A Case of a Micronesian Woman in Hawai'i with Lymphoma and the Role of Implicit Bias in Medicine Affecting Her Care.

Medically indigent patients, patients of color, those with insufficient health insurance, or patients with severe diseases have a high rate of poor health care quality caused by unconscious implicit and explicit biases. Awareness of the relationship between unconscious implicit bias and negative health care outcomes is increasing in the health care community. The objective of this case study was to examine implicit biases that negatively affected the patient care of a young Micronesian woman with a severe cutaneous disease in Hawai'i. Her medical care and death may have been affected by a combination of implicit biases, including bias based on her race, type of health insurance, and underlying disease. Implicit biases and their role in health care disparities are often unintentional and not obvious. Increased awareness by health care providers may help to avoid inequities in clinical decision-making and improve outcomes.

Conflicts of Interest in "Throwaway" Dermatology Publications: Analysis of the Open Payments Database.

BACKGROUND: Dermatology journals, periodicals, editorials, and news magazines are influential resources that are not uniformly regulated and subject to influence from the pharmaceutical industry. This study evaluates industry payments to physician editorial board members of common dermatology publications, including "throwaway" publications. OBJECTIVE: The aim of this study was to characterize the extent and nature of industry payments to editorial board members of different dermatologic publications in order to ascertain differences in payments between different types of publications. METHODS: A list of editorial board members was compiled from a collection of clinical dermatology publications received over a 3-month period. Data from the Open Payments database from 2013 to 2019 were collected, and analysis of payments data was performed. RESULTS: Ten publications were evaluated, and payments data for 466 physicians were analyzed. The total compensation across all years was US $75,622,369.64. Consulting, services other than consulting, and travel or lodging payments constituted most of the payments. A fraction of dermatologists received the majority of payments. The top payers were manufacturers of biologic medications. Payment amounts were higher for throwaway publications compared to peer-reviewed journals. CONCLUSIONS: Editorial board members of dermatology publications received substantial payments from the pharmaceutical industry. A minority of physicians receive the lion's share of payments from industry. "Throwaway" publications have more financial conflict of interest than do peer-reviewed journals. The impact of these conflicts of interest on patient care, physicians' practice patterns, and patient perception of physicians is noteworthy.

Digging for the Deeper Diagnoses in Dermatology.

In a small private dermatology practice, I became aware that knowledge of some patients' adverse childhood experiences, traumatic experiences, and social determinants of health was essential to establish a successful therapeutic relationship. I discuss how these factors play important and lifelong roles in the disorders that dermatologists see, but these factors have not been addressed in the dermatology literature.

Conflicts of interest among dermatology textbook authors.

BACKGROUND: Conflict of interest as it relates to medical education is a burgeoning topic of concern. Dermatology textbooks are an influential resource for dermatologists. This study evaluates industry payments to authors of major dermatology textbooks. OBJECTIVE: The primary objective of this study is to evaluate whether authors of dermatology textbooks had appreciable conflicts of interest in the form of payments from industry. METHODS: This is a retrospective study in which the authors and editors of eight commonly used general dermatology textbooks were entered into the ProPublica Dollars for Docs database to identify industry payments data from 2016. RESULTS: The total compensation for 381 authors in 2016 was $5,892,221. Zero payments were reported for 39.6% of authors. Of the dermatologists, 50%, 66%, 70%, and 81% received less than $100, $500, $1000, and $5000, respectively. The top 10% of dermatologists who collected payments received $5,267,494, which represented 89% of the total payment amount. LIMITATIONS: The study was limited to eight textbooks. Data are only as accurate as reported to the Centers for Medicare and Medicaid Services. The database does not include information on dermatologists from non-U.S. institutions. Funding for clinical trials and other avenues of support (e.g., lasers, cosmetic instruments, institutional payments) are also not captured in this database. CONCLUSION: A minority of authors of influential dermatology textbooks received the lion's share of payments from industry.

Electrocardiographic changes after high-dose corticosteroid pulse therapy in pemphigus patients.

PURPOSE: The objective of the current study was to evaluate the effect of intravenous methylprednisolone pulse therapy on myocardial repolarization alterations, especially QT dispersion in anticipation of cardiovascular risks in patients with pemphigus vulgaris. METHODS: The current study is a prospective-controlled study on the electrocardiographic changes after methylprednisolone pulse therapy in 50 patients with pemphigus vulgaris. RESULTS: A total of 50 patients (28 female and 22 male) were included in our study. The mean heart rate was significantly higher in male patients both before (92 ± 10.80 versus 82.75 ± 12.01 ms) and after pulse therapy (102.73 ± 14.26 versus 91.07 ± 15.02 ms) (p value < .01). The value of heart rate was significantly greater after receiving steroid pulse therapy. Corrected QT dispersion before pulse therapy was 19.92 ± 8.2 ms that increased to 40.68 ± 18.12 ms after treatment (p value < .001). CONCLUSION: Our study shows that there is a relationship between pulse steroid infusion and increased predisposition to the occurrence of cardiac arrhythmias. QT dispersion could be a good marker to assess this risk in these patients.

Diffuse normolipemic plane xanthoma associated with monoclonal gammopathy.

Diffuse normolipemic plane xanthoma (DNPX) was first described by Altman and Winkelmann in 1962. It is a rare and non-inherited form of xanthomatosis. Clinically, the dermatosis is characterized by the presence of symmetric yellowish-orange plaques that favor the neck, upper trunk, flexural folds and periorbital region. It has been recognized to be associated with hematological diseases, especially with multiple myeloma and monoclonal gammopathy. We present a patient with diffuse plane xanthoma, normal lipid level, and monoclonal gammopathy.

Cherry Picking in the 'Aina: Inequalities of Access to Dermatologic Care in Hawai'i.

There is evidence that people who are insured by Medicaid have difficulty accessing health care from private providers. This study documents access to dermatology care for a hypothetical patient insured by Medicaid in the State of Hawai'i. Posing as young Medicaid patient with a changing mole, we called all dermatologists listed on the American Academy of Dermatology website and requested an appointment to be seen. Only 23% of dermatologists contacted accept all Medicaid plans and an additional 12% accept some. Thus 65% of dermatologists called do not provide specialist care to Hawai'i's Medicaid population.

Glowing in the dark: case report of a clue-poor melanoma unmasked by polarized dermatoscopy.

We report a case of a melanoma arising in a congenital-type compound nevus, which was excised because it was observed by both the patient and the treating dermatologist to have changed. Because the lesion was routinely photo-documented with both polarized and non-polarized dermatoscopy images prior to excision, these images were available for subsequent examination. Matched images are presented in what appears to be unique in the published literature: polarizing-specific white lines are identified as a compelling clue to the diagnosis of melanoma in a lesion that contains no clues apparent in the non-polarized image. Dermatopathology images reveal that the melanoma is arising in conjunction with a congenital type nevus. As expected, dermatoscopic polarizing-specific white lines are evident on the melanoma but not the nevus, and while a possible explanation is discussed, this remains speculative.

Dronaderone-induced phototoxicity.

Phototoxicity is a skin reaction that occurs in patients using photosensitizing drugs in combination with exposure to ultraviolet light. Common photosensitizing pharmacologic agents include antibiotics, non-steroidal anti-inflammatory drugs, diuretics, neuroleptics, retinoids, and amiodarone. Dronaderone is a novel antiarrhythmic that is similar in composition to amiodarone, but is non-iodinated and also has a methane-sulfonyl group, significantly decreasing its incidence of adverse effects as compared to amiodarone. While phototoxicity is a commonly reported complication of amiodarone, this reaction has rarely been documented in patients using dronaderone. We report the case of a 63 year-old woman with a history of atrial fibrillation that presented with a phototoxic drug eruption following use of dronaderone for maintenance of normal sinus rhythm.