Visual Learning Equity Initiative Enhances Preclinical Dermatologic Image Representation: A Cross-Sectional Study.

Despite growing diversity in the United States population, studies show that medical education lacks representation of conditions in darker skin tones. Given that medical conditions present differently in different skin tones, limited exposure to images of darker tones in medical training may contribute to incorrect or delayed diagnoses, perpetuating health inequities. This study examines the preclinical curriculum at the Georgetown University School of Medicine (GUSOM) to report on its image representation with respect to skin tone and to assess the impact of a student-driven initiative in achieving visual learning equity (VLE). Of 1050 preclinical images, 58.2% depicted conditions in light/white skin tones, 31.3% in medium/brown, and 10.5% in dark/black. The microbiology and pathology courses had the highest percentages of dark/black and medium/brown images. Infectious disease images made up 36.3% of all images with 54.6% light/white, 31.5% medium/brown, and 13.9% dark/black. Overall, the first images representing conditions were 63.5% light/white, 30.0% medium/brown, and 6.6% dark/black. When dark/black images were presented first, 64.3% were of infectious diseases, compared to 35.1% for medium/brown and only 28.4% for white/light first images that were infectious diseases. A significant increase in images of conditions in darker skin tones was observed in the IRD course 2022 compared to the IRD course 2020 (P<.001). Our study highlights an underrepresentation of darker skin tones compared to lighter skin tones in the GUSOM preclinical curriculum. A student-led initiative significantly increased the representation of darker skin tones in dermatologic images, demonstrating the potential impact of such efforts in achieving VLE in medical education.J Drugs Dermatol. 2024;23(7):519-524.  doi:10.36849/JDD.7992.

A widespread blistering eruption: diffuse cutaneous mastocytosis.

Diffuse cutaneous mastocytosis with bullous formation is a rare childhood disease. We report a 5-month-old male who presented with a 3-week history of cutaneous bullae and pruritus. On examination, he had erythema of the cheeks bilaterally and diffuse slightly hyperpigmented, indurated skin on his trunk and abdomen. There were tense vesicles, bullae, and erosions linearly arranged on his trunk and extremities. Both the laboratory and imaging workup were normal. Subsequently, a punch biopsy of a vesicle on the abdomen was obtained and findings confirmed a diagnosis of diffuse cutaneous mastocytosis. An EpiPen(r) was prescribed due to the slightly increased anaphylaxis risk compared to other forms of mastocytosis. There are many purported triggers of diffuse cutaneous mastocytosis and there is currently no known cure which makes management of this disease challenging. This case highlights a rare condition for which official treatment guidelines do not exist. A prompt dermatologic diagnosis is necessary to ensure proper workup and regulation is in place.

Review of hair prosthetic options for patients with alopecia.

BACKGROUND: Advanced cases of alopecia can be very difficult to treat pharmacologically. Hair loss can be emotionally taxing for many, leading to depression, anxiety, or suicide. Currently, there is limited medical literature on prosthetic hair devices available for patients with alopecia. AIM: The purpose of this review is to educate dermatologists with a thorough review of hair prostheses to assist them in counseling patients with alopecia. PATIENTS/METHODS: We provide an overview of the various hair prostheses in detail and discuss their respective advantages and disadvantages. RESULTS: When considering the optimal hair prosthesis for a patient, it's important to know the hair coverage the patient requires, the material of different attachments, the type of hair fiber required, and the cap foundation. Additionally, financial options and potential adverse effects after applying a prosthesis to the scalp are important aspects to consider. CONCLUSION: A dermatologist should be able to discuss hair camouflaging techniques with their patients, including the benefits of the various options based on patients' preferences, needs, and type of hair loss. Dermatologists are the experts in the management of skin, nail, and hair disorders, and an understanding of the prosthetic options available to patients with alopecia can improve patient care and quality of life outcomes.

The role of tralokinumab in the treatment of atopic dermatitis and future perspectives for adolescents.

Atopic dermatitis (AD) is an inflammatory skin disease that frequently occurs in adolescents. Although there are many treatment options, the challenge for clinicians is finding an effective long-term drug for AD with a favorable safety profile. The purpose of this review is to describe the role of tralokinumab, an IL-13 inhibitor, in treating adolescent AD. The clinical efficacy and safety of tralokinumab were established in clinical trials for adults with moderate-to-severe AD. Based on the results of these trials and the preliminary results of trials conducted on adolescents with AD, tralokinumab effectively alleviates symptoms with tolerable adverse effects. Extending the use of tralokinumab to adolescents with moderate-to-severe AD seems promising for the future.

Atopic dermatitis (AD) is a common long-term skin disease characterized by scaling, redness, itching, pain and sleep disturbances. Fortunately, many treatment options are available depending on the severity of the disease. In this article, the authors describe the potential role of tralokinumab, a drug that blocks a key signal in the immune system that causes AD. The results of recent studies and trials imply that tralokinumab can be effective in providing at least short-term relief of AD symptoms in patients unresponsive to other treatments. So far, it has had an acceptable overall safety profile. The future of tralokinumab treatment in the adolescent population seems promising.

Analyzing disparities in access to teledermatology compared with dermatology clinic visits before, during, and after COVID-19 quarantine.

The COVID-19 pandemic has caused significant changes in dermatologic care, likely exacerbating health disparities for specific minority populations. The use of teledermatology has also become more prevalent during this period. The aim of this study was to determine if the proportion of teledermatology versus office-based visits varied significantly during three study periods of the COVID-19 pandemic. The secondary objective was to determine whether there are significant differences in the use of office-based dermatology versus teledermatology care across the following demographic subgroups: insurance type, race/ethnicity, age, and language during the same periods. A chart review of dermatology visits in electronic medical records at a tertiary referral center in Washington, DC, was conducted. The overall telehealth visit rate was 0% in the prequarantine period, 61.12% during the quarantine period, and 10.59% in the postquarantine period. After assessing telehealth utilization rates among the demographic subgroups, we noted that Medicaid users, Black patients, 64-year-olds or older, and English speakers may benefit the least from telehealth services. Teledermatology use necessitated by the COVID-19 pandemic may have promoted health care disparities for specific marginalized populations.

Refractory Pediatric Psoriasis and Atopic Dermatitis: The Importance of Therapeutical Adherence and Biological Management.

The rates of refractory pediatric psoriasis and atopic dermatitis (AD) have steadily risen over the last few decades, demanding newer and more effective therapies. This review aims to explore the reasons for resistant disease, as well as its management; this includes the indications for, efficacy of, and safety of current therapies for refractory pediatric dermatologic disease. A PubMed search for key phrases was performed. Poor medication adherence is the most common cause of resistant disease and may be managed with techniques such as simplified treatment regimens, more follow-ups and educational workshops, as well as framing and tailoring. Once problems with adherence are ruled out, escalating treatment to stronger biologic therapy may be indicated. Development of anti-drug antibodies (ADAs) can cause patients' disease to be refractory in the presence of potent biologics, which may be addressed with regular medication use or concomitant methotrexate. If patients with AD fail to respond to biologic therapy, a biopsy to rule out mycosis fungoides, or patch testing to rule out allergic contact dermatitis, may be indicated. A limitation of this study is the absence of more techniques for the management of poor medication adherence. Managing medication adherence, escalating treatment when appropriate, and addressing possible anti-drug antibodies will help assure control and relief for patients with resistant disease.