Assessing the impact of the skin cancer awareness now (SCAN!) intervention several months following the intervention.

BACKGROUND: West Virginia (WV) is the third most rural state in the US and has a high incidence of skin cancer. Intervention efforts in WV are impeded by structural barriers, low health literacy, and lack of health care access. Community pharmacies and pharmacists are highly accessible and may be helpful in promoting skin cancer prevention. OBJECTIVE(S): The purpose of the study was to evaluate the impact of the Skin Cancer Awareness Now (SCAN!) pharmacy-based sun-safety intervention at follow-up. METHODS: Surveys assessed SCAN's effect on skin cancer prevention at preintervention and follow-up. The follow-up survey was administered between 8 and 12 months after our initial feasibility study. Questions included demographics, cancer history, cancer worry, knowledge, cancer communication, and skin cancer screening intentions. Multivariate repeated measures ANOVA assessed the change in worry, importance, knowledge, and intentions to be sun safe. RESULTS: Participants (n=56, response rate= 62.2%) had a mean age of 44.7 (standard deviation: 19.3) years. Most were females (87.5%), Whites (92.9%), and 48.2% lived in rural areas. Knowledge and intentions significantly improved over time. At follow-up, participants (41.1%) mentioned that they plan on discussing skin cancer prevention with their pharmacist in the future. CONCLUSION: The SCAN! intervention can be a useful resource for skin cancer prevention in community pharmacy settings. Community pharmacies have the potential to be change agents in skin cancer prevention by providing education on sun protection or detection and by promoting sun-safety behaviors.

Localized Versus Generalized Granuloma Annulare: A Retrospective Review of 407 Patients.

BACKGROUND: Granuloma annulare has been linked to diabetes, dyslipidemia, thyroid disease, collagen vascular disease, malignancies, infectious hepatitis, and systemic infections. However, these associations have not been systematically investigated when categorized by its clinical variants. OBJECTIVE: To evaluate disease associations of localized and generalized granuloma annulare. METHODS: In total, 407 granuloma annulare patients from 1989 to 2019 were retrospectively reviewed, categorized by clinical variant (localized or generalized), age (pediatric or adult), and diagnostic method (clinical or histologic). Descriptive statistical analyses and multivariate logistic regression analysis were performed. Fisher's exact tests were conducted to produce unbiased probability values. RESULTS: Overall, 75.2% of the study sample was female, 47.2% had dyslipidemia, 24.8% were diabetic, and 24.6% had thyroid disease. Dyslipidemia (OR 2.15, CI 1.95-2.35, P < .001), diabetes (OR 1.16, CI 1.01-1.31, P = .041), and histologic diagnosis (OR 2.08, CI 1.21-3.52, P = .007) were associated with increased risk of GGA compared to LGA. When stratified by adult versus pediatric cases, dyslipidemia and diagnostic method remained significant, but diabetes did not. CONCLUSIONS: Evaluating granuloma annulare by its clinical variants may help to determine disease associations with each variant.

SCAN! A pharmacy-based, sun safety feasibility study.

OBJECTIVES: Skin cancer is the most common form of cancer, and individuals from the medically underserved Appalachian region are at elevated risks for cancer morbidity and mortality. Skin cancer can be prevented by decreasing ultraviolet light exposure (sunscreen sun protection factor 30, shade, clothing, sunglasses, hats) and can be caught at an early treatable stage through a routine skin examination. The Skin Cancer Awareness Now! (SCAN!) pilot project promoted skin cancer prevention and screening in community pharmacies, using a dynamic communication model. The objectives of the study were to understand (1) the feasibility of the SCAN! and (2) the preliminary impact of the SCAN! METHODS: We conducted pre- and postintervention surveys of the SCAN!, a student pharmacist-led or pharmacy resident-led intervention in community pharmacies (n = 3). RESULTS: Participants (n = 90) had a mean age of 43.8 (SD= 18.4) years, were predominantly white (92.1%), without a college degree (65.6%), and had an average family income in the range of $25,000-$49,999, with approximately 16% falling below the poverty level. To begin, the SCAN! scored highly in attention (mean = 5.8), liking (mean = 6.1), comprehension (mean = 6.7), and intentions to be sun safe (mean = 6.0). Most improved in their knowledge of the amount of sunscreen needed per application for sun safety (66%, P < 0.01) and of melanoma features from pre- and postintervention (39%, P < 0.01). A multivariate analysis of variance indicated that knowledge and intentions improved (all P's < 0.01). Interaction effects indicated that improvements in knowledge were greater for those in the rural pharmacy (P = 0.03), and improvements in perceived importance were greater for those in urban pharmacies (P = 0.01). CONCLUSION: The SCAN! intervention was well received by the population. Our study provides evidence that community pharmacy is a novel venue for skin cancer prevention interventions, particularly for rural, medically underserved populations.

Pentoxyfilline as a treatment for subcorneal pustular dermatosis.

Subcorneal pustular dermatosis (SPD) is a rare pustular neutrophilic dermatosis in which groups of sterile pustules appear in the superficial (subcorneal) skin. This chronic condition can be associated with significant morbidity and decreased quality of life. Dapsone is the first-line therapy for SPD, but some patients fail to respond or cannot tolerate it. In these instances, patients may be treated with second-line therapies such as phototherapy, topical corticosteroids, or systemic agents including glucocorticoids, acitretin, immunosuppressive, or biologic medications. These therapies may not always be efficacious and can be associated with intolerable adverse effects. Here, we report a case of a patient who sustained long-term remission and no side effects with the novel use of pentoxifylline, a tumor necrosis factor-alpha inhibitor, as monotherapy. Pentoxifylline should be considered as a possible therapy in patients with SPD intolerant to dapsone.

An unusual case of dermatitis herpetiformis.

An adolescent boy whose initial presentation consisted of an asymmetric, nonvesicular rash was eventually diagnosed with dermatitis herpetiformis (DH). Certain factors, including lesions limited to the genitals, an initial biopsy revealing nonspecific findings on microscopy studies, and the absence of characteristic direct immunofluorescence findings lessened initial clinical suspicions of DH over that of scabies infestation. Classic microscopic findings of DH were identified on repeat biopsy. Serologic studies revealed immunoglobulin A (IgA) endomysial and IgA tissue transglutaminase positivity. Response to dapsone proved dramatic. Histopathologic findings, serology, and response to treatment rather than classical clinical findings and direct immunofluorescence supported the diagnosis of DH in this case.

Macerated foot dermatitis related to occlusive footwear.

Gram-negative bacterial toe-web infections (GNBTWI's) are relatively under-recognized among physicians. Even though skin infections are usually thought to involve gram-positive bacteria, gram-negative organisms have a particular affinity for the toe-web. We present two patients with GNBTWI's who presented with maceration of the toe-webs, vesiculopustules and a hyperkeratotic rim. Treatment includes using both oral and topical antibiotics along with antifungals to treat co-existing dermatophyte infections. Awareness of this condition is particularly important for primary care physicians in West Virginia, as a few of the potential risk factors include wearing occlusive footwear, such as work boots, and type II diabetes mellitus.

Fluoroscopy-induced chronic radiation dermatitis.

A 62-year-old man with a history of 2 previous cardiac catheterizations presented with an itchy, nontender skin lesion over his right scapula. The skin lesion had been present for >5 years. Review of the medical records found evidence of a prolonged and complicated cardiac catheterization 8 years previously. Physical examination revealed an 8 × 6 cm, well-demarcated, erythematous reticulated atrophic plaque with telangiectasias and ulceration. Biopsy confirmed histologic changes consistent with radiation dermatitis. In conclusion, the characteristic histologic findings of radiation dermatitis, along with the location over the right scapula and the history of prolonged fluoroscopic exposure during cardiac catheterization, led to the clinical diagnosis of fluoroscopy-induced chronic radiation dermatitis.

Symmetrical drug-related intertriginous and flexural exanthema secondary to topical 5-fluorouracil.

We report the case of a 56-year-old man who developed a distinctive skin eruption after treating actinic keratoses on the dorsal aspects of his right and left hands with topical 5-fluorouracil (5-FU). The distribution of his rash was characteristic of symmetrical drug-related intertriginous and flexural exanthema (SDRIFE), also known as baboon syndrome.

Multiple congenital plaquelike glomuvenous malformations with type 2 segmental involvement.

Multiple congenital glomuvenous malformations (GVMs) are rare. Almost all reported cases describe the multiple congenital plaquelike GVM variant. We report a case of multiple congenital plaquelike GVMs suggestive of type 2 segmental involvement following Blaschko lines.

The rectovaginal examination: physician attitudes and practice patterns.

BACKGROUND: The value of screening with the rectovaginal examination (RVE) has not been validated. This study describes physician attitudes and practice patterns regarding the RVE. METHODS: Cross-sectional survey of residents and faculty in general internal medicine and obstetrics/gynecology (OB/GYN) at a university hospital. RESULTS: Thirty-four percent of physicians surveyed reported routinely performing the RVE. More OB/GYN than internal medicine physicians reported doing the RVE routinely (60% versus 27%, P = 0.02), and felt it provided additional information (80% versus 44%, P = 0.01). More respondents believed that it provides additional information to the routine pelvic examination (53%) than agreed with its routine inclusion (42%) or that reported routinely performing it (34%). (P = 0.0001) CONCLUSIONS: More OB/GYN than internal medicine physicians routinely perform the RVE and believe it adds additional information to the routine pelvic examination. Additional research is indicated to determine if frequent omission of the RVE impacts women's health.

Effect of a patient care partnership project on cost and quality of care at an academic teaching hospital.

BACKGROUND: In 1998, the Patient Care Partnership Project was conducted by general internal medicine physicians and hospital administration in an academic health care center. The project was designed to optimize cost, quality, and service results to inpatients. METHODS: The project focused on improved communication among physicians, a nurse discharge planner, and hospital administration regarding appropriate resource utilization. The outcomes were average cost per inpatient, length of hospital stay, 30-day readmission rates, mortality rates, and resident and patient satisfaction. Comparisons were made with three control groups. RESULTS: The postintervention generalist-staffed services showed significant reductions in average costs per patient and length of stay. These parameters increased in the specialist group from 1997 to 1998. Readmission rates remained stable, and mortality rates actually decreased. Patient and resident satisfaction remained unchanged. CONCLUSIONS: A collaborative effort between generalists and hospital administration led to a significant improvement in resource utilization compared with the three control groups, with no compromise in quality outcomes.