RESUMO
Introduction: One of the challenges faced by the Colombian Health System is to improve access to health services for the dispersed and isolated rural population, particularly in the field of dermatology. This article examines the implementation of a teledermatology service using a PC and camera versus smartphone technology. Methods: A total of 542 teledermatology visits were conducted, involving 478 patients, in addition to 64 visits for clinical follow-up for patients as per the dermatologist's recommendation. Out of the 478 patients, 461 met the inclusion criteria and agreed to participate in the study. The data collection instrument from the general practitioner or referring provider covered three consultation moments: (1) sending an initial consultation, (2) providing a response to the patient, and (3) sending a follow-up consultation. Seven hundred forty-seven records were completed by the general practitioner for the three consultation moments. Furthermore, 372 consultations were documented by the dermatologist or referring provider for two moments: (1) response to the initial consultation by the dermatologist, and (2) response to the follow-up consultation by the dermatologist. After validating the information reported in the instruments, a descriptive analysis of the data was conducted, utilizing absolute frequencies and percentages for qualitative variables and measures of central tendency (mean, median, standard deviation, and interquartile range) for quantitative variables. The data were analyzed from 747 records of the referring provider instrument related to 461 patients, between 18 and 98 years of age, with a predominantly female representation. Results: The results indicated that for teleconsultations conducted using a mobile device, the average total duration of the teleconsultation was longer on the traditional platform compared with the mobile device (13.03 vs. 8.27 min). Additionally, it was observed that the time taken to store, send, and capture a single image (clinical or dermoscopic) using the mobile device was three times lower than that on the conventional platform (25 vs. 75 s). Similar findings were noted for teleconsultations carried out by the dermatologist, predominantly utilizing a mobile device. The average consultation time was shorter for the mobile device compared with the traditional platform (8.14 vs. 12 min). Conclusions: The cost reduction suggests that the operation of the service is more efficient with smartphone technology in comparison to the use of a PC and camera. Teledermatology with smartphones provides a streamlined, efficient, and technically sound process for obtaining clinical and dermoscopic images.
Assuntos
Dermatologia , Fotografação , Smartphone , Telemedicina , Humanos , Feminino , Dermatologia/métodos , Dermatologia/economia , Dermatologia/instrumentação , Masculino , Adulto , Pessoa de Meia-Idade , Adolescente , Fotografação/instrumentação , Idoso , Adulto Jovem , Colômbia , Telemedicina/economia , Dermatopatias/diagnóstico , Dermatopatias/terapia , Consulta Remota/economia , Consulta Remota/instrumentação , Idoso de 80 Anos ou maisRESUMO
Skin-on-a-chip (SoC) technologies are emerging as a paradigm shift in dermatology research by replicating human physiology in a dynamic manner not achievable by current animal models. Although animal models have contributed to successful clinical trials, their ability to predict human outcomes remains questionable, owing to inherent differences in skin anatomy and immune response. Covering areas including infectious diseases, autoimmune skin conditions, wound healing, drug toxicity, aging, and antiaging, SoC aims to circumvent the inherent disparities created by traditional models. In this paper, we review current SoC technologies, highlighting their potential as an alternative to animal models for a deeper understanding of complex skin conditions.
Assuntos
Dispositivos Lab-On-A-Chip , Dermatopatias , Humanos , Dermatopatias/imunologia , Animais , Pele/imunologia , Pele/patologia , Dermatologia/métodos , Dermatologia/instrumentação , Dermatologia/tendências , Modelos Animais de DoençasRESUMO
Despite the huge improvement in smartphone cameras, there has not been any real interest in the UK in pursuing patient-facing teledermatology within the sphere of skin lesion triage. High-specification dermoscopic images can be generated with smartphone attachments, but, to date, no formal clinical trial has been performed to establish the efficacy and feasibility of these consumer-level dermoscopes in skin lesion triage. The objectives of this study were to assess the ability of patients to capture dermoscopic images using a smartphone attachment, and to identify the safety and diagnostic accuracy of consumer-level dermoscopy in triaging out benign skin lesions from the 2-week-wait (2WW) cancer pathway. We recruited 78 patients already attending a face-to-face clinic at two locations. They were provided with instruction leaflets and asked to obtain dermoscopic and macroscopic images of their lesion(s) using their own smartphones. The images (and a brief history) were distributed to five experienced blinded assessors (consultants), who were asked to state their working diagnosis and outcome (reassurance, routine review or 2WW pathway), as they would in teledermatology. We compared their outcomes to the gold-standard in-person diagnosis and/or histological diagnosis, where available. The device achieved 100% sensitivity in diagnosing melanoma and squamous cell carcinoma (SCC). The specificity for the diagnoses of melanoma (89%) and SCC (83%) was high. The overall diagnostic accuracy was 77% for both benign and malignant lesions, The diagnostic accuracy was high for seborrhoeic keratosis (91%) and simple naevi (81%). Patient-captured dermoscopic images using bespoke smartphone attachments could be the future in safely triaging out benign lesions.
Assuntos
Dermoscopia , Neoplasias Cutâneas , Smartphone , Triagem , Humanos , Dermoscopia/instrumentação , Dermoscopia/métodos , Triagem/métodos , Feminino , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Adulto , Idoso , Telemedicina/instrumentação , Dermatopatias/diagnóstico , Dermatopatias/patologia , Dermatopatias/diagnóstico por imagem , Dermatologia/instrumentação , Dermatologia/métodos , Melanoma/diagnóstico , Melanoma/patologia , Melanoma/diagnóstico por imagem , Sensibilidade e Especificidade , Adulto Jovem , Idoso de 80 Anos ou maisRESUMO
Volume scanning electron microscopy (VSEM) involves the serial sectioning and imaging of a sample using scanning electron microscopy (SEM), followed by segmentation and three-dimensional (3D) reconstruction using computer software packages to allow visualization of 3D structures. VSEM can reveal qualitative and quantitative properties of organelles and cells within tissues at nanoscale. The ability to visualize spatial relationships of structures of interest within and across cells in 3D space in particular sets VSEM apart from conventional SEM and transmission electron microscopy. Here, we provide an overview of VSEM platforms and image processing, highlighting characteristics that will aid selection of a method to address specific research questions in dermatological research.
Assuntos
Imageamento Tridimensional/métodos , Microscopia Eletrônica de Varredura/métodos , Animais , Pesquisa Biomédica/instrumentação , Pesquisa Biomédica/métodos , Dermatologia/instrumentação , Dermatologia/métodos , Células HEK293 , Humanos , Imageamento Tridimensional/instrumentação , Microscopia Eletrônica de Varredura/instrumentação , Pele/citologia , Pele/diagnóstico por imagem , Pele/patologiaAssuntos
COVID-19 , Transmissão de Doença Infecciosa/prevenção & controle , Controle de Infecções , Complicações na Gravidez , Dermatopatias , Telemedicina/métodos , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Dermatologia/instrumentação , Dermatologia/métodos , Dermatologia/tendências , Feminino , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Equipamento de Proteção Individual/provisão & distribuição , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/prevenção & controle , Complicações na Gravidez/terapia , Gestão de Riscos/organização & administração , SARS-CoV-2 , Dermatopatias/epidemiologia , Dermatopatias/terapia , Estados Unidos/epidemiologiaRESUMO
Artificial intelligence (AI) utilizes computer algorithms to carry out tasks with human-like intelligence. Convolutional neural networks, a type of deep learning AI, can classify basal cell carcinoma, seborrheic keratosis, and conventional nevi, highlighting the potential for deep learning algorithms to improve diagnostic workflow in dermatopathology of highly routine diagnoses. Additionally, convolutional neural networks can support the diagnosis of melanoma and may help predict disease outcomes. Capabilities of machine learning in dermatopathology can extend beyond clinical diagnosis to education and research. Intelligent tutoring systems can teach visual diagnoses in inflammatory dermatoses, with measurable cognitive effects on learners. Natural language interfaces can instruct dermatopathology trainees to produce diagnostic reports that capture relevant detail for diagnosis in compliance with guidelines. Furthermore, deep learning can power computation- and population-based research. However, there are many limitations of deep learning that need to be addressed before broad incorporation into clinical practice. The current potential of AI in dermatopathology is to supplement diagnosis, and dermatopathologist guidance is essential for the development of useful deep learning algorithms. Herein, the recent progress of AI in dermatopathology is reviewed with emphasis on how deep learning can influence diagnosis, education, and research.
Assuntos
Inteligência Artificial/estatística & dados numéricos , Dermatologia/educação , Patologia/educação , Neoplasias Cutâneas/diagnóstico , Algoritmos , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/patologia , Aprendizado Profundo/estatística & dados numéricos , Dermatologia/instrumentação , Diagnóstico Diferencial , Testes Diagnósticos de Rotina/instrumentação , Humanos , Ceratose Seborreica/diagnóstico , Ceratose Seborreica/patologia , Aprendizado de Máquina/estatística & dados numéricos , Melanoma/diagnóstico , Melanoma/patologia , Redes Neurais de Computação , Nevo/diagnóstico , Nevo/patologia , Variações Dependentes do Observador , Patologia/instrumentação , Pesquisa/instrumentação , Neoplasias Cutâneas/patologiaAssuntos
Dermatologia/instrumentação , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias Cutâneas/diagnóstico , Pontos de Referência Anatômicos , Biópsia/instrumentação , Biópsia/métodos , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Cuidados Pré-Operatórios/instrumentação , Couro Cabeludo/anatomia & histologia , Couro Cabeludo/patologia , Couro Cabeludo/cirurgia , Pele/patologia , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgiaRESUMO
BACKGROUND: Traditional in-person discussion alone is often used for preoperative education in Mohs micrographic surgery (MMS). The appropriate use of more modern education techniques is not well defined in the MMS literature. OBJECTIVE: The authors aim to evaluate patient education techniques for MMS, address education in special populations, and highlight opportunities for improvement. METHODS AND MATERIALS: We performed a PubMed literature search with keywords "Mohs" and "education", "teaching", "understanding", "explanation", "preoperative", or "consent" with no restriction on publication time frame due to literature scarcity. RESULTS: Teledermatology consultation, MMS videos, 3D models, pamphlets/online materials, and shared medical appointments appear to be effective techniques (GRADE B). Analogies are also anecdotally helpful when integrated into traditional verbal education (GRADE C). The role of preoperative educational phone calls is more controversial (GRADE C). CONCLUSION: Regardless of the education technique utilized, no singular technique entirely replaces the traditional in-person discussion. Having access to multiple modalities can be beneficial for patients, allowing them options to choose their preferred method(s) of education. MMS is a difficult topic to conceptualize, and further research into educational techniques is needed to provide clear guidelines for Mohs surgeons.
Assuntos
Dermatologia/métodos , Cirurgia de Mohs , Educação de Pacientes como Assunto/métodos , Neoplasias Cutâneas/cirurgia , Dermatologia/instrumentação , Dermatologia/organização & administração , Humanos , Modelos Anatômicos , Educação de Pacientes como Assunto/organização & administração , Satisfação do Paciente , Cuidados Pré-Operatórios/métodos , Melhoria de Qualidade , Consulta Remota/instrumentação , Consulta Remota/métodos , Consulta Remota/organização & administração , Gravação em VídeoRESUMO
Hypertrophic scars (HTS) following burns and other trauma and are associated with significant functional and psychosocial impairment. Ablative fractional lasers (AFLs) are increasingly being applied in the treatment of HTS supported by a rapidly expanding multidisciplinary base of literature. The multidisciplinary authors sought to evaluate existing literature, provide context and identify gaps, and make recommendations for a path forward. A systematic review was conducted to identify literature pertinent literature through September 2019. Retrospective cohort, randomized controlled trials, quasi-randomized controlled trials, observational prospective cohort, or case series with five or more subjects with hypertrophic scars incurred from burns and related trauma were considered. Twenty-two of the 23 evaluated studies documented statistically significant and/or meaningful qualitative improvements in nearly all outcome measures. Adverse events were generally infrequent and minor. Significant heterogeneity was observed among the studies included in this systematic review, precluding metaanalysis of pooled data. There is abundant existing literature on the use of AFLs in the management of HTS but study heterogeneity limits generalizability. Future studies should prioritize standardized protocols including assessments of function and quality of life.
Assuntos
Queimaduras/complicações , Cicatriz Hipertrófica/cirurgia , Dermatologia/métodos , Terapia a Laser/métodos , Pele/lesões , Queimaduras/cirurgia , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/patologia , Cicatriz Hipertrófica/psicologia , Dermatologia/instrumentação , Dermatologia/normas , Humanos , Terapia a Laser/instrumentação , Terapia a Laser/normas , Guias de Prática Clínica como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Pele/patologia , Lesões dos Tecidos Moles/complicações , Lesões dos Tecidos Moles/cirurgia , Resultado do TratamentoRESUMO
Optical coherence tomography (OCT) is a non-invasive, high-resolution imaging technique with a growing impact in dermatology. The principle of OCT is comparable to that of sonography, except that it uses infrared laser light instead of ultrasound waves. It has been clinically demonstrated that OCT is suitable for discriminating between different types of non-melanoma skin cancer at an early stage of disease. Optical coherence tomography generates two- or three-dimensional images of up to 2 mm penetration depth, a field of view of 6 mm × 6 mm, and an acquisition time of seconds. The resolution capability of OCT is more than 3 to 100 times higher than that of ultrasound imaging. It is of particular interest that the additional information on vasculature provided by OCT angiography enables the assessment and monitoring of inflammatory skin diseases. The use of OCT to locate exact blister levels was demonstrated for diagnosing autoimmune bullous diseases. It is anticipated that detection of subclinical lesions could indicate a relapse of the disease. In the future, this could enable intervention and early treatment. Furthermore, the development of high-speed OCT could allow fast scanning and bedside imaging of large body sites.
Assuntos
Doenças Autoimunes , Dermatologia , Imageamento Tridimensional , Dermatopatias , Tomografia de Coerência Óptica , Doenças Autoimunes/diagnóstico por imagem , Dermatologia/instrumentação , Dermatologia/métodos , Humanos , Imageamento Tridimensional/instrumentação , Dermatopatias/diagnóstico por imagemAssuntos
Infecções por Coronavirus/prevenção & controle , Dermatologia/instrumentação , Exclusão Digital , Disparidades nos Níveis de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Telemedicina/instrumentação , Betacoronavirus/patogenicidade , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Dermatologia/normas , Dermatologia/tendências , Acessibilidade aos Serviços de Saúde/economia , Humanos , Controle de Infecções/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , SARS-CoV-2 , Dermatopatias/diagnóstico , Dermatopatias/terapia , Telemedicina/normas , Telemedicina/tendênciasAssuntos
Aerossóis/administração & dosagem , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Dermatologia/instrumentação , Transmissão de Doença Infecciosa/prevenção & controle , Pandemias , Pneumonia Viral/epidemiologia , Dermatopatias/epidemiologia , COVID-19 , Infecções por Coronavirus/transmissão , Desenho de Equipamento , Humanos , Pneumonia Viral/transmissão , SARS-CoV-2RESUMO
In dermatology, there are many bedside diagnostic tests that may aid in more rapid diagnosis and early initiation of appropriate therapy. When performed correctly, these bedside diagnostic tests can provide both sensitive and specific results. We discuss bedside diagnostic tests, such as the Tzanck smear, potassium hydroxide (KOH) preparation, and mineral oil preparation, with a specific focus on their use in diagnosing infectious dermatoses.
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Dermatologia/métodos , Indicadores e Reagentes/química , Testes Imediatos , Dermatopatias Infecciosas/diagnóstico , Coloração e Rotulagem/métodos , Dermatologia/instrumentação , Humanos , Hidróxidos/química , Óleo Mineral/química , Compostos de Potássio/química , Pele/microbiologia , Dermatopatias Infecciosas/microbiologia , Coloração e Rotulagem/instrumentaçãoAssuntos
Congressos como Assunto/estatística & dados numéricos , Dermatologia/instrumentação , Educação Médica/métodos , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Congressos como Assunto/tendências , Dermatologia/educação , Humanos , Aprendizagem , SARS-CoV-2/isolamento & purificação , Interface Usuário-ComputadorRESUMO
The cutaneous manifestations of lupus, especially chronic cutaneous lupus erythematosus, are a source of significant morbidity and can negatively impact patient quality of life. While the active inflammatory component of the disease may be adequately treated, patients are frequently left with residual skin damage and disfiguring aesthetic deficits. Dermatologists lack guidelines regarding the use and safety of various reconstructive and cosmetic interventions in this patient population. Laser treatments are largely avoided in the lupus population because of the possible photodamaging effects of ultraviolet and visible light. Similarly, given the autoimmune nature of this disease, some physicians avoid injectable treatment and grafts because of the concern for disease reactivation via antigenic stimulation. In the second article in this continuing medical education series we compile available data on this topic with the goal of providing evidence-based guidance on the cosmetic treatment of patients with lupus erythematosus with a focus on chronic cutaneous lupus erythematosus.
Assuntos
Técnicas Cosméticas/normas , Dermatologia/normas , Lúpus Eritematoso Discoide/terapia , Guias de Prática Clínica como Assunto , Técnicas Cosméticas/instrumentação , Preenchedores Dérmicos/administração & dosagem , Preenchedores Dérmicos/efeitos adversos , Dermatologia/instrumentação , Dermatologia/métodos , Estética , Medicina Baseada em Evidências/instrumentação , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Imunossupressores/uso terapêutico , Lasers de Estado Sólido/uso terapêutico , Lúpus Eritematoso Discoide/complicações , Lúpus Eritematoso Discoide/imunologia , Lacunas da Prática Profissional , Qualidade de Vida , Pele/efeitos dos fármacos , Pele/imunologia , Pele/efeitos da radiação , Resultado do TratamentoRESUMO
Morphea and systemic sclerosis are inflammatory, sclerosing disorders. Morphea primarily affects the dermis and subcutaneous fat, while systemic sclerosis typically involves the skin and internal organs. Functional impairment and cosmetic disfigurement are common in both diseases. Treatment options to mitigate disease progression remain limited. Both functional impairment and cosmetic deficits negatively impact quality of life and psychological well-being in this patient population. While the number of cosmetic procedures performed in the United States continues to rise each year, limited data exist regarding best practices for correcting aesthetic deficits caused by autoimmune conditions. There is scarce information to guide safety decisions regarding laser parameters, soft tissue augmentation, treatment intervals, and the concurrent use of immune-modifying or immune-suppressing medications. Given the fears of disease reactivation and exacerbation from postprocedural inflammation along with limited data, it is difficult for clinicians to provide evidence-based cosmetic treatment with realistic expectations with regard to short- and long-term outcomes. In the first article in this continuing medical education series, we attempt to address this practice gap.
Assuntos
Técnicas Cosméticas/normas , Dermatologia/normas , Guias de Prática Clínica como Assunto , Esclerodermia Localizada/terapia , Escleroderma Sistêmico/terapia , Técnicas Cosméticas/efeitos adversos , Técnicas Cosméticas/instrumentação , Preenchedores Dérmicos/administração & dosagem , Dermatologia/instrumentação , Dermatologia/métodos , Estética , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/normas , Humanos , Imunossupressores/uso terapêutico , Lasers de Corante/uso terapêutico , Lacunas da Prática Profissional , Qualidade de Vida , Esclerodermia Localizada/complicações , Esclerodermia Localizada/imunologia , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/imunologia , Pele/efeitos dos fármacos , Pele/imunologia , Pele/efeitos da radiação , Resultado do TratamentoRESUMO
BACKGROUND AND OBJECTIVES: Even though many industrially manufactured medicines are available, extemporaneous preparations still have their niche in dermatology. In several countries, dermatovenerologists are one of the specialists prescribing extemporaneous medicines the most. In order to increase the quality of compounded medications and minimize risks to patient safety, several countries, for example, Germany and the United States of America (USA), created standardized compounded preparation monographs. Latvia, unlike these countries, does not have any officially approved standardized compounded preparation monographs. The purpose of this survey is to analyze the extemporaneous prescriptions prescribed by Latvian dermatovenerologists to identify the active ingredients, combinations of active ingredients, and excipients prescribed by dermatovenerologists the most often, and to find out how many active ingredients are most often compounded in different dosage forms. To understand whether the extemporaneous formulations used in Latvia for dermatological indications are evidence-based, they were compared with German and USA formulations. MATERIALS AND METHODS: A database was created entering data on all the prescriptions prepared in the selected pharmacies in 2017 to summarize information on extemporaneous prescriptions. The prescriptions prescribed by Latvian dermatovenerologists were selected and compared with German and USA formulations. RESULTS: Data from 17 Latvian pharmacies were collected, and 2521 extemporaneous formulations were analyzed. In preparation of semi-solid dosage forms, 25 bulk drug substances and 37 industrially manufactured preparations were used; in preparation of suspensions, 25 bulk drug substances and 10 industrially manufactured preparations were used; in preparation of topical solutions, 23 bulk drug substances and two industrially manufactured preparations were used; in preparation of topical powders, nine bulk drug substances were used; in preparation of oral solutions, five bulk drug substances were used. CONCLUSIONS: The analyzed prescriptions contained active ingredients used in Germany and the USA, as well as active ingredients, the use of which is limited in Germany and the USA. In Latvia, topical dosage forms containing two or more active ingredients are widely prescribed.