Perceptual learning in dermatology-A Finnish cohort study of undergraduate medical students.

BACKGROUND: Implicit visual skills play an important role in the recognition of skin-related conditions. OBJECTIVES: We aimed to evaluate effectiveness and practicability of digital perceptual learning modules (PLMs) during undergraduate teaching of dermatology. METHODS: The study consisted of four subsequent dermatology courses including 105 medical students. PLMs designed for an online setting were carried out before, during and at course ends, as well as 6-12 months after the courses (N = 33). We investigated four important outcome measures regarding perceptual learning: diagnostic accuracy (%-percentage of correct responses), decision duration (response time), recognized features (decision basis) and student-perceived confidence. RESULTS: Diagnostic accuracy (p < 0.001, effect size η p 2 = 0.82), fluency (p < 0.001, η p 2 = 0.23) and confidence (p < 0.001, η p 2 = 0.74) increased significantly with successive PLMs during courses. Students classified more visual features and based the diagnosis more on primary lesion. Accuracy increased in all tasks during the courses and reached over 90% in diagnoses of the first to third task difficulty quartile. In the most difficult quartile accuracy reached to 60%. In the follow-up, students' performance remained at high level. Analysis of diagnostic errors showed that there were specific conditions which were systematically confused with each other. CONCLUSIONS: Digital PLMs improved high rates of diagnostic accuracy, fluency and student-perceived confidence in recognition of skin-related conditions. There was a long-term consistency in high performance suggesting effective learning retention. In the digital setting, PLMs were practicable and easily integrated into traditional teachings. We believe that there is extensive potential for a wider use of perceptual learning to improve nonanalytical visual skills in dermatology and medical education in general.

Factors associated with severity of atopic dermatitis - a Finnish cross-sectional study.

BACKGROUND: Severity-associated factors in atopic dermatitis (AD) have focussed on early onset, concomitant atopic diseases, markers of Th2-shifted inflammation and filaggrin mutations. OBJECTIVES: To investigate factors associated with severe AD in Finnish patients. METHODS: We conducted a single-centre, cross-sectional observational study with 502 AD patients aged 4.79 to 79.90 years (mean 32.08 years). Disease severity was assessed with the Rajka-Langeland severity score and EASI and associated clinical signs were evaluated. Data regarding onset, relatives, atopic and other comorbidities was gathered retrospectively. We investigated total serum IgE-levels, a panel of filaggrin null mutations and functional variants of genes associated with skin barrier defects. RESULTS: Factors more frequent in severe AD included early onset (P = 0.004, 95%CI 0.000-0.024), male sex (P = 0.002, 95%CI 0.000-0.11), history of smoking (P = 0.012, 95%CI 0.000-0.024), concomitant asthma (P = 0.001, 95%CI 0.000-0.011), palmar hyperlinearity (P = 0.013, 95%CI 0.014-0.059), hand dermatitis (P = 0.020, 95%CI 0.000-0.029) and history of contact allergy (P = 0.042, 95%CI 0.037-0.096). Body mass indices (P < 0.000, 95%CI 0.000-0.011) and total serum IgE-levels (P < 0.000, 95%CI 0.000-0.011) were higher in severe AD. No differences were observed for allergic rhinitis, allergic conjunctivitis, food allergy, peanut allergy, prick positivity, keratosis pilaris, history of herpes simplex infections, filaggrin null mutations and other gene variants. CONCLUSIONS: Severity determinants in Finnish patients seem to be early-onset, male sex, smoking, overweight, concomitant asthma, palmar hyperlinearity, hand dermatitis and high IgE-levels. A sub-typing of patients in relation to confirmed severity determinants may be useful for course prediction, prognosis and targeted AD management.

Safety of tacrolimus 0.03% and 0.1% ointments in young children with atopic dermatitis: a 36-month follow-up study.

BACKGROUND: Topical tacrolimus is used off-label in young children, but data are limited on its use in children under 2 years of age and for long-term treatment. AIM: To compare safety differences between topical tacrolimus (0.03% and 0.1% ointments) and topical corticosteroids (mild and moderate potency) in young children with atopic dermatitis (AD). METHODS: We conducted a 36-month follow-up study with 152 young children aged 1-3 years with moderate to severe AD. The children were followed up prospectively, and data were collected on infections, disease severity, growth parameters, vaccination responses and other relevant laboratory tests were gathered. RESULTS: There were no significant differences between the treatment groups for skin-related infections (SRIs) (P = 0.20), non-SRIs (P = 0.20), growth parameters height (P = 0.60), body weight (P = 0.81), Eczema Area and Severity Index (EASI) (P = 0.19), vaccination responses (P = 0.62), serum cortisone levels (P = 0.23) or serum levels of interleukin (IL)-4, IL-10, IL-12, IL-31 and interferon-γ. EASI decreased significantly in both groups (P < 0.001). In the tacrolimus group, nine patients (11.68%) had detectable tacrolimus blood concentrations at the 1-week visit. There were no malignancies or severe infections during the study, and blood eosinophil counts were similar in both groups. CONCLUSIONS: Topical tacrolimus (0.03% and 0.1%) and topical corticosteroids (mild and moderate potency) are safe to use in young children with moderate to severe AD, and have comparable efficacy and safety profiles.

The spectrum of skin-related conditions in primary care during 2015-2019-A Finnish nationwide database study.

Background: Skin-related conditions are the frequent cause of doctors' consultations in primary care. Methods: Based on nationwide data bank information of the Finnish Institute for Health and Welfare, we analysed the 20 most frequent main diagnoses for each ICD-10 category of all general practitioners' visits in the public health care in Finland over the years 2015-2019. Results: The total amount of doctor's visits was 19 204 613 of which 1 489 228 consultations (7.80%) had a skin-related condition as the main diagnosis. The most frequent skin-related conditions were eczematous eruptions, bacterial skin infections and benign skin neoplasms accounting for 749 351 consultations (50.32%). The spectrum of skin-related conditions was diverse, with a large quantity of rarer diagnoses. Some diagnoses showed significant proportional changes. Conclusions: The results demonstrate that a limited amount of conditions comprises most of the skin-related consultations in primary care in Finland. Undergraduate education in dermatology should concentrate on the most frequent conditions seen by general practitioners, but also address the wide range of skin problems.

Critical evaluation of the undergraduate curriculum-are we asking the right questions?

The curricular content in medical education needs continuous development and therefore must regularly undergo a critical evaluation. Here, the author describes an implemented shift in the teaching substance of an undergraduate dermatology course aimed to focus on relevance and practicability for general practitioners. The changes were based on a comprehensive nationwide database analysis of the spectrum of skin-related conditions seen in primary care.

Skin Biomes.

The cutaneous microbiome has been investigated broadly in recent years and some traditional perspectives are beginning to change. A diverse microbiome exists on human skin and has a potential to influence pathogenic microbes and modulate the course of skin disorders, e.g. atopic dermatitis. In addition to the known dysfunctions in barrier function of the skin and immunologic disturbances, evidence is rising that frequent skin disorders, e.g. atopic dermatitis, might be connected to a dysbiosis of the microbial community and changes in the skin microbiome. As a future perspective, examining the skin microbiome could be seen as a potential new diagnostic and therapeutic target in inflammatory skin disorders.