Research prioritization of men's health and urologic diseases.

OBJECTIVES: We sought to determine whether disease representation in the Cochrane Database of Systematic Reviews (CDSR) reflects disease burden, measured by the Global Burden of Disease (GBD) Study as disability-adjusted life-years (DALYs). MATERIALS AND METHODS: Two investigators performed independent assessment of ten men's health and urologic diseases (MHUDs) in CDSR for systematic review and protocol representation, which were compared with percentage of total 2010 DALYs for the ten conditions. Data were analyzed for correlation using Spearman rank analysis. RESULTS: Nine of ten MHUDs were represented by at least one CDSR review. There was a poor and statistically insignificant positive correlation between CDSR representation and disease burden (rho = 0.42, p = 0.23). CDSR representation was aligned with disease burden for three conditions, greater than disease burden for one condition, and less than disease burden for six conditions. CONCLUSIONS: These results yield high-quality estimates to inform future research prioritization for MHUDs. While prioritization processes are complex and multi-faceted, disease burden should be strongly considered. Awareness of research priority setting has the potential to minimize research disparities on a global scale.

YouTube as a source of health information: Analysis of sun protection and skin cancer prevention related issues.

Although social media ubiquitously supplementstraditional information sources such as newspapers,magazines, radio, and television, investigation of onlinehealth information related to sun protection and skincancer prevention has been scarce and largely limitedto English language sources. Using the search terms"sun protection," "sunscreen," "skin cancer prevention,""tanning bed" and "vitamin D," we investigated 281YouTube videos presented in 6 languages: English,German, French, Spanish, Swedish, and Danish. Foreach video, we used a four-sectioned checklist toassess general information, popularity, expert drivenmeasures, and heuristic driven measures. Differencesbetween languages were detected: English languagevideos were most frequently viewed (median numberof views: 5488 compared to 248 -1591 in otherlanguages). Approximately 60% of videos revealednegative effects of solar ultraviolet (UV)-exposure.The majority of videos (75%) targeted adults. Videoson tanning beds and sunscreen contained false ormisleading information 40% and 20% of the time,respectively. We confirm observations made withrespect to other medical disciplines that the generalquality of YouTube contributions is often inferiorand does not deliver sustainable information. Othersources of information should be included whensearching for health information online.

Comparing cutaneous research funded by the US National Institutes of Health (NIH) with the US skin disease burden.

BACKGROUND: Disease burden should be an important component for guiding research funding. OBJECTIVE: We sought to examine the relationship between dermatologic research funded from 2012 to 2013 by the National Institutes of Health (NIH) and US skin disease burden as measured by disability-adjusted life years in the Global Burden of Disease 2010 study. METHODS: A cross-sectional analysis was independently performed by 2 researchers who matched projects from the 2012 to 2013 NIH Research Portfolio Online Reporting Tools with 15 skin conditions and their respective disability-adjusted life years from Global Burden of Disease 2010. RESULTS: The NIH funded 1108 projects spanning the 15 skin conditions. Melanoma received almost half of the total skin condition budget (49.5%). Melanoma, nonmelanoma skin cancer, and leprosy were funded above what would be suggested by their disease burden, whereas dermatitis, acne vulgaris, pruritus, urticaria, decubitus ulcer, fungal skin diseases, alopecia areata, cellulitis, and scabies appeared underfunded. Bacterial skin diseases, viral skin diseases, and psoriasis were well matched with disease burden. LIMITATIONS: Disease burden is one of many factors that may be used to guide priority-setting decisions. CONCLUSION: Skin disease burden measured by disability-adjusted life year metrics partially correlates with NIH funding prioritization. Comparing US disease burden with NIH funding suggests possible underfunded and overfunded skin diseases.

Primary Cutaneous T-cell Lymphoma With Aberrant CD-20 Expression.

IMPORTANCE: Primary cutaneous T-cell lymphoma with aberrant expression of cluster of differentiation (CD) 20 is an exceedingly rare manifestation of cutaneous T-cell lymphoma that is easily misdiagnosed as B-cell lymphoma. The significance and prognostic implications of T-cell neoplasms demonstrating the classic CD20 B-cell marker have yet to be elucidated. OBSERVATIONS: We present a case of primary cutaneous T-cell lymphoma with aberrant CD20 expression in a 97-year-old male who presented with a 2-year history of pruritic plaques and nodules covering his body. Nodule biopsy demonstrated a dense, atypical dermal T-lymphocytic infiltrate consisting of predominantly large cells exhibiting classic T-cell markers (CD4 and CD3) along with aberrant expression of the B-cell marker CD20 (expressed in late pro-B to mature B cells). CONCLUSIONS: The patient was tentatively diagnosed with primary cutaneous CD30-negative large T-cell lymphoma with aberrant CD20 co-expression, pending workup to exclude systemic lymphoma with cutaneous involvement. He unfortunately passed away 4 days after the initial dermatologic presentation. RELEVANCE: The prognostic implications of CD20-positive T-cell lymphoma require further exploration, along with the potential role of CD20 antibody in treatment of this rare malignancy.

Indoor Tanning Practices of Colorado High School Students.

For the first time, the 2013 Colorado Youth Risk Behavior Survey assessed indoor tanning practices of Colorado high school students. The survey revealed that girls are more likely to use indoor tanning devices than boys and that the majority of students who tan do so once or twice annually. Health care professionals and policymakers should focus on these groups in efforts to curtail indoor tanning and the associated risk of skin cancer in youth.

Defining intrinsic vs. extrinsic atopic dermatitis.

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterized by eczematous lesions, i.e. ill-demarcated erythematous patches and plaques. AD is commonly associated with elevated immunoglobulin E (IgE) and atopic disorders, such as asthma, hay fever, and food allergies. Rackemann and Mallory were some of the first to distinguish between asthma based on the presence ("extrinsic") or absence ("intrinsic") of allergy. This distinction has subsequently been applied to AD based on the presence ("extrinsic") or absence ("intrinsic") of increased IgE and atopic disease. Although the distinction between intrinsic and extrinsic AD is widely used, it remains controversial.

Patient use of social media to evaluate cosmetic treatments and procedures.

BACKGROUND: With a growing sphere of influence in the modern world, online social media serves as a readily accessible interface for communication of information. Aesthetic medicine is one of many industries increasingly influenced by social media, as evidenced by the popular website, "RealSelf," an online community founded in 2006 that compiles ratings, reviews, photographs, and expert physician commentary for nearly 300 cosmetic treatments. OBJECTIVE: To investigate the current preferences of patients regarding cosmetic non-surgical, surgical, and dental treatments on RealSelf and in the documented medical literature. METHODS: On a single day of data collection, all cosmetic treatments or procedures reviewed on the RealSelf website were tabulated, including name, percent "worth it" rating, total number of reviews, and average cost. Patient satisfaction rates documented in the current medical literature for each cosmetic treatment or procedure were also recorded. Statistical t-testingcomparing RealSelf ratings and satisfaction rates in the literature was performed for each category-non-surgical, surgical, and dental. RESULTS: The top ten most-commonly reviewed non-surgical treatments, top ten most-commonly reviewed surgical procedures, and top 5 most-commonly reviewed dental treatments, along with documented satisfaction rates in the medical literature for each treatment or procedure were recorded in table format and ranked by RealSelf "worth it" rating. Paired t-testing revealed that satisfaction rates documented in the literature were significantly higher than RealSelf "worth it" ratings for both non-surgical cosmetic treatments (p=0.00076) and surgical cosmetic procedures (p=0.00056), with no statistically significant difference for dental treatments. CONCLUSIONS: For prospective patients interested in cosmetic treatments or procedures, social media sites such as RealSelf may offer information helpful to decision-making as well enable cosmetic treatment providers to build reputations and expand practices. "Worth it" ratings on RealSelf may, in fact, represent a more transparent view of cosmetic treatment or procedural outcomes relative to the high satisfaction rates documented in medical literature. Massive online communication of patient experiences made possible through social media will continue to influence the practice of medicine, both aesthetic and otherwise.

Comparing burden of dermatologic disease to search interest on google trends.

Google Trends is a publicly available resource for comparing Internet search query frequency and trends interest in queries over time. The tool provides country, region, and city-specific data for term search volume on Google Search. Our study sought to compare the relative search interest to the burden of disease for the fifteen skin conditions studied by the Global Burden of Disease (GBD) 2010 project. Searches on Google Trends were conducted by using the most inclusive terms and true ICD code definitions as possible for the skin conditions studied. We report that relative interest on Google Trends did largely correlate to burden of disease reported by the GBD 2010 study, though some conditions were either underrepresented or overrepresented. Acne and herpes were the most Googled skin disease terms. This study provides further insight into what may be the most burdensome skin diseases because those with more burdensome diseases likely sought out information on their condition.

Impact of a dermatology wiki website on dermatology education.

BACKGROUND: The Dermatology Education Wiki (dermwiki) website serves as a resource platform for medical students and residents. The readily accessible interface provides dermatology articles, survival guides, didactic lectures, and links to faculty talks as well as research opportunities. OBJECTIVE: To assess medical student and resident satisfaction with the dermwiki website. METHODS: Fourth-year medical students taking a dermatology elective were provided with a temporary password to access relevant dermwiki information. A satisfaction survey was created to assess whether medical students found the website helpful. Second- and third-year dermatology residents were also surveyed to compare satisfaction scores prior to and after the introduction of the dermwiki website. End-of-rotation medical student exam scores were tabulated and compared to the average scores from years prior to the development of the dermwiki website. RESULTS: Medical students rated the dermatology elective with the dermwiki website higher than rotations without a wiki (8.12 vs 7.31). Students planning to go into dermatology were more satisfied with the dermwiki website, reported accessing the website more frequently (11 times vs 9.5 times), and reported more time spent studying (12.2 hours vs 6.7 hours) than students not going into dermatology. End-of-rotation medical student exam scores did not differ from those prior to the development of the demwiki website. Ten second- and third-year dermatology residents unanimously stated that they were more satisfied with the program after the institution of the dermwiki website. CONCLUSIONS: Overall, addition of the dermwiki website to the dermatology elective curriculum has improved medical student and resident satisfaction scores. The improvement is greater among students planning to enter the field of dermatology. This study serves as a model for the incorporation of internet-based interactive tools to transform and supplement the learning environment.

Global mortality from conditions with skin manifestations.

BACKGROUND: Global Burden of Disease Study is a research database containing systematically compiled information from vital statistics and epidemiologic literature to inform research, public policy, and resource allocation. OBJECTIVE: We sought to compare mortality among conditions with skin manifestations in 50 developed and 137 developing countries from 1990 to 2010. METHODS: This was a cross-sectional study to calculate mean age-standardized mortality (per 100,000 persons) across countries for 10 disease categories with skin manifestations. We compared differences in mortality from these disorders by time period (year 1990 vs year 2010) and by developing versus developed country status. RESULTS: Melanoma death rates were 5.6 and 4.7 times greater in developed compared with developing countries in 1990 and 2010, respectively. Measles death rates in 1990 and 2010 were 345 and 197 times greater in developing countries, and corresponding syphilis death rates were 33 and 45 times greater. LIMITATIONS: Inability to adjust for patient-, provider-, and geographic-level confounders may limit the accuracy and generalizability of these results. CONCLUSION: The mortality burden from skin-related conditions differs between developing and developed countries, with the greatest differences observed for melanoma, measles, and syphilis. These results may help prioritize and optimize efforts to prevent and treat these disorders.

Social media impact factor: the top ten dermatology journals on Facebook and Twitter.

Academic journals are mainly rated according to their impact factors. However, considering the enormous worldwide impact of social media, journals and potential authors may want to take social media impact into account.

Dermatology on YouTube.

YouTube, reaches upwards of six billion users on a monthly basis and is a unique source of information distribution and communication. Although the influence of YouTube on personal health decision-making is well established, this study assessed the type of content and viewership on a broad scope of dermatology related content on YouTube. Select terms (i.e. dermatology, sun protection, skin cancer, skin cancer awareness, and skin conditions) were searched on YouTube. Overall, the results included 100 videos with over 47 million viewers. Advocacy was the most prevalent content type at 24% of the total search results. These 100 videos were "shared" a total of 101,173 times and have driven 6,325 subscriptions to distinct YouTube user pages. Of the total videos, 35% were uploaded by or featured an MD/DO/PhD in dermatology or other specialty/field, 2% FNP/PA, 1% RN, and 62% other. As one of the most trafficked global sites on the Internet, YouTube is a valuable resource for dermatologists, physicians in other specialties, and the general public to share their dermatology-related content and gain subscribers. However, challenges of accessing and determining evidence-based data remain an issue.

Dermatology on instagram.

The novel photo-sharing social networking platform, Instagram, has an impressive following of 75 million daily users, with a predominantly younger and female demographic. This study investigated the presence of dermatology-related content on Instagram. The most popular professional dermatological organizations, dermatology journals, and dermatology related patient advocate groups on Facebook and Twitter, determined from a prior study, were searched for established profiles on Instagram. In addition, dermatology-related terms (i.e. dermatology, dermatologist, alopecia, eczema, melanoma, psoriasis, and skin cancer) and dermatology-related hashtags (i.e. #dermatology, #dermatologist, #melanoma, #acne, #psoriasis, and #alopecia) were searched. None of the top ten dermatological journals or professional dermatological organizations were found on Instagram. Although only one of the top ten patient advocate groups related to dermatology conditions, Melanoma Research Foundation, had an Instagram presence, there were many private offices, cosmetic products, and some patient advocacy groups. This novel social networking platform could grant dermatology journals and other professional organizations a unique opportunity to reach younger demographic populations, particularly women, with the potential for true educational and life-changing impact.

Update on mobile applications in dermatology.

BACKGROUND: As the use of mobile devices surpasses that of personal computers, medical applications increasingly provide easy access to a diverse range of health care resources. PURPOSE: To analyze changes in the number of dermatologic mobile applications since 2012. METHODS: We examined five mobile platforms (Apple, Android, Windows, Nokia, and Blackberry) for dermatology-related diagnoses applications. The apps were categorized by purpose, cost, and target audience. RESULTS: A total of 365 dermatologic mobile applications were analyzed with 225 new mobile applications found since 2012. Since the last query, there was a decrease in market share of reference materials (26.6% in 2012 to 15.9% in 2014) and self-surveillance/diagnosis applications (17.9% in 2012 to 12.9% in 2014) while teledermatology apps increased from 3.5% of total apps in 2012 to 9% in 2014. CONCLUSIONS: Dermatology apps continue to proliferate with minimal regulation. As technology continues to advance and physicians have greater access to mobile- health information, novel advancements in diagnosis may lead to more time-and-location-flexible patient care.

Dermatology on Tumblr.

Tumblr broke into the social media scene in 2007 as a micro-blogging platform that hosts 169 million blogs, 75 billion total posts, and 111 million posts daily to date. This study aimed to determine the presence of dermatology-focused journals, organizations, and groups on Tumblr. These were entered into the Tumblr search query to identify affiliated Tumblr blogs and 'dermatology Tumblr' was searched on Google to determine the first four distinct results that were active within the last six months. None of the dermatology-focused journals, organizations, or groups maintained a Tumblr blog and three of the first four blogs on Google were maintained by private practices. In conclusion, Tumblr remains a social media domain that lacks a strong presence from dermatology journals and organizations, remaining an untapped resource for information dissemination and interaction with the public.

News reports: update on buying indoor UV tanning with university debit cards.

BACKGROUND & OBJECTIVE: Indoor tanning by adults under 35 years of age increases the risk of developing melanoma 59% to 75%. Cost is a major barrier limiting young adults from purchasing indoor tanning services. Our recent study by Boyers et al determined that 18 of 96 major universities, all in the eastern and southern United States, had university-sponsored debit cards with indoor tanning affiliations. These debit cards, which conveniently link with student identification (ID) cards, help with student living expenses and are often loaded with money by parents. By creating agreements with indoor tanning salon vendors, universities are endorsing a World Health Organization class I carcinogen. To expand the results of our previous study, we broadened our search to further assess universities in the western United States as well as Australia, New Zealand, Ireland, Canada, and the United Kingdom. METHODS: Using www.collegeboard.edu, we identified the 4 largest residential colleges in Arizona, California, Colorado, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. Additionally, we investigated the top international universities, utilizing www.topuniversities.com. Internet searches, phone calls, and email correspondence were used to determine if an institution had a student ID-linked debit card. Universities with affiliations to bank debit cards and cards that could only be used on campus were excluded. RESULTS: In the western United States, indoor tanning merchants were affiliated with University of Arizona, Embry-Riddle Aeronautical University: Prescott Campus, and the University of Denver student debit cards. Of the original 18 schools with affiliations according to the Boyers et al study, 2 universities no longer have agreements and 5 created agreements with additional tanning salons. Of 45 universities examined in our international search, no debit cards were discovered for off-campus purchases. Therefore, the concerning issue of university associations with tanning salons appears to be solely a domestic problem. CONCLUSIONS: Our findings indicate that the formation of financial agreements between universities and tanning salons is an ever-present and growing problem in the United States. Since Boyers et al, we have engaged in outreach efforts with alumni, faculty, administration, and local university cancer centers to terminate university ties with tanning salon vendors. Further advocacy efforts are critical to combat this dangerous association, reduce the frequency of skin cancer, and protect the health of young adults.

The global, regional, and national burden of seborrheic dermatitis: results and insights from the Global Burden of Disease 2019 Study.

Seborrheic dermatitis (SD) is a chronic skin disease affecting infants, adolescents, and adults. The cause of SD is not known. Previous studies suggested genetic and environmental roles in the etiology of the disease. However, epidemiological data on SD have been scarce. The study aimed to analyze the burden of SD. We analyzed national and macro-regional SD data from the Global Burden of Disease Study 2019 (GBD 2019) resources. Regression analysis was performed to compute the annual percent change (APC) and identify significant changes in the temporal prevalence trends of SD from 1990 to 2019 relative to age-standardized and crude world population. Pearson correlation test was used to evaluate the association between prevalence and Socio-Demographic Index (SDI) at a macro-regional level. Over the years, from 1990 to 2019, the age-standardized prevalence of SD had a slow growth trend, with an APC of + 0.10% (p < 0.001), while crude prevalence has been showing a greater increase with an APC of +0.32 (p < 0.001). In 2019, the regions with the highest prevalence in the world were Sub-Saharan Africa and North America, while Central Asia and Eastern Europe showed the lowest prevalence. Prevalence distribution by age showed an increase starting at the age class 60-64, then peaked at the age class 80-84, and a subsequent decrease. Males appeared to be slightly more affected than females at older ages. Correlation patterns between prevalence and SDI were not significant. In this study, we found that the prevalence of SD varies between the geographical regions. However, the overall age-standardized prevalence of the disease has been stable throughout 30 years (1990-2019).

Prescribing Patterns of Oral Antibiotics and Isotretinoin for Acne in a Colorado Hospital System: Retrospective Cohort Study.

BACKGROUND: Guidelines established by the American Academy of Dermatology recommend oral antibiotics as first-line therapy for mild, moderate, and severe acne. However, it is recommended to minimize the duration of oral antibiotic use, and there is increasing support for other systemic agents for acne. OBJECTIVE: We sought to characterize the use of oral antibiotics and isotretinoin for the treatment of acne in the pediatric and young adult population aged 10 through 20 years and the adult population aged 21 to 45 years from 2011 to 2019. METHODS: We conducted a retrospective, observational cohort study using electronic data from the enterprise data warehouse of the University of Colorado Anschutz Medical Campus and its affiliates, with data in the format of the Observational Health Data Sciences and Informatics (OHDSI) Observational Medical Outcomes Partnership (OMOP) common data model. Categorical values (sex, race, and ethnicity) were compared using chi-square tests, and continuous variables (age) were compared using 2-tailed t tests. RESULTS: Our cohort of 15,704 patients was composed of mostly White (12,776/15,704, 81.4%), non-Hispanic or Latino (13,307/15,704, 84.7%), and female (11,093/15,704, 70.6%) patients. Among the 4605 male patients in the eligible cohort, 1810 (39%) received an oral antibiotic treatment, in comparison to 3109 (28%) of the 11,093 eligible women (P<.001). Among the 4605 men who were eligible for treatment with isotretinoin in this population, 988 (21.5%) received a course of isotretinoin, compared to only 10.4% (1159/11,093) eligible women (P<.001). Male patients were 1.67 times more likely to have received an antibiotic prescription (odds ratio [OR] 1.67, 95% CI 1.55-1.79) and over twice as likely to have received an isotretinoin prescription (OR 2.34, 95% CI 2.13-2.57) than female patients. CONCLUSIONS: Minocycline was the most frequently prescribed antibiotic for the treatment of acne in this study cohort. From 2015 to 2019, there was no significant change in the number of antibiotic prescriptions over time. Men were significantly more likely to receive both oral antibiotics and isotretinoin than female patients. Multiple factors could be contributing to this discrepancy, including the burden of iPLEDGE, additional systemic treatment options for female patients, and the difference in acne severity across sexes. We could not determine the difference in severity of acne between male and female patients in our cohort, and further research is needed to ascertain the variation across sexes.