Direct to Patient Synchronous Teledermatology During COVID-19 Pandemic.

Background: During the COVID-19 pandemic, teledermatology became a popular mode of health care delivery. Thus, deciphering which diagnoses are best suited for synchronous video visits is important to guide providers on appropriate patient care. Methods: We conducted a retrospective study of 1,647 submitted synchronous video visits from September 1, 2020 to March 31, 2021 at a single, large academic institution. Results: Video visits' follow-up rate was significantly associated with diagnosis subtype (p < 0.001). Compared with patients with skin lesions and nonskin dermatologic conditions, patients with a rash had higher odds of being recommended to have their follow-up visit as a video visit (odds ratio [OR] = 0.222, p < 0.001; OR = 0.296, p < 0.001). Patients with a rash had lower odds of being recommended to have their follow-up visit as an in-person office visit when compared with skin lesions (OR = 9.679, p < 0.001), nonskin dermatologic conditions (OR = 4.055, p < 0.001), and other skin dermatologic conditions (OR = 2.23, p < 0.01). Demographically, employed, middle-aged patients with private insurance made up the majority of video visit usage. African American patients were less likely to utilize a video visit compared with Asian patients (OR = 2.06, p < 0.038). Conclusions: Certain dermatologic diagnoses, most notably rashes, are more conducive to video visit management. Rashes made up 86% of new patient video visits, were more likely to have video visit follow-up if needed and were more likely to not require further follow-up indicating that the management of rashes from initial diagnosis to completion in care is suitable for video visit management.

The many masks of cutaneous Lyme disease.

Early cutaneous Lyme disease, erythema migrans, may show different histopathologic patterns. The intent of this case series is to raise awareness of these findings to prevent misdiagnosis and keep this entity in the differential. Erythema migrans develops after a tick bite and subsequent infection with the spirochete, Borrelia burgdorferi. It most commonly manifests as a solitary, annular lesion with a bull's-eye appearance. Classic histopathologic findings include superficial and deep perivascular and interstitial lymphocytic infiltrates mixed with plasma cells and eosinophils. We identified and reviewed eight cases of early erythema migrans. Each patient had confirmed B. burgdorferi IgM seropositivity and IgG seronegativity. Histopathologic evaluation of these biopsies reveals a diversity of patterns. Seven of eight cases show sparse to mild perivascular and interstitial mixed infiltrate of variable amount of lymphocytes, eosinophils, neutrophils and plasma cells, with only one case showing a dense inflammatory infiltrate. Epidermal changes such as spongiosis and interface change are seen in some cases. Additionally, perineural lymphocytic infiltrate is seen in one case, periadnexal infiltrate in four cases and pigment incontinence in one case. Based on variable histopathologic findings, it is important to consider erythema migrans in the differential diagnosis for prompt diagnosis and treatment.

Systematized contact dermatitis and montelukast in an atopic boy.

Upon ingestion, the artificial sweetener, aspartame is metabolized to formaldehyde in the body and has been reportedly associated with systemic contact dermatitis in patients exquisitely sensitive to formaldehyde. We present a case of a 9-year-old Caucasian boy with a history of mild atopic dermatitis that experienced severe systematized dermatitis after being started on montelukast chewable tablets containing aspartame. Patch testing revealed multiple chemical sensitivities which included a positive reaction to formaldehyde. Notably, resolution of his systemic dermatitis only occurred with discontinuation of the montelukast chewables.

A diagnostic pearl in allergic contact dermatitis to fragrances: the atomizer sign.

Allergic contact dermatitis (ACD) reactions to fragrances may present in a variety of ways because of exposure to these allergens from a wide range of sources. We describe a diagnostic pearl for this common ACD, primarily seen overlying the prominentia laryngea (Adam's apple) both in women and girls, which we have called the atomizer sign.

Alternatives for fragrance-allergic children.

In 2007 "fragrances" were named "allergen of the year" by the American Contact Dermatitis Society to highlight the importance of this group of allergens. Because fragrance allergy in children is a real problem that is potentially avoidable by substituting products free of these sensitizing chemicals (see Table, page 103), action toward awareness and prevention is imperative.

[Ultraviolet absorption of prescription sunblocks in Mexico]. / Absorción ultravioleta de los protectores solares para prescripción en México.

BACKGROUND: An appropriate sunscreen should provide high and broad ultraviolet protection both for the B and A range. The objective was quantify the ultraviolet absorption spectrum in sunscreens available for medical prescription, and analyze its relationship with the labeled Sun Protection Factor (SPF). MATERIAL AND METHODS: Thirty-nine sunscreens were analyzed in vitro using ultraviolet spectroscopy following exposure to simulated solar irradiation. RESULTS: Fifty-six percent of sunscreens absorbed 90% or more of ultraviolet radiation. Seventy-five percent (n = 34) absorbed more than 95% of ultraviolet B radiation, and 46% (n = 18) more than 90% of ultraviolet A. There was no significant association between ultraviolet absorption and SPF. CONCLUSION: We were unable to estimate ultraviolet absorption only by its SPF. Protection differed considerably among products with similar SPF. Our study highlights regulation deficiencies in marketing practices of these products.

Effects of lavender olfactory input on cosmetic procedures.

OBJECTIVES: To evaluate the effects of the aroma of essential oil of lavender against placebo on subjects' pain perceptions and levels of anxiety when undergoing elective cosmetic facial injections of botulinum toxin type A (BOTOX(®) COSMETIC) for the correction of glabellar wrinkles. METHODS: Subjects (N=30) who had not previously received any cosmetic facial injections were randomized to essential oil of lavender aroma exposure or to placebo during elective cosmetic facial injections of BOTOX(®) (12 U) for the correction of glabellar wrinkles. Evaluations of subjects' pain perceptions and levels of anxiety assessed by the Spielberger State-Trait Anxiety Inventory, heart rate (HR), and blood pressure (BP) measurements were taken at baseline, before, and after injections. RESULTS: Subjects exposed to essential lavender oil showed a significant reduction in HR after the injection as compared to the pre-injection HR. Subjects exposed to the placebo did not show any significant difference in BP or HR between pre-injection and postinjection. CONCLUSIONS: Although essential oil of lavender did not have an effect on the subjects' perception of pain during a facial injection, subjects showed significant increases in parasympathetic activity when exposed to the lavender aroma. Lavender aromatherapy has the potential to ease anxiety in patients undergoing minimally invasive facial cosmetic procedures.

Patterns of cosmetic contact allergy.

Certain patterns of dermatitis, such as those affecting the face, eyelids, lips, and neck, should raise the suspicion of a cosmetic-related contact allergy. Patch testing with a broad screening series, supplemented by a patient's own personal care products, should be considered when evaluating patients with suspected cosmetic dermatitis. Once the offending allergen is identified, an avoidance regimen should be established to avoid further exposure.

Ethics of selling skin care.

One of the most controversial topics surrounding the practice of dermatology is in-office dispensing of nonprescription skin care products by dermatologists. The controversy is not new, with legitimate arguments debated for and against it. The ongoing debate will continue, emotionally charged and with sharply demarcated battle lines, but without the promise of ever reaching a consensus. Regardless of one's position, the objective is to develop strategies to improve the practice of dermatology and the welfare of patients.

Aging and contact dermatitis: a review.

As the population continues to age, understanding the differences between aged and young skin becomes more important to the clinician. Contact dermatitis is just one of the clinical entities that presents differently in the geriatric population. Reactions can be delayed in onset, and prolonged in duration. These altered presentations are the direct result of the pathophysiologic changes that occur in aging skin. It is especially important to recognize contact dermatitis in this age group, and to treat in a timely fashion.

Inflammation in green (chromium) tattoos during patch testing.

We report three patients with permanent tattoos and chronic dermatitis. During patch testing, the patients' dermatitis worsened, and the previously quiescent green-colored portions of the tattoos became inflamed. All three patients were patch-tested and had positive reactions to potassium dichromate 0.25% in petrolatum. Avoidance led to the resolution of both the dermatitis and the tattoo inflammation. We recommend assessment of permanent tattoos for inflammation in all patients undergoing patch testing, for additional diagnostic correlation.