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1.
J Drugs Dermatol ; 20(1): 112-113, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33400409

RESUMO

The coronavirus disease 2019 pandemic has quickly and abruptly altered workflow and education across medical specialties. As the health crisis persists in the United States, change will be the norm for the foreseeable future. Dermatology residents report high levels of anxiety, with concerns ranging from redeployment to career prospects.1.


Assuntos
Ansiedade/prevenção & controle , Competência Clínica , Dermatologia/educação , Dermatologia/métodos , Educação a Distância/métodos , Internato e Residência/métodos , Ansiedade/psicologia , Competência Clínica/normas , Dermatologia/normas , Humanos , Internato e Residência/normas
4.
J Formos Med Assoc ; 120(1 Pt 2): 422-428, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32563581

RESUMO

BACKGROUND/PURPOSE: Population aging and unequal accessibility of health care are increasingly important in developed countries. One strategy to overcome these issues is utilizing telemedicine, which is recently made possible technologically by the advancement of internet speed, high speed zooming cameras, and the information storages. In Taiwan, the telemedicine is granted legally by the amendment for Taiwan's Physician Act in 2018. METHODS: Kaohsiung Chang Gung Memorial Hospital (Kaohsiung CGMH) is the first hospital in Taiwan to provide the telemedicine service connecting to Cheng Kung Branch of Taitung Hospital since Nov 2018. Consultation services from Dermatology, ENT, and Ophthalmology have been delivered in the live-interactive and face to face module every week. RESULTS: Dermatology consultation comprises the majorities. In the first year, there were totally 426 dermatology consultation services. Eczema, fungal infections, and scabies infestation were the three most common diseases in the beginning. The disease diagnosis became more diverse after several months, including some ready-to-treat diseases pending correct diagnosis, such as pediculosis, psoriasis, and urticaria. Coupled with dermoscopic images, diseases such as hair loss, pediculosis capitis, skin tumor, and scabies, were diagnosed promptly. The subjective patient improvement rate was more than 75% year-round and the case closure rate was more than 85% year-round. CONCLUSION: Teledermatology is a promising approach to serve the remote medical-underprivileged regions. The teledermatology is anticipated to help underserved regions, nursing homes, prisons, and in situations with severe pandemic infections, such as COVID-19.


Assuntos
Dermatologia/métodos , Acesso aos Serviços de Saúde/organização & administração , Hospitais de Distrito , Hospitais Rurais , Serviços de Saúde Rural/organização & administração , Dermatopatias , Telemedicina/métodos , Dermatologia/organização & administração , Humanos , Dermatopatias/diagnóstico , Dermatopatias/terapia , Taiwan , Telemedicina/organização & administração
5.
JAMA Netw Open ; 3(12): e2030107, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33326027

RESUMO

Importance: The incidence of skin cancer is increasing and evaluation of the utility of total body skin examination (TBSE) in detecting incidental skin cancers is warranted. Objectives: To evaluate the proportion and rate of incidental skin cancer detection in urgent skin cancer clinics and investigate the rate of incidental skin cancer detection in 2 groups based on the degree of clinical suspicion of the index lesion for malignancy. Design, Setting, and Participants: A multicenter retrospective cohort study with a case note review of consecutive secondary care consultations was conducted using data from 2 urgent suspected skin cancer screening clinics in UK National Health Service trusts. The study was performed from January 1, 2015, to March 31, 2016, and data analysis was performed from October 14, 2018, to February 1, 2019. Patients included those presenting with a skin lesion suspicious of malignancy who were referred to the urgent suspected skin cancer clinic (N = 5944) over 15 months. Patients who accepted and received a TBSE were subsequently included in the analysis. Main Outcomes and Measures: The proportion and rate of incidental skin cancer detection through TBSE and whether a clinically suspicious (malignant) index lesion was associated with a higher chance of having a malignant incidental lesion. Results: Of the 5944 patients referred to the clinic, 4726 individuals (79.5%) were evaluated. In the cohort included in the analyses, the median age was 57 years (interquartile range, 39-73 years); 2567 patients (54.3%) were women. A total of 1117 skin cancers were identified; of these, 242 lesions (21.7%) were detected incidentally through TBSE, including 197 of 570 (34.6%) basal cell carcinomas, 16 of 250 (6.4%) squamous cell carcinomas, and 25 of 215 (11.6%) melanomas. The detection rate of incidental malignant lesions was 5.1 lesions per 100 patients examined (5.1%; 95% CI, 4.5%-5.8%). There was a higher detection rate of histologically confirmed incidental malignant lesions in individuals with clinically suspicious index lesions requiring biopsy (10.9%; 95% CI, 9.5%-12.5%) compared with those presenting with clinically benign index lesions (2.0%; 95% CI, 1.6%-2.5%) (P < .001). Conclusions and Relevance: The findings of this study support the use of TBSE for urgent skin cancer referrals, highlighting the potential harms of solitary lesion assessment in a subgroup. Individuals presenting with a clinically suspicious index lesion requiring biopsy are most likely to benefit from TBSE and should be counseled regarding the benefit.


Assuntos
Carcinoma Basocelular/patologia , Carcinoma de Células Escamosas/patologia , Melanoma/patologia , Encaminhamento e Consulta/estatística & dados numéricos , Neoplasias Cutâneas , Biópsia/métodos , Biópsia/estatística & dados numéricos , Dermatologia/métodos , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exame Físico/métodos , Exame Físico/estatística & dados numéricos , Estudos Retrospectivos , Pele/patologia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/patologia , Reino Unido
6.
Dermatol Online J ; 26(11)2020 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-33342172

RESUMO

The COVID-19 pandemic required a transition to telemedicine to limit viral spread. Dermatology seems particularly well-suited for telemedicine, however, this pandemic transformed teledermatology into the predominant means of delivering care. Providers are limited in their ability to promptly and accurately manage disease without access to in-person tools. This monumental switch to teledermatology may disadvantage certain patient populations, including those with limited technological literacy (such as the elderly) or access to the internet. Dermatologists must acknowledge these limitations and recognize the consequences of severely limited in-person visits over a prolonged period of time.


Assuntos
Dermatologia/métodos , Dermatopatias/diagnóstico , Telemedicina/métodos , Biópsia , Alfabetização Digital , Humanos , Acesso à Internet , Dermatopatias/patologia , Dermatopatias/terapia
7.
South Med J ; 113(9): 462-465, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32885267

RESUMO

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has drastically changed resident training in the United States. Here, we explore the early perceived effects of COVID-19 on dermatology residents through an electronic sample survey and identify possible areas for targeted improvement in lieu of a possible second wave of COVID-19 cases. METHODS: On April 3, 2020, a survey of link with 25 questions was sent to dermatology program coordinators to be disseminated among dermatology residents in the United States. The survey was closed on April 13, 2020. All of the questions were optional and no personal identifiers were collected. RESULTS: A total of 140 dermatology residents from 50 different residency programs across 26 states responded to the survey. The majority of respondents (85%) reported negative effects of COVID-19 on their overall wellness. Despite the majority of residents (92%) speculating that COVID-19 will have negative long-term effects on the US economy, only 33% agreed or strongly agreed that it will affect their job prospects. Teledermatology was widely implemented following the declaration of a national emergency (96% of represented residencies compared with only 30% before the pandemic), with heavy resident involvement. The majority of residents (99%) reported having virtual didactics and that they found them to be beneficial. Most residents were uncomfortable with the prospect of being reassigned to a nondermatology specialty during the pandemic. In addition, 22% of residents believed that their leadership were not transparent and prompt in addressing changes relating to COVID-19. CONCLUSIONS: Dermatology residents were affected negatively by COVID-19 in regard to their well-being, clinical training, and education. Several areas of improvement were identified that could improve our preparedness for a second wave of the virus.


Assuntos
Infecções por Coronavirus , Dermatologia , Pandemias , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral , Dermatopatias/terapia , Telemedicina , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Dermatologia/educação , Dermatologia/métodos , Educação/métodos , Feminino , Humanos , Internato e Residência/estatística & dados numéricos , Masculino , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Percepção Social , Inquéritos e Questionários , Telemedicina/métodos , Telemedicina/tendências , Estados Unidos
9.
Hautarzt ; 71(9): 691-698, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32720165

RESUMO

ADVANTAGES OF ARTIFICIAL INTELLIGENCE (AI): With responsible, safe and successful use of artificial intelligence (AI), possible advantages in the field of dermato-oncology include the following: (1) medical work can focus on skin cancer patients, (2) patients can be more quickly and effectively treated despite the increasing incidence of skin cancer and the decreasing number of actively working dermatologists and (3) users can learn from the AI results. POTENTIAL DISADVANTAGES AND RISKS OF AI USE: (1) Lack of mutual trust can develop due to the decreased patient-physician contact, (2) additional time effort will be necessary to promptly evaluate the AI-classified benign lesions, (3) lack of adequate medical experience to recognize misclassified AI decisions and (4) recontacting a patient in due time in the case of incorrect AI classifications. Still problematic in the use of AI are the medicolegal situation and remuneration. Apps using AI currently cannot provide sufficient assistance based on clinical images of skin cancer. REQUIREMENTS AND POSSIBLE USE OF SMARTPHONE PROGRAM APPLICATIONS: Smartphone program applications (apps) can be implemented responsibly when the image quality is good, the patient's history can be entered easily, transmission of the image and results are assured and medicolegal aspects as well as remuneration are clarified. Apps can be used for disease-specific information material and can optimize patient care by using teledermatology.


Assuntos
Inteligência Artificial , Dermatologia/métodos , Melanoma/diagnóstico por imagem , Aplicativos Móveis , Neoplasias Cutâneas/diagnóstico por imagem , Smartphone , Telemedicina/instrumentação , Humanos , Interpretação de Imagem Assistida por Computador , Oncologia , Melanoma/diagnóstico , Neoplasias Cutâneas/diagnóstico
10.
Int J Dermatol ; 59(9): 1043-1056, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32621284

RESUMO

Recommendations were made recently to limit or stop the use of oral and systemic immunotherapies for skin diseases due to potential risks to the patients during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic. Herein, we attempt to identify potentially safe immunotherapies that may be used in the treatment of cutaneous diseases during the current COVID-19 pandemic. We performed a literature review to approximate the risk of SARS-CoV-2 infection, including available data on the roles of relevant cytokines, cell subsets, and their mediators in eliciting an optimal immune response against respiratory viruses in murine gene deletion models and humans with congenital deficiencies were reviewed for viral infections risk and if possible coronaviruses specifically. Furthermore, reported risk of infections of biologic and non-biologic therapeutics for skin diseases from clinical trials and drug data registries were evaluated. Many of the immunotherapies used in dermatology have data to support their safe use during the COVID-19 pandemic including the biologics that target IgE, IL-4/13, TNF-α, IL-17, IL-12, and IL-23. Furthermore, we provide evidence to show that oral immunosuppressive medications such as methotrexate and cyclosporine do not significantly increase the risk to patients. Most biologic and conventional immunotherapies, based on doses and indications in dermatology, do not appear to increase risk of viral susceptibility and are most likely safe for use during the COVID-19 pandemic. The limitation of this study is availability of data on COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Síndrome da Liberação de Citocina/imunologia , Fármacos Dermatológicos/efeitos adversos , Suscetibilidade a Doenças/induzido quimicamente , Pneumonia Viral/epidemiologia , Dermatopatias/tratamento farmacológico , Animais , Betacoronavirus/imunologia , Produtos Biológicos/efeitos adversos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/virologia , Dermatologia/métodos , Dermatologia/estatística & dados numéricos , Modelos Animais de Doenças , Suscetibilidade a Doenças/imunologia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Humanos , Fatores Imunológicos/efeitos adversos , Camundongos , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/imunologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Índice de Gravidade de Doença , Dermatopatias/imunologia
11.
Dermatol Online J ; 26(4)2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32621674

RESUMO

The application of teledermatology for evaluating acne patients has yielded comparable therapeutic outcomes with traditional face-to-face evaluation, but follow-up compliance between these modalities is not well-studied. Our objective is to compare the rate and duration of follow-up between acne patients initially evaluated by teledermatology versus in-person outpatient consultation. Electronic medical review of acne patients, 18-35 years-old seen via teledermatology and face-to-face evaluation at the University of Pittsburgh Medical Center between 2010-2018 was performed. Teledermatology patients were less likely to follow-up in the first 90 days (13.0% versus 31.0%, P<0.001) compared to patients seen face-to-face with overall follow-up rates of 22% among both modalities. The median time to follow-up was 45.5 days (IQR: 13/57) in the teledermatology group compared to 64 days (IQR: 56/77) in the face-to-face group (P<0.001). Teledermatology patients were more likely to be treated with oral antibiotics (43.0% versus 28.5%) or oral spironolactone (18.5% versus 12.5%) compared to patients seen face-to-face (P<0.001). Teledermatology poses a promising solution to extend dermatologic care with earlier access to follow-up. Our data demonstrates a need to improve teledermatology follow-up education to improve follow-up care.


Assuntos
Acne Vulgar/terapia , Assistência Ambulatorial , Dermatologia/métodos , Telemedicina , Adulto , Assistência ao Convalescente/métodos , Registros Eletrônicos de Saúde , Feminino , Humanos , Masculino , Educação de Pacientes como Assunto , Estudos Retrospectivos , Adulto Jovem
15.
Med Mycol J ; 61(2): 17-21, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32475885

RESUMO

Wood's lamp was demonstrated to be useful in three cases of dermatophytoma treated during clinical dermatological practice. Clinical signs of onychomycosis are longitudinal yellow and white striae on the nail plate and are diagnosed by KOH direct microscopic examination. For its treatment, surgical debridement is recommended. Usefulness of the Wood's lamp for diagnosis of tinea capitis caused by Microsporum canis is standard. In the first and second cases, we used Wood's lamp (Woody™) to make a clear margin for debridement of onychomycosis. In the third case, onychomycosis was unsuccessfully treated using topical 5% luliconazole nail solution for 1 year and 10 months with yellow nail discoloration. Under Wood's lamp, we were able to distinguish luliconazole crystal staining from onychomycosis. This method is simple and quick, and useful for nail observation in dermatology clinics.


Assuntos
Dermatologia/métodos , Onicomicose/diagnóstico , Idoso , Humanos , Imidazóis/administração & dosagem , Masculino , Microsporum/patogenicidade , Pessoa de Meia-Idade , Unhas/microbiologia , Unhas/patologia , Onicomicose/tratamento farmacológico , Onicomicose/microbiologia , Onicomicose/patologia , Fatores de Tempo
17.
Dermatol Ther ; 33(4): e13804, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32530503

RESUMO

We aim to evaluate the change in the diagnostic spectrum in dermatology outpatient applications compared to before COVID-19. All patients were enrolled from the Department of Dermatology between February 12 and May 8, 2020, the duration of 4 weeks before COVID-19 and 8 weeks after were analyzed in three parts consisting of 4 weeks. Data obtained from the database such as age, gender, diagnoses were anonymized. Repeated applications with the same diagnosis in 10 days after the first presentation were ignored. Compared to the pre-outbreak, there was a 3.5-fold decrease in dermatology applications in the first month after COVID-19 and an 8.8-fold in the second month. We found a significant increase in the frequency of diagnoses such as generalized pruritus, pityriasis rosea, alopecia areata, bacterial skin/mucosa diseases, and zona zoster after COVID-19. The frequency declined in diseases such as verruca vulgaris, hyperpigmentation, skin tag, melanocytic nevus, and seborrheic keratosis/solar lentigo. It has been found that the frequencies of most diseases, including acne (⁓25% of patients), did not change. We think that many factors, such as affecting the quality of life, risk perception, increased stress burden may cause a change in the diagnostic distribution of the dermatology applications.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Dermatologia/métodos , Pneumonia Viral/epidemiologia , Dermatopatias/diagnóstico , Pele/patologia , Adulto , Comorbidade , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pandemias , Qualidade de Vida , Estudos Retrospectivos , Dermatopatias/epidemiologia , Adulto Jovem
18.
J Am Acad Dermatol ; 83(3): 958-959, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32531304
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