Assuntos
Carcinoma de Células Escamosas , Transplante de Órgãos , Neoplasias Cutâneas , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/prevenção & controle , Quimioprevenção , Método Duplo-Cego , Humanos , Transplante de Órgãos/efeitos adversos , Projetos Piloto , Sirolimo/efeitos adversos , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/prevenção & controle , TransplantadosRESUMO
OBJECTIVES: To conduct an audit of teledermatologist expert skin advice, a store and forward tele-dermatological service, to determine its effectiveness and user satisfaction in managing cutaneous adverse drug reactions in patients with hepatitis C, and to demonstrate a unique collaborative model of care for patients receiving specialised drug therapy. METHODS: A retrospective analysis of data on teledermatologist expert skin advice referrals from January 2014 to December 2015 was performed. The primary outcomes assessed included number of referrals, referral locations, diagnoses, response times, quality of clinical information provided and user satisfaction ratings. RESULTS: Altogether 43 consultations from 29 referring sites were received from Australian metropolitan and rural settings. Of the patients, 43 were diagnosed with an adverse drug reaction related to the use of either telaprevir or simeprevir. The average time taken for the dermatologist to reply electronically with a final diagnosis and management plan was 1 h 57 min. As many as 26% of referrals required additional photos to establish a diagnosis due to poor-quality images or insufficient detail. Altogether 18 clinicians completed the customer satisfaction survey, all of whom rated teledermatologist expert skin advice nine or above on a scale of one to 10. CONCLUSIONS: Teledermatologist expert skin advice was regarded by clinicians as a valuable patient care service. The platform is a novel modality that supports patients undergoing specialised treatments at risk of cutaneous adverse drug reaction.
Assuntos
Dermatologia/métodos , Toxidermias/diagnóstico , Telemedicina/métodos , Antivirais/efeitos adversos , Atitude do Pessoal de Saúde , Toxidermias/etiologia , Toxidermias/terapia , Feminino , Hepatite C/tratamento farmacológico , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Oligopeptídeos/efeitos adversos , Estudos Retrospectivos , Simeprevir/efeitos adversos , Telemedicina/organização & administração , Fatores de TempoRESUMO
OBJECTIVE: To conduct an audit of the Skin Emergency Telemedicine Service at Princess Alexandra Hospital in Brisbane from January to December 2014, and determine whether there has been any change in the number, type and location of referrals. METHODS: Retrospective analyses of referrals to the teledermatology service were conducted and compared with the 2012 audit. Main outcomes assessed included the number of referrals, referral site location, telediagnosis categories, image characteristics and response times. RESULTS: In 2014, 318 cases were referred to the teledermatology service. The highest number of cases (n = 140) were referred from Princess Alexandra Hospital and Queen Elizabeth II Jubilee Hospital emergency departments. However, referrals to the teledermatology service came from as far as 1600 km distant from Brisbane. The most common provisional telediagnoses were dermatitis or eczema, skin infection or drug eruption. Over half of all referrals (62%) received a response within 3 h and a further 20% were responded to within 3-6 h. Almost half all referring doctors (48%) attached very large image files (> 500 kb) to their referral. CONCLUSIONS: The Skin Emergency Telemedicine Service has proved to be a successful, sustainable and valuable addition to the specialist dermatology services provided across Queensland. With adequate funding and resources and appropriate attention to ethical and legal considerations, our service could significantly change the management of Queenslanders with acute skin conditions.
Assuntos
Dermatologia/tendências , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/diagnóstico , Telemedicina/tendências , Austrália , Dermatologia/métodos , Emergências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Fotografação , Estudos Retrospectivos , Fatores de TempoRESUMO
BACKGROUND: Data suggest that photodynamic therapy using topical methyl aminolevulinate (MAL PDT) may be a noninvasive alternative to excisional surgery for nodular basal cell carcinoma (BCC). In the studies described here, we investigated the histologic response, tolerability, and cosmetic outcome with MAL PDT for primary nodular BCC (
Assuntos
Ácido Aminolevulínico/análogos & derivados , Carcinoma Basocelular/tratamento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ácido Aminolevulínico/efeitos adversos , Ácido Aminolevulínico/uso terapêutico , Carcinoma Basocelular/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fotoquimioterapia/efeitos adversos , Fármacos Fotossensibilizantes/efeitos adversos , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
A 22-year-old woman presented with recurrent non-ulcerating skin nodules overlying the great saphenous vein on the anteromedial lower legs. Histology showed a granulomatous phlebitis, and polymerase chain reaction performed on lesional skin detected DNA specific for Mycobacterium tuberculosis. The lesions resolved with anti-tuberculous therapy. This case may be a further example of nodular granulomatous phlebitis, a phlebitic tuberculid.
Assuntos
Granuloma/diagnóstico , Granuloma/etiologia , Flebite/diagnóstico , Flebite/etiologia , Tuberculose Cutânea/complicações , Tuberculose Cutânea/diagnóstico , Adulto , Antituberculosos/uso terapêutico , Diagnóstico Diferencial , Feminino , Granuloma/tratamento farmacológico , Granuloma/microbiologia , Humanos , Isoniazida/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Paniculite/diagnóstico , Flebite/tratamento farmacológico , Flebite/microbiologia , Rifampina/uso terapêutico , Resultado do Tratamento , Tuberculose Cutânea/tratamento farmacológico , Tuberculose Cutânea/microbiologiaRESUMO
The finding of mutations in the PTCH gene in both Gorlin's syndrome and sporadic basal cell carcinomas has significantly advanced our understanding of the molecular defects that lead to the formation of these tumours. Knowledge of the specific molecular and functional changes that have taken place in these tumours will help us devise more defined therapies, as well as give us a better understanding of normal molecular pathways involved in skin development and function. The following is a summary of our current understanding of the molecular and cellular biology of basal cell carcinoma.