Acne accounts for an almost 2.5-fold higher proportion of dermatology visits among adult females compared to adult males in the United States: A study of the national ambulatory medical care survey from 2002-2016.

BACKGROUND: Acne vulgaris affects a significant number of females into adulthood. Juvenile acne and adult acne have different presentations and potentially distinctive pathogeneses. However, patterns in treatments specifically related to the adult female population have previously not been studied. METHODS: Retrospective database analysis of healthcare utilization and medications prescribed for acne using the National Ambulatory Medical Care Survey (NAMCS) data from 2002-2016 was performed. RESULTS: After age 20, acne accounted for an almost 2.5-fold higher proportion of dermatology visits among females compared to males (10.1% vs. 4.1%, P < 0.001). Tetracycline-class antibiotics were the most prescribed therapy within all age groups of females between 2002-2016. However, there was also a substantial rise in prescriptions of spironolactone beginning in 2012. CONCLUSION: A significantly greater proportion of dermatology visits by adult females are for acne in comparison to adult males. Tetracycline-class antibiotics remain the most prescribed therapy in adult age groups despite a potentially different pathogenesis of adult acne. Therefore, there is a need for further studies comparing the effectiveness of therapies specifically for adult female acne.

A Practical Guide to Advanced Topical Drug Delivery Systems in Dermatology.

Dermatological diseases such as atopic dermatitis, acne, and psoriasis result in significant morbidity and decreased quality of life. The first line of treatment for such diseases is often topical medications. While topical delivery allows active drug to be delivered directly to the target site, the skin is a virtually impermeable barrier that impedes delivery of large molecules. Thus, the formulation and delivery system are integral elements of topical medications. Patients also have preferences for the properties of topical formulations and these preferences can positively or negatively impact adherence. Therefore, the choice of topical formulation is a key consideration. Recent developments in drug delivery systems have produced enhanced topical treatments that improve efficacy, safety, and patient acceptability. Awareness of the delivery system in which drugs are formulated is critical as this can have profound implications on treatment success. This paper provides an overview and clinical commentary on advances in topical delivery systems and their impact on dermatological practice.

Advances for pediatricians in 2022: allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology.

The last year saw intensive efforts to advance knowledge in pediatric medicine. This review highlights important publications that have been issued in the Italian Journal of Pediatrics in 2022. We have chosen papers in the fields of allergy, anesthesiology, cardiology, dermatology, endocrinology, gastroenterology, genetics, global health, infectious diseases, metabolism, neonatology, neurology, oncology, pulmonology. Novel valuable developments in epidemiology, pathophysiology, prevention, diagnosis and treatment that can rapidly change the approach to diseases in childhood have been included and discussed.

Applications of Human Pluripotent Stem Cell-Derived Skin Organoids in Dermatology.

Pluripotent stem cells have the potential to become any cell type, and recently, they have been used to create organoids that can recapitulate several pertinent features of human organs. Skin organoids have been developed that possess many of the crucial accessory organs, including hair follicles, sebaceous glands, nerves, fat, and melanocytes. These skin organoids present the opportunity to study skin development and disease as well as perform screens to identify new drug candidates. In the future, skin organoids might augment clinical practice by serving as source material for transplantation to treat wounds or other conditions. Nevertheless, several limitations, such as the lengthy differentiation protocol, which can result in heterogeneous products, must first be addressed before the full potential of skin organoids can be realized. The purpose of this article is to provide a broad overview of skin organoids so that a broader audience can become familiar with this technology, which has important implications for dermatologic research and medicine.

Ecology and resistance to UV light and antibiotics of microbial communities on UV cabins in the dermatology service of a Spanish hospital.

Microorganisms colonize all possible ecological habitats, including those subjected to harsh stressors such as UV radiation. Hospitals, in particular the UV cabins used in phototherapy units, constitute an environment in which microbes are intermittently subjected to UV irradiation. This selective pressure, in addition to the frequent use of antibiotics by patients, may represent a threat in the context of the increasing problem of antimicrobial resistance. In this work, a collection of microorganisms has been established in order to study the microbiota associated to the inner and outer surfaces of UV cabins and to assess their resistance to UV light and the antibiotics frequently used in the Dermatology Service of a Spanish hospital. Our results show that UV cabins harbor a relatively diverse biocenosis dominated by typically UV-resistant microorganisms commonly found in sun-irradiated environments, such as Kocuria, Micrococcus or Deinococcus spp., but also clinically relevant taxa, such as Staphylococcus or Pseudomonas spp. The UV-radiation assays revealed that, although some isolates displayed some resistance, UV is not a major factor shaping the biocenosis living on the cabins, since a similar pool of resistant microorganisms was identified on the external surface of the cabins. Interestingly, some Staphylococcus spp. displayed resistance to one or more antibiotics, although the hospital reported no cases of antibiotic-resistance infections of the patients using the cabins. Finally, no association between UV and antibiotic resistances was found.

South Dakota Dermatology: Urban vs Rural Wait Times Survey and Dermatologist Density.

BACKGROUND: As of 2019, the state of South Dakota had only 32 registered dermatologists, one per 27,569 people. Wait times to be seen for dermatologic care are affected by factors such as socioeconomic status, provider distribution, and patient to provider ratios. This inaccessibility to care or prolonged wait times may lead to diagnosis and treatment delays, and disease progression. We hypothesized wait times to see a dermatologist would be longer in rural areas than urban areas in South Dakota. METHODS: Dermatology clinics throughout South Dakota were contacted to obtain wait times. An internet search was conducted to develop a list of dermatology providers. A population of 50,000 or greater defined an urban area and a ratio of 4 dermatologists per 100,000 people was used as an ideal patient to provider ratio. RESULTS: Overall, 75% of South Dakota's dermatology clinics participated with an equal rural to urban distribution. There was no statistically significant difference in wait times for new (p=0.787) or established patients (p=0.461) comparing rural and urban clinics. All South Dakota cities with clinics met the goal patient to dermatologist ratio except for Dakota Dunes (included as part of the Sioux City, Iowa metro population). CONCLUSIONS: The data does not support the hypothesis that wait times for dermatologists would be longer in rural locations than urban locations. Despite adequate dermatologist to patient ratios throughout most of South Dakota, wait times of over 6 weeks were found at both urban and rural locations, indicating the need for future studies to assess potential solutions for improving timely access to dermatologic care.

Building a Group Practice and Going Big.

Guided by experiences learned over 50 years of guiding a solo practice to an independent private practice with 28 providers and 7 practice locations in southeastern Virginia, the author describes some of the pros and cons as well as pearls and pitfalls and gives practical advice on how to evolve from a small practice to a large group while maintaining independence in today's ever-changing medical marketplace.

Economics of a Dermatology Practice.

Understanding the economics behind any medical practice comes down to one basic concept: Profit = Revenue - Expenses. This article aims to demystify the details that underlie this simple formula and to provide the budding dermatologist the information and the tools needed to determine their own profitability in the "real world."

How to Be a Successful Businesswoman in Dermatology.

Successful businesswomen in dermatology know what type of practice they want and create a plan to make it happen. They align their business with their life and surround themselves with people who support their goals. They accept support but know how to delegate. They do the hard work required to be successful, gaining knowledge and strength from the experience. When they make mistakes, they learn from them. They try to make the most of each patient's experience, while acknowledging that relationships with family, friends, and colleagues, as well as personal growth, are of utmost significance outside of their practices.

Musings from a Bent Arrow: The Road from Private Practice to Academics.

This biographical article takes the reader on the unlikely journey of a small-town dermatologist, Robert T. Brodell MD, from private practice to academics. It is designed to demonstrate that the road less traveled may be of interest to many other "regular" dermatologists in private practice… particularly those who enjoy teaching. The themes of hard work, dedication, overcoming failure, optimism, and passion are apparent. Life experiences are the basis for recommendations that may help others develop and then reach their academic goals. We hope that this will serve as a guide for physicians who aspire to take this leap.

Basic Legal Considerations in Starting and Maintaining a Dermatology Practice.

The thrill of starting a dermatology practice can be intoxicating. Starting up a business allows the physician to have their own practice by themselves or with other key individuals to launch the brand and ideas. This article provides guidance on the steps a dermatologist should consider when starting a new practice or adding a new partner. In addition, this article details the tools a physician can use to evaluate the various types of "entities," which are sole proprietorship, general partnership, corporations, and limited liability companies, and examines the 4 primary areas that tend to determine whether the parties are sufficiently aligned for success.

Incorporating Cosmetic Procedures into Your Dermatology Practice.

Cosmetic procedures can be a nice addition to many different types of dermatology practices. It is part of our specialty, and the author would encourage anyone interested to pursue adding a few procedures to their current practice. Why perform cosmetic procedures? It can be esthetically pleasing for many dermatologists, there is a growing demand for esthetic procedures, and it is a source of additional increased revenue not tied to Medicare.

Insight Into Dermatology Providers' Perspectives on Approaches to Sensitive Skin: A Pilot Survey.

Sensitive skin (SS) is a common patient complaint; however, there are no consistent guidelines to guide dermatologists' approaches to diagnosis and management of SS. Attendees of an international dermatology conference were surveyed to gauge dermatology providers' experiences and perspectives on SS. Survey results suggest that although the definition and diagnosis of SS are ambiguous, SS is increasingly being considered as a unique condition. Patients are commonly seeking dermatologic care for SS; however, dermatologists identified challenges with diagnosis, counseling patients, selecting products or medications, and assessing clinical improvement. These data highlight both a significant demand and a current need for improved provider resources for SS. Citation: McCormick ET, Desai S, Friedman A. Insight into dermatology providers’ perspectives on/and approaches to sensitive skin: a pilot survey. J Drugs Dermatol. 2023;22(9):950-951. doi:10.36849/JDD.7450.

Cannabis and cannabinoids in dermatology: protocol for a systematic review and meta-analysis of quantitative outcomes.

INTRODUCTION: Following the discovery of various effects on skin function by modifying endocannabinoid systems, multiple preclinical studies have revealed the promise of cannabis and cannabinoids in the treatment of a variety of skin diseases. However, its clinical efficacy is still debated. METHODS AND ANALYSIS: The protocol has been prepared using the Preferred Items for Systematic Review and Meta-analysis Protocols guidelines. A systematic search will be conducted using PubMed, EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials and Web of Science. We will include randomised controlled trials and observational studies investigating alterations to dermatological characteristics following administration of cannabis and cannabinoids for dermatological diseases and disorders. The two reviewers will perform both the title and abstract and full-text screenings. The Cochrane Risk-of-Bias 2 and ROBINS-1 tools will be used to evaluate the risk of bias. If a group of comparable studies for each quantitative outcome can be discovered, we will conduct a random effects meta-analysis. We will investigate heterogeneity using a combination of visual inspection of the forest plot, the Cochran's Q test and Higgins' test [I2]. Sensitivity analyses will be performed to assess the statistical robustness of the primary outcome. To evaluate a publication bias, the Egger's regression asymmetry test and funnel plots will be considered. ETHICS AND DISSEMINATION: This study does not require ethical approval because no original data will be collected. The findings will be presented at conferences and published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42023397189.

Timeliness of diagnosis and treatment of cutaneous melanoma with dermatology, general practice, plastics surgery collaboration - are we meeting standards?

Introduction Melanoma is a serious type of skin cancer with a high burden in New Zealand. MelNet Quality Statements (2021) guide the timeliness of investigations and management for melanoma patients, who might experience long delays waiting for treatment. Aim To assess compliance of melanoma diagnosis and treatment timeliness with the MelNet Quality Statements at Waikato Hospital and in primary care for melanoma and melanoma in situ (MIS). Methods This is a retrospective clinical audit of patients referred via the Suspected Skin Cancer (SSC) teledermatology pathway between June 2020 and June 2022, and histologically confirmed as having melanoma or MIS. Time intervals between elements of service were analysed. Results For 43 melanomas and 105 MIS, compliance with MelNet Quality Statements across all melanoma services was poor, except for teledermatology response rates (100% compliance). From referral to first cancer treatment (Statement 2.1.1), compliance was 50% in general practice and 7.7% in Waikato Hospital. From teledermatologist response to biopsy (Statement 2.1.3), compliance was 65.2% in general practice and 7.7% in hospital plastics department. Histopathological reporting delays were also identified. Discussion Long delays for melanoma care in hospital likely reflect system failures (such as inadequate funding and human resources) and the increasing burden of skin cancer. In contrast, primary care provided quicker diagnostic biopsies and surgical treatments for melanoma.

A practical guide to clinical photography prior to skin biopsy: key tips and proposed workflow.

High-quality clinical photography has become an integral part of dermatology in the context of patient evaluation and monitoring, clinical teaching, and research. Technological advancements in smartphones have allowed dermatologists to incorporate photography in workflows; however, acquiring quality photos poses its own challenges. Outlining a best practice approach to image capture prior to biopsy will facilitate establishing a team-based approach for the implementation of clinical photography in workflow. We propose this guide with the intent of improving patient care though photography in the clinical setting and the goal of integrating high-quality photography into routine clinical practice.