Most Online Resources for Home Suture Removal are Poor in Quality.

Introduction: At home suture or staple removal can be stressful for patients and may lead some to seek out additional instruction via online resources as an adjunct to what was explained to them by their provider. The purpose of this study was to examine the existing online resources available to patients who may be interested in or have been instructed to remove sutures at home after a simple procedure, such as a skin biopsy or excision. Methods: A systematic search was conducted using internet search engines to identify videos and webpages targeting at home suture removal instruction. The DISCERN instrument was used to evaluate the information quality of each included resource. Results: There was no statistically significant difference between average DISCERN scores for videos and webpage resources, and the majority were rated poor in quality. Conclusions: The online resources for at home suture and staple removal were often not comprehensive and were below the standard quality for written information. Health care providers should consider referring their patients to validated online sources for suture removal to prevent misinformation and improve patient safety.

A Multi-Site Survey Study of Patient Satisfaction with Teledermatology.

Introduction: Telemedicine has been of heightened focus due to spikes in usage during the COVID-19 pandemic. Disparities in health care may affect patient satisfaction with this resource depending on factors such as patient race, age, or socioeconomic background. The purpose of this study was to analyze patient satisfaction with teledermatology to identify any differences in satisfaction based on race, age, and income during the COVID-19 pandemic period. Methods: A 21-question, IRB-approved survey was administered to patients at two academic dermatology clinics in Kansas City. Patient satisfaction was measured using a five-point Likert scale. Results: A total of 64 completed surveys were analyzed (17.8% response rate). Most of the participants were female (n = 48, 75%), age 45 to 60 (n = 17, 26.6%), and reported White for race (n = 55, 85.9%). Overall, 73.4% (n = 47) of patients reported being satisfied with their visit. However, only 38.7% (n = 24) of participants were likely to choose a video over an in-person visit. Reasons for low patient satisfaction included concerns regarding ability to perform an accurate physical exam with a video visit (n = 9, 14.1%), receiving inadequate care (n = 4, 6.3%), protected privacy (n = 3, 4.7%), and provider understanding the patient (n = 2, 3.1%). Conclusions: Our findings were similar to prior studies stating no difference in patient satisfaction with regards to age, income, or race and patients reporting high satisfaction with teledermatology appointments despite a preference for in-person dermatology visits. Future studies with a larger diverse cohort of participants are needed to elucidate and address possible disparities associated with teledermatology use.

Non-dermatomal cutaneous herpes zoster infection in a solid-organ transplant patient.

Diagnosis of atypical generalized forms of herpes zoster can be a challenge and may lead to a delay in treatment. Herpes zoster can present with atypical clinical manifestations, some with higher risk of complications that are potentially life-threatening. We describe a patient that presented with several ulcerated papules and plaques in a non-dermatomal distribution in whom disseminated cutaneous herpes zoster was proven by molecular amplification testing. Patients with disseminated herpes zoster should be treated initially with intravenous antiviral therapy, followed by oral acyclovir, valacyclovir, or famciclovir in most adults, with close follow-up. Earlier treatment may reduce the risk of developing complications and progression of visceral involvement. This case adds to the evolving literature related to herpes zoster, especially regarding patients with immunosuppressed status.

Herpes vegetans on the shoulder mimicking nonmelanoma skin cancer.

Atypical morphologic and anatomic presentations of herpetic infection can be a diagnostic and therapeutic challenge. Although herpes simplex virus type 2 (HSV-2) infections primarily occur in the oral or anogenital region, our patient presented with ulcerated vegetative plaques on the shoulder sharing clinical features with nonmelanoma skin cancer (NMSC). Depending on the clinical appearance and anatomical site, proper workup including biopsy can be pivotal to arrive at a correct diagnosis as lesions can mimic a broad spectrum of cutaneous diseases, particularly if the lesion occurs in an atypical location. Dermatology providers should include HSV-2 in the differential diagnosis when challenged with unusual ulcerated or verrucous lesions.

Activity-Based Checks (ABCs) of Pain: A Functional Pain Scale Used by Surgical Patients.

Introduction: Increased rates of surgery, combined with concerns about high-risk pain medications, have highlighted the need for improved methods of meaningfully assessing pain. In response to lack of medical context and functional data in existing scales, the Activity-Based Checks (ABCs) was developed. Methods: This prospective, cohort study was deployed at a single-institution, academic center. The primary outcome was to correlate the ABCs to the 0 - 10 numeric rating scale (NRS) in post-operative general surgery patients. Secondary outcomes included assessing the impact of patient factors and prescribing patterns on opioid consumption, in milligrams of morphine equivalents (MME), after discharge. Results: The function that correlated most to the NRS at discharge was "Out of Bed to Chair". Indicators of better mental health were correlated inversely with MME consumption. Interestingly, the largest predictor of MME taken was MME prescribed. Over 40% of prescribed opioids goes unused. Conclusions: Functional pain scales, like the ABCs, may be useful adjuncts to evaluate pain. Individual functions, such as, "Out of Bed to Chair", may be of particular importance. Clinicians must be aware that the strongest predictor of MMEs taken by patients was MMEs prescribed, highlighting the importance of better pain assessments and opioid stewardship.

Vitamin K2 Awareness in Sun-Protected Patients Supplementing With Vitamin D.

Dermatologists often recommend vitamin D for sun-protected patients. Most patients are not aware of the key role vitamin K2 plays in vitamin D metabolism and do not receive sufficient dietary vitamin K2. A survey of 50 sun-protecting patients shows 4/50 understood the role of vitamin K2 and 1/50 was supplementing vitamin K2. Therefore, counseling on vitamin K2 supplementation may be of benefit to sun-protected dermatology patients. J Drugs Dermatol. 2021;20(2):228-229. doi:10.36849/JDD.5829.