Use of teledermatology by dermatology hospitalists is effective in the diagnosis and management of inpatient disease.

BACKGROUND: Patient outcomes are improved when dermatologists provide inpatient consultations. Inpatient access to dermatologists is limited, illustrating an opportunity to use teledermatology. Little is known about the ability of dermatologists to accurately diagnose disease and manage inpatients with teledermatology, particularly when using nondermatologist-generated clinical data. METHODS: This prospective study assessed the ability of teledermatology to diagnose disease and manage 41 dermatology consultations from a large urban tertiary care center, using internal medicine referral documentation and photographs. Twenty-seven dermatology hospitalists were surveyed. Interrater agreement was assessed by the κ statistic. RESULTS: There was substantial agreement between in-person and teledermatology assessment of the diagnosis with differential diagnosis (median κ = 0.83), substantial agreement in laboratory evaluation decisions (median κ = 0.67), almost perfect agreement in imaging decisions (median κ = 1.0), and moderate agreement in biopsy decisions (median κ = 0.43). There was almost perfect agreement in treatment (median κ = 1.0), but no agreement in follow-up planning (median κ = 0.0). There was no association between raw photograph quality and the primary plus differential diagnosis or primary diagnosis alone. LIMITATIONS: Selection bias and single-center nature. CONCLUSIONS: Teledermatology may be effective in the inpatient setting, with concordant diagnosis, evaluation, and management decisions.

A systematic review and meta-analysis of the effects of topical nitrates in the treatment of primary and secondary Raynaud's phenomenon.

BACKGROUND: Multiple placebo-controlled trials have assessed locally applied topical nitrate preparations in treating Raynaud's phenomenon (RP). OBJECTIVES: The objective of this meta-analysis was to assess the effects of local topical nitrates in primary and secondary RP with respect to a combined end point integrating parameters of digital blood flow and clinical severity. METHODS: A systematic review was performed using MEDLINE, Embase, and the Cochrane library. Only trials comparing locally applied topical nitrates with placebo comparators were included. Studies were appraised for bias by 2 independent reviewers. RESULTS: A total of 7 placebo-controlled trials including 346 patients were used in the meta-analysis; 4 trials used nitroglycerin ointments, 2 used the nitroglycerin gel vehicle MQX-503, and 1 used compounded nitrite. The meta-analysis results supported a moderate-to-large treatment effect in RP (standardized mean difference [SMD] = 0.70; 95% CI, 0.35-1.05; P < .0001). Subgroup analyses showed a large treatment effect in secondary RP (SMD = 0.95; 95% CI, 0.25-1.65; P = .008) and moderate effect in primary RP (SMD = 0.45; 95% CI, 0.05-0.85; P = .03). LIMITATIONS: Limitations include the inclusion of multiple topical nitrate preparations and integration of different outcomes assessments. CONCLUSION: Local topical nitrates have significant efficacy in the treatment of both primary and secondary RP.

Superficial acral fibromyxoma and other slow-growing tumors in acral areas.

Superficial acral fibromyxoma (SAFM) is a rare fibromyxoid mesenchymal tumor with a predilection for the distal extremities and frequent nail bed involvement. Superficial acral fibromyxoma typically arises as a solitary, slow-growing nodule on a toe or finger, with the great toe being the most commonly affected site. Histopathologically, SAFM characteristically presents as a well-circumscribed but unencapsulated dermal tumor composed of spindle and stellate cells in a loose storiform or fascicular arrangement embedded in a myxoid, myxocollagenous, or collagenous stroma. The tumor often occupies the entire dermis and may extend into the subcutis and occasionally the underlying fascia and bone. The characteristic immunohistochemical profile of SAFM includes expression of CD34, epithelial membrane antigen (EMA), and CD99; it is notably negative for S-100 protein. We report 3 cases of SAFM and also provide a review of the literature on the clinical and histopathologic presentations of this unique entity as well as the differential diagnosis.

Identification and Management of Night Eating Syndrome in the Adolescent and Young Adult Population.

Objective: Night eating syndrome (NES) is a lesser-known eating disorder that can lead to significant morbidity in adults. However, there is little research into the condition and its comorbidities in the adolescent and young adult population. We sought to compile the existing literature on NES in university student populations to aid health care providers in identifying and treating the condition and its symptoms before it causes adverse health outcomes.Methods: We conducted a review of the literature from 2003 to present with no limitations using PubMed and Google Scholar. Search terms were night eating syndrome AND student, yielding 23 articles that were deemed relevant to the review. A manual search of the literature using only night eating syndrome was performed to identify any additional studies not included in the initial search. This search yielded an additional 4 articles of interest, including those related to treatment options. A total of 25 studies were included in the final review.Results: Adolescent patients exhibiting conditions including depression, eating disorders, insomnia, and high levels of stress should be monitored for the development of night eating symptoms. Children of mothers with NES should also be monitored during adolescence, as this confers a higher risk. Interestingly, increased body mass index is not associated with NES in adolescence. Patients that are identified as being at risk should have their comorbid conditions managed medically, while those diagnosed with NES can potentially be treated with cognitive-behavioral therapy and/or selective serotonin reuptake inhibitors.Conclusions: NES is a clinical entity that requires further investigation, especially concerning adolescents and the development of symptoms during the transition into adulthood. More research is needed on the treatment of the syndrome, as several treatments have been studied but none are US Food and Drug Administration approved.