Comparison of the Skindex-Teen and the Skindex-29 quality of life survey instruments in a predominantly American Indian adolescent population.

BACKGROUND/OBJECTIVES: The Skindex-29 and Skindex-Teen assess dermatology-related quality of life among adults and adolescents, respectively. This study directly compared the same adolescents' responses to the Skindex-29 relative to Skindex-Teen in a predominantly American Indian and/or Alaska Native population. This population is underrepresented in medical research. Although skin-related quality-of-life issues are widespread, American Indian and/or Alaska Native adolescents are not well-represented in related studies. METHODS: Data were collected in-person by self-report survey at two regional powwows in Denver, Colorado in 2021 and 2022. Respondents completed the full Skindex-29 and Skindex-Teen (40 unique items total). RESULTS: Eighty-six adolescents, 12-17 years old, completed the survey. The majority (70.9%, 61/86) of respondents self-identified as American Indian and/or Alaska Native. Analyses were conducted with all respondent survey data. Nearly two-thirds (64.0%, 55/86) of our respondents had a Skindex-29 score that revealed their quality of life was impaired at least mildly by skin disease. The Skindex-29 and Skindex-Teen demonstrated good reliability; there was substantial concordance between responses to the two measures (r values ranged from 0.88 to 0.97 for similar subscales). Compared to younger adolescents (aged 12-14), older adolescents (aged 15-17) reported worse dermatology-related quality of life and emotional toll based on higher Skindex-29 total, Skindex-Teen total, Skindex-29 Emotional subscale, and Skindex-Teen Psychosocial Functioning subscale scores. CONCLUSIONS: American Indian and/or Alaska Native adolescents suffer from skin-related quality-of-life issues. The Skindex-Teen and Skindex-29 generated similar information regarding quality of life in young patients with skin disease. While the Skindex-Teen may be slightly more relevant to adolescents, these surveys were highly concordant. Both the Skindex-Teen and Skindex-29 exhibited frequent "never" responses to questions about impact of skin conditions on relationships with others and tendencies to stay home. Thus, careful attention should be paid to such questions to ensure their relevance to adolescents.

Retrospective chart review of patient socioeconomic status and language preference associated with live video telehealth in a pediatric dermatology practice.

Pediatric teledermatology rapidly expanded with the COVID-19 pandemic, and the impacts of this expansion on patients' access to care have not yet been entirely defined. In this retrospective study of 3027 patients in an academic pediatric dermatology practice, patients who identified as having a primary language other than English were less likely to access pediatric dermatology care during the COVID lockdown. This study did not identify a significant or meaningful difference in age, geography, socioeconomic status, ethnicity, or race between patients who were offered pediatric dermatology care that was either in-person or via synchronous telehealth. These findings are overall reassuring that there were not major disparities in telehealth utilization during the COVID shelter-in-place mandate, although highlight the need for institutions to ensure systems are in place to enhance telehealth access for patients with non-English primary language.

Publication Trends of Qualitative Research in Dermatology: A Scoping Review.

Importance: Qualitative studies serve as a tool for dermatologists and researchers in dermatology to engage with and understand perspectives of populations with different cultures and backgrounds. Objective: To assess (1) current approaches to qualitative dermatologic research and (2) the publication trends of these studies with the aim to inform researchers regarding qualitative research and its significance and applicability in the field of dermatology. Evidence Review: A scoping review was conducted in which PubMed and CINAHL Plus were searched using dermatology AND qualitative, dermatology, and 7 qualitative methods terms. Studies were selected for inclusion using 3 levels of screening. Level 1 excluded articles published in a language other than English. Level 2 excluded articles of studies involving mixed methods, quantitative methods, systematic review, and meta-analysis. Level 3 excluded articles that were not specific to general dermatology, medical dermatology, pediatric dermatology, dermatologic surgery, dermatopathology, or education and training associated with dermatology. Finally, all duplicates were removed. The searches were conducted from July 23 to 28, 2022. All articles obtained from PubMed and CINAHL Plus searches were recorded in REDCap. Findings: A total of 1398 articles were reviewed, and of these, 249 (17.8%) were qualitative dermatology studies. Common qualitative methods included content analysis (58 [23.3%]) and grounded theory/constant comparison (35 [14.1%]). Individual interviews were the most common data collection method (198 [79.5%]), and patients (174 [69.9%]) were the most common participant type. Patient experience (137 [55.0%]) was the most common investigated topic. Overall, 131 qualitative studies (52.6%) in dermatology were published in dermatology journals, and 120 qualitative studies (48.2%) in dermatology were published between 2020 and 2022. Conclusions and Relevance: Qualitative research in dermatology is becoming more prevalent. There is value in qualitative research, and we encourage researchers in dermatology to incorporate qualitative methods in their studies.

Dermatology Access and Needs of American Indian and Alaska Native People.

OBJECTIVES: To describe skin disease prevalence, access to dermatologic care, and teledermatology interest among American Indians and Alaska Natives. METHODS: Data were collected via self-report surveys administered in person at two community powwows in Denver, Colorado in 2021 and 2022. RESULTS: Most American Indian and/or Alaska Native respondents (94.5%, n=225) reported at least one skin disease. The top three active skin diseases among adolescents were acne, scarring, and eczema. The top three among adults were dry skin, hair loss, and acne. Only 20.9% (n=47) of respondents with skin disease had seen a dermatologist. Approximately one-third of respondents (34.0%, n=81) were open to engaging with teledermatology in their home; 43.3% (n=103) were open to engaging with teledermatology in their local clinic; 42.0% (n=100) were not interested in engaging teledermatology from their home or in their local clinic. CONCLUSIONS: Skin disease is prevalent and access to dermatologic care is poor among American Indian and Alaska Native people.

Solitary cutaneous infantile myofibroma as a hallmark of myofibromatosis: Two cases and review of the literature.

Infantile myofibroma (IM) commonly presents as a benign cutaneous fibrous tumor in infancy. Although the majority of solitary IM regress without any morbidity, some cases have underlying bone or visceral involvement that can lead to both morbidity and mortality. In this report with review of the literature, we present two cases of solitary cutaneous IM with internal involvement and discuss screening cases of solitary IM with full body imaging.

When is synchronous telehealth acceptable for pediatric dermatology?

BACKGROUND/OBJECTIVES: We evaluated the acceptance of synchronous (live video) telehealth for pediatric dermatology. METHODS: This was a prospective, single-center study of patient and dermatologist surveys paired at the encounter level for telehealth encounters with Children's Hospital Colorado Pediatric Dermatology Clinic between 21 April 2020 and 22 May 2020. RESULTS: Dermatologists were most receptive to a telehealth encounter for isotretinoin monitoring (96.6%) and non-isotretinoin acne (89.5%). In contrast, 71.8% and 58.8% of patients surveyed were open to telehealth for isotretinoin encounters and non-isotretinoin acne encounters, respectively. There was no significant correlation between patient and dermatologist satisfaction regarding a telehealth encounter (r = 0.09, CI [-0.09, 0.26], p = .34) or between patient and dermatologist preference for telehealth encounter (r = 0.07, CI [-0.11, 0.25] p = .46). Dermatologists reported needing a photo to aid their physical examination in 38/363 (10.7%) of encounters and preferred in-person examinations when an encounter would have benefitted from laboratories, procedures, dermatoscopic examination, examination by palpation, and accurate weights in infants. CONCLUSIONS: Synchronous, live-video telehealth is an effective method of healthcare delivery in certain situations for pediatric dermatology, but it does not replace in-person encounters. Families and dermatologists have different perceptions about its acceptance.

Skin and Mucosal Manifestations in NEMO Syndrome: A Case Series and Literature Review.

OBJECTIVES: To characterize the skin and mucosal findings of NEMO syndrome. METHODS: Retrospective review of clinical characteristics from a cohort of two families with mutations in IKBKG (the NEMO-encoding gene). A literature review identified 86 studies describing 192 patients with IKBKG mutations whose data were also included. SETTING: Single center with literature review. PARTICIPANTS: Patients with mutations in IKBKG from our center and reported in the literature. MAIN OUTCOMES AND MEASURES: Skin and mucosal characteristics of patients with NEMO syndrome. RESULTS: In addition to ectodermal dysplasia and recurrent infections, male patients had findings of ichthyosis, palmoplantar keratoderma, and inflammatory skin diseases. Both male and female patients had mucocutaneous ulcers and slow-to-heal chronic wounds. In combination with patients from the literature, 59% (85/144) of males had ectodermal dysplasia with anhidrosis (EDA) features, and 8% and 10% (12/144; 6/63) of males and females had dental findings, respectively. 4% (6/144) of males and 32% (20/63) of females had mucocutaneous ulcers. Ichthyosis/xerosis was present in 15% of males (21/144) but only 2% (1/63) females. Similarly, 13% (18/144) of male patients presented with dermatitis while this was reported in only 2% (1/63) of females. CONCLUSIONS: Our results both confirm and expand upon the known spectrum of mucocutaneous findings in NEMO syndrome. Further genetic studies are needed to correlate specific mutations to clinical and morphologic subtypes.

Persistent dysesthesias in involuted infantile hemangiomas: An uncommon complication in a common condition.

BACKGROUND/OBJECTIVES: Infantile hemangiomas (IHs) are common benign vascular tumors of infancy. IHs tend to grow in the first few months of life and then gradually involute over years, often leaving fibrofatty residua or textural changes in their place. Classically, these lesions are painless throughout their entire natural history; however, we now report on seven patients with involuted IH with intermittent but persistent sensory symptoms. METHODS: This is a multicenter case series in which members of the Birthmarks Focused Study Group of the Pediatric Dermatology Research Alliance (PeDRA) and the Hemangioma Investigator Group contributed patients with IH and dysesthesias from their clinical practices. Charts were then reviewed to document clinical details. RESULTS: Seven patients were included, presenting at an average age of 14.6 years (range 3-48 years) for complaints related to discomfort in the region of involuted IH. The majority (6/7) reported pain or tenderness to the area. One patient reported pruritus. All patients reported intermittent symptoms. The length of symptoms ranged between 4 months and 5 years. Treatment was attempted in 5/7 patients. Ice, oral propranolol, topical capsaicin, and intralesional triamcinolone partially improved symptoms. CONCLUSIONS: Persistent cutaneous dysesthesias were present in seven patients, in most cases many years after completion of involution. Further research is needed to fully elucidate the pathophysiology and optimal treatments for this IH complication.

A randomized, controlled trial comparing topical steroid application to wet versus dry skin in children with atopic dermatitis (AD).

BACKGROUND: Soak and smear (SS), a technique whereby a bath is followed by topical corticosteroid (TCS) application to wet skin, is reported to be a beneficial adjunctive therapy for patients with recalcitrant atopic dermatitis (AD). OBJECTIVE: We evaluated whether SS is of greater benefit than application of TCS to dry skin for the treatment of childhood AD. METHODS: A randomized, investigator-blinded, controlled study was performed in children with AD. Patients were randomized to apply TCS either via SS (n = 22) or to dry skin (n = 23) for 14 days. The primary outcome was an improvement in the Eczema Area and Severity Index score. Secondary outcomes included assessments of disease burden, pruritus, and sleep; morning cortisol levels; and adverse effects. RESULTS: Patients with AD severity who applied TCS via SS or to dry skin improved 84.8% (95% confidence interval 77.5-92.1) and 81.4% (95% confidence interval 70.3-92.4) by Eczema Area and Severity Index score, respectively. There was no statistical difference between the 2 groups (P value = .85). LIMITATIONS: Small sample size limited the power of our study. CONCLUSIONS: We did not find that application of TCS to presoaked skin works better than application to dry skin for the treatment of AD in children.