E-Consults in Dermatology: A Retrospective Analysis.

Dermatology electronic consultations (e-consults) placed by primary care providers (PCPs) can increase access to specialty care while reducing wait times and providing accurate clinical outcomes. These e-consults also may reduce barriers for underserved patients who historically have limited access to dermatologic care. Our retrospective chart review examines patient outcomes from a dermatology e-consult program at a tertiary care medical center. E-consults effectively increased access to dermatology care while shortening wait times and reducing health care expenditures.

Bromhidrosis treatment modalities: A literature review.

BACKGROUND: Treatment options for Bromhidrosis include botulinum toxin therapy, microwave-based therapy, laser therapy, and surgical intervention. Limited studies compare their efficacies. OBJECTIVE: The purpose of this literature review is to compare the efficacy and safety of these treatments for bromhidrosis. METHODS: A PubMed search included terms bromhidrosis and bromhidrosis AND treatment. RESULTS: A total of 25 articles were reviewed. Botulinum toxin therapy shows consistent benefit but requires repeated therapies. Microwave therapies have shown promising results but require larger cohort sizes with bromhidrosis. Similarly, laser therapy has shown promise with biopsy-proven results, but long-lasting effects remain unknown. Surgery has the best long-term prognosis, but the ideal surgical method remains unknown. LIMITATIONS: Each study varied in their treatment interval and method of assessing bromhidrosis, making direct comparisons difficult. CONCLUSIONS: Managing bromhidrosis requires shared decision making with the patient. Mild-to-moderate symptoms may be treated initially with botulinum toxin therapy. In cases that are refractory, laser therapy should be considered, as it is better studied than microwave therapy currently. Lastly, if the condition is severe and refractory to other options, surgery can be considered, although the ideal method remains unknown.

Understanding eligibility creep in psoriasis assessments: a survey study.

Psoriasis severity assessments for clinical trial entry may be unintentionally overestimated, especially if trial eligibility is chiefly dependent on rating of disease severity. When this results in patients with less severe phenotypes joining clinical trials it is referred to as eligibility creep. We investigated the potential impact of psychosocial incentives on psoriasis lesion severity grading. A survey was constructed and disseminated through Amazon Mechanical Turk. Participants completed two vignette-style questions prompted with a randomly allocated psychosocial incentive. Questions required participants to grade and select psoriasis lesion pictures for a fictional trial. Participants also decided whether or not to schedule re-evaluation of patients deemed ineligible at initial visit. There were 646 participants. There was no significant difference in number of total lesions selected for study inclusion between incentive groups (Kruskal-Wallis, P=0.30). In general, participants completing empathy and professional uncertainty incentives selected the most and least number of lesion pictures for trial inclusion, respectively. Participants prompted with empathy incentives had significantly greater rates of choosing to schedule a follow-up visit for ineligible patients compared to participants prompted with other incentives (69.7% versus 59.1%, Chi square P=0.046). Situations evoking empathy may contribute to eligibility creep.

Review of the holistic management of pediatric atopic dermatitis.

Atopic Dermatitis (AD) is a chronic inflammatory skin disease that is broadly characterized by eczematous lesions and pruritus. This condition is detrimental in a multitude of ways, including patient quality of life (QOL), family QOL, economic burden, and psychosocial afflictions. Current management needs to incorporate a holistic approach which considers the financial, emotional, and physical limitations of both the treatments and the provider. A non-systematic search was conducted on the holistic management of pediatric AD. Various search queries were used such as the key terms of "atopic dermatitis," "pediatric," "eczema," "management," and more to encompass treatments, adherence, and comorbidities. There is an association with AD and depression in children, and its prevalence should be screened for routinely in children with AD. Collaboration with other specialties may prove to be prudent in addressing this comorbidity. Objective quality of life scores can open the door to much needed conversation with patients to get them the help they need. In expanding our scope, we find the extended consequences of AD have a ripple effect on families of pediatric patients. Lastly, we introduce a model for improving treatment adherence. CONCLUSION: Patient quality-of-life can be negatively affected by the symptoms, expense, stigma, and time commitment, and inconvenience imposed by complicated treatment regimens. To ensure proper, holistic management of pediatric AD, multiple factors must be considered; seasonal changes, lifestyle modifications, and the psychosocial impact are just a couple of factors that require monitoring. WHAT IS KNOWN: • Atopic dermatitis impacts patients and their families in quality of life, economically, and psychosocially. • Current treatment revolves largely around treating physical manifestation of disease with first line measures such as topical steroids. WHAT IS NEW: • The holistic management of AD incorporates a good physician-patient relationship, frequent follow-up, and providing structured written plans. • We introduce the house building model for improving treatment adherence. KEY POINTS: Pediatric AD can be managed in a more holistic manner which incorporates several factors from the lives of patients and their families. Pediatric patients suffer from many physical and mental comorbidities which should be screened for. Adherence with treatment may be improved by following a model which emphasizes establishing a good physician-patient relationship, frequent follow-up, and providing structured written plans.

Abametapir for the Treatment of Head Lice: A Drug Review.

OBJECTIVE: This article reviews the pharmacology, safety, efficacy, and clinical importance of abametapir 0.74% (Xeglyze) for the treatment of head lice. DATA SOURCES: From 2020 to May 2021, a systematic review of the MEDLINE and EMBASE databases was conducted using the terms abametapir, Xeglyze, Ha44, and head lice. Bibliographies, Food and Drug Administration (FDA) drug package inserts, and ClinicalTrials.gov were searched for further information. STUDY SELECTION AND DATA EXTRACTION: All relevant full-text articles in English were considered for inclusion, with a final article date range of 1999 to 2020. DATA SYNTHESIS: Abametapir chelates heavy metal cations and inhibits metalloproteinases critical to louse ova development, hatching, and adult survival. In phase II, abametapir had direct ovicidal activity inhibiting 100% of treated louse eggs from hatching, compared with 64% in the vehicle-treated group. In two identical phase III clinical trials, subjects treated with a single 10-minute application of abametapir had greater treatment success compared with vehicle-treated subjects, with 81.1% success versus 50.9% in study 1 (P = 0.001) and 81.8% versus 47.2% in study 2 (P < 0.001). Abametapir was well tolerated, with only mild adverse effects. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Abametapir is a newly FDA-approved, single-application treatment for head lice in patients aged 6 months and older. This review highlights the safety and efficacy of abametapir in the treatment of head lice. CONCLUSIONS: In the wake of increasing widespread resistance to first-line treatment options, abametapir offers a safe and effective new treatment option for head lice infestations.

Factors Influencing Patient Preferences for Phototherapy: A Survey Study.

There is limited literature regarding patient preferences for phototherapy. Patients may consider different forms of phototherapy depending on a multitude of factors important to them, including safety, cost, efficacy, insurance issues, and convenience. This study aimed to determine which form of phototherapy-in-office UVB, at-home UVB, home tanning, salon tanning, and sunbathing-was preferred by survey participants and the reasons for their preferences. Additionally, participants were asked which forms of phototherapy they considered safest and most efficacious, cost-effective, and convenient.

How should medical students prepare for a clinical dermatology rotation?

Skin diseases are commonly encountered in medical practice, yet medical students often receive little dermatology training. There is little research on what self-study materials best prepare students. We aim to identify which resources dermatology residents have found to be most useful in preparing for clinical dermatology rotations and dermatology residency. Forty current dermatology residents and fellows responded to our REDCap-generated survey. Data was analyzed using descriptive statistics. Most respondents (N=36, 90%) reported using outside resources to prepare for clinical dermatology rotations and dermatology residency. American Academy of Dermatology (AAD) modules and other online resources were most used (N=31, 77.5%) and most recommended (N=32, 80%). However, 67.5% of all respondents also used printed textbooks in some capacity, but low-to-no cost, usefulness, and easy accessibility of online resources made them more favorable among study participants. Multiple clinical dermatology rotations were recommended for preparing for dermatology residency (N= 34, 85%), as were other rotations, including internal medicine (N=22, 55%) and rheumatology (N=17, 42.5%). Overall, the AAD modules and online resources are most useful when preparing for clinical dermatology rotations because of favorable cost and accessibility. Compared to clinical rotations in other specialties, multiple rotations in dermatology may be most helpful for dermatology residency.

The effect of physician appearance on patient perceptions of treatment plans.

The presentation of a physician's clothing and themselves is an important part of the physician-patient interaction. Physician attire can impact patient satisfaction and trust in their physician. We sought to discover the influence physician attire may have on patients' comfort level with proposed treatment plans, which could influence treatment adherence. We surveyed 495 subjects to better understand the relationship between physician attire and patients' perceptions of treatment plans. We found subjects' comfort level in proposed treatment plans was not significantly affected by physician attire. This finding suggests physician attire may not be as important when considering the potential effect on treatment adherence.

Current pharmacological treatment guidelines for psoriasis and psoriatic arthritis.

INTRODUCTION: Psoriasis is a common chronic skin condition that is prevalent worldwide. Despite the numerous treatment options available, discrepancies exist between international guidelines. Areas covered: This review aims to evaluate the current international guidelines for the systemic treatment of psoriasis and psoriatic arthritis. Expert commentary: Most guidelines are unanimous on medication dosing and laboratory monitoring. However, even the most up-to-date guidelines do not include many of the new biologic medications. Guidelines will require frequent updates to include the newer treatments and will soon need to state a recommendation on the use of biosimilars.

Predictive genetic profiles for regional lymph node metastasis in primary cutaneous melanoma: a case-matched pilot study.

Melanoma confers an estimated lifetime risk of one in 50 for 2016. Clinicopathologic staging and sentinel lymph node biopsy (SLNB) have been the standard of care for T2 and T3 lesions. Molecular biomarkers identified in the primary lesion suggestive of metastatic potential may offer a more conclusive prognosis of these lesions. Our purpose was to investigate molecular mutations in primary melanoma that were predictive for micrometastasis as defined by a positive sentinel lymph node (SLN) in a case-controlled manner: nine patients with negative SLN and nine with positive SLN. The two cohorts were statistically identical as shown by a t-test for age (P=0.17), race (P=0.18), Breslow depth (P=0.14), Clark level (P=0.33), host response (P=0.17), ulceration (P=0.50), satellite nodules (P=0.17), lymphovascular invasion (P=0.50), and mitotic activity (P=0.09). While no single gene was significantly associated with SLN status, multivariate analysis using classification and regression tree assessment revealed two unique gene profiles that completely represented regional metastases in our cohort as defined by a positive SLN: PIK3CA (+) NRAS (-) and PIK3CA (-) ERBB4 (-) TP53 (+) SMAD4 (-). These profiles were identified in 89% of the patients with positive SLN; none of these profiles were identified in the SLN-negative cohort. We identified two unique gene profiles associated with positive SLN that do not overlap other studies and highlight the genetic complexity that portends the metastatic phenotype in cutaneous melanoma.