mpox. JYNNEOS, which carries approval for mpox use, has less adverse effect potential than ACAM2000, and may also be used as post-exposure prophylaxis, preferably within 4 days of exposure.
Topics: Animals; Humans; Diagnosis, Differential; Mpox (monkeypox); COVID-19; Dermatologists; Smallpox; COVID-19 Testing
PubMed: 37106278
DOI: 10.1007/s40257-023-00778-4 -
JAMA Dermatology May 2022This cross-sectional study uses Medicare data to characterize billing patterns of dermatologist-dermatopathologists and their geographic distribution in the US from 2013...
This cross-sectional study uses Medicare data to characterize billing patterns of dermatologist-dermatopathologists and their geographic distribution in the US from 2013 to 2017.
Topics: Dermatologists; Dermatology; Humans; Skin Neoplasms
PubMed: 35385058
DOI: 10.1001/jamadermatol.2022.0073 -
Journal of Cosmetic Dermatology Jan 2023Artificial intelligence (AI) has an important role to play in future healthcare offerings. Machine learning and artificial neural networks are subsets of AI that refer... (Review)
Review
INTRODUCTION
Artificial intelligence (AI) has an important role to play in future healthcare offerings. Machine learning and artificial neural networks are subsets of AI that refer to the incorporation of human intelligence into computers to think and behave like humans.
OBJECTIVE
The objective of this review article is to discuss perspectives on the AI in relation to Coronavirus disease (COVID-19).
METHODS
Google Scholar and PubMed databases were searched to retrieve articles related to COVID-19 and AI. The current evidence is analysed and perspectives on the usefulness of AI in COVID-19 is discussed.
RESULTS
The coronavirus pandemic has rendered the entire world immobile, crashing economies, industries, and health care. Telemedicine or tele-dermatology for dermatologists has become one of the most common solutions to tackle this crisis while adhering to social distancing for consultations. While it has not yet achieved its full potential, AI is being used to combat coronavirus disease on multiple fronts. AI has made its impact in predicting disease onset by issuing early warnings and alerts, monitoring, forecasting the spread of disease and supporting therapy. In addition, AI has helped us to build a model of a virtual protein structure and has played a role in teaching as well as social control.
CONCLUSION
Full potential of AI is yet to be realized. Expert data collection, analysis, and implementation are needed to improve this advancement.
Topics: Humans; Artificial Intelligence; Dermatologists; COVID-19; Pandemics; Referral and Consultation
PubMed: 35976075
DOI: 10.1111/jocd.15310 -
JAMA Dermatology Nov 2018As the US population continues to increase and age, there is an unmet need for dermatologic care; therefore, it is important to identify and understand the... (Comparative Study)
Comparative Study
IMPORTANCE
As the US population continues to increase and age, there is an unmet need for dermatologic care; therefore, it is important to identify and understand the characteristics and patterns of the dermatologist workforce.
OBJECTIVE
To analyze the longitudinal dermatologist density and urban-rural disparities using a standardized classification scheme.
DESIGN, SETTING, AND PARTICIPANTS
This study analyzed county-level data for 1995 to 2013 from the Area Health Resources File to evaluate the longitudinal trends and demographic and environmental factors associated with the geographic distribution of dermatologists.
MAIN OUTCOMES AND MEASURES
Active US dermatologist and physician density.
RESULTS
In this study of nationwide data on dermatologists, dermatologist density increased by 21% from 3.02 per 100 000 people to 3.65 per 100 000 people from 1995 to 2013; the gap between the density of dermatologists in urban and other areas increased from 2.63 to 3.06 in nonmetropolitan areas and from 3.41 to 4.03 in rural areas. The ratio of dermatologists older than 55 years to younger than 55 years increased 75% in nonmetropolitan and rural areas (from 0.32 to 0.56) and 170% in metropolitan areas (from 0.34 to 0.93). Dermatologists tended to be located in well-resourced, urban communities.
CONCLUSIONS AND RELEVANCE
Our findings suggest that substantial disparities in the geographic distribution of dermatologists exist and have been increasing with time. Correcting the workforce disparity is important for patient care.
Topics: Adult; Dermatologists; Dermatology; Female; Follow-Up Studies; Healthcare Disparities; Humans; Male; Middle Aged; Retrospective Studies; Rural Population; United States; Urban Population
PubMed: 30193349
DOI: 10.1001/jamadermatol.2018.3022 -
Journal of Ultrasound Mar 2023The purpose of this presentation is to show the ultrasonography findings of normal variants and benign and malignant diseases that affect the nipple-areolar complex....
The purpose of this presentation is to show the ultrasonography findings of normal variants and benign and malignant diseases that affect the nipple-areolar complex. Many of which have unspecific clinical and radiological presentations that can present a challenge for medical specialists. Experienced specialists need to know the different imaging modalities used to study the nipple-areolar complex and the aspect not exactly senology, as well as dermatologist who approach the ultrasound must know the anatomy of this complex area. We will show you a combined clinical and radiological approach to evaluate the nipple-areolar complex, the findings for the normal morphology and the most common benign and malignant diseases that can affect this region. We discuss the characteristics of the different ultrasonography findings and provide guidance on how to avoid artifacts and pitfalls.
Topics: Humans; Nipples; Dermatologists; Ultrasonography; Radiography
PubMed: 36085438
DOI: 10.1007/s40477-022-00722-y -
International Journal of Women's... Mar 2017
PubMed: 28492044
DOI: 10.1016/j.ijwd.2017.02.015 -
Dermatology and Therapy Jun 2020Machine learning (ML) has the potential to improve the dermatologist's practice from diagnosis to personalized treatment. Recent advancements in access to large datasets... (Review)
Review
Machine learning (ML) has the potential to improve the dermatologist's practice from diagnosis to personalized treatment. Recent advancements in access to large datasets (e.g., electronic medical records, image databases, omics), faster computing, and cheaper data storage have encouraged the development of ML algorithms with human-like intelligence in dermatology. This article is an overview of the basics of ML, current applications of ML, and potential limitations and considerations for further development of ML. We have identified five current areas of applications for ML in dermatology: (1) disease classification using clinical images; (2) disease classification using dermatopathology images; (3) assessment of skin diseases using mobile applications and personal monitoring devices; (4) facilitating large-scale epidemiology research; and (5) precision medicine. The purpose of this review is to provide a guide for dermatologists to help demystify the fundamentals of ML and its wide range of applications in order to better evaluate its potential opportunities and challenges.
PubMed: 32253623
DOI: 10.1007/s13555-020-00372-0 -
Dermatology and Therapy Apr 2022While the diagnoses made at visits to the dermatologist are well characterized, the reasons patients visit the dermatologists are not well described. Understanding why...
INTRODUCTION
While the diagnoses made at visits to the dermatologist are well characterized, the reasons patients visit the dermatologists are not well described. Understanding why patients present to dermatologists could be helpful in identifying patients' unmet needs and developing outreach programs to improve patients' access to care. The purpose of this study is to characterize the reasons why US patients sought medical attention from dermatologists.
METHODS
We evaluated the National Ambulatory Medical Care Survey (NAMCS) between 2007 and 2018, the most recent years available, to characterize the most common reasons patients visit the dermatologist.
RESULTS
Sixty-four thousand records were identified in the NAMCS estimating 1.55 billion visits to the dermatologist in the US during the study period. The most common reasons for visits were skin examination (7.8%), skin lesion (7.5%), and discoloration/abnormal pigmentation (7.3%). For patients ≤ 18 years, the most common reasons for visits were acne (28%), warts (7.7%), and skin rash (6.4%). For patients 19-65 years and ≥ 66 years, skin examinations (7.7%) and skin lesions (10%) were the most common reasons for visits to dermatologists, respectively.
CONCLUSION
By identifying the most common reasons for visits to the dermatologist, we can improve our understanding of a patient's needs and appropriate health outreach resources to improve patients' access to care.
PubMed: 35286613
DOI: 10.1007/s13555-022-00706-0