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1.
J Drugs Dermatol ; 18(10): 980-984, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584775

RESUMO

Background: The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing likely due to improved detection and a growing elderly population. Although the prognosis of cSCC is excellent with complete surgical excision, many patients who go on to develop metastasis are initially classified as low-risk. The most commonly used staging systems, American Joint Committee on Cancer (AJCC) and Brigham Women's Hospital (BWH), have low sensitivity and low positive predictive value for predicting metastasis. A gene expression profile test (cSCC-GEP) is in development to identify patients with cSCC at high risk for metastasis and death. Objective: To determine the impact of cSCC-GEP test results on management decisions made by dermatologists for cSCC patients. Design, Setting, and Participants: 402 dermatologists attending a national dermatology conference completed an online survey designed to determine the impact of cSCC-GEP test results on management decisions in a variety of clinical situations. Participants answered a series of questions related to three cSCC patient vignettes, each featuring different patient and lesion characteristics. Main Outcomes and Measures: Proportion of dermatologists who would recommend radiation, chemotherapy/immunotherapy, or sentinel lymph node biopsy (SLNBx) for each patient vignette (without cSCC-GEP results, with a lower risk result, or with a higher risk result). The effect of the test results on the follow-up intervals recommended by dermatologists was also examined. Results: In the majority of vignettes, a lower risk cSCC-GEP test result led to a statistically significant decrease in the proportion of dermatologists who would recommend radiation, chemotherapy/immunotherapy, SLNBx, or quarterly follow-up. Conversely, a higher risk cSCC-GEP result significantly altered management toward increased intensity (more recommendations for radiation, chemotherapy/immunotherapy, SLNBx, or quarterly follow-up) in all vignettes. Conclusions and Relevance: The results of a cSCC-GEP test appear to significantly impact decisions made by dermatologists regarding subsequent management, SLNBx, and follow-up intervals for patients with cSCC. J Drugs Dermatol. 2019;18(10):980-984.


Assuntos
Carcinoma de Células Escamosas/terapia , Tomada de Decisão Clínica/métodos , Dermatologia/métodos , Perfilação da Expressão Gênica , Neoplasias Cutâneas/terapia , Adulto , Assistência ao Convalescente/métodos , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/patologia , Dermatologistas/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Medição de Risco/métodos , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/patologia , Inquéritos e Questionários/estatística & dados numéricos
2.
J Drugs Dermatol ; 18(9): 904-908, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524346

RESUMO

Dermatologists are among the most inventive physicians, trained in the multiple disciplines of medical dermatology, surgical dermatology, and dermatopathology. Many of the advances in dermatology practice have been derived from inventive colleagues who identify opportunities for improvement in practice, develop viable prototypes to address these practice opportunities, and persevere through the hard work of developing new technologies to advance the practice of dermatology. In this article, we will review the basic elements of invention, patents, and the range of outcomes associated with the pursuit of invention. Examples of innovative dermatologic technologies and approaches will be reviewed. Opportunities abound for dermatologists to contribute to the advancement of medical care through invention in our specialty. J Drugs Dermatol. 2019;18(9):904-908.


Assuntos
Tecnologia Biomédica/métodos , Dermatologia/métodos , Invenções/legislação & jurisprudência , Dermatopatias/terapia , Tecnologia Biomédica/legislação & jurisprudência , Fármacos Dermatológicos/uso terapêutico , Dermatologistas , Dermatologia/instrumentação , Dermatologia/legislação & jurisprudência , Desenho de Equipamento , Humanos , Patentes como Assunto , Dermatopatias/diagnóstico
3.
J Drugs Dermatol ; 18(8): 798-802, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31424710

RESUMO

Cutaneous fungal infections account for millions of office visits per year, yet their varied presentations often lead to misdiagnosis. If dermatology clinics are Clinical Laboratory Improvement Amendment (CLIA) certified, direct microscopy with potassium hydroxide or other stains can be used to inexpensively and rapidly diagnose fungal infections. In this survey, we examined dermatologists' perceptions of fungal preparations and CLIA certification to identify barriers that prevent the use of these bedside diagnostics. The response rate was 13% (n=308, based on the number of emails opened). When a cutaneous fungal infection is suspected, 20.94% rarely/never and 19.86% sometimes perform fungal preparations, often because they think clinical diagnosis is adequate or that preparations take too long. 21.32% reported not having CLIA certification, most frequently because the process requires too much work, or they do not know how to apply. Of providers with CLIA certification, over 25% thought it was difficult to obtain. Our results demonstrate that numerous barriers prevent the common use of fungal preparations, including the perception that clinical diagnosis is sufficient and the lack of required CLIA certification. These barriers emphasize the need for additional education about cutaneous fungal infections and use of bedside diagnostics. Additionally, policy-based interventions are necessary to ease the process of CLIA certification.


Assuntos
Dermatomicoses/diagnóstico , Fungos/isolamento & purificação , Indicadores e Reagentes/química , Adulto , Idoso , Dermatologistas/estatística & dados numéricos , Dermatologia/métodos , Dermatologia/estatística & dados numéricos , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Diagnóstico Diferencial , Feminino , Humanos , Hidróxidos/química , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estatística & dados numéricos , Microscopia , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Compostos de Potássio/química , Padrões de Prática Médica/estatística & dados numéricos , Pele/microbiologia , Pele/patologia , Inquéritos e Questionários/estatística & dados numéricos
4.
Cutis ; 103(6): 346-350, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31348449

RESUMO

Chemical burns to the eyes are one of the few ocular emergencies that dermatologists may encounter in their everyday clinic. As such, dermatologists should be confident in their ability to urgently manage ocular chemical injuries should accidental exposure occur during a procedure. We report a case of accidental ocular exposure to aluminum chloride hexahydrate during skin biopsy of the cheek and subsequent transient ocular injury that resolved with early appropriate management. This article provides background information on acute chemical ocular injuries, offers practical step-by-step guidance for the dermatologist, and highlights immediate copious irrigation as perhaps the most critical step in determining the clinical course of the injury.


Assuntos
Cloreto de Alumínio/efeitos adversos , Queimaduras Químicas/terapia , Queimaduras Oculares/terapia , Irrigação Terapêutica/métodos , Cloreto de Alumínio/administração & dosagem , Queimaduras Químicas/etiologia , Dermatologia/métodos , Emergências , Queimaduras Oculares/induzido quimicamente , Feminino , Humanos , Pessoa de Meia-Idade
6.
Int J Dermatol ; 58 Suppl 1: 4-28, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282026

RESUMO

This Clinical Practice Guideline on the systemic treatment of Psoriasis includes the recommendations elaborated by a panel of experts from the Latin American Psoriasis Society SOLAPSO, who assessed the quality of the available evidence using the GRADE system and the PICO process to guide the literature search. To answer each question, the experts discussed the results of randomized controlled trials, observational studies and metanalysis evaluating the interventions identified (non-biologics, biologics and phototherapy) in different populations of patients with moderate to severe plaque-psoriasis, which was summarized in Tables ad-hoc. The main end-points considered to assess efficacy were PASI 50, 75, 90 and 100, PGA 0-1 and significant improvement of health-related quality of life. Specific adverse events, either severe or leading to treatment interruption, were also evaluated. The 31 recommendations included in this CPG follow the structure proposed by GRADE: direction (for or against) and strength (strong or weak). The goal of this CPG is to improve the management of patients with psoriasis by recommending interventions of proved benefit and providing a reference standard for the treating physician. Adhering to the contents of this CPG does not guarantee therapeutic success. The final decision on the specific treatment is the responsibility of the physician based on the individual circumstances and considering the values, the preferences and the opinions of the patient or caregivers.


Assuntos
Produtos Biológicos/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Dermatologia/normas , Fototerapia/normas , Psoríase/terapia , Administração Oral , Dermatologia/métodos , Humanos , Injeções Subcutâneas , América Latina , Fototerapia/métodos , Psoríase/diagnóstico , Índice de Gravidade de Doença , Sociedades Médicas/normas
8.
Eur J Pharm Biopharm ; 140: 121-140, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31059780

RESUMO

Since the first patent for microneedles was filed in the 1970s, research on utilising microneedles as a drug delivery system has progressed significantly. In addition to the extensive research on microneedles for improving transdermal drug delivery, there is a growing interest in using these devices to manage dermatological conditions. This review aims to provide the background on microneedles, the clinical benefits, and challenges of the device along with the potential dermatological conditions that may benefit from the application of such a drug delivery system. The first part of the review provides an outline on benefits and challenges of translating microneedle-based drug delivery systems into clinical practice. The second part of the review covers the application of microneedles in treating dermatological conditions. The efficacy of microneedles along with the limitations of such a strategy to treat diseased skin shall be addressed.


Assuntos
Dermatologia/instrumentação , Sistemas de Liberação de Medicamentos/instrumentação , Microinjeções/instrumentação , Administração Cutânea , Animais , Dermatologia/métodos , Sistemas de Liberação de Medicamentos/métodos , Humanos , Microinjeções/métodos , Agulhas , Pele/metabolismo
9.
J Am Acad Dermatol ; 81(3): 834-846, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31009668

RESUMO

The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma (PRP), recently garnering significant interest in alopecia, acne scarring, and skin rejuvenation. In other conditions of dermatology, such as chronic wounds and vitiligo, PRP has been investigated but has received less attention. The objective of this literature review was to focus on conditions of medical dermatology and to consolidate the available evidence on PRP for the practicing dermatologist. This review evaluates the literature up to October 31, 2018, and a search was conducted in the PubMed database for "platelet-rich plasma," "platelet releasate," "platelet gel," "platelet-rich fibrin" or "PRP" and "dermatology," "skin," "cutaneous," "wound," or "ulcer." In total, 14 articles met the inclusion criteria for this review. In studies representing Levels of Evidence 1b-4 according to the Centre for Evidence-Based Medicine, Oxford, PRP significantly improved wound healing in chronic diabetic ulcers, venous ulcers, pressure ulcers, leprosy ulcers, acute traumatic wounds, and ulcers of multifactorial etiologies. Two studies also documented benefits of adjunctive PRP in stable vitiligo. In chronic wounds of multiple etiologies and vitiligo, PRP warrants further investigation because it represents a potential therapeutic adjunct or alternative with a favorable side effect profile.


Assuntos
Alopecia/terapia , Cicatriz/terapia , Dermatologia/métodos , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Humanos , Rejuvenescimento , Cicatrização
12.
Eur J Dermatol ; 29(S1): 4-7, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-31017580

RESUMO

Diagnosis in dermatology is largely based on contextual factors going far beyond the visual and dermoscopic inspection of a lesion. Diagnostic tools such as the different types of dermoscopy, confocal microscopy and optical coherence tomography (OCT) are available and all of these have shown their importance in improving the dermatologist's ability, especially in the diagnosis of skin cancer. Their use, however, remains limited and time consuming, and optimizing their practice appears to be difficult, requiring extensive pre-processing, lesion segmentation and extraction of domain-specific visual features before classification. Over the last two decades, image recognition has been a matter of interest in a large part of our society and in industry, leading to the development of several techniques such as convolutional processing combined with artificial intelligence or neural networks (CNN/ANN). The aim of the present manuscript is to provide a short overview of the most recent data about CNN in the field of dermatology, mainly in skin cancer detection and its diagnosis.


Assuntos
Inteligência Artificial , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico , Pele/diagnóstico por imagem , Algoritmos , Aprendizado Profundo , Dermatologia/métodos , Dermoscopia , Humanos , Processamento de Imagem Assistida por Computador , Melanócitos , Melanoma/diagnóstico por imagem , Microscopia Confocal , Sensibilidade e Especificidade , Pele/patologia , Neoplasias Cutâneas/diagnóstico por imagem , Tomografia de Coerência Óptica
13.
Cutis ; 103(2): E27-E28, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30893396

RESUMO

When physicians reference the diet in a standard admissions order set, do patients think they are talking about weight loss? Communication with patients is fraught with potential for misunderstanding, even in seemingly simple words and concepts. This article explores some examples particularly relevant to dermatologists.


Assuntos
Comunicação , Dermatologistas , Dermatologia/métodos , Relações Médico-Paciente , Dieta , Humanos , Terminologia como Assunto
15.
J Am Acad Dermatol ; 80(3): 581-589, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30744874

RESUMO

More than 10 million lesbian, gay, bisexual, and transgender (LGBT) persons live in the United States. Improving their health is a public health priority. LGBT persons have specific health concerns and face health care disparities. Awareness of those issues and disparities can enable dermatologists to provide medically appropriate and culturally competent care to LGBT patients. This review highlights terminology important in caring for LGBT persons, LGBT demographics in the United States, health care disparities faced by LGBT persons, and approaches to caring for LGBT patients.


Assuntos
Dermatologia/métodos , Disparidades em Assistência à Saúde , Assistência ao Paciente , Minorias Sexuais e de Gênero , Demografia , Identidade de Gênero , Disparidades nos Níveis de Saúde , Humanos , Comportamento Sexual , Terminologia como Assunto , Estados Unidos
16.
J Am Acad Dermatol ; 80(3): 591-602, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30744875

RESUMO

Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM. Women who have sex with women experience disparities in STDs, including chlamydia and HPV. Transgender patients have unique, and often unmet, dermatologic needs during gender transition (also called gender affirmation), related to hormonal therapy and gender-affirming surgery. Familiarity with LGBT health issues and disease-prevention guidelines can enable dermatologists to provide medically appropriate and culturally competent care to LGBT persons.


Assuntos
Dermatologia/métodos , Homossexualidade Feminina , Homossexualidade Masculina , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Dermatopatias/diagnóstico , Dermatopatias/epidemiologia , Pessoas Transgênero , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto , Doenças Sexualmente Transmissíveis/prevenção & controle , Dermatopatias/prevenção & controle
18.
J Drugs Dermatol ; 18(2s): s99, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30811152

RESUMO

It has been said that the best treatment for a given patient is the one that the patient will actually use. The comment, often spoken with humor, actually underscores several important aspects of dermatology care today. Foremost is the fact that patient adherence (as influenced by their satisfaction with treatment) is a critical driver of clinical success. Additionally, dermatologists now often have a range of vehicle formulations from which to select treatment.


Assuntos
Fármacos Dermatológicos/administração & dosagem , Sistemas de Liberação de Medicamentos/métodos , Cooperação do Paciente , Veículos Farmacêuticos , Dermatopatias/tratamento farmacológico , Administração Cutânea , Dermatologia/métodos , Humanos
20.
Rural Remote Health ; 19(1): 4895, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30673294

RESUMO

INTRODUCTION: The high incidence of skin cancer in Brazil has resulted in an urgent need for more efficient methods of reducing the time between initial diagnosis and therapy. Such delays are significant in large countries like Brazil, where a considerable proportion of the population live in remote areas with limited access to specialized medical care. To address this problem the use of mobile phones as screening devices for suspicious skin lesions has been incorporated as long-distance teledermatology services. Digital photography is now a convenient ancillary option to minimize treatment delays caused by the distance between the specialist doctor and patients. The authors have developed a friendly mobile application and website to take high quality digital images of suspicious lesions, and to capture patient data easily and quickly to be analyzed by skin cancer professionals at another location. METHODS: This was a prospective study of a population of 39 individuals monitored by routine skin cancer screening by the Cancer Prevention Department at Barretos Cancer Hospital during 2016. All patients were evaluated in the dermatology clinic, where a differential diagnosis was made based on the clinical information and direct examination of suspicious lesions. A second dermatologist assessed the same clinical information and digital images of all lesions captured by teledermatology, and provided an independent diagnostic opinion on the likelihood of the lesions being benign or suggestive of malignancy. The diagnostic efficiencies of teledermatology and standard dermatology were then compared to the histopathological findings of each biopsy as the diagnostic gold standard, and then statistical parameters of each approach were evaluated. RESULTS: The lesions studied in this comparison were mostly found on the face (69%), followed by upper limbs (15%), scalp (8%), trunk (6%) and lower limbs (2%). Final histopathological analyses of the biopsies in the study group showed that 71% of lesions were malignant, with 32% being squamous cell carcinoma and 68% being classified as basal cell carcinoma, and 29% were considered benign lesions. The overall sensitivities of teledermatology in comparison to face-to-face evaluation in the clinic were similar (clinic, 80.0%; teledermatology, 80.8%). Other comparisons including accuracy (clinic, 78.9%; teledermatology, 79.5%); specificity (clinic, 76.9%; teledermatology, 76.9%); positive predictive value (clinic, 87.0%; teledermatology, 87.5%); and negative predictive value (clinic, 66.7.0%; teledermatology, 66.7%) all showed equivalence. The inter-observer kappa value between face-to-face examination and teledermatology showed excellent agreement at 0.958. CONCLUSION: These preliminary findings indicate that the cell phone application developed to aid the diagnosis of skin cancer showed great potential and reliability, and can therefore be considered as an ancillary option in countries like Brazil, with isolated communities that have limited access to dermatology clinics.


Assuntos
Dermatologia/métodos , Detecção Precoce de Câncer/métodos , Interpretação de Imagem Assistida por Computador/métodos , Neoplasias Cutâneas/diagnóstico , Telemedicina/métodos , Adulto , Brasil , Telefone Celular , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aplicativos Móveis/estatística & dados numéricos , Fotografação
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