Skin Cancer and Dermoscopy Training for Primary Care Physicians: A Pilot Study.

INTRODUCTION: The primary objective of this study was to determine the diagnostic accuracy and effect of an educational training on skin cancer course and dermoscopy use among primary care physicians in rural areas of Colombia. The secondary objective was to assess the diagnostic accuracy of skin cancer diagnosis and detection rate after 3 months of the initial training. METHODS: Twenty-one primary care physicians from 6 rural areas of Colombia participated in a 2-day skin cancer and dermoscopy training, followed by a day-long hands-on session on dermoscopy at a free skin cancer screening event. Pre- and post-tests were performed using clinical and dermoscopic images to evaluate the user's ability to diagnose and differentiate benign and malignant neoplasms. In addition, participants' levels of confidence were assessed. RESULTS: After the training, the sensitivity and specificity of characterizing skin lesions as benign or malignant or providing a specific diagnosis (ie, angioma, seborrheic keratosis, basal cell carcinoma, etc.) increased by 23.6% (62.9% to 86.5%; P < 0.0001) and 21% (54.7% to 75.7%; P < 0.0017), respectively. In addition, levels of confidence when diagnosing skin lesions changed from extremely low or low, to high or extremely high by 20.7% (38.3% to 59%) using dermoscopic images (odds ratio (OR) 3.22; 95% confidence interval (CI): 2.67-3.86; P < 0.0001). The secondary objective was not achieved due to loss of follow-up of the majority of participants. CONCLUSION: Providers serving populations with limited healthcare access may benefit from education in diagnosing and differentiating skin cancer with the use of dermoscopy, which may ultimately improve patient care and reduce healthcare costs.

Increased Association between Previous Pregnancies and Use of Chemical Relaxers in 74 Women with Central Centrifugal Cicatricial Alopecia.

BACKGROUND: Central centrifugal cicatricial alopecia (CCCA) is a type of scarring alopecia exclusively seen in women of African descent. The etiology is unknown and epidemiologic studies including data on comorbidities in patients with CCCA are limited. Our primary objective was to identify possible etiologic and lifestyle associations in patients with CCCA. MATERIALS AND METHODS: A retrospective chart review was conducted for patients diagnosed with CCCA between January 1, 2013, and January 1, 2018, at a university dermatology outpatient clinic. Controls consisted of age-, sex-, and race-matched African-American women diagnosed with other hair loss conditions. Data from 74 cases and 96 controls were collected and analyzed via logistic regression. In addition, a phone survey was conducted in the CCCA cohort asking specific questions related to their condition and quality of life. RESULTS: A significant relationship was found between CCCA and previous pregnancies as well as the use of chemical relaxers: patients with CCCA were 11.71 times more likely to have had a previous pregnancy (P < 0.001) and 12.37 times more likely to have used chemical relaxers in the past (P < 0.001). Association with uterine fibroids was found not statistically significant (P > 0.05). CONCLUSION: We identified an association between previous pregnancies and use of chemical relaxers in patients diagnosed with CCCA when compared to controls. These findings may help to plan prospective studies aiming at establishing a more concrete link between hormones and CCCA.

Traditional and advanced therapeutic modalities for wounds in the paediatric population: an evidence-based review.

OBJECTIVE: Children can have non-healing wounds due to a wide range of pathologies, including epidermolysis bullosa (EB), pilonidal disease and Stevens-Johnson syndrome, with some causes being iatrogenic, including extravasation injuries and medical device-related hospital-acquired pressure ulcers. Furthermore, paediatric wounds are vastly different from adult wounds and therefore require a different treatment approach. While there are numerous types of dressings, topical remedies, and matrices with high-tier evidence to support their use in adults, evidence is scarce in the neonatal and paediatric age groups. The purpose of this review is to discuss the basic principles in paediatric wound management, as well as to present new treatment findings published in the literature to date. The benefits and risks of using different types of debridement are discussed in this review. Various topical formulations are also described, including the need to use antibiotics judiciously. METHOD: Databases were searched for relevant sources including Pubmed, Embase, Web of Science and DynaMed. Search terms used included 'wound care', 'wound management', 'paediatrics', 'children', 'skin substitutes', and 'grafts'. Additionally, each treatment and disease entity was searched for relevant sources, including, for example: 'Apligraf', 'dermagraft', 'Manuka honey', 'antibiotic', 'timolol', and 'negative pressure wound therapy' (NPWT). RESULTS: Amniotic membrane living skin equivalent is a cellular matrix that has been reportedly successful in treating paediatrics wounds and is currently under investigation in randomised clinical trials. Helicoll is an acellular matrix, which shows promise in children with recessive dystrophic EB. NPWT may be used as a tool to accelerate wound closure in children; however, caution must be taken due to limited evidence to support its safety and efficacy in the paediatric patient population. Integra has been reported as a useful adjunctive treatment to NPWT as both may act synergistically. Hospitalised children and neonates frequently have pressure ulcers, which is why prevention in this type of wound is paramount. CONCLUSION: Advancements in wound care are rapidly expanding. Various treatments for non-healing wounds in paediatric and neonatal patients have been reported, but high tier evidence in these populations is scarce. We hope to shed light on existing evidence regarding the different therapeutic modalities, from debridement techniques and dressing types to tissue substitutes and topical remedies. There have been promising results in many studies to date, but RCTs involving larger sample sizes are necessary, in order to determine the specific role these innovative agents play in paediatric wounds and to identify true safety and efficacy.

Dupilumab as a novel therapy for bullous pemphigoid: A multicenter case series.

BACKGROUND: Bullous pemphigoid (BP) is an autoimmune blistering disorder occurring mostly in the elderly that lacks adequate treatments. OBJECTIVE: To describe our experience using dupilumab in a series of patients with BP. METHODS: This is a case series of patients from 5 academic centers receiving dupilumab for BP. Patients were eligible if they had a clinical diagnosis of BP confirmed by lesional skin biopsy evaluated by one of more of the following: hematoxylin and eosin staining, direct immunofluorescence, or enzyme-linked immunosorbent assay for BP180 or BP230, or both. RESULTS: We identified 13 patients. Patients were an average age of 76.8 years, and the average duration of BP before dupilumab initiation was 28.8 months (range, 1-60 months). Disease clearance or satisfactory response was achieved in 92.3% (12 of 13) of the patients. Satisfactory response was defined as clinician documentation of disease improvement and patient desire to stay on the medication without documentation of disease clearance. Total clearance of the BP was achieved in 53.8% (7of 13) of patients No adverse events were reported. LIMITATIONS: Include small sample size, lack of a control group, lack of a standardized assessment tool, and lack of standardized safety monitoring. CONCLUSION: Dupilumab may be an additional treatment for BP, leading to disease clearance or satisfactory response in 92.3% of patients, including in those in whom previous conventional therapy had failed.

Increased Preauricular Wrinkles in Frontal Fibrosing Alopecia Compared to Age-Matched Controls: A Prospective Study of 64 Patients.

INTRODUCTION: Frontal fibrosing alopecia (FFA) is a scarring alopecia affecting mainly postmenopausal females. Associated clinical signs include facial papules, glabellar red dots, depression of frontal veins, and lichen planus pigmentosus. Our objective was to establish the validity of increased preauricular lines as another clinical marker of FFA. MATERIALS AND METHODS: Thirty-two females with FFA were compared to 32 age-matched females with either androgenetic alopecia or chronic telogen effluvium. Bilateral images of the preauricular area were taken, and disease severity was calculated in all FFA patients using the FFA severity scale (FFASS). The average number of preauricular lines were determined and compared based on group, age, and severity. RESULTS: Patients with FFA had a significantly higher mean number of preauricular lines than controls (p = 0.002). Intergroup analysis among the FFA patients revealed no significant difference between FFASS and the number of wrinkles or the number of wrinkles in patients ≥60 years old. DISCUSSION AND CONCLUSION: Females with FFA have increased preauricular lines compared to age-matched controls regardless of age, and disease severity was not correlated to increased lines. Although the cause is unknown, atrophy and loss of elastic fibers in biopsies of the preauricular area in diseased patients may contribute. These findings reveal another potential clinical marker of FFA.

The Skin Cancer Index: quality-of-life outcomes of treatments for nonmelanoma skin cancer.

Introduction: Non-melanoma skin cancers (NMSCs) are the most common malignancies in humans. When treating NMSC, quality-of-life (QOL) is an important consideration. The purpose of this study was to measure and compare QOL outcomes of two common therapies for NMSC: Mohs micrographic surgery and excision, using a disease-specific QOL instrument, the Skin Cancer Index (SCI).Methods: The University of Miami Institutional Review Board approved this retrospective chart review of patients diagnosed with NMSC from 2016 through 2019 at a private dermatology clinic (Deerfield Beach, FL, USA). Disease-specific QOL before and after surgery was measured with the SCI.Results: Pre- and post-surgery surveys were completed by 208 patients undergoing Mohs surgery and 30 patients undergoing excisional surgery. All patients were similar in age, gender, and race, and most patients undergoing either procedure had a history of additional prior skin cancers. For the Mohs cohort, the total SCI scores and each of the subscales were significantly higher post-surgery when compared with the baseline scores. In contrast, in the excision cohort, the social subscale was significantly lower post-surgery when compared with the baseline scores.Conclusion: There is limited data in the literature describing the specific effects of Mohs or excision for NMSC on QOL using a disease-specific QOL instrument. Our data supports increased QOL at 2-week follow up for patients with NMSC treated with Mohs, but no improvement in QOL was noted for patients treated with excision. This data is limited by the fact there were far more patients that underwent Mohs as opposed to excision, which gave the Mohs cohort greater statistical power when analyzing the difference in SCI.

Alopecia as a systemic disease.

Alopecia is a skin condition of great social and psychologic impact. Primary alopecia originates from the hair follicles and usually does not have systemic manifestations; however, secondary alopecia can affect the hair follicles in the setting of systemic diseases, medications, and external trauma. Connective tissue diseases, granulomatous diseases, bullous diseases, infections, and tumors are some of the systemic diseases that will be covered in this review. Trichoscopy is a useful noninvasive tool that can help with the diagnosis in the office and can guide the selection of the optimal site for the scalp biopsy. Histopathology is the ultimate tool for the diagnosis in most cases of secondary alopecia and can be performed on vertical and horizontal sections. In most cases, treating the underlying condition is the single most important strategy, but topical treatments for the alopecia are also applied.