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3.
J Telemed Telecare ; : 1357633X221074504, 2022 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-35108130

RESUMO

The policy changes prompted by the COVID-19 pandemic caused synchronous models (primarily video visits) to supplant asynchronous models (store-and-forward or shared digital photographs) as the default and predominant modality of teledermatology care. Here, we call attention to the unique strengths and limitations of these models in terms of clinical utility, accessibility, and cost-effectiveness. Strengths of synchronous visits include direct physician-patient interaction and current reimbursement parity; limitations include variable video image quality, technological difficulties, and accessibility barriers. Strengths of asynchronous visits include greater convenience, especially for clinicians, and potential for image quality superior to video; limitations include less direct physician-patient communication, barriers to follow-up, and limited reimbursement. Both synchronous and asynchronous models have been shown to be cost-effective. Teledermatology is positioned to play a prominent role in patient care post-pandemic. Moving forward, dermatologists are challenged to optimize teledermatology use in order to improve outcomes, efficiency, and workflows to meet diverse patient needs. Future directions will depend on sustainable reimbursement of both teledermatology formats by government and private payers.

10.
J Am Acad Dermatol ; 86(1): 113-121, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34517079

RESUMO

BACKGROUND: Cutaneous reactions after COVID-19 vaccination have been commonly reported; however, histopathologic features and clinical correlations have not been well characterized. METHODS: We evaluated for a history of skin biopsy all reports of reactions associated with COVID-19 vaccination identified in an international registry. When histopathology reports were available, we categorized them by reaction patterns. RESULTS: Of 803 vaccine reactions reported, 58 (7%) cases had biopsy reports available for review. The most common histopathologic reaction pattern was spongiotic dermatitis, which clinically ranged from robust papules with overlying crust, to pityriasis rosea-like eruptions, to pink papules with fine scale. We propose the acronym "V-REPP" (vaccine-related eruption of papules and plaques) for this spectrum. Other clinical patterns included bullous pemphigoid-like (n = 12), dermal hypersensitivity (n = 4), herpes zoster (n = 4), lichen planus-like (n = 4), pernio (n = 3), urticarial (n = 2), neutrophilic dermatosis (n = 2), leukocytoclastic vasculitis (n = 2), morbilliform (n = 2), delayed large local reactions (n = 2), erythromelalgia (n = 1), and other (n = 5). LIMITATIONS: Cases in which histopathology was available represented a minority of registry entries. Analysis of registry data cannot measure incidence. CONCLUSION: Clinical and histopathologic correlation allowed for categorization of cutaneous reactions to the COVID-19 vaccine. We propose defining a subset of vaccine-related eruption of papules and plaques, as well as 12 other patterns, following COVID-19 vaccination.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19 , Exantema , Dermatopatias/induzido quimicamente , COVID-19/prevenção & controle , Exantema/induzido quimicamente , Humanos , Sistema de Registros
11.
Dermatol Clin ; 39(4): 599-608, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34556249

RESUMO

The accelerated implementation and use of teledermatology during the coronavirus disease 2019 pandemic has met with successes and challenges. This review explores how telemedicine was used in dermatology before the pandemic, the regulatory adaptions made in response to the pandemic, and the effectiveness of the rapid implementation of teledermatology during the coronavirus disease 2019 pandemic, and, finally, how teledermatology has expanded in response to the pandemic. This review examines lessons learned and how teledermatology's reliance on digital technologies might paradoxically exacerbate health care disparities, and finally, considers the future outlook.


Assuntos
COVID-19/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias/diagnóstico , Dermatopatias/terapia , Telemedicina/estatística & dados numéricos , Dermatologia/organização & administração , Humanos , Consulta Remota/estatística & dados numéricos , Índice de Gravidade de Doença
16.
Cutis ; 107(3): 157-159, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33956610

RESUMO

Recent studies have highlighted poor representation of darker skin types in medical textbooks and other educational materials. However, whether online educational materials also have poor representation of darker skin types remains less studied, even though trainees are increasingly relying on such resources. We evaluated representation of darker skin types in the Basic Dermatology Curriculum of the American Academy of Dermatology (AAD), a standardized curriculum for dermatology education. Results show that representation of darker skin types in photographs is low. Educators should consider tapping into existing resources for photographs of diverse skin types when designing future curricula.


Assuntos
Dermatologia , Currículo , Dermatologia/educação , Humanos , Estados Unidos
17.
J Am Acad Dermatol ; 85(1): 46-55, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33838206

RESUMO

BACKGROUND: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. OBJECTIVE: To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. METHODS: A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. RESULTS: From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. LIMITATIONS: Registry analysis does not measure incidence. Morphologic misclassification is possible. CONCLUSIONS: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination.


Assuntos
Vacinas contra COVID-19/efeitos adversos , Erupção por Droga/etiologia , Adulto , Erupção por Droga/epidemiologia , Feminino , Saúde Global , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
18.
Curr Dermatol Rep ; : 1-8, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33747638

RESUMO

PURPOSE OF REVIEW: Dermatologists have been at the forefront of researching telemedicine to expand access to care. The current COVID-19 pandemic has prompted even greater expansion and implementation of teledermatology. This review discusses the research examining the potential impact of teledermatology addressing disparities in care. RECENT FINDINGS: Teledermatology appears to increase access to dermatology given expanded means to deliver care. Specifically, recent studies have found increased access among Medicaid-insured, resource-poor urban and rural, and elderly populations. Teledermatology implementation also facilitates education among providers at different levels of training. Still, as some patients have inconsistent access to the required technology, increased reliance on telemedicine may also potentially increase disparities for some populations. SUMMARY: Teledermatology may serve to reduce disparities in health care access in many underserved and marginalized communities. Future research should continue to study implementation, especially given the expansion during the COVID-19 pandemic. Ultimately, teledermatology may play an important role in ensuring equitable care access for all.

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