The Use of Teledermatology for Skin Cancer Referrals: A Retrospective Study in a Single Tertiary Centre.

INTRODUCTION: Teledermatology utilises telecommunications technology to deliver dermatological care remotely, incorporating live video consultations, store-and-forward systems, and hybrid approaches. It is particularly valuable in underserved or remote areas with limited access to dermatologists. Reported benefits include reduced face-to-face consultations for benign lesions, leading to increased capacity for severe cases, improved access for rural patients, and enhanced satisfaction among clinicians and patients. The COVID-19 pandemic accelerated the adoption of teledermatology, integrating it into the National Health Service (NHS) framework for managing referrals and ensuring continuity of care. This study examines the outcomes of two-week wait referrals for suspected skin cancer, focusing on diagnostic concordance between teledermatology and histopathology. MATERIALS AND METHODS: The study was conducted at Addenbrooke's Hospital, part of Cambridge University Hospitals, via a retrospective review of patient records from November 2022 to May 2023. Inclusion criteria were all patients referred by their general practitioner (GP) under the two-week wait for suspected skin cancer pathway. Data collected included patient demographics, waiting times, clinical and histological diagnoses, and patient re-referrals for the same problem. The primary objective was to assess diagnostic concordance between the clinical diagnosis from teledermatology and histopathology. Secondary objectives included accuracy of lesion site description, patient waiting times, and computed time savings from the use of teledermatology. RESULTS: The study covered 71 patients (34 males, 37 females) aged 19-87 years (mean: 59.63), with Fitzpatrick skin I-III predominating. A total of 110 individual lesions were assessed, and 46 required surgical management. Clinical and histological concordance was 62%, with 100% accuracy for basal cell carcinoma (BCC) and melanoma. The service saved 10 hours of consultant time and reduced the need for 62 initial face-to-face consultations. Lesion site documentation had a 73% correlation between GPs and dermatologists. Diagnoses varied widely between GPs and dermatologists, with a 31% concordance. CONCLUSION: Our study shows that teledermatology is a safe and effective method for managing two-week wait referrals for suspected skin cancer, reducing footfall, and saving time and costs for both clinicians and patients. While there are limitations, the usage of teledermatology allows increasingly limited capacity for face-to-face consultations to be reserved for high-risk patients. Further studies in different regions should explore teledermatology's utility across diverse demographics, particularly to address healthcare disparities for those with darker skin tones.

The History and Current Status of Platelet-Rich Plasma Therapy in Dermatology.

Since the 1800s, platelet-rich plasma (PRP) has been used as a treatment for a wide range of medical conditions with a concomitant effect of tending to reduce the need for some invasive procedures. The aim of this narrative review was to concisely document the history and current usage of PRP specifically in the field of dermatology. Four databases (PubMed, Google Scholar, CINAHL, and Web of Science) were searched for primary articles written in English that evaluated human subjects and focused on PRP use in dermatology. Initial search terms included "platelet rich plasma," "alopecia," "androgenic alopecia," "dermatology," "PDGF," "aging," "skin rejuvenation," "diabetic ulcers," "venous leg ulcers," "acne," "acne scars," "scars," "hyperpigmentation," "melasma," "hypopigmentation," "vitiligo," and "PRP." After review, articles were excluded if they were commentaries, editorials, animal studies, review articles, or were unrelated to dermatology. The bibliography of retrieved articles was also searched for relevant articles. The present review results describe the function of PRP from its first usage for thrombocytopenia to its usage for melasma. In this time frame, its use in dermatology has gone through many evolutions from using its healing factors for treating wounds to using it as the treatment for wrinkles, hair loss, scars, ulcers, and skin pigmentation disorders. Its anti-inflammatory and growth factors have been shown to initiate a healing cascade that promotes the growth and regeneration of tissues. It is hoped that this review will help educate patients and physicians about the efficacy of PRP therapy and thereby help avoid unnecessary invasive procedures for certain conditions.

Inhaled Analgesia in Dermatologic Settings: A Comprehensive Overview of Methoxyflurane.

Pain management is an important aspect of dermatologic procedures, which are typically performed on awake patients in outpatient settings. The first-line modalities for procedural analgesia during most dermatologic procedures are topical and injectable local anesthetics, such as lidocaine. However, in some medical and cosmetic dermatologic procedures, pain cannot be effectively managed with local anesthetics due to procedure-specific lack of efficacy, large treatment surface areas, high dosage requirements, allergies, or other contraindications. In these circumstances, methoxyflurane inhalers may be highly beneficial. Methoxyflurane (Penthrox®) has demonstrated efficacy for providing pain relief in randomized controlled trials in patients who presented to emergency departments with acute trauma-related pain, as well as in patients undergoing painful procedures for other medical indications. The limited side effect profile, ease of patient self-administration, rapid onset and quick resolution of central nervous system effects following cessation makes methoxyflurane an ideal choice for analgesia during outpatient dermatologic procedures. This review provides an overview of the supporting evidence for methoxyflurane inhalers and clinical commentary on potential indications for methoxyflurane use in dermatology.

Untapped saga of paediatric nevo-blaschkoid seborrheic keratosis.

Seborrheic keratosis (SK) has long been known to be an acquired benign tumour of adulthood. Nevo-blaschkoid pattern of SK presenting during infancy is rare and puts a clinician in a quandary regarding final diagnosis. This hypothesis of paediatric SK being a subtype of epidermal nevus (EN) has muddled the understanding of both disorders. There are histopathological pointers that differentiate seborrheic keratosis from SK-like histology of EN. Here, we present a child with blaschkoid SK with onset during infancy. Dermoscopic evaluation showed comedo-like openings suggestive of SK. The benefits of performing shave biopsy were twofold. Diagnostic confirmation of it being SK and not SK-type of EN and therapeutic option of their simultaneous removal ensured prompt management.

Novel methylenetetrahydrofolate reductase (MTHFR) mutation presenting with neonatal encephalopathy, hair loss and marfanoid features.

We present a case of a male term neonate with lethargy, hypotonia, hypoventilation and severe encephalopathy. The infant had a history of two siblings who died in the neonatal period from unclear causes. The infant exhibited skin and hair abnormalities, including desquamation of the extremities, angular stomatitis, cheilitis, neonatal acne and thin, sparse hair. Additionally, the infant had a tall stature; long, slender fingers and toes; and facial dysmorphism characterised by a long, narrow face with increased interpalpebral distance. The condition deteriorated rapidly, and unfortunately, death occurred before a definitive diagnosis could be established. Tandem mass spectrometry suggested low methionine and clinical exome sequencing identified a nonsense mutation in the MTHFR gene.

Scoring Criteria for Autoimmune Bullous Diseases: Utility, Merits, and Demerits.

Background: Scoring systems play a crucial role in dermatology by providing objective measurements of disease severity, treatment efficacy, and outcome comparisons. In autoimmune blistering diseases (AIBDs), standardized scoring systems are essential for accurate evaluations; however, there is currently a lack of consensus on scoring methods. Objective: This literature review explores scoring systems in AIBDs by tracing their development, addressing challenges, and highlighting their role in defining endpoints, regulatory considerations, and clinical trials. Materials and Methods: Existing scoring systems for AIBDs, such as the Pemphigus Disease Area Index, Autoimmune Bullous Skin Disorder Intensity Score, Pemphigus Oral Lesions Intensity Score, Oral Disease Severity Score, and Pemphigus Vulgaris Activity Score, are examined for their validity, reliability, and responsiveness. The Bullous Pemphigoid Disease Area Index for bullous pemphigoid is also discussed. The concept of minimal clinically important differences is explored to determine clinically significant improvements in disease severity. Conclusion: This review provides a comprehensive understanding of the central role of scoring systems in dermatology and their implications for research and clinical practice in AIBDs.

Botulinum Toxin for the Treatment of Postmenopausal Craniofacial Hyperhidrosis.

Postmenopausal craniofacial hyperhidrosis describes a unique subset of primary focal hyperhidrosis in menopausal woman. This condition can be challenging to treat and may require multiple treatment modalities before patients express satisfaction with the results. Current treatment options for craniofacial hyperhidrosis include oral antimuscarinic agents, topical aluminum chloride powder, and botulinum toxin injections. We present the case of a 68-year-old female with craniofacial hyperhidrosis who did not respond to topical agents and did not tolerate an oral antimuscarinic agent. The patient was successfully treated with 100 units of onabotulinum toxin A along the forehead, frontal hairline, and periauricular scalp and reported significant improvement in symptoms and quality of life as a result. We review the literature describing targeted intradermal injection of botulinum neurotoxin as an alternative to medical therapy for craniofacial hyperhidrosis.

The importance of pathway programs in increasing diversity in dermatology: Efforts made by the American Academy of Dermatology.

Our country's population continues to diversify, highlighting the need for an equally diverse physician workforce to care for patients. Unfortunately, the percentage of underrepresented minority residents in dermatology has remained relatively unchanged over the past several years. To address this disparity, the American Academy of Dermatology created the Pathways Programs to focus on early exposure to dermatology, skill-building workshops, research, and mentorship. The overarching goal is to increase the number of underrepresented minority dermatologists, which will result in improved patient care and mitigation of healthcare disparities.

Treatment methods for oesophageal strictures in paediatric patients with epidermolysis bullosa: a systematic review.

BACKGROUND: Epidermolysis bullosa (EB) is a collection of rare, inherited disorders that require treatment in specialised centres by multidisciplinary teams knowledgeable about the unique features and challenges of EB manifestations and complications.A major gastrointestinal complication in patients with EB is oesophageal strictures. Effective management of oesophageal strictures can significantly improve patients' quality of life. This study systematically reviews the current literature on treatment options for oesophageal strictures in paediatric patients with EB. METHODS: In September 2023, we conducted a systematic search for articles on the treatment of oesophageal stricture in patients with EB. We searched PubMed, Scopus, Embase and Ovid database without language or publication date restrictions. We screened 1042 articles, 15 of them were included in the current review. We extracted the following data from these studies: patient demographics, stricture characteristics, procedural details, clinical outcomes, complications and recurrences. RESULTS: Overall, in the reviewed papers, strictures were located mostly in cervical oesophagus followed by thoracic lesions. Moreover, in most of the cases only a single stricture was reported, but multiple strictures were not uncommon. Stricture treatment approaches included medical management, bougienage, as well as fluoroscopic and endoscopic balloon dilation or a combination of these methods. In most studies, fluoroscopic dilation was used as the primary treatment method in 756 procedures. They commonly used general anaesthesia for the procedure, only one study used sedation. Hospital stays were usually brief, with an average duration of 1 day, and in one study patients were discharged after just 4 hours. Most patients experienced symptom relief, could resume oral intake and gained weight soon after the procedure. However, recurrence rates had large variations from 12% to 83%. Studies reported median recurrence intervals ranging from 7 to 18 months. This review showed that complications such as perforation, fever and odynophagia were relatively uncommon, and were controlled by conservative treatment. CONCLUSIONS: Both fluoroscopic and endoscopic balloon dilation are widely used methods for the management of oesophageal strictures in patients with EB. Each technique presents its own set of advantages and potential complications. Although the current evidence is notably limited, practical clinical decision-making may favour the fluoroscopic technique over endoscopic balloon dilation due to a comparatively reduced risk of procedural trauma. To ascertain the most effective approach, high-quality randomised controlled trials are imperative to delineate the superiority of one technique over the other.

Oral Mucosal Lesions in Patients Attending Dermatology Outpatient Department of a Tertiary Care Center in Kathmandu: A Descriptive Cross-sectional Study.

INTRODUCTION: Oral mucosal lesions though mostly benign, may impair the quality of life of patients. Some may even progress to malignancies. Many physicians, including dermatologists, tend to skip oral examinations, missing many important diagnoses. Understanding the frequency and types of oral mucosal lesions in dermatological settings can help in early diagnosis, referral and adequate treatment. This study was done to determine demographic characteristics and clinical presentations of patients with oral mucosal lesions presenting to the out-patient department (OPD) of dermatology in Nepal Armed Police Force (APF) Hospital, Kathmandu. METHODS: This cross-sectional descriptive study was conducted after obtaining the ethical approval from the Institutional Review Committee of Nepal APF Hospital. Retrospective data of 264 patients presenting with oral mucosal lesions to the dermatology OPD were collected from 1st January 2021 to 31st December 2023 by using a pre-formed proforma. Data was entered in SPSS software and descriptive statistics were computed. RESULTS: Out of 13,832 cases, oral mucosal lesion was seen in 264 (1.90%) cases among which 153 (57.96%) cases were males with male female ratio of 1.37:1. Most common age group affected was 31-45 years 96 (36.36%). Buccal mucosa 86 (32.57%) was the commonest site involved followed by tongue 73 (27.65%). Aphthous ulcer 82 (31.06%) was the commonest lesion found followed by oral candidiasis 25 (9.46%) and oral lichen planus 24 (9.09%). CONCLUSIONS: Aphthous ulcer was the commonest oral mucosal lesion seen in patients visiting dermatology outpatient department of Nepal APF Hospital, with buccal mucosa being the commonest site affected.

Triple therapy approach for treating chromoblastomycosis in a Lebanese patient.

Chromoblastomycosis, though rare in non-endemic regions like Lebanon, should be considered in patients presenting with chronic, verrucous skin lesions unresponsive to conventional therapies. Multimodal treatment combining oral antifungals, cryotherapy, and adjunctive topical 5-Fluorouracil demonstrates efficacy in managing refractory cases. Follow-up visits three and 6 months after treatment cessation showed sustained lesion clearance and no recurrence.

Itchy and Swollen: Atopic Dermatitis With Cephalocervical Lymphadenitis in an Infant.

We present a case of a three-month-old Hispanic female seen in the clinic for atopic dermatitis (AD) along with a rare incidence of associated cephalocervical lymphadenitis. The patient had a three-month history of redness, irritation, inflammation, and pruritus of the scalp, face, torso, and lymph nodes. The history and examination originally indicated seborrheic dermatitis with AD, impetigo, and folliculitis on the differential. Due to the rarity of this presentation, it is crucial to increase clinical recognition and awareness of this combination among physicians to improve patient outcomes. Recognizing this unusual presentation can lead to more accurate diagnoses and tailored treatment plans, ultimately benefiting the patient while also advancing our understanding of similar cases.

"Infantgram?" recruitment of infants to a clinical sleep study via social media.

Study Objectives: This study aimed to outline the strategy and outcomes of a study team in recruiting participants for an infant sleep study via social media during the COVID-19 pandemic, to assess the feasibility of recruitment via social media, and to quantitatively and qualitatively explore parental satisfaction and perceptions of recruitment via social media. Methods: The assessing sleep in infants with early-onset atopic dermatitis by longitudinal evaluation (SPINDLE) study recruited infants with and without atopic dermatitis for a longitudinal study assessing sleep. Infants were recruited via social media and their parents were interviewed to explore their experience of recruitment via social media. Results: In total, 57 controls and 33 cases were recruited. Of the 45 controls recruited via social media, 43 (95.6%) were recruited via Instagram and 2 (4.4%) were recruited via Twitter. Of the seven cases recruited via social media, 6 (85.7%) were recruited via Facebook (via sharing of Instagram posts by third parties on Facebook) and 1 (14.3%) was recruited via Instagram. All (100%, n = 28) mothers recruited via social media who completed the full study were satisfied with this approach to recruitment. Specific reasons why mothers reported engaging following exposure to the social media posts included the benefit of additional health checks for their baby, the benefit to scientific advancement, and the opportunity for a stimulating outing following the COVID-19 lockdowns. Conclusions: Our experience highlights parents' acceptance of recruitment via social media, the optimization of time and financial resources, and the benefit of using internet-based recruitment during a pandemic.

Spotlight on the Uncommon: A Rare Case of a Malignant Glomus Tumor of the Skin.

Glomus tumors arise from a neuromyoarterial plexus origin, typically demonstrating branching vascular channels and aggregates of specialized glomus cells. They are characteristically identified in the subungual region of the hand, with the presentation of firm, red or blue nodules that are painful and sensitive to temperature. However, very few cases of malignant glomus tumors of the skin have been reported in the medical literature, making this case quite unique. This case report aims to identify an additional case of this rare condition, discuss the treatment plan pursued, and bring awareness to this distinct oncological entity. A 41-year-old female patient initially presented to her primary care physician with an enlarging and painful nodule on her left temple that had been present for the last two months. The patient was then referred to plastic surgery for excision and pathological workup of the mass. The pathology report of the excised specimen revealed a malignant glomus tumor of the skin. The patient was subsequently scheduled for an oncologic workup with medical oncology and radiation oncology, and a wide excision was performed after the pathologic diagnosis. With negative margins from the wide excision and no evidence of disease spread, it was determined that there was no role for systemic therapy or radiation therapy at that time. Biannual dermatologic examination and monitoring are indicated for follow-up. With very few reports of similar cases and little information in the medical literature on the treatment of this type of neoplasm, this is a unique and rare case that warrants discussion and exposure. Making the correct diagnosis, performing a complete workup, and removing the malignant glomus tumor are all essential parts of medical management in this case, and this type of neoplasm should not be excluded when evaluating the presentation of unusual cutaneous lesions.