Implementation of Teledermatology in Alberta, Canada: A Report of One Thousand Cases.

BACKGROUND: Teledermatology utilizes photoimaging and background information to allow dermatologists to remotely provide a diagnosis to practitioners. ConsultDerm is an asynchronous, web-based teledermatology software that allows practitioners to submit their electronic referrals for assessment by board-certified dermatologists. OBJECTIVE: Our study aimed to retrospectively analyze teledermatology's utilization in Canada by using the teledermatology platform ConsultDerm. METHODS: After implementing inclusion criteria, 1000 patients were selected, and relevant demographic and clinical information were extracted for data analysis. In addition, an online survey with pre-formulated questions was distributed to 7 dermatologists currently using the ConsultDerm platform to determine their experience in utilizing teledermatology. RESULTS: Of the 1000 patients, 66.5% had not received treatment prior to their teledermatology referral, and on average, patients experienced symptoms for 489.5 days prior to their referral. Diagnoses made were categorized by conditions, most common being dermatitis (37.1%), followed by acneiform conditions (10.6%), benign lesions/neoplasms (12.1%), infections (9.4%), and dyspigmentation (3.1%). Most consults originated from small population centers, and the referring practitioners were predominantly family physicians. Dermatologists utilizing the platform expressed ease of use, however, areas of improvement were identified such as increasing the quality of imaging and more detailed patient history. CONCLUSION: Through our analysis of 1000 cases, we identified how a teledermatology consultation could be used to assess a wide variety of cutaneous conditions, improving access for patients who may face barriers to seeing a dermatologist.

Retrospective Study of Patients With SJS/TEN Treated at a Tertiary Burn Unit in Canada: Overview of 17 Years of Treatment.

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions. OBJECTIVES: To learn about the clinical characteristics of patients with SJS/TEN including treatments provided, outcomes, and mortality. METHODS: We conducted a retrospective chart review of patients who were hospitalized with the diagnosis of SJS/TEN at the Ross Tilley Burn Center between the years 1999 and 2015. RESULTS: A total of 43 patients were identified with a mean age of 54 ± 19 (58, 18-85). The most common offending medications were allopurinol and carbamazepine. The overall mortality rate in our study is 21% with the most common causes of death being multiorgan failure and sepsis. The majority of our patients had oral (84%), ocular (79%), and genital (60%) involvement during hospitalization. Our data revealed that combination treatment involving oral corticosteroids with intravenous immunoglobulin (IVIG) had the highest mortality rate in our study since 55% (6/11) of patients who were treated in this manner passed away compared to 11% (2/18) of patients passing away who were treated with solely IVIG and 33% (1/3) who were treated with only supportive care. Our study also demonstrates the addition of etanercept and cyclosporine treatment in the second time period we studied: 2008-2015 versus the earlier time period of 1999-2007. None of the patients in our study who were treated with therapies including cyclosporine and/or etanercept passed away. CONCLUSIONS: Our study sheds light on a possible beneficial role of cyclosporine and etanercept for the treatment of SJS and TEN and reinforces the necessity of a multidisciplinary care team for patients.

SJS/TEN 2019: From science to translation.

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are potentially life-threatening, immune-mediated adverse reactions characterized by widespread erythema, epidermal necrosis, and detachment of skin and mucosa. Efforts to grow and develop functional international collaborations and a multidisciplinary interactive network focusing on SJS/TEN as an uncommon but high burden disease will be necessary to improve efforts in prevention, early diagnosis and improved acute and long-term management. SJS/TEN 2019: From Science to Translation was a 1.5-day scientific program held April 26-27, 2019, in Vancouver, Canada. The meeting successfully engaged clinicians, researchers, and patients and conducted many productive discussions on research and patient care needs.

Photodistributed sarcoidosis: a case report and approach to management.

Sarcoidosis is an idiopathic disease, characterized by non-caseating granulomas in multiple organs/tissues. Cutaneous involvement occurs in approximately one-quarter of patients with a wide variety of presenting morphologies. This case report describes a case of photodistributed sarcoidosis, a rare cutaneous variant, with systemic involvement. A 42-year-old man presented with a history of a pruritic, rash with photoexacerbated annular plaques along with arthralgias and bone pain. Compared to previous reports of photodistributed sarcoidosis, our case presented with annular plaques rather than papules, and there was no prior exposure to ionizing radiation. He was treated successfully with prednisone and hydroxychloroquine. It is important to include sarcoidosis in the differential of photodistributed dermatoses.

Severe Physical Complications among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.

INTRODUCTION: Few studies have reported the physical complications among Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) survivors. OBJECTIVE: The aim of this study was to comprehensively characterize the physical complications among SJS/TEN survivors and to learn about patients' perspectives of surviving SJS/TEN. METHODS: SJS/TEN survivors older than 18 years of age were assessed by different methods: a medical interview; a questionnaire assessing patients' perspectives; thorough skin, oral mucous membrane, and ophthalmic examinations; and a retrospective assessment of medical records. RESULTS: Our cohort consisted of 17 patients with a mean time of 51.6 ± 74.7 months (median 9, range 1-228) following SJS/TEN. The most common physical complications identified in the medical examination were post-inflammatory skin changes (77%), cutaneous scars (46%), dry eyes (44%), symblepharon, and chronic ocular surface inflammation (33% each). Novel physical sequelae included chronic fatigue (76%) and pruritus (53%). We also found a novel association between the number of mucous membranes affected in the acute phase of SJS/TEN and hair loss during the 6 months following hospital discharge; hair loss was reported in 88% of the group of patients who had three or more mucous membranes affected versus 29% of patients who had less than three mucous membranes involved (p = 0.0406). Following hospital discharge due to SJS/TEN, 59% of patients were followed by a dermatologist, although 88% had dermatological complications; 6% were followed by an ophthalmologist, even though 67% had ophthalmological complications; and 6% of female survivors were followed by a gynecologist, even though 27% had gynecological complications. CONCLUSION: Survivors of SJS/TEN suffer from severe physical complications impacting their health and lives that are mostly under recognized and not sufficiently treated by medical professionals.

Enucleation Refusal for Retinoblastoma: A Global Study.

BACKGROUND: Enucleation (eye removal) is often the only curative treatment for the childhood eye cancer retinoblastoma, yet parental refusal of enucleation commonly contributes to treatment delay and poor survival globally. METHODS: Physicians who treat retinoblastoma were surveyed to glean underlying reasons for treatment refusal. RESULTS: Refusal rates were higher when less time was spent with parents explaining retinoblastoma/enucleation, and where fewer support services were available. Reasons for refusal included parental belief in alternative treatments, culture, and social stigma. CONCLUSIONS: We suggest strategies to increase parental compliance with enucleation and save the lives of children with retinoblastoma.

An evaluation of accessibility and content of microsurgery fellowship websites.

BACKGROUND: Websites for residency and fellowship programs serve as effective educational and recruitment tools. OBJECTIVE: To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development. METHODS: A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive 'Google' search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics using t tests and ANOVA (two-tailed; P<0.05 was considered to be statistically significant). RESULTS: A list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed 'eligibility criteria' (87%) and 'general information' (87%). 'Evaluation criteria' were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on 'extremity' versus 'breast' (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process. CONCLUSION: Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process.

HISTORIQUE: Les sites Web pour les programmes de résidence et de surspécialisation sont des outils de formation et de recrutement efficaces. OBJECTIF: Évaluer l'accessibilité et le contenu des sites Web de surspécialisation souvent utilisés par les candidats en microchirurgie en vue de leur perfectionnement de carrière. MÉTHODOLOGIE: Les chercheurs ont compilé la liste des sites Web de surspécialisation en microchirurgie (SSW) d'un an à partir du site Web centralisé de l'American Society for Reconstructive Microsurgery (ASRM), puis ont effectué une recherche complète dans Google en octobre 2015. Ils ont évalué l'accès au SSW et procédé à une analyse détaillée des variables liées au recrutement clé et à la formation. Ils ont corrélé le contenu des sites Web avec les caractéristiques des programmes au moyen du test de Student et de l'analyse de variance (bilatéraux; P<0,05 était considéré comme statistiquement significatif). RÉSULTATS: Les chercheurs ont compilé une liste de 53 programmes admissibles. Seulement 15 liens sur les 51 programmes de l'ASRM (29 %) étaient fonctionnels. En moyenne, le contenu combiné du site Web de l'ASRM et des SSW individuels disposait de 2,91 des six variables de recrutement et de 1,32 des six variables de formation, respectivement. La majorité des programmes comportaient un volet « Critères d'admissibilité ¼ (87 %) et un volet « Renseignements généraux ¼ (87 %). Les « critères d'évaluation ¼ étaient moins bien définis (4 %). Le score de recrutement était plus élevé aux États-Unis que dans les programmes internationaux (51 % par rapport à 33 %, respectivement; P=0.02). Il était également plus élevé dans les programmes axés sur les membres que sur les seins (58 % par rapport à 37 %; P=0,0028). Les scores de formation étaient similaires à l'égard du lieu, de la dimension du programme, de la surspécialisation d'intérêt ou de la participation au processus de jumelage en microchirurgie. CONCLUSION: Il y a peu d'information relative au recrutement et à la formation dans la plupart des SSM. Les établissements universitaires devraient maintenir le contenu de leur site à jour et complet afin de mieux aider les candidats dans le cadre de leur processus de candidature.