Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma.

BACKGROUND: Asthma trials and guidelines often do not distinguish between adolescents and younger children. Using a large English data set, we evaluated the impact of age on asthma characteristics, management and exacerbations. METHODS: Primary care medical records, 2004-2021, were linked to hospital records. Children were categorised by age at diagnosis and followed until the next age bracket. Ages (based on management guidelines) were 5-8 years, 9-11 years and adolescents (12-16 years). Characteristics evaluated included body mass index, allergies and events before and after diagnosis (symptoms, medication). Exacerbation incidence was calculated. Multivariable Cox proportional hazards determined associations with exacerbations. RESULTS: 119 611 children were eligible: 61 940 (51.8%) 5-8 years, 32 316 (27.7%) 9-11 years and 25 355 (21.2%) adolescents. Several characteristics differed by age; children aged 5-8 years had the highest proportion with eczema, food/drug allergy and cough, but adolescents had the highest proportion with overweight/obesity, aeroallergen sensitisation, dyspnoea and short-acting-beta-agonist only use. Exacerbation rates were highest in the youngest children (per 100 person-years (95% CI): 5-8 years =13.7 (13.4-13.9), 9-11 years =10.0 (9.8-10.4), adolescents =6.7 (6.5-7.0)). Exacerbation risk factors also differed by age; 5-8 years: male, eczema and food/drug allergy were strongly associated, but for children ≥9 years old, obesity and aeroallergen sensitisation were strongly associated. For all children, higher socioeconomic deprivation was significantly associated with having an exacerbation. Delayed diagnosis was most common in children aged 5-8 years and was associated with increased exacerbations across all ages. CONCLUSION: Children's baseline characteristics and exacerbation rates varied according to their age group. Clinical guidelines should consider age at time of diagnosis more discretely than the broad range, 5-16 years, as this appears to impact on asthma severity and management.

Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE- and Institute of Medicine-based recommendations.

BACKGROUND: Guidance addressing atopic dermatitis (AD) management, last issued in 2012 by the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force, requires updating as a result of new treatments and improved guideline and evidence synthesis methodology. OBJECTIVE: To produce evidence-based guidelines that support patients, clinicians, and other decision-makers in the optimal treatment of AD. METHODS: A multidisciplinary guideline panel consisting of patients and caregivers, AD experts (dermatology and allergy/immunology), primary care practitioners (family medicine, pediatrics, internal medicine), and allied health professionals (psychology, pharmacy, nursing) convened, prioritized equity, diversity, and inclusiveness, and implemented management strategies to minimize influence of conflicts of interest. The Evidence in Allergy Group supported guideline development by performing systematic evidence reviews, facilitating guideline processes, and holding focus groups with patient and family partners. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach informed rating the certainty of evidence and strength of recommendations. Evidence-to-decision frameworks, subjected to public comment, translated evidence to recommendations using trustworthy guideline principles. RESULTS: The panel agreed on 25 recommendations to gain and maintain control of AD for patients with mild, moderate, and severe AD. The eAppendix provides practical information and implementation considerations in 1-2 page patient-friendly handouts. CONCLUSION: These evidence-based recommendations address optimal use of (1) topical treatments (barrier moisturization devices, corticosteroids, calcineurin inhibitors, PDE4 inhibitors [crisaborole], topical JAK inhibitors, occlusive [wet wrap] therapy, adjunctive antimicrobials, application frequency, maintenance therapy), (2) dilute bleach baths, (3) dietary avoidance/elimination, (4) allergen immunotherapy, and (5) systemic treatments (biologics/monoclonal antibodies, small molecule immunosuppressants [cyclosporine, methotrexate, azathioprine, mycophenolate, JAK inhibitors], and systemic corticosteroids) and UV phototherapy (light therapy).

Emollients for preventing atopic eczema: Cost-effectiveness analysis of the BEEP trial.

BACKGROUND: Recent discoveries have led to the suggestion that enhancing skin barrier from birth might prevent eczema and food allergy. OBJECTIVE: To determine the cost-effectiveness of daily all-over-body application of emollient during the first year of life for preventing atopic eczema in high-risk children at 2 years from a health service perspective. We also considered a 5-year time horizon as a sensitivity analysis. METHODS: A within-trial economic evaluation using data on health resource use and quality of life captured as part of the BEEP trial alongside the trial data. Parents/carers of 1394 infants born to families at high risk of atopic disease were randomised 1:1 to the emollient group, which were advised to apply emollient (Doublebase Gel or Diprobase Cream) to their child at least once daily to the whole body during the first year of life or usual care. Both groups received advice on general skin care. The main economic outcomes were incremental cost-effectiveness ratio (ICER), defined as incremental cost per percentage decrease in risk of eczema in the primary cost-effectiveness analysis. Secondary analysis, undertaken as a cost-utility analysis, reports incremental cost per Quality-Adjusted Life Year (QALY) where child utility was elicited using the proxy CHU-9D at 2 years. RESULTS: At 2 years, the adjusted incremental cost was £87.45 (95% CI -54.31, 229.27) per participant, whilst the adjusted proportion without eczema was 0.0164 (95% CI -0.0329, 0.0656). The ICER was £5337 per percentage decrease in risk of eczema. Adjusted incremental QALYs were very slightly improved in the emollient group, 0.0010 (95% CI -0.0069, 0.0089). At 5 years, adjusted incremental costs were lower for the emollient group, -£106.89 (95% CI -354.66, 140.88) and the proportion without eczema was -0.0329 (95% CI -0.0659, 0.0002). The 5-year ICER was £3201 per percentage decrease in risk of eczema. However, when inpatient costs due to wheezing were excluded, incremental costs were lower and incremental effects greater in the usual care group. CONCLUSIONS: In line with effectiveness endpoints, advice given in the BEEP trial to apply daily emollient during infancy for eczema prevention in high-risk children does not appear cost-effective.

Emollients for prevention of atopic dermatitis: 5-year findings from the BEEP randomized trial.

BACKGROUND: The effectiveness of emollients for preventing atopic dermatitis/eczema is controversial. The Barrier Enhancement for Eczema Prevention trial evaluated the effects of daily emollients during the first year of life on atopic dermatitis and atopic conditions to age 5 years. METHODS: 1394 term infants with a family history of atopic disease were randomized (1:1) to daily emollient plus standard skin-care advice (693 emollient group) or standard skin-care advice alone (701 controls). Long-term follow-up at ages 3, 4 and 5 years was via parental questionnaires. Main outcomes were parental report of a clinical diagnosis of atopic dermatitis and food allergy. RESULTS: Parents reported more frequent moisturizer application in the emollient group through to 5 years. A clinical diagnosis of atopic dermatitis between 12 and 60 months was reported for 188/608 (31%) in the emollient group and 178/631 (28%) in the control group (adjusted relative risk 1.10, 95% confidence interval 0.93 to 1.30). Although more parents in the emollient group reported food reactions in the previous year at 3 and 4 years, cumulative incidence of doctor-diagnosed food allergy by 5 years was similar between groups (92/609 [15%] emollients and 87/632 [14%] controls, adjusted relative risk 1.11, 95% confidence interval 0.84 to 1.45). Findings were similar for cumulative incidence of asthma and hay fever. CONCLUSIONS: Daily emollient application during the first year of life does not prevent atopic dermatitis, food allergy, asthma or hay fever.

Effect of Prenatal Omega-3 Polyunsaturated Fatty Acid Supplementation on Childhood Eczema: A Systematic Review and Meta-Analysis.

It is uncertain about the effect of omega-3 polyunsaturated fatty acid (ω-3 PUFA) supplementation during pregnancy on the incidence of eczema among children. The aim of this review was to test if there is an effect of ω-3 PUFA supplementation during pregnancy on the risk of eczema among children of different ages. Two authors independently carried out the selection of published works, data extraction, and evaluation of the likelihood of bias. The PubMed, Medline, the Cochrane Library, Web of Science, and Embase databases updated to the date of March 2021 have been researched thoroughly for literature review. Quality Assessment of studies was evaluated using the updated tool (Rob2) provided by the Cochrane collaboration group. Six unique randomized controlled trials from 7 studies including 1,646 mother-infant pairs were contained in this review. Pooled data showed no pronounced decline in the incidence of eczema (RR = 1.09, 95% CI = 0.82~1.46, p = 0.54) or IgE-associated eczema (RR = 0.67; 95% CI = 0.29~1.57; p = 0.34). However, the subgroup analyses on "IgE-associated eczema" showed a significant decrease among the "≤3-year-old children" (RR = 0.70; 95% CI = 0.50~0.96; p = 0.03) in the ω-3 PUFAs group compared with the placebo. Supplementing the maternal diet with ω-3 PUFAs during pregnancy cannot reduce the danger of eczema or IgE-associated eczema among all children; however, there may be a subgroup-specific effect on 3-year-old or even younger children in reducing the incidence of IgE-associated eczema.

Outpatient utilization patterns for atopic dermatitis in the United States.

BACKGROUND: The prevalence and demographics of atopic dermatitis (AD) in the United States have changed. Little is known about trends and determinants of outpatient health care utilization. OBJECTIVE: Determine the trends and determinants of outpatient health care utilization for AD in US adults and children. METHODS: Data from the 1993-2015 National Ambulatory Medical Care Survey were analyzed, including data on 110,095 pediatric and 642,140 adult outpatient visits. RESULTS: AD visits were made predominantly to primary care physicians (PCPs) (768,882 mean visits annually), dermatologists (466,529 mean visits annually), and allergists (18,445 mean visits annually). The frequency of AD visits increased overall from 1996-1999 to 2012-2015 (from 867,649 to 1,950,546 annually [Rao-Scott chi-square P = .02]), particularly among PCPs (from 339,889 to 1,025,739 [P = .02]). The frequency of AD visits to dermatologists decreased (from 446,669 to 371,003 [P = .01]). AD visits to PCPs were most common among children aged 0 to 4 years (32.0%). Adults with comorbid allergic rhinitis or food allergies had greater odds of seeing an allergist. AD visits to PCPs were more likely to be visits due to an acute condition (51.5%), whereas AD visits to dermatologists were more likely to be visits due to a chronic condition (41.2%). LIMITATIONS: AD severity was unavailable. CONCLUSIONS: Outpatient visits for AD in the United States over time increased overall, but those to dermatologists decreased. Dermatologists are most commonly seeing patients whose visit is due to chronic AD, and they should tailor treatment appropriately.

Which outcomes should be measured in hand eczema trials? Results from patient interviews and an expert survey.

BACKGROUND: Hand eczema (HE) is a common skin disease characterized by itch, pain and visible skin changes such as fissures, erythema and vesicles. It is not yet clear which outcome domains are most important for patients. The Hand Eczema Core Outcome Set (HECOS) initiative is developing a consented set of core domains and suitable measurement instruments for the future application in all HE trials. This includes an online Delphi survey about core domains, which requires a 'Long List' of all domains that might be important to measure. OBJECTIVES: To compile a 'Long List' of candidate outcome domains for therapeutic HE trials with suggestions from patients and experts. METHODS: First, 60 patients with chronic HE were interviewed at seven study sites in Croatia, Denmark, Germany, the Netherlands and Spain. Patients were asked about domains that were important from their perspectives. Second, 185 HE experts were invited by email to complete an online survey. With an open question, they were asked to suggest up to six domains. RESULTS: Suggestions were provided by 58 patients and 82 experts. Most patients and experts suggested to measure the domains 'signs', 'symptoms' and 'HE-related quality of life'. Specifically, >25% of patients said that less itch, pain or fissures indicated a successful treatment. Among experts, >25% suggested 'itch' and 'ability to work' as core sub-domains. Further outcomes from the domains 'HE control over time', 'patient-reported treatment experience' and 'skin barrier function' were mentioned. CONCLUSION: 'Itch' was rated high among patients with HE and professional HE experts. While patients emphasized fissures as important, experts underlined the ability to work. This investigation allowed us to define a 'Long List' of 7 candidate outcome domains with 58 sub-domains. From this list, a panel of stakeholders will select core domains during an online Delphi survey.

Individual Article: Over-the-Counter Moisturizers Significantly Improve Skin Hydration in Adults With Eczema/Atopy-Prone Skin.

BACKGROUND: Many adults suffer from dry, itchy skin, particularly those with eczema-prone skin. This study evaluated the effects of two over-the-counter (OTC) moisturizing products on skin hydration, transepidermal water loss (TEWL), ceramide levels, and patient experience. METHODS: Single-center, randomized, double-blind, split-body study evaluating the effectiveness of an Eczema Soothing Moisturizer (ESM) versus an Itch Relief Moisturizing Lotion (IRML) applied twice daily for 4 weeks in healthy adults with self-perceived persistent mild-to-moderate eczema-prone skin. Assessments included corneometer for skin hydration, evaporimeter for TEWL, tape stripping to measure ceramide NS and AS levels on the skin of the arm and leg, and a self-assessed participant-reported outcome questionnaire. RESULTS: A total of 30 adults completed the study. Both products significantly increased hydration, but the effect of ESM was greater than IRML (P=0.001), and both significantly decreased TEWL. At week 4, there were increases in NS and AS ceramides at both the legs and arms for both products (P<0.05 vs BL). Individually, ceramide content was significantly improved for ESM in the leg and for IRML in the arm at week 4 (P<0.05 vs BL). Participant photos show ESM was beneficial across a range of skin phototypes. Both products resulted in favorable perceptions from study participants. CONCLUSIONS: These moisturizers improved skin hydration, skin barrier, ceramide levels in the skin, and were well-perceived by the participants. This suggests that both products are beneficial for patients with eczema and eczema-prone skin. However, the hydrating effect of ESM was significantly greater than IRML. J Drugs Dermatol. 2023;22:10(Suppl 2):s16-20.

A Review of Existing and New Treatments for the Management of Hand Eczema.

Hand eczema is a chronic condition that affects an estimated 14.5% of the general population. It has severe quality of life ramifications in those that struggle with it, including days missed from work or school, productivity loss and impaired work functioning. For years, the standard of care included topical moisturizing creams, topical steroids and more recently systemic agents. As new therapeutic targets emerge and recent advances are being developed, it is now more possible than ever that hand eczema can be managed via the underlying mechanisms. A review of the literature was conducted to identify current treatment options for hand eczema and chronic hand eczema. The terms 'hand eczema', 'hand dermatitis' were used to search PubMed, CENTRAL and Embase. To identify new therapies still undergoing investigation, we used the terms 'hand eczema', 'hand dermatitis', 'atopic dermatitis', and 'vesicular eczema of hands and/or feet' to search Clinicaltrials.gov for all studies until December 2022. There were 56 ongoing clinical trials identified for pharmacological treatments for hand eczema on Clinicaltrials.gov from 2000 - 2022, with 16 that are new or ongoing. These included studies for dupilumab, ruxolitinib, delgocitinib (LEO124249), gusacitinib (ASN002), AFX 5931, and roflumilast (ARQ-252). Two major classes of drugs emerging for the treatment of hand eczema include IL-4/IL-13 inhibitors and JAK inhibitors. With the increase in efficacy seen with these new drugs, we are also noting improved adverse effect profiles, making them attractive options to add to a clinician's management toolbox for patients with hand eczema.

Acceptance of skin products in healthcare workers: an empirical investigation.

BACKGROUND: Healthcare workers (HCWs) are at high risk of developing hand eczema (HE). This can be exacerbated by hygiene measures related to the coronavirus disease (COVID-19). Using mild skin cleansers and emollients or moisturizers is central in the prevention of HE-especially with increased COVID-19 hygiene regimes. AIMS: This study aimed to assess parameters important for the acceptance of a skincare concept in HCWs. METHODS: In this proof-of-concept user trial, HCWs were provided ad libitum with hand wash oil and hand cream during the 6-month period, when occupationally acquired COVID-19 infections among HCWs were peaking in Germany and then surveyed about acceptance of the products using questionnaires. RESULTS: Of 135 HCWs, 115 (85%) responded. Skin tolerance of the hand wash oil and the hand cream was rated very good by 63% and 52% of the 115 participants, respectively. Of the 115 participants, 58% and 57% were very satisfied with the hand wash oil and the hand cream, respectively. CONCLUSIONS: Acceptance of skin cleansing and skincare products in HCWs seems influenced by parameters such as self-assessed skin tolerance and self-reported overall satisfaction. It must be assumed that products are only used as recommended if they are well-accepted. Employers might survey employees about acceptance of products using the parameters identified to adjust concepts if necessary to sustainably contribute to the prevention of HE.

S2k guideline diagnosis, prevention, and therapy of hand eczema.

The consensus-based guideline "Diagnosis, prevention, and treatment of hand eczema (HE)" provides concrete instructions and recommendations for diagnosis, prevention, and therapy of HE based on an evidence- and consensus-based approach. The guideline was created based on the German guideline "Management von Handekzemen" from 2009 and the current guideline of the European Society of Contact Dermatitis (ESCD) "Guidelines for diagnosis, prevention, and treatment of hand eczema" from 2022. The general goal of the guideline is to provide dermatologists and allergologists in practice and clinics with an accepted, evidence-based decision-making tool for selecting and conducting suitable and sufficient therapy for patients with hand eczema. The guideline is based on two Cochrane reviews of therapeutic and preventive interventions for HE. The remaining chapters were mainly developed and consented based on non-systematic literature research by the expert group. The expert group consisted of members of allergological and occupational dermatological professional associations and working groups, a patient representative, and methodologists. The proposals for recommendations and key statements were consented by using a nominal group process during a consensus conference on September 15, 2022. The structured consensus-building process was professionally moderated. This guideline is valid until February 22, 2028.

Venous eczema: more than just a rash.

Venous eczema-also known as varicose, gravitational or stasis eczema-is a common form of eczema. In fact, 37-44% of patients with leg ulcers can present with a venous eczema. It is highly unpleasant, and can disrupt an individual's personal and social life. In this article, Drew Payne provides a community nurse's perspective on what venous eczema is, how to manage it in patients, and how to prevent further reoccurences.

Individual participant data meta-analysis versus aggregate data meta-analysis: A case study in eczema and food allergy prevention.

INTRODUCTION: Meta-analysis traditionally uses aggregate data from published reports. Individual Participant Data (IPD) meta-analysis, which obtains and synthesizes participant-level data, is potentially more informative, but resource-intensive. The impact on the findings of meta-analyses using IPD in comparison with aggregate data has rarely been formally evaluated. METHODS: We conducted a secondary analysis of a Cochrane systematic review of skincare interventions for preventing eczema and food allergy in infants to identify the impact of the analytical choice on the review's findings. We used aggregate data meta-analysis only and contrasted the results against those of the originally published IPD meta-analysis. All meta-analysis used random effects inverse variance models. Certainty of evidence was evaluated using GRADE. RESULTS: The pooled treatment effects for the Cochrane systematic review's co-primary outcomes of eczema and food allergy were similar in IPD meta-analysis (eczema RR 1.03, 95% CI 0.81, 1.31; I2 41%, 7 studies 3075 participants), and aggregate meta-analysis (eczema RR 1.01 95% CI 0.77, 1.33; I2 53%, 7 studies, 3089 participants). In aggregate meta-analysis, the statistical heterogeneity could not be explained but using IPD it was explained by one trial which used a different, bathing intervention. For IPD meta-analysis, risk of bias was assessed as lower and more adverse event data were available compared with aggregate meta-analysis. This resulted in higher certainty of evidence, especially for adverse events. IPD meta-analysis enabled analysis of treatment interactions by age and hereditary eczema risk; and analysis of the effect of treatment adherence using pooled complier-adjusted-causal-effect analysis, none of which was possible in aggregate meta-analysis. CONCLUSIONS: For this systematic review, IPD did not significantly change primary outcome risk ratios compared with aggregate data meta-analysis. However, certainty of evidence, safety outcomes, subgroup and adherence analyses were significantly different using IPD. This demonstrates benefits of adopting an IPD approach to meta-analysis.

Enhancement of stratum corneum lipid structure improves skin barrier function and protects against irritation in adults with dry, eczema-prone skin.

BACKGROUND: The skin of patients with atopic dermatitis is characterized by abnormal stratum corneum lipid levels. Consequently, the lamellar matrices are disrupted and skin barrier function is diminished, increasing skin sensitivity to irritants and allergens. OBJECTIVES: To determine whether a cream containing ceramides, triglycerides and cholesterol in a multivesicular emulsion can reinforce the skin barrier and protect against skin irritation. METHODS: A randomized observer-blind intrapatient-controlled study in 34 adults with dry, eczema-prone skin was conducted. Each participant underwent 4 weeks of treatment with the test cream on one forearm and lower leg and a reference emollient cream on the other. Skin properties were determined before and after treatment. Lipid structure was assessed by Fourier-transform infrared spectroscopy using a novel interface. RESULTS: Skin barrier integrity was greater at sites treated with the test cream [effect size for area under the transepidermal water loss curve -162, 95% confidence interval (CI) -206 to -118]. Skin sensitivity to sodium lauryl sulfate was reduced (-0·5 points visual redness, 97·57% CI -1·00 to -0·25), as was transepidermal water loss (-15·3 g m-2 h-1 , 95% CI -20·3 to -10·4) compared with the reference. Sites treated with the test cream displayed enhanced lipid chain ordering, which was significantly associated with skin barrier integrity (r = 0·61). Compared with the reference, treatment with the test cream increased hydration (8·61 capacitance units, 95% CI 6·61-10·6) and decreased signs of dryness. CONCLUSIONS: The test cream facilitates skin barrier restoration and protects the skin from dryness and irritation. Compared with a commonly prescribed emollient in the UK, the test cream is highly suited to the management of dry, sensitive skin.

Eruptive keratoacanthomas associated with dupilumab therapy.

We would like to present the case of eruptive keratoacanthomas associated with dupilumab therapy, which occurred in an 85-year-old woman receiving biologic therapy for the treatment of atopic dermatitis. With the increasing prevalence of Dupilumab usage, this is an important potential complication of which clinicians should be aware.

Effects of an emollient application on newborn skin from birth for prevention of atopic dermatitis: a randomized controlled study in Thai neonates.

BACKGROUND: Enhancing the skin barrier in high-risk neonates by daily use of emollients during infancy might prevent atopic dermatitis (AD); however, there have been no studies on this topic in a country with a tropical climate. Climate may affect the results of the use of emollients in neonates for AD prevention and possible adverse cutaneous eruptions. OBJECTIVES: To test the hypothesis that emollients used during infancy can prevent AD in high-risk neonates in a country with a tropical climate and to evaluate other possible adverse cutaneous eruptions in this population. METHODS: This was a randomized controlled study in a tertiary care hospital with a 6 months' duration. Eligible neonates were randomly assigned to receive either emollient and skincare advice (emollient group) or skincare advice only (control group). The intervention was started within 3 weeks of birth. RESULTS: The emollient group showed a significant reduction in the cumulative incidence of AD at 6 months (relative risk, 0.39; 95% CI 0.24-0.64; P < 0.001). The emollient group started to develop AD later and had a lower severity of AD than the control group (P < 0.001). Compared to moderate adherence, low adherence to emollient application was associated with a lower number of patients with AD (P = 0.008). Potentially emollient-related cutaneous eruptions, such as miliaria, and suspected cutaneous infections, such as impetigo, were more frequent in the emollient group. Exposure to passive smoking showed a significant difference in the development of AD compared to non-smoking exposure, both during pregnancy and after the child's birth (P < 0.001). CONCLUSIONS: This study suggests that, in a tropical climate, emollient applied to the skin of at-risk neonates on an 'as needed' basis (depending on environmental factors, level of skin dryness), rather than on a 'daily basis', can provide a substantial benefit for AD prevention.

Pustular Psoriasis Appearing Induced by Dupilumab Therapy in a Patient With Atopic Dermatitis.

Dupilumab inhibits T-helper 2 (Th2)-driven inflammation cascade by blocking interleukin-4 (IL-4) and IL-13 signaling, which has been recognized to play a crucial role in the pathogenesis of atopic dermatitis (AD) and shown encouraging efficacy on moderate to severe AD.1 We report an interesting Chinese AD case, which developed into pustular psoriasis after treatment with dupilumab.

A Desperate Need for Psoriasis Health Care in Remote Regions as Revealed by a Live Interactive Teledermatology Program Serving Penghu Islands in Taiwan Strait.

Introduction: Several studies indicated that teledermatology is good for people living on offshore islands. However, what disease benefits the most from interactive dermatology geographically in offshore islands remain uncertain. Objectives: This study aimed to investigate the seasonal and geographical distribution with different diseases in remote regions of Penghu islands in Taiwan Strait, thus to study the medical needs for specific disease in remote islands. The cost differences among three models by professional dermatologists were analyzed. Methods: This interactive teledermatology program serving Penghu Hospital, Ministry of Health and Welfare (MOHW-PH, March 2020 to February 2021) from a medical center in Taiwan recruited 145 patients with 280 patient-visits. The seasons, the timing from residential houses to MOHW-PH, the number of disease diagnosis, and the numbers of teledermatology visits are compared. The association of the distance from residential houses to MOHW-PH with different disease diagnosis was analyzed. Results: Eczema (33%), dermatophytosis (13%), and psoriasis (11%) were most common. Seasonal analysis showed dermatophytosis and eczema are more common in summer and winter, respectively. Geographical analysis showed that psoriasis has relatively higher case numbers, higher visits per case, with cases living in longer distances. The patient satisfaction was good (>95%). Among the three care modes of dermatologist, the cost estimation of interactive teledermatology and in-person clinic were similar yearly (2.4-2.9 million New Taiwan Dollars, roughly 80,000-90,000 USD). Conclusions: The study indicates that health care for psoriasis, being underprivileged but in desperate need in distant regions, could be delivered with quality and satisfaction by interactive teledermatology.

Fifteen-minute consultation: How to manage eczema in children.

Atopic eczema is common and has a major impact on quality of life. Paediatricians and general practitioners play a key role in the non-specialist treatment of atopic eczema. However, the clinical nature of the diagnosis, multitude of topical therapies and sometimes complicated treatment strategies can leave both clinicians and families feeling bewildered. This article aims to provide a concise, patient-focused summary of the assessment and management of childhood atopic eczema.

Red legs: how to differentiate between cellulitis, venous eczema and lipodermatosclerosis.

Community nurses often encounter people with red legs. There are a number of reasons why an individual may develop red legs. The most common causes of red legs are cellulitis, venous eczema and lipodermatosclerosis. All have different causes and require different treatments. This article aims to enable readers to differentiate between these conditions which can appear similar, and to offer effective evidence-based care.