Prescribing Patterns of Isotretinoin for Acne Among Dermatologists in Central Jordan.

INTRODUCTION: Prescribing practices among dermatologists play a crucial role in managing acne, particularly concerning medications like isotretinoin. In Jordan's central region, encompassing the Governorates of Amman, Balqa, Zarqa, and Madaba, dermatologists in both public and private sectors encounter diverse cases of acne. Understanding their prescription patterns and awareness regarding isotretinoin usage is essential for optimizing acne treatment outcomes and minimizing potential risks. METHODS: This study aimed to evaluate dermatologists' practices in prescribing isotretinoin for acne. It relied on the descriptive analytical approach, with the study population including all dermatologists working in the public and private sectors in the central region of Jordan. Simple random sampling was used to include 147 male and female doctors. An online questionnaire was adopted to collect data from the study sample, which was distributed through social media platforms and messaging platforms such as Facebook, WhatsApp, and Instagram to dermatologists working in the central region. RESULTS:  In this study of 147 dermatologists, 58 (39.45%) prescribed isotretinoin primarily for severe acne, and 53 (36.06%) prescribed isotretinoin to about 50-100 patients per year, with the initial dosage based on guidelines (n=102, 69.39%). The majority (n=115; 78.23%) refrained from prescribing if liver enzymes were elevated. Pregnancy tests were required by 42 (28.57%) in the first session, while 78 (53.07%) deemed it the patient's responsibility. Common precautions included sunscreen (n=77; 52.38%) and moisturizing cream (n=31, 21.09%). Only six of the dermatologists (4.08%) advised their patients not to use contact lenses, and only 17 (11.57%) prescribed moisturizing eye drops. CONCLUSION: This study's findings emphasize how crucial physicians' experience is when it comes to prescribing isotretinoin for severe acne. Continued educational initiatives are imperative to address gaps in patient information and safeguards in order to optimize treatment outcomes and ensure patient safety.

Tradeoffs and decision-making in moderate to severe psoriasis for oral versus injectable treatments: data from patients and dermatologists in Australia.

BACKGROUND: Oral systemic and injectable biologic treatments are available in Australia to treat moderate to severe psoriasis. OBJECTIVE: To examine how patients and dermatologists in Australia choose between oral and injectable treatments for psoriasis. METHODS: In this discrete choice experiment (DCE), adults with moderate to severe psoriasis and dermatologists were asked to choose between 2 treatments labeled by mode of administration ('oral' or 'subcutaneous injection'), each with randomly assigned levels for 9 treatment attributes. Needle fear was rated by patients. RESULTS: Completed surveys from 178 patients and 43 dermatologists were included in the analysis. Symptom reduction, safety, and mode of administration were attributes found to have a significant impact on treatment choice; dosing frequency was a significant attribute for the injectable option. When treatment attributes were held equal, patients and dermatologists preferred oral versus injectable treatments for moderate disease. Patients with higher levels of needle fear were more likely to favor an oral treatment versus patients with lower levels of needle fear. LIMITATIONS: Participation bias may limit the generalizability of these findings. CONCLUSION: Participants preferred oral over injectable treatment for moderate psoriasis. These findings corroborate the need for efficacious oral therapies to treat the disease.

Can dermatologists reach their full potential in teledermatology? A validation study of diagnostic performance of skin diseases in live video conferencing teledermatology.

The diagnostic accuracy rate of live videoconferencing (LVC) teledermatology, by board-certified dermatologists compared to non-dermatologists has not yet been fully investigated. The aim of this study was to compare the diagnostic accuracy of board-certified dermatologists, dermatology specialty trainees, and board-certified internists in LVC teledermatology. We examined the diagnostic accuracy of clinicians from different specialties in diagnosing the same group of patients. The clinicians were isolated from each other during the diagnosis process. We enrolled 18 volunteer physicians (six board-certified dermatologists, six dermatology specialty trainees, and six board-certified internists) who reviewed the skin conditions of 18 patients via LVC teledermatology. The diagnostic accuracy of the participating physicians was evaluated using the final diagnosis as the reference standard. The diagnostic accuracy averages were compared according to the physicians' specialties and disease categories. The mean ± standard deviation diagnostic accuracy of the most detailed level diagnosis was 83.3% ± 3.5% (range, 77.8%-89.0%) for board-certified dermatologists, 53.7 ± 20.7% (range 27.8%-77.8%) for dermatology specialty trainees, and 27.8 ± 5.0% (range, 22.2%-33.3%) for board-certified internists. Board-certified dermatologists showed significantly higher diagnostic accuracy, not only against board-certified internists (p < 0.0001) but also against dermatology specialty trainees (p < 0.05). Disease categories with high accuracy rates (≥80%) only by board-certified dermatologists were inflammatory papulosquamous dermatoses (87.5%), compared to 58.3%, and 20.8% for dermatology specialty trainees and board-certified internists respectively). For inflammatory erythemas and other reactive inflammatory dermatoses the accuracy rates for board-certified dermatologists, dermatology specialty trainees, and board-certified internists were 83.3%, 33.3%, 8.3% respectively; for melanoma in situ neoplasms, 83.3%, 50.0%, 66.7% respectively), and for genetic disorders of keratinization 83.3%, 33.3%, and 0% respectively). Our findings showed that board-certified dermatologists may have high diagnostic accuracy with practical safety and effectiveness in LVC teledermatology.

Development, Feasibility, and Acceptability of the Electronic Patient Benefit Index for Psoriasis in Clinical Practice: Mixed Methods Study.

BACKGROUND: Patient-reported outcomes are relevant in clinical practice showing patient benefits, supporting clinicians' decision-making, and contributing to the delivery of high standards of care. Digital monitoring of patient-reported outcomes is still rare. The Patient Benefit Index (PBI) measures benefits and goals from patients' views and may be relevant for regular documentation and shared decision-making. OBJECTIVE: This study aimed to develop electronic versions of the PBI to examine their feasibility and acceptability in clinical practice for patients with psoriasis. METHODS: We developed an app and a web version of the existing, valid PBI using focus groups and cognitive debriefings with patients before conducting a quantitative survey on its feasibility and acceptability. Conduction took part in an outpatient dermatology care unit in Germany. Descriptive and subgroup analyses were conducted. RESULTS: A total of 139 patients completed the electronic PBIs (ePBIs) and took part in the survey. The ePBI was understandable (n=129-137, 92.8%-98.6%) and feasible, for example, easy to read (n=135, 97.1%) and simple to handle (n=137, 98.5%). Acceptability was also high, for example, patients can imagine using and discussing the ePBI data in practice (n=91, 65.5%) and documenting it regularly (n=88, 63.3%). They believe it could support treatment decisions (n=118, 84.9%) and improve communication with their physician (n=112, 81.3%). They can imagine filling in electronic questionnaires regularly (n=118, 84.9%), even preferring electronic over paper versions (n=113, 81.2%). Older and less educated people show less feasibility, but the latter expected the relationship with their physician to improve and would be more willing to invest time or effort. CONCLUSIONS: The app and web version of the PBI are usable and acceptable for patients offering comprehensive documentation and patient participation in practice. An implementation strategy should consider patients' needs, barriers, and facilitators but also physicians' attitudes and requirements from the health care system.

Assessing the Application of Large Language Models in Generating Dermatologic Patient Education Materials According to Reading Level: Qualitative Study.

BACKGROUND: Dermatologic patient education materials (PEMs) are often written above the national average seventh- to eighth-grade reading level. ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT are large language models (LLMs) that are responsive to user prompts. Our project assesses their use in generating dermatologic PEMs at specified reading levels. OBJECTIVE: This study aims to assess the ability of select LLMs to generate PEMs for common and rare dermatologic conditions at unspecified and specified reading levels. Further, the study aims to assess the preservation of meaning across such LLM-generated PEMs, as assessed by dermatology resident trainees. METHODS: The Flesch-Kincaid reading level (FKRL) of current American Academy of Dermatology PEMs was evaluated for 4 common (atopic dermatitis, acne vulgaris, psoriasis, and herpes zoster) and 4 rare (epidermolysis bullosa, bullous pemphigoid, lamellar ichthyosis, and lichen planus) dermatologic conditions. We prompted ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT to "Create a patient education handout about [condition] at a [FKRL]" to iteratively generate 10 PEMs per condition at unspecified fifth- and seventh-grade FKRLs, evaluated with Microsoft Word readability statistics. The preservation of meaning across LLMs was assessed by 2 dermatology resident trainees. RESULTS: The current American Academy of Dermatology PEMs had an average (SD) FKRL of 9.35 (1.26) and 9.50 (2.3) for common and rare diseases, respectively. For common diseases, the FKRLs of LLM-produced PEMs ranged between 9.8 and 11.21 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). For rare diseases, the FKRLs of LLM-produced PEMs ranged between 9.85 and 11.45 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). At the fifth-grade reading level, GPT-4 was better at producing PEMs for both common and rare conditions than ChatGPT-3.5 (P=.001 and P=.01, respectively), DermGPT (P<.001 and P=.03, respectively), and DocsGPT (P<.001 and P=.02, respectively). At the seventh-grade reading level, no significant difference was found between ChatGPT-3.5, GPT-4, DocsGPT, or DermGPT in producing PEMs for common conditions (all P>.05); however, for rare conditions, ChatGPT-3.5 and DocsGPT outperformed GPT-4 (P=.003 and P<.001, respectively). The preservation of meaning analysis revealed that for common conditions, DermGPT ranked the highest for overall ease of reading, patient understandability, and accuracy (14.75/15, 98%); for rare conditions, handouts generated by GPT-4 ranked the highest (14.5/15, 97%). CONCLUSIONS: GPT-4 appeared to outperform ChatGPT-3.5, DocsGPT, and DermGPT at the fifth-grade FKRL for both common and rare conditions, although both ChatGPT-3.5 and DocsGPT performed better than GPT-4 at the seventh-grade FKRL for rare conditions. LLM-produced PEMs may reliably meet seventh-grade FKRLs for select common and rare dermatologic conditions and are easy to read, understandable for patients, and mostly accurate. LLMs may play a role in enhancing health literacy and disseminating accessible, understandable PEMs in dermatology.

Niveles de vitamina D en dermatólogos y residentes de dermatología de diferentes regiones de Colombia: un estudio piloto / Vitamin D Levels in Dermatologists and Residents of Dermatology in Different Areas of Colombia: a Pilot Study

Introducción: La deficiencia de vitamina D es considerada una pandemia. En la actualidad existen numerosas publicaciones que documentan esta deficiencia en pacientes con osteopenia y/o osteoporosis; sin embargo, no hay estudios en Colombia ni en Latinoamérica que evalúen la deficiencia e insuficiencia de vitamina D en población sana, ni en dermatólogos, quienes pueden ser susceptibles de adquirir esta deficiencia por las largas jornadas laborales y la falta de exposición solar. Objetivo: Determinar la prevalencia de deficiencia de vitamina D en dermatólogos y residentes de dermatología en Colombia, y establecer sí la región de origen estaba asociada a niveles de vitamina D. Metodología: estudio tipo piloto, observacional, analítico de corte transversal, en el cual se incluyeron dermatólogos y residentes de dermatología asistentes al congreso Colombiano de dermatología 2016. A todos los participantes se les aplicó un cuestionario, se practicó examen físico y se midió niveles de 25 hidroxi vitamina D3. Resultados: 100 participantes fueron incluidos en el estudio: la edad media fue 39 años, el 67 % eran mujeres, con prevalencia de insuficiencia o deficiencia de vitamina D del 96% y concentración media de vitamina D de 18.20 ng/ml. Conclusiones: La deficiencia de vitamina D es altamente prevalente en dermatólogos y residentes de dermatología en Colombia, se sugieren intervenciones preventivas en esta población, debido a la alta morbimortalidad relacionada con tal deficiencia...(AU)

Introduction: Vitamin D deficiency is considered as a pandemic. Now, there are lots of publications documenting this deficiency in patients with osteopenia and / or osteoporosis; however, there are no studies either in Colombia or Latin America that evaluate vitamin D deficiency and insufficiency in a healthy population, or in dermatologists, who can be susceptible to acquire this deficiency by the long working hours and the lack of sun exposure. Objective: To determine the prevalence of vitamin D deficiency in dermatologists and residents of dermatology in Colombia and to establish if the area of origin was associated with vitamin D levels. Methodology: This is a pilot, observational, cross-sectional and analytical study in which dermatologists and dermatology residents attending to the 2016 Colombian Congress of Dermatology were included. All participants were given a questionnaire; a physical exam was performed to them and their levels of 25-hydroxyvitamin D3 were measured as well. Results: 100 participants were included in this study: their average age was 39 years; 67% of them were women, with a prevalence of vitamin D deficiency or insufficiency of 96% and with a mean of vitamin D concentration of 18.20 ng/ml. Conclusions: Vitamin D deficiency is highly prevalent in dermatologists and residents of dermatology in Colombia. With this population, some preventive interventions are suggested due to the high morbimortality related to such deficiency...(AU)

Introdução: a deficiência de vitamina D é considerada uma pandemia. Existem agora inúmeras publicações documentando essa deficiência em pacientes com osteopenia e / ou osteoporose; no entanto, não há estudos na Colômbia ou na América Latina que avaliem a deficiência e insuficiência de vitamina D na população saudável, nem em dermatologistas, que podem ser suscetíveis de adquirir essa deficiência devido aos longos dias de trabalho e falta de exposição solar. Objetivo: Determinar a prevalência de deficiência de vitamina D em dermatologistas e residentes de dermatologia na Colômbia e determinar se a região de origem estava associada a níveis de vitamina D. Metodologia: estudo piloto, observacional, transversal, analítico em que dermatologistas e residentes de dermatologia presentes no Congresso Colombiano de Dermatologia 2016 foram incluídos. Todos os participantes receberam um questionário, exame físico e níveis de 25 hidroxi vitamina D3. Metodologia: estudo piloto, observacional, transversal, analítico em que dermatologistas e residentes de dermatologia presentes no Congresso Colombiano de Dermatologia 2016 foram incluídos. Todos os participantes receberam um questionário, exame físico e níveis de 25 hidroxi vitamina D3. Resultados: 100 participantes foram incluídos no estudo: idade média foi de 39 anos, 67% eram mulheres, com prevalência de deficiência de vitamina D ou insuficiência de 96% e concentração média de vitamina D de 18.20 ng/ml. Conclusões: A deficiência de vitamina D é altamente prevalente em dermatologistas e residentes de dermatologia na Colômbia. As intervenções preventivas nesta população, são sugeridas por causa da alta morbidade e mortalidade associada a esta deficiência...(AU)

Correlación clínico-patológica en entidades dermatológicas. Clínica Ces Medellín 1995-1997 / Clinic-patological correlation in dermatologicals diseases: Clinica Ces Medellin 1995-1997

A diario el dermatólogo se enfrenta con la tarea de hacer un buen diagnostico clínico, pero ¿cuántos de éstos se correlacionan en una forma adecuada con el estudio anatomopatológico? Para evaluar dicha concordancia se planteó este estudio, además se buscaba comparar el acierto de los dermatólogos con los de los médicos de otras especialidades. El presente es un estudio analítico buscando la correlación entre los diagnósticos clínicos y los de anatomía - patológica de todas las biopsias procesadas en la Clínica CES durante el período comprendido entre enero de 1995 y mayo de 1997. Para tal fin se revisaron todas las órdenes de solicitud de biopsias y los informes de patología respectivos. En total se tabularon 1198 muestras. La concordancia diagnóstica de los clínicos con los diagnósticos realizados mediante patología fue de 72,3% para los dermatólogos, 11% para los cirujanos plásticos y 16,7% para el grupo de otros médicos. En los tumores benignos no hubo diferencia significativa en la coincidencia diagnóstica entre las diferentes especialidades. La coincidencia entre dermatólogos y otros en los tumores benignos es muy semejante (55,9% y 53,2%); en las entidades infecciosas el grupo de otros médicos tuvo mejor correlación que los dermatólogos. Sería interesante realizar un trabajo por diagnósticos específicos y comparar con otros médicos, para evaluar la causa real de la poca correlación de los dermatólogos y el mejor desempeño de otros especialistas en entidades infecciosas y tumorales.

Everyday the dermatologist faces the responsibility of making a good clinical diagnosis, but how many of these are appropriately correlated with the anatomopathological studies? This study was made to evaluate such correlation, and to see how good are the diagnosis made by dermatologists compared to other specialists. This descriptive study is looking for the concordance between clinical diagnoses and the anatomy – pathology biopsies processed at the CES Clinic during the period between January 1995 and May 997. For such aim all the biopsy requests and the respective information of pathology were reviewed. 1198 samples were tabulated. The concordance viewed between clinical diagnoses and those made through pathology was of 72.3% for the dermatologists, 11% for plastic surgeons and 16.7% for the group of other physicians. In the benign tumors there was no significant difference in the diagnostic concordance among the different specialties. The coincidence between dermatologists and others in the benign tumors is very similar with 55.9% and 53.2%, respectively; in the infectious entities the group of other doctors had better correlation than the dermatologists. It would be interesting to conduct a specific diagnostic research and compare with other physicians, to assess the real cause of the low correlation of dermatologists and better perform of other specialistsin infectious and tumor entibies.