Three-part scoring system (tripartite) for teledermatology versus International Contact Dermatitis Research Group criteria to interpret patch test readings: A comparative, observational study.

Background The International Contact Dermatitis Research Group (ICDRG) grading is the gold standard and is used to interpret patch test results in allergic contact dermatitis (ACD). The ICDRG readings include a combination of visual and palpation findings. Digital photography limits palpation. An alternative scoring system exists to analyse 2D images and interpret patch test readings in teledermatology (TD). Aims To compare tri-partite scoring system (TPSS) (TD) with ICDRG (face-to-face) and to assess the feasibility of TPSS by TD. Methods In this observational study, two investigators each scored the patch test readings for 78 patients at the 48th h, 96th h and on the 7th day. Results The TPSS has a sensitivity of 100%, specificity of 93.34%, positive predictive value of 91.67% and negative predictive value of 100%. At a confidence interval of 95%, Cohen's kappa (0.90) indicated excellent agreement between both investigators. The concordance between both scoring systems was at 93.2% for agreement and 6.82% for disagreement. Polysensitisation (6 patients with 16 allergens) was detected equally in both methods. Limitations A single centre study. Conclusion The readings obtained by TPSS were in agreement with ICDRG. TPSS can reduce the number of patient visits by 50% and may be used during COVID-19 times and beyond.

Severity grading of dermatological emergencies based on comorbidities and systemic involvement: An observational study.

Dermatological emergency is defined as any urgent/immediate care. Dermatological conditions compromise about 5-8% of all cases presenting to the emergency department. A grading system can help dermatologist's and allied medical personnel to triage a patient accordingly. Currently no severity grading for dermatological emergencies is available. All patients seen in OPD for dermatological consultations requiring urgent interventions were included. Detailed history and clinical examination were done. Patients were assessed according to the onset, symptoms, distribution, examination, body surface area percentage and mucosal involvement. The severity was graded separately based on comorbidities and systemic involvement. Grade I was no comorbidity or systemic involvement. Grade II was 1 comorbidity or systemic involvement. Grade III was 2 comorbidities or systemic involvement. Grade IV was > 2 comorbidities or multiorgan involvement. Interesting emergency cases observed in Covid period were noted. There were 202 cases, the most common age group was 19-64 (69.8%). Male (49%) and females (51%) had equal preponderance. Most common emergency was acute urticaria with or without angioedema (25.24%). There were 113 (55.94%) inpatients and 89 (44.05%) were outpatients. Acute on chronic onset (34.5%), pain (41.6%), vesicles (30.1%), erosion (23.9%), ulcers (9.7%) and more than 50% body surface area involvement (64.6%) were seen more in admitted cases. Grade I was most common for both comorbidities and systemic involvement. However, grades II, III and IV were higher in admitted cases for both grading systems. The presence of comorbidities and systemic involvement increases the severity of dermatological emergency. Six patients had relapse. Seven patients had methotrexate toxicity. The proposed grading system based on comorbidities and systemic involvement helps to assess the severity of dermatological emergencies.

Patch Testing in Allergic Contact Dermatitis over the Lower Extremities.

BACKGROUND: There is an increased incidence of allergic contact dermatitis (ACD) over the lower extremities due to over-the-counter topical preparations, occupational risk, and usage of several chemicals in the manufacture of designer footwear. AIMS AND OBJECTIVES: The aim of the study was to identify the common allergens and polysensitization pattern involved in ACD over the lower extremities. MATERIALS AND METHODS: It is a cross-sectional study, wherein a total of 80 patients were recruited over a period of 18 months. Demographic and clinical characteristics were noted. Patch test was done with the Indian standard series. Interpretation of patch test readings was read according to the International Contact Dermatitis Research Group criteria at 48 and 96 h. RESULTS: There were 45 males and 35 females (M:F= 1.3:1). Mean age was 41.65 years. Most of the patients belonged to 21-40 years age group. Farmers, homemakers, and students were commonly affected. Most common presentation was itching, hyperpigmentation, and scaly plaques over the feet. Patch test was performed in 75% of the patients. One or more positive results were observed in 57% of the patients. Common allergens noted were potassium dichromate (35%), followed by nickel sulfate (23.5%), mercapto mix, and mercaptobenzothiazole. Potassium dichromate and nickel were the common allergens reported in males and females, respectively. Neomycin was the common medication responsible for dermatitis medicamentosa. Polysensitization was seen with mercapto mix, mercaptobenzothiazole, potassium dichromate, and fragrance mix. CONCLUSION: Potassium dichromate and nickel were the common allergens responsible for ACD over the lower extremities. Polysensitization was seen commonly with mercapto mix, mercaptobenzothiazole, and fragrance mix. RECOMMENDATION: Screening for usage of topical preparations and late patch test readings (96 h or more) is recommended.

Patient-assisted teledermatology practice: what is it? When, where, and how it is applied?

Recent teledermatology practice has been focused on different models made possible by robust advances in information technology leading to consistent interaction between the patient and health care professionals. Patient-assisted teledermatology practice also called patient-enabled teledermatology or home based teledermatology is one such novel model. There is a lack of scientific literature and substantive reviews on patient-assisted teledermatology practice. The present article reviews several studies and surveys on patient-assisted teledermatology practice and outlines its advantages and barriers to clinical utility and analyses the potentiality of this concept. Incorporating patient-assisted teledermatology practice as a novel model in the revised classification of teledermatology practice is proposed. In patient-assisted teledermatology, the patient can upload his/her clinical images as a first contact with the dermatologist or an initial face-to-face examination can be followed by teledermatology consultations. The latter method is well suited to chronic diseases such as psoriasis, vitiligo, and leg ulcers, which may need frequent follow-up entailing significant costs and time, particularly in the elderly. Teledermatology may also be used by the treating dermatologist to seek expert opinion for difficult cases. Studies have demonstrated the importance and usability of the concept of patient-assisted teledermatology practice. Various teledermatology care models are available and the appropriate model should be chosen depending on whether the clinical situation is that of easily diagnosed cases ("spotters"), chronic cases or doubtful cases and difficult-to-manage cases.

Role of tetracycline in recalcitrant erythema nodosum.

Erythema nodosum is a type of septal panniculitis. We report a case of 40 year old male of chronic and recalcitrant erythema nodosum who responded to tetracycline. The possible mechanism of action of tetracycline is analyzed. Tetracycline should be considered as a logical option in recalcitrant erythema nodosum.

A longitudinal study of consistency in diagnostic accuracy of teledermatology tools.

BACKGROUND: Diagnostic accuracy (DA) is an outcome measure to assess the feasibility of teledermatology tools. Despite ample data with variable DA values, no study has examined the aggregate DA value obtained from the available studies and observed its consistency over a period of time. This kind of a longitudinal study about teledermatology will be necessary to check its usefulness and plan for further implementation. AIMS: To observe the DA trend over a period of 15 years (1997-2011). METHODS: Only those studies (n = 59) using a single tool for general, tertiary, and subspecialty teledermatology practice were included to obtain the DA values. Studies were graded based on the number of subjects and gold standard comparison between teledermatologist and clinical dermatologist (face-to-face examination). RESULTS: This analysis sought to identify the DA trend was carried out by evaluating 17 store and forward teledermatology (SAFT) based and 8 Video conference (VC) tool-based studies with 2385 and 1305 patients respectively, in comparison with the gold-standard assessment. The average DA was 73.35% ± 14.87% for SAFT and 70.37% ± 7.01% for VC. One sample t-test analysis with 100% accuracy as standard value revealed 28% deficiency for SAFT (t = 7.925; P = 0.000) and 30% deficiency for VC (t = 11.955; P = 0.000). Kruskall-Wallis test confirmed the consistency of DA values in the SAFT (χ2 = 1.852, P = 0.763) tool. CONCLUSION: SAFT and VC were adequately validated on a large number of patients by various feasibility studies with the gold standard (face-to-face) comparison between teledermatologists and clinical dermatologists. The DA of SAFT was good, stable over the 15 years and comparable to VC. Health-care providers need to plan for appropriate utility of SAFT either alone or in combination with VC to implement and deliver teledermatology care in India.

Newer insights in teledermatology practice.

The study and practice of dermatology care using interactive audio, visual, and data communications from a distance is called teledermatology. A teledermatology practice (TP) provides teleconsultation as well tele-education. Initially, dermatologists used videoconference. Convenience, cost-effectiveness and easy application of the practice made "store and forward" to emerge as a basic teledermatology tool. The advent of newer technologies like third generation (3G) and fourth generation (4G) mobile teledermatology (MT) and dermatologists' interest to adopt tertiary TP to pool expert (second) opinion to address difficult-to-manage cases (DMCs) has resulted in a rapid change in TP. Online discussion groups (ODGs), author-based second opinion teledermatology (AST), or a combination of both are the types of tertiary TP. This article analyzes the feasibility studies and provides latest insight into TP with a revised classification to plan and allocate budget and apply appropriate technology. Using the acronym CAP-HAT, which represents five important factors like case, approach, purpose, health care professionals, and technology, one can frame a TP. Store-and-forward teledermatology (SAFT) is used to address routine cases (spotters). Chronic cases need frequent follow-up care. Leg ulcer and localized vitiligo need MT while psoriasis and leprosy require SAFT. Pigmented skin lesions require MT for triage and combination of teledermoscopy, telepathology, and teledermatology for diagnosis. A self-practising dermatologist and national health care system dermatologist use SAFT for routine cases and a combination of ASTwith an ODG to address a DMC. A TP alone or in combination with face-to-face consultation delivers quality care.

Online reprint request: search, access, read, and update.

Online reprint request (ORR) is the standard protocol to obtain the reprints (e-print/hard copy) using the internet (author's e-mail address) when the required literature is not available. The problem of higher cost of surface mail for the author and the reader, as well as the time taken to receive postal reprints, is overcome by ORR. This technique has its limitation in message failure, expiration of mail (e-mail decay), or journal not providing author's e-mail address. This article analyzes the available practical solution to overcome these barriers. This process facilitates the exchange of scientific information. In e-mail decay, reprint request can be sent in the following order: a) search and send to author's latest e-mail address, b) co-author's latest or affiliated institution's e-mail address, c) postal reprint request providing the requestor's e-mail address. This protocol can be practiced when library facilities or required literature is not available. Literature can be pooled and used for residency teaching programs, like group discussions, journal clubs, and e-learning exercises (teleeducation), to update the recent advances for practice and research.

Teledermatology: its role in dermatosurgery.

Dermatologic surgery and aesthetic dermatology are rapidly emerging and expanding specialties in India. However, dermatologists practicing surgeries and aesthetics in India represent a highly selected group and are mostly confined to metros. Dermatologists in the peripheral and remote regions need to reach these specialists for the benefit of their patients and teledermatology is an invaluable tool for this purpose. Video-conference, store and forward, Satellite communication, Hybrid teledermatology, mobile teledermatology, Integration model, nurse-led teledermatology, teledermatology focusing difficult-to-manage cases, screening and triage services are the various teledermatology services developed to suit the needs of dermatology care from a distance. Types of teledermatology service, pattern of net work connectivity and purpose of dermatology service are the three cardinal parameters for management of the dermatoses from a distance. This article reviews the literature, and analyzes the possible options available for a teledermatosurgery practice.

Store and forward teledermatology.

Store and forward and real time or videoconferences are the two types of teledermatology services practiced. Dermatology and radio-diagnosis are visual specialties suited for store-and-forward teledermatology (SAFT). Advances in information technology, electronic instruments and biotechnology have revolutionized and brought changes in SAFT. Cellular phone, digital camera, personal digital assistants, Wi-Fi, Wi-Max and computer- aided-design software are incorporated to deliver the quality health care to remote geographic regions. Complete SAFT care equivalent to face-to-face consultation (Gold standard) is essential. Health care providers in rural areas are the 'eyes' for the consultants. Consultants to guide them should have a rapid periodic audit of visual parameters and dimensions of lesions. Given this background, this article reviews advances in 1) capture, store and transfer of images. 2) Computer Aided measurements of generalized and localized lesions and 3) the integration model to meet all the above two requirements in a centralized location. This process enables diagnosis, management, periodic assessment and complete follow-up care to achieve patient and physician satisfaction. Preservation of privacy and confidentiality of digital images is important. Uniform rules and regulations are required. Indian space research organization (ISRO), Government of India has demonstrated telemedicine pilot projects utilizing the satellite communication and mobile telemedicine units to be useful in meeting the health care needs of remote and rural India. we have to join hands with them to meet dermatology problems in rural areas.