Proposal for a Severity Score (DeASI, Dermatophytosis Area and Severity Index) for the Evaluation of Dermatophyte Infections - A Delphi Consensus Study.

Background: There has been a significant increase in the incidence of recurrent, resistant, and extensive dermatophyte infections worldwide recently. This menace has spurred the need for more well-designed randomized controlled trials to optimize the treatment of dermatophyte skin infections. One of the limitations in designing such studies is the limited availability of standard and validated score, to measure the severity of dermatophyte infections. Aims: To create a severity score for the evaluation of dermatophyte infections. Materials and Methods: A Delphi consensus model was used to frame a severity scoring tool for superficial dermatophyte skin infections. Fourteen experts participated in the first round and twelve experts participated in the second round. Results: Based on the expert consensus, a final scoring system proposed was: Final Severity Score (FSS) = Sum total of Body Surface Area (BSA) in hand units for each patch multiplied by the sum of the scores for pruritis (P), lichenification (L), and actively raised borders (A) for each patch (FSS = BSA in hand units × (P + E + L + A) of patch 1 + BSA in hand units × (P + E + A) of patch 2 …etc.). For measuring hand units more accurately fractional values of 0.25 can be used (0.25 corresponding to an approximate 1/4th of a hand unit). A score of +1 will be added in case of the following - 1) Close contact/family member affected, 2) History of at least one recurrence in the previous 6 months after a course of oral antifungals, 3) History of immunosuppression (on immunosuppressive medication or having underlying immunosuppressive disease). The scores will be valid only if the patient has not used any treatment topical or systemic, for at least 2 weeks before enrolment. Conclusion: The proposed Dermatophytosis Area and Severity Index (DeASI) score will help the physicians and researchers standardize the treatment protocol for dermatophytosis, henceforth, assessing the response to therapy. This will also help to standardize the parameters of effectiveness while designing any clinical trial.

Add-on Plastic Tips for Cryogen Administration in Difficult-to-access Areas.

Targeted cryotherapy of lesions in difficult to access location is a challenging scenario. We propose the use of add-on tips fashioned from disposable micropipettes, needle caps, and syringe barrels as a solution.

Clinical Images in Dermatology Manuscripts - A Study of Journal Submission Guidelines.

Background: Images are an important element of any scientific publication, more so for a very visual specialty such as dermatology. Dermatology journals generally include detailed instructions related to images submitted with the manuscripts, including technical aspects such as file format, resolution, and editing. We aimed to review and critically analyze instructions for images in the top 50 dermatology journals [as per the latest Clarivate journal citation report (JCR) ranking]. Methods: The top 50 journals as per the latest Clarivate JCR were included in the study. Instructions for images were reviewed for each of the journals. The main points analyzed included file type, resolution, size limits, editing limits, support for post-processing of images and details regarding patient consent. Results: Only half the journals (25) had clear, detailed, and specific instructions for the images. Only one journal specifically mentioned pixels per inch (PPI) as the descriptive term, and the remaining used dots per inch (DPI), whereas 6 did not mention either. Twenty-three journals did not mention the recommended size of the image. The most common minimum resolution mentioned was 300 DPI (41 journals). Although 24 of the journals mentioned editing limits, none of the journals elaborated on image plagiarism in the instructions. Twenty-one of the fifty did not mention a clear policy on patient consent. Conclusions: Image submission guidelines for dermatology journals need to be made more elaborate yet easier to understand. Developing a consensus, followed by standardization of these submission guidelines, can help both authors and journals.

Who Has Got Your Back? A Modification of Selfie Stick Examination.

We describe the use of screen mirroring, as a modification of the previously described "selfie-stick examination" method for the examination of skin lesions on the back of the patient. This would be especially useful in the context of patient initiated tele-dermatology for lesions over the back.

Practical suggestions to improve standardization of repeated open application testing (ROAT) for daily use products.

Introduction: Repeated open application testing (ROAT) is an important adjuvant in the evaluation of allergic contact dermatitis. There are variations in the way ROAT is used by practitioners and standardizing the method, in terms of the area and amount of the antigen applied, could help improve the validity of the process. Aim: Our study attempts to address ways in which part of the ROAT technique can be standardized - with respect to the area and amount of application and validation of the same through consensus opinion. Material and methods: Two proposed modifications - one for the area of application (using waterproof surgical markers and a stencil to mark the area of application) and one for daily amount applied (using easily available 1 cm3 syringes), for the ROAT technique were drafted. The same was discussed with a total of 10 dermatologists. The participants were given four statements and were asked to choose one option for each statement (strongly agree - agree - neutral - disagree - strongly disagree). All the respondents were also asked to give their opinion on possible limitations and problems of the proposed modifications and possible solutions for the same. Results: There was generally a consensus among the 10 dermatologists, with the majority agreeing that the proposed modifications were both effective and practical. Conclusions: Simple practical modifications of the ROAT technique like marking the area to be applied using a waterproof skin marker and stencil, and the use of 1 cm3 syringes to dispense the test product, can improve the standardization of the process.

Window Approach in Conventional Phototherapy to Protect Non-lesional Skin.

We propose the use of protective coverings-gloves, socks, or clothing, with windows cut out into them, to ensure that the phototherapy targets only the affected areas.

Localized alopecia with itching on the scalp.

We describe the use of trichoscopy to arrive at a diagnosis, and discuss the possible differential diagnoses in a patient presenting with localized itching and alopecia of the scalp.

Increased incidence of facial pityriasis versicolor in children during the COVID-19 pandemic-A consequence of mask usage?

We describe a case series of seven children presenting with pityriasis versicolor on the face, localized to the area of coverage by the mask. The increased use of face masks after the opening up of schools, combined with a humid environment and associated sweating might be responsible for an increased presentation of facial pityriasis versicolor in children in our community.

DICODerma: A Practical Approach for Metadata Management of Images in Dermatology.

Clinical images are vital for diagnosing and monitoring skin diseases, and their importance has increased with the growing popularity of machine learning. Lack of standards has stifled innovation in dermatological imaging, unlike other image-intensive specialties such as radiology. We investigate the meta-requirements for utilizing the popular DICOM standard for metadata management of images in dermatology. We propose practical design solutions and provide open-source tools to integrate dermatologists' workflow with enterprise imaging systems. Using the tool, dermatologists can tag, search, organize and convert clinical images to the DICOM format. We believe that our less disruptive approach will improve the adoption of standards in the specialty.