Dermatology workforce projections in the United States, 2021 to 2036.

BACKGROUND: There has been a growing imbalance between supply of dermatologists and demand for dermatologic care. To best address physician shortages, it is important to delineate supply and demand patterns in the dermatologic workforce. The goal of this study was to explore dermatology supply and demand over time. METHODS: We conducted a cross-sectional analysis of workforce supply and demand projections for dermatologists from 2021 to 2036 using data from the Health Workforce Simulation Model from the National Center for Health Workforce Analysis. Estimates for total workforce supply and demand were summarized in aggregate and stratified by rurality. Scenarios with status quo demand and improved access were considered. RESULTS: Projected total supply showed a 12.45% increase by 2036. Total demand increased 12.70% by 2036 in the status quo scenario. In the improved access scenario, total supply was inadequate for total demand in any year, lagging by 28% in 2036. Metropolitan areas demonstrated a relative supply surplus up to 2036; nonmetropolitan areas had at least a 157% excess in demand throughout the study period. In 2021 adequacy was 108% and 39% adequacy for metropolitan and nonmetropolitan areas, respectively; these differences were projected to continue through 2036. CONCLUSIONS: The findings suggest that the dermatology physician workforce is inadequate to meet the demand for dermatologic services in nonmetropolitan areas. Furthermore, improved access to dermatologic care would bolster demand and especially exacerbate workforce inadequacy in nonmetropolitan areas. Continued efforts are needed to address health inequities and ensure access to quality dermatologic care for all.

Teledermatología sincrónica en tiempos de Covid-19. Percepción del dermatólogo / Synchronous teledermatology in times of Covid-19. Dermatologist perception

Teledermatology (TD) is a remote medical care tool that experienced a great boom during the COVID19 pandemic, resulting in an increase in both, the number of remote consultations and the number of dermatologists who practice it. Several studies have reported a high degree of satisfaction among patients attended by this method. However, few studies have done so in dermatologists. We set out to investigate the experience of Chilean dermatologists with the tool by means of an online survey. Results. A total of 156 surveys were completed. The number of dermatologists using TD increased from 19.9% to 80.8% during the pandemic. They cited the absence of the physical examination-dermatoscopy as the main limitation to developing TD and reported feeling more comfortable with some pathologies. Dermatologists feel moderately comfortable and confident with the tool, however, they experienced varying degrees of stress and frustration. Only 40.8% plan to continue using TD in the future. Conclusion. Synchronous TD has clear limitations, however, these should emerge as an opportunity to consider in its development and its platforms, in order to generate a more comfortable tool for more dermatologists and thus extend its use, as an important tool for equal access to health care in Chile. (AU)

Dermatologic Research Potential of the Observational Health Data Sciences and Informatics (OHDSI) Network.

BACKGROUND: The Observational Health Data Sciences and Informatics (OHDSI) network enables access to billions of deidentified, standardized health records and built-in analytics software for observational health research, with numerous potential applications to dermatology. While the use of the OHDSI has increased steadily over the past several years, review of the literature reveals few studies utilizing OHDSI in dermatology. To our knowledge, the University of Colorado School of Medicine is unique in its use of OHDSI for dermatology big data research. SUMMARY: A PubMed search was conducted in August 2020, followed by a literature review, with 24 of the 72 screened articles selected for inclusion. In this review, we discuss the ways OHDSI has been used to compile and analyze data, improve prediction and estimation capabilities, and inform treatment guidelines across specialties. We also discuss the potential for OHDSI in dermatology - specifically, ways that it could reveal adherence to available guidelines, establish standardized protocols, and ensure health equity. Key Messages: OHDSI has demonstrated broad utility in medicine. Adoption of OHDSI by the field of dermatology would facilitate big data research, allow for examination of current prescribing and treatment patterns without clear best practice guidelines, improve the dermatologic knowledge base and, by extension, improve patient outcomes.

Janus kinase inhibitors in dermatology: Part II. A comprehensive review.

The Janus kinase-signal transducer and activator of transcription (JAK-STAT) intracellular signaling pathway is implicated in the pathogenesis of a number of inflammatory dermatoses. Clinical trials and other studies have demonstrated the efficacy of JAK inhibitors in the treatment of a variety of dermatologic conditions. Here we review JAK inhibitors currently under investigation for the treatment of alopecia areata, vitiligo, sarcoidosis, necrobiosis lipoidica, granuloma annulare, and systemic lupus erythematosus with a special emphasis on safety and the implications of JAK inhibitors during the novel coronavirus 2019 pandemic.

Effect of universal varicella vaccination and behavioral changes against coronavirus disease 2019 pandemic on the incidence of herpes zoster.

BACKGROUND: Since 2014, universal varicella vaccination has reduced the varicella and herpes zoster (HZ) incidence in vaccine recipients and increased the incidence in the child-rearing generation until 2017. OBJECTIVE: This study aimed to understand the future epidemiologic trends of HZ after the disappearance of varicella epidemics and during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: The Miyazaki Dermatologist Society has been monitoring and analyzing the incidence of HZ patients after universal vaccination since 1997. RESULTS: The HZ incidence in Oka varicella vaccine recipients aged 0-4 years decreased with the reduction in chickenpox incidence. The HZ incidence among those aged 5-9 years increased between 2015 and 2017 and decreased thereafter. From 2014-2020, the HZ incidence continued to increase to 36.6%, 51.3%, 70.2%, 56.7%, and 27.3% among those aged 10-19, 20-29, 30-39, 40-49, and 50-59 years, respectively. The HZ incidence in patients aged ≥ 60 years increased by 2.3% annually from 2014 to 2020, corresponding to an annual 2% increase since 1997, and was unaffected by varicella epidemics. COVID-19 infection control measures, lifestyle changes and the resulting stress did not affect the HZ incidence in 2020. CONCLUSION: Universal varicella vaccination eliminated varicella epidemics, and HZ was reduced in vaccine recipients. The HZ incidence for those aged 10-59 years increased from 2014 to 2020, in contrast to those aged ≥ 60 years, which is attributable to booster immunity expiration due to varicella contact in this age group.

Coronavirus Disease 2019 and Dermatology Practice Changes.

The impact of the COVID-19 pandemic on dermatology practice cannot be overstated. At its peak, the pandemic resulted in the temporary closure of ambulatory sites as resources were reallocated towards pandemic response efforts. Many outpatient clinics have since reopened and are beginning to experience a semblance of pre-pandemic routine, albeit with restrictions in place. We provide an overview of how COVID-19 has affected dermatology practice globally beginning with the rise of teledermatology. A summary of expert recommendations that shape the "new normal" in various domains of dermatology practice, namely, dermatology consultation, procedural dermatology, and phototherapy, is also provided.

The Impact of the COVID-19 Pandemic on Global Health Dermatology.

In this article, we discuss the impact of the COVID-19 pandemic on various areas of global health dermatology, including patient care, neglected tropical diseases, education, and collaborations. Information was collected from literature review and informal interviews with more than 20 dermatologists from around the world. Many of the setbacks and hardships experienced by the global health community in the last year highlight long-standing global interdependencies and systems that perpetuate ethnic, economic, and social inequalities on local and global scales. The pandemic has brought discussions on global health colonialism and domestic health inequality to the forefront.

A systematic review of carbohydrate-based microneedles: current status and future prospects.

Microneedles (MNs) are minimally invasive tridimensional biomedical devices that bypass the skin barrier resulting in systemic and localized pharmacological effects. Historically, biomaterials such as carbohydrates, due to their physicochemical properties, have been used widely to fabricate MNs. Owing to their broad spectrum of functional groups, carbohydrates permit designing and engineering with tunable properties and functionalities. This has led the carbohydrate-based microarrays possessing the great potential to take a futuristic step in detecting, drug delivery, and retorting to biologicals. In this review, the crucial and extensive summary of carbohydrates such as hyaluronic acid, chitin, chitosan, chondroitin sulfate, cellulose, and starch has been discussed systematically, using PRISMA guidelines. It also discusses different approaches for drug delivery and the mechanical properties of biomaterial-based MNs, till date, progress has been achieved in clinical translation of carbohydrate-based MNs, and regulatory requirements for their commercialization. In conclusion, it describes a brief perspective on the future prospects of carbohydrate-based MNs referred to as the new class of topical drug delivery systems.

Advances in gene therapy and their application to skin diseases: A review.

With recent advances in genetic engineering technology, gene therapy is now being considered as a treatment not only for congenital diseases but also acquired diseases, such as cancer. Gene therapeutic agents for hereditary immune disorders, haemophilia, retinal diseases, neurodegenerative diseases, and lymphoma have been approved in the United States and Europe. In the field of dermatology, clinical trials of gene therapy have been conducted, because the skin is an easily accessible organ that represents an attractive tissue for gene therapy. In recent years, gene therapy has been attempted for a variety of skin diseases, such as genodermatoses (including epidermolysis bullosa and Netherton syndrome), cutaneous lymphoma, and malignant melanoma. As a result, it is difficult to grasp the current status of gene therapy in dermatology. This review focuses on each of the gene-transfer techniques currently in use and describes the current status of gene therapy for skin diseases using each technology.

Treatment Update of Port-Wine Stain: A Narrative Review.

BACKGROUND: Port-wine stain (PWS) is a congenital vascular malformation affecting 0.3–0.5% of normal population. These characteristic lesions arise due to the interplay of vascular, neural, and genetic factors. Treatment options include lasers, cosmetic tattooing, electrotherapy, cryosurgery, derma-abrasion, and skin grafting; however, none of these treatment alternatives appears to be satisfactory and is unable to provide consistent, satisfactory responses or even complete cures. Currently, laser is the treatment of choice, as it is comparatively safe and more effective than other procedures. The most commonly used modality is pulsed dye laser (PDL). The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) to January 2020 and reference lists of respective articles. Only articles published in English language were included. J Drugs Dermatol. 20(5): doi:10.36849/JDD.5005.

Visualising the past to plan the future: a network analysis of the largest European dermatology conference.

BACKGROUND: The annual conference of the European Academy of Dermatology and Venereology is one the largest dermatology conferences worldwide. OBJECTIVES: Network analysis can be used for in-depth insight into trending topics and underlying trends at the congress. MATERIALS & METHODS: Network analysis was employed to assess the entirety of the submitted abstracts to the congress in 2019. The data were processed, analysed, and visualised using easy-to-understand network graphs. Topics were then compared to their respective global burden (Disease Adjusted Life Years [DALYs]) and the number of respective publications on PubMed in the year 2018. RESULTS: Overall, 1,280 lecture titles and 1,941 poster titles were included in the final analysis. The most frequently used terms were "patients" (n = 473), "treatment" (n = 301), and "psoriasis" (n = 335). Relative to DALYs, "psoriasis" (+21.9%) among others, was rather over-represented, while "fungal skin diseases" (-7.6%) and "urticaria" (-6.4%) were under-represented. Compared to the relative number of PubMed publications in 2018, "psoriasis" (+20.3%), "acne" (+7.9%), and "alopecia" (+3.1%) were over-represented, while "melanoma" (-22.5%), "dermatitis" (-4.2%) and "pruritus" (-3.4%) were rather under-represented. CONCLUSION: The network analysis showed that the congress was a patient and therapy-centred event. An explanation for the particular focus on chronic inflammatory skin diseases and melanoma would be the introduction of new therapies at the congress. To delineate trends over time, a longitudinal network analysis including several congresses should be conducted and could be used to determine additional topics to be included in future events.

Teledermatology During COVID-19: An Updated Review.

The coronavirus disease 2019 (COVID-19) pandemic has fundamentally transformed the landscape of providing dermatologic care. In an age of lockdowns and social distancing, teledermatology (TD) has emerged as a powerful tool to deliver remote care. Here, we review literature on TD use during the pandemic to evaluate the positives and negatives of TD implementation. We especially consider the reception of TD in underserved communities and the developing world as well as the ethico-legal challenges wrought by the burgeoning utilization of this new paradigm of care. The potential of TD to occupy a more prominent role in dermatologic care in a post-COVID-19 world is also discussed.