Review of patient registries in dermatology.

BACKGROUND: Patient registries are datasets containing information on patients with a particular disease or patients who are undergoing a specific treatment. OBJECTIVE: Our objective was to search for and catalog the types of registries being used in dermatology and investigate their characteristics and uses. METHODS: We searched Google, the Registry of Patient Registries, Orphanet, and ClinicalTrials.gov to compile a list of dermatology disease registries. We also conducted a literature review on the uses of dermatology registries using PubMed. RESULTS: We identified 48 dermatology patient registries, with 23 distinct diseases represented. We also identified 11 registries used for postmarketing surveillance of skin disease. LIMITATIONS: Our search was limited to registries in English. CONCLUSIONS: Registries are commonly used for the study of rare dermatologic diseases and for postsurveillance monitoring of systemic therapies in more common dermatologic diseases, such as psoriasis.

Costs of Common Psoriasis Medications, 2010-2014.

BACKGROUND: Costs for psoriasis have increased in recent years, in part due to the introduction of biologic agents. OBJECTIVE: To identify the most common and most costly (from the payer perspective) drugs used in the treatment of psoriasis. METHODS: We analyzed patient data from a large claims-based database in order to identify the most common and most costly medications used in the treatment of psoriasis from 2010 to 2014. RESULTS: The three most common psoriasis medications, accounting for 81.1% of all psoriasis medications, were topical corticosteroids. The three most costly drugs, accounting for only 9.6% of all psoriasis medications, were biologics, accounting for 86% of the cost of psoriasis medications. CONCLUSIONS: Biologic agents are used far less commonly in the treatment of psoriasis than topical treatments. Despite the relatively small number of patients using biologic agents, biologics are responsible for a large proportion of the cost of psoriasis pharmacotherapy.

Increasing adherence to topical therapy in psoriasis through use of solution medication.

Patient outcomes and clinical improvement are closely related to topical medication adherence, and is especially important in chronic dermatological diseases such as psoriasis. About one-fifth of patients undergoing topical treatment were dissatisfied with its convenience for various reasons. Providers can help increase adherence through selecting the correct medication vehicle, involving family members or friends in the patient's mediation application, and explaining likely side effects to the patient prior to use of the medication. Increased inherence will lead to better psoriasis disease control.

Most people with psoriasis or rosacea are not being treated: a large population study.

When left untreated, psoriasis and rosacea can have long-term health and psychosocial implications. The purpose of this study was to estimate the percentage of Americans with psoriasis or rosacea who are not being treated. Patient data from a large claims-based database were analyzed to identify the number of patients who are treated for psoriasis or rosacea. The numbers of patients treated were compared to the estimated prevalences of these diseases in the general population, identified from previously published sources. Of the 18,632,362 patients in the database, 140,439 (0.75%) were seen for psoriasis and 165,130 (0.89%) were seen for rosacea. Based on published sources, 3.2% of Americans have psoriasis and about 5.0% have rosacea. We therefore estimated that 77% of people with psoriasis and 82% of people with rosacea are untreated. Greater awareness, resources, and community outreach projects are potential tools that could eliminate this disparity and increase the quality of life for patients with these diseases.

Hypothyroidism in Patients with Psoriasis or Rosacea: A Large Population Study.

Hypothyroidism is a common disease, and there may be a link between hypothyroidism and inflammatory skin disease. The purpose of this study is to assess whether hypothyroidism is more prevalent in psoriasis or rosacea patients. We utilized a large claims-based database to analyze rates of hypothyroidism in patients with psoriasis and rosacea compared to other patients with skin diseases. Participants were patients between 20-64 years of age with ICD-9 diagnosis codes for psoriasis, rosacea, and hypothyroidism. We found that rates of hypothyroidism in rosacea and psoriasis patients were similar to rates of hypothyroidism in those without rosacea or psoriasis.

Hypothyroidism in Patients with Psoriasis or Rosacea: A Large Population Study.

Hypothyroidism is a common disease, and there may be a link between hypothyroidism and inflammatory skin disease. The purpose of this study is to assess whether hypothyroidism is more prevalent in psoriasis or rosacea patients. We utilized a large claims-based database to analyze rates of hypothyroidism in patients with psoriasis and rosacea compared to other patients with skin diseases. Participants were patients between 20-64 years of age with ICD-9 diagnosis codes for psoriasis, rosacea, and hypothyroidism. We found that rates of hypothyroidism in rosacea and psoriasis patients were similar to rates of hypothyroidism in those without rosacea or psoriasis.

Upstaging From Melanoma in Situ to Invasive Melanoma on the Head and Neck After Complete Surgical Resection.

BACKGROUND: Melanoma in situ (MIS) diagnosed from a subtotal biopsy may be upstaged to invasive melanoma after resection. The frequency of this phenomenon is markedly variable. OBJECTIVE: To quantify the rate of upstaging MIS on the head and neck after resection at this institution, characterize the location of the invasive component relative to the clinically evident lesion, and determine the rate of upstaging with time. MATERIALS AND METHODS: The authors retrospectively reviewed clinical records of adult patients with a preoperative diagnosis of MIS on the head and neck from January 1994 to August 2012. Patient and tumor characteristics were recorded. RESULTS: In total, 624 patients met the inclusion criteria and 24 (4%) were upstaged after resection. Four patients had invasive disease beyond the clinically evident lesion. The annual percentage of upstaged lesions seemed to show an increasing trend with time. CONCLUSION: Upstaging of MIS on the head and neck occurs at a relatively low rate that may be increasing with time. Invasive components of lentigo maligna melanoma may exist beyond the clinically evident margins. Histological examination of the maximal amount of the surgical specimen is paramount for optimal staging and treatment of MIS.

The Role of Toluidine Blue in Mohs Micrographic Surgery: A Systematic Review.

Toluidine blue (TB) is a metachromatic dye used as a stain in frozen sections in Mohs micrographic surgery (MMS). The current literature on the use of TB is sparse and generally qualitative in nature. The aim of this systematic review was to summarize and evaluate the existing literature analyzing TB use in MMS. The PubMed and Cochrane databases were searched for relevant studies published before December 1, 2019. Studies that analyzed the use of TB in frozen sections applicable to MMS were included. A total of 25 articles were reviewed, of which 12 fit the inclusion criteria. Our analysis showed that TB may play an important role in the successful diagnosis and treatment of particular cutaneous tumors.

Accuracy of real-time SNOMED-CT coding by clinicians in an urban tertiary emergency department: A retrospective cohort study.

OBJECTIVE: This study aimed to determine the accuracy of the reported diagnoses and procedures to the National non-Admitted Patient Collection (NNPAC) from Auckland City Hospital Adult Emergency Department, and whether there were disparities between Maori and non-Maori patients. METHODS: We audited 5788 (n = 594 Maori, 5194 non-Maori) visits in February 2021 to determine whether diagnoses and procedures were recorded and whether these were recorded differently for Maori compared to non-Maori. A random sample of case notes, stratified by five common chief presenting complaints (n = 114) were selected to compare clinician recording of diagnoses and procedures in real time, to those derived from the clinical notes by auditors blinded to the actual diagnosis and patient name and ethnicity. The New Zealand Emergency Department SNOMED-CT reference set was used to code diagnoses. RESULTS: Maori were less likely to have a diagnosis recorded when discharged from the ED compared to non-Maori, relative risk 1.48 (1.08, 2.04), p = 0.016 (n = 3045). Failure to record diagnoses was due to flaw in the system for extracting diagnoses from electronic notes, rather than failure to make a diagnosis. There was agreement in 111/114 cases for diagnosis: 53/56, 94.6% (95 %CI 85,99) for Maori, and 58/58, 100% (95 %CI 93,100) for non-Maori; p = 0.115. There was agreement in 60/114 cases for procedures completed: 31/56, 55.4% (95 %CI 42,66) for Maori, and 29/58, 50% (95 %CI 38,62) for non-Maori; p = 0.567. CONCLUSION: Maori were less likely to have a diagnosis recorded at discharge due to systemic bias in how we captured diagnoses electronically. Our system should change to remove this inequity. The diagnoses recorded using SNOMED-CT were mostly an accurate reflection of clinician's notes, while recording of procedures was poor.

Disposition disparities in an urban tertiary emergency department.

OBJECTIVE: To explore disparities between Maori and non-Maori patients with respect to triage acuity and disposition based on presenting complaint. METHODS: This was a retrospective review of 5788 (n = 594 Maori, n = 5194 non-Maori) ED visits in February 2021, extracted from the hospital data warehouse. RESULTS: Maori were triaged similarly to non-Maori but were less likely to be admitted compared to non-Maori: relative risk 0.87 (0.78, 0.97), P = 0.008. CONCLUSION: Maori were less likely to be admitted for similar presenting complaints, despite similar triage acuity. Further research is required to determine the reasons for this apparent inequity.

Management of full-thickness skin grafts.

Full-thickness skin grafts are a commonly used reconstructive method following Mohs micrographic surgery. The literature varies on the most appropriate methods of suturing and securing grafts as well as best practices to dress the graft postoperatively. Our objective was to review various approaches to management of full-thickness skin grafts, including suturing the graft, securing the graft, and topical emollient use on the graft postoperatively. It was found that absorbable sutures, plain gut, provide preferable outcomes with full-thickness skin grafts. The tie-over bolster is the most-used method for securing skin grafts after placement, although several other methods have demonstrated efficacy, including the polyurethane foam, sandwich, and quilting suture methods. While various topical emollients are used in the immediate postoperative period, plain white petrolatum is the least likely to form allergic contact dermatitis.

Is your patient a candidate for Mohs micrographic surgery?

This guide for family physicians describes the advantages of Mohs surgery and which patients make good candidates for the procedure.

Quantity and characteristics of flap or graft repairs for skin cancer on the nose or ears: a comparison between Mohs micrographic surgery and plastic surgery.

One benefit of Mohs micrographic surgery (MMS) is maximal tissue sparing compared to standard excisional surgery techniques. It also has the highest statistical cure rate for appropriately selected nonmelanoma skin cancers (NMSCs) in cosmetically sensitive areas, making it a preferred choice for many self-referred patients or their referring physicians. Patients and nondermatologist physicians may be unaware of how frequently Mohs surgeons perform complex surgical repairs compared to other specialists. Our objective was to compare the quantity and characteristics of flap or graft repairs on the nose or ears following skin cancer extirpation performed by either a fellowship-trained Mohs surgeon or plastic surgeons at 1 academic institution. A retrospective chart review of all skin cancer surgeries was performed to collect data on all flap or graft repairs on the nose or ears at Baylor Scott and White Health (Temple, Texas) from October 1, 2016, to October 1, 2017. We collected secondary data on final defect size prior to the repair, skin tumor type, referring specialty for the procedure, and patient demographics. We found that Mohs surgeons performed a larger number of complex repairs on cosmetically sensitive areas compared to plastic surgeons following skin cancer removal, which may be unrecognized in several specialties that refer patients for management of skin cancers, creating a possible practice gap. More data may aid referring providers in optimally advising and managing patients with cutaneous malignancies.

Cost of diagnosing psoriasis and rosacea for dermatologists versus primary care physicians.

Growing incentives to control health care costs may cause accountable care organizations (ACOs) to reconsider how skin disease is best managed. Limited data have suggested that disease management by a primary care physician (PCP) may be less costly than seeing a specialist, though it is not clear if the same is true for the management of skin disease. This study assessed the cost of seeing a dermatologist versus a PCP for diagnosis of psoriasis and rosacea.

Pharmacoeconomic Considerations in Treating Actinic Keratosis: An Update.

Actinic keratosis is one of the most common dermatological diagnoses worldwide, especially among the elderly, fair-skinned, and immunocompromised, and is associated with a risk of transformation to skin cancer. With actinic keratosis and skin cancer prevalence increasing as the aged population expands in the US, optimizing treatment strategies may produce cost savings for the healthcare system. Since the time of our last review in 2008, investigation of the economic considerations in treating actinic keratosis has advanced. To provide an update of treatment cost effectiveness and to review factors relating to the costs of care, we conducted a systematic review of pharmacoeconomic publications since December 2008. We identified 11 pharmacoeconomic studies, with one cost-of-treatment, five cost-effectiveness, and five cost-utility analyses. Photodynamic therapy (PDT) was well tolerated and produced a favorable cosmetic outcome in most studies. Ingenol mebutate, the newest but most expensive topical field therapy, 5-fluorouracil, and PDT were the most cost-effective treatments in our review. Patient adherence to therapy and the management of adverse effects were significant contributors to treatment costs. In the US, treatment guidelines and formalized cost-effectiveness analyses for actinic keratosis are absent from the recent literature. Future pharmacoeconomic investigation will depend on up-to-date comparative efficacy data, as well as clarification of rates of, and management strategies for, adverse effects, therapeutic non-adherence, and lesion recurrence.

Mohs Micrographic Surgery for the Management of Cutaneous Malignancies.

Mohs micrographic surgery is a specialized form of skin cancer surgery in which the Mohs surgeon acts as both surgeon and pathologist. The procedure is characterized by its histopathologic margin control and ability to spare tissue, particularly in cosmetically sensitive locations. Mohs surgery is known for both limiting the size of the final defect and its high cure rate. In this review, the authors highlight indications for the procedure, detail the technique itself, discuss cutaneous tumors for which Mohs micrographic surgery is indicated, and present the economic benefit of Mohs surgery.