Oral contraceptives for acne treatment: US Dermatologists' knowledge, comfort, and prescribing practices.

The use of oral contraceptive pills (OCPs), which can be an effective treatment of acne in women, is poorly understood among many dermatologists. In this study, we surveyed 116 US dermatologists about their knowledge, comfort, and prescribing practices pertaining to the use of OCPs. The majority of respondents had previously prescribed OCPs and believed they were an effective treatment of acne in women. Despite adverse effects such as increased risk for venous thromboembolism (VTE) associated with OCPs, especially those containing drospirenone, our study indicated that many dermatologists believe the benefits of increased treatment efficacy may outweigh the risks.

Who uses the emergency department for dermatologic care? A statewide analysis.

BACKGROUND: Emergency department (ED) visits for skin symptoms are on the rise. The nature of these visits is not yet well characterized. OBJECTIVE: We sought to conduct a longitudinal analysis comparing patients discharged from the ED with dermatologic primary diagnoses to those with nondermatologic primary diagnoses. METHODS: Using the California State ED Database, we compared demographic variables and visit characteristics of patients discharged with dermatologic primary diagnoses (International Classification of Diseases, Ninth Revision, Clinical Modification codes 680-709) to those of patients discharged with nondermatologic primary diagnoses from 2005 to 2011. RESULTS: Patients given dermatologic primary diagnoses in the ED were more likely to be male, aged 18 to 54 years, white or Native American, and low income. They tended to be self-pay patients or have Medicaid, to live in less populous areas, and to visit the ED on the weekend. LIMITATIONS: Results from California may not be generalizable nationally. The databases we used were based on administrative records, which have limited clinical detail. CONCLUSION: The population of patients discharged home from the ED with dermatologic primary diagnoses appears to differ significantly from the population receiving nondermatologic primary diagnoses.

Causes and recommendations for unanticipated ink retention following tattoo removal treatment.

While placement of ink into the skin is a long-standing tradition, patients are now seeking tattoo removal on a more frequent basis. Once considered acceptable removal options, tattoo ink removal via physical destruction included dermabrasion, chemical destruction, salabrasion, thermal destruction, and cryotherapy. Now these options are used extremely infrequently. These modalities provided unpredictable results and often required prolonged healing times and left patients with skin discoloration, pain, scarring, and ink retention. Even the widely adopted use of lasers, now considered the gold standard method, offers some level of unpredictability surrounding the natural progression of ink resolution. Multiple factors need to be taken into consideration when successfully removing tattoo pigment including the modalities used, number and frequency of treatments, proper device technique, and physiological barriers to tattoo removal. This paper serves to elucidate the common causes of ink retention following tattoo removal treatment with recommendations on how best to address this relatively common occurrence.

Basic pharmacology of topical imiquimod, 5-fluorouracil, and diclofenac for the dermatologic surgeon.

BACKGROUND: Ultraviolet radiation (UVR) contributes to the vast majority of nonmelanoma skin cancer (NMSC). As the incidence of NMSC continues to rise, topical therapies will be used with increasing frequency. Topical therapies may benefit high-risk surgical candidates as an alternative treatment modality and may improve overall cosmesis. The most commonly employed topical therapies are imiquimod, 5-fluorouracil (5-FU), and diclofenac. OBJECTIVE: To review the detailed mechanism of action and side-effect profiles of each topical therapy used to treat NMSC and to explore newly discovered actions. Uncommon adverse events are also presented. MATERIALS AND METHODS: An extensive literature search was performed to describe the pharmacologic actions of imiquimod, 5-FU, and diclofenac. CONCLUSION: A keen understanding of the pharmacologic concepts of these topical therapies may aid the dermatologic surgeon in making sound choices before, during, and after surgery.

Medical school dermatology curriculum: are we adequately preparing primary care physicians?

BACKGROUND: There is a lack of information regarding the dermatology learning needs of primary care physicians and residents. OBJECTIVE: To determine dermatologic topics that primary care physicians consider important and to determine primary care residents' ratings of the teaching adequacy of these topics in the undergraduate medical curriculum. METHODS: Primary care physicians and residents were surveyed regarding the importance and teaching adequacy of 17 dermatologic content areas. RESULTS: Ninety-two primary care physicians identified 13 dermatologic content areas important for their practices. Two hundred fifty-two primary care residents identified 8 adequately taught topics and 9 inadequately taught topics. LIMITATIONS: Internal medicine and family medicine physicians and residents from only 10 regions were surveyed. CONCLUSION: Seventeen content areas can be divided into 3 categories: dermatologic topics that are important and adequately taught, topics that are unimportant, and a group of important, yet inadequately taught content areas. This latter group should be further integrated into dermatology curricula at U.S. medical schools.

A community-based study of acne-related health preferences in adolescents.

OBJECTIVE: To examine preferences for acne-related outcomes in adolescents. DESIGN: Community-based, cross-sectional survey study. SETTING: Four public high schools in San Francisco, California. PARTICIPANTS: Volunteer sample of 266 adolescents with acne. MAIN OUTCOME MEASURES: Health utilities for current acne state and 3 hypothetical acne-related states (100% clearance, 50% clearance, and 100% clearance but with residual scarring) using time trade-off (TTO) and willingness to pay metrics. A self-administered written survey was used. RESULTS: The mean (median) utilities for current acne state using the TTO metric was 0.961 (0.985). One hundred percent acne clearance received a higher utility score (mean [median] score, 0.978 [0.994]) than 50% clearance (0.967 [0.992]; P < .001 by Wilcoxon signed rank test) and 100% clearance with scarring (0.965 [0.992]; P < .001). Although current acne state utility was not correlated with physician-rated severity (P = .23), a significant association with subject-rated severity was observed in both univariate analysis (P = .01) and after adjustment for duration of acne, having seen a physician for acne, and income (P = .05). Adolescents were willing to pay a median of $275 to have never had acne in their lifetime and were willing to pay significantly more for 100% clearance than for 50% clearance or 100% clearance but with scarring (P < .001 for both comparisons). CONCLUSIONS: We describe adolescents' acne-related health state utilities. Compared with current acne state utility, both partial and total clearance with scarring are substantially less preferable than total clearance. Subjects' self-rated disease severity correlates with current acne state utility, whereas physician-rated severity does not. A self-administered paper instrument can effectively assess adolescents' acne-related preferences in community-based samples.