The psychologic impact of loose anagen syndrome and short anagen syndrome.

Loose anagen syndrome (LAS) and short anagen syndrome (SAS) are congenital hair disorders presenting with reduced hair length with or without hair thinning. We conducted a non-validated online questionnaire of self-identified familial participants in a Facebook support group to assess psychologic symptoms, including anxiety, depression, low self-esteem, sadness, insecurity, worry, frustration, and body dysmorphia, in patients and their caregivers. Of 163 total respondents, negative psychologic symptoms were reported in 44.2% (38/89) of LAS patients, 48.3% (43/89) of LAS caregivers, 56.8% (42/74) of SAS patients, and 47.2% (35/74) of SAS caregivers. Our data indicate that both LAS and SAS have strong psychologic, emotional, and social impacts on affected children and their caregivers.

Underserved Populations and Health Equity in Dermatology: Digital Medicine and the Role of Artificial Intelligence.

We have reviewed the current literature focused on the role of artificial intelligence for underserved populations and health equity in dermatology. Studies evaluating the utility and safety of artificial intelligence model builds and how they meet predefined benchmarks, as well as the clinical applications of artificial intelligence, including decision support systems and operational management were the focus of this study. The seven studies included in our review provide an approach that assures underserved populations are the focus when developing and testing artificial intelligence technology. They provide examples that could guide future studies focused on expanding care to underserved dermatology populations through the use of artificial intelligence.

Psychological Interventions Are More Effective Than Educational Interventions at Improving Atopic Dermatitis Severity: A Systematic Review.

We determined which educational and/or psychological interventions were most effective in atopic dermatitis (AD). A systematic review of published studies evaluated the effectiveness of educational and/or psychological interventions in MEDLINE, Embase, SCOPUS, LILACS, Cochrane, China National Knowledge Infrastructure, Taiwan Electronic Periodical Services, and CiNii. Two reviewers conducted title/abstract, full-text review, and data extraction. Twenty-four prospective studies were included, including 20 randomized controlled trials. Educational (4/7 studies) and combined educational and psychological (5/6 studies) interventions reduced AD severity; psychological (10/11 studies) interventions showed the greatest benefit. The most commonly studied psychological intervention was habit reversal training (8/11 studies), which was most frequently incorporated in studies that reduced AD severity (8/10 studies). The most commonly studied educational interventions were education on AD triggers (7/7 studies) and skin care (7/7 studies); they were incorporated in all studies that reduced AD severity. Different psychological and/or educational interventions successfully reduced AD severity, especially habit reversal training.

The impact of prurigo nodularis on quality of life: a systematic review and meta-analysis.

Prurigo nodularis (PN) is a chronic, pruritic, debilitating disease. Previous studies found that chronic pruritus in general negatively affects patients' quality of life (QoL). However, results about the impact of PN on QoL are conflicting. Our objective was to assess the QoL burden of PN. A systematic review was conducted of all published studies that assessed QoL measures in PN. OVID MEDLINE, EMBASE, SCOPUS, and Web of Science were searched. Pooled meta-analysis (means) was performed using random-effects weighting. Overall, 13 studies met inclusion criteria. All studies identified QoL reductions in patients suffering from PN compared to control groups. The most common QoL instrument used was the Dermatology Life Quality Index [n = 9 studies; pooled mean (95% confidence interval): 13.8 (10.6-16.9), denoting a very large effect]. In particular, PN was associated with substantial impact on multiple domains of QoL. No publication bias was detected. In conclusion, QoL is negatively impacted in PN. Future studies are necessary to determine the best instruments of measuring QoL in PN patients, better understand this association, and assess the impact in males and females separately. PROSPERO CRD42019136193.

Treating Melanoma in Situ During a Pandemic with Telemedicine and a Combination of Imiquimod, 5-Fluorouracil, and Tretinoin.

The recent coronavirus disease 2019 (COVID-19) pandemic has created a quandary for the physician in terms of evaluating and treating cutaneous skin cancers, particularly melanomas. At the onset of the pandemic, many planned medical and surgical visits for skin cancers were postponed. Physicians and patients have had to balance the risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with that of worsening morbidity and mortality due to delays in skin cancer treatments. We present a male patient who had two melanoma-in-situs (MISs) that were treated during the COVID-19 pandemic with a combination of topical imiquimod 5% cream, 5-fluorouracil 2% solution, and tretinoin 0.1% cream. The successful treatments occurred without in-person visits and with the aid of telemedicine. Although surgery is the standard for the treatment of melanoma in situ, this case demonstrates an effective viable treatment modality for MIS during a pandemic situation.

Error tolerance: an evaluation of residents' repeated motor coordination errors.

BACKGROUND: The study investigates the relationship between motor coordination errors and total errors using a human factors framework. We hypothesize motor coordination errors will correlate with total errors and provide validity evidence for error tolerance as a performance metric. METHODS: Residents' laparoscopic skills were evaluated during a simulated laparoscopic ventral hernia repair for motor coordination errors when grasping for intra-abdominal mesh or suture. Tolerance was defined as repeated, failed attempts to correct an error and the time required to recover. RESULTS: Residents (N = 20) committed an average of 15.45 (standard deviation [SD] = 4.61) errors and 1.70 (SD = 2.25) motor coordination errors during mesh placement. Total errors correlated with motor coordination errors (r[18] = .572, P = .008). On average, residents required 5.09 recovery attempts for 1 motor coordination error (SD = 3.15). Recovery approaches correlated to total error load (r[13] = .592, P = .02). CONCLUSIONS: Residents' motor coordination errors and recovery approaches predict total error load. Error tolerance proved to be a valid assessment metric relating to overall performance.

Intestinal Pseudo-Obstruction and Total Villous Atrophy of the Terminal Ileum: An Unusual Presentation of Untreated Celiac Disease.

Intestinal pseudo-obstruction (IPO) is a rare complication of celiac disease (CD) and has often resulted in laparotomy for diagnosis. We report an adult case of CD presenting as IPO with severe protein calorie malnutrition (PCM) and negative endomysial as well as tissue transglutaminase antibodies. This is the first case report of CD presenting with combined IPO, severe PCM, negative first-line celiac serologies, and terminal ileal atrophy that was diagnosed without laparotomy. A non-surgical diagnosis was achieved by expanded laboratory and endoscopic methods, including video capsule endoscopy. Extent of pathologic gut involvement and response to treatment with budesonide and gluten-free diet is described.