Impact of dermatology eConsults on access to care and skin cancer screening in underserved populations: A model for teledermatology services in community health centers.

BACKGROUND: The clinical outcome of teledermatology with dermoscopy in large-scale primary care networks remains unclear. OBJECTIVE: We evaluate the impact of implementing a teledermatology consultation program with dermoscopy on a statewide scale, focusing on access to care and skin cancer screening for medically underserved populations. METHODS: Descriptive retrospective cohort study of 2385 dermatology referrals from primary care from June 2014 through November 2015. RESULTS: Before implementation of electronic consultations (eConsults), access to dermatology was limited; only 139 (11%) of 1258 referrals resulted in a confirmed appointment with a median wait time of 77 days. Post implementation, 499 of 1127 consults (44%) were sent electronically, and of those, 16% required a face-to-face visit with a median wait time of 28 days. Ten malignancies were identified via eConsults. Overall consult volume remained stable pre- and post-eConsult implementation. LIMITATIONS: We evaluated eConsults in medically underserved populations seeking care at community health centers. Results might not be generalizable to other populations or in other settings. CONCLUSION: eConsults increase access to dermatologic care and reduce wait times for patients receiving medical care at community health centers. Implementing dermoscopy into teledermatology could increase access to skin cancer screening and treatment for medically disadvantaged populations.

A "Solution" for Patients Unable to Swallow a Pill: Crushed Terbinafine Mixed With Syrup.

Because oral terbinafine is now formulated only as a tablet, there is a barrier to treatment of superficial fungal infections in patients who are unable to swallow a pill such as young children and patients with pill dysphagia. We describe a preparation method that allows this population to safely and effectively use oral terbinafine.

A dermatologic perspective on multisystem inflammatory syndrome in children.

As of May 2020, an emerging immune-mediated syndrome primarily affecting children has been detected primarily in Europe and the United States. The incidence of this syndrome appears to mirror the initial infectious assault with a delay of several weeks. This syndrome has been termed "multisystem inflammatory syndrome in children" (MIS-C) and is observed in association with the coronavirus disease 2019. The phenotypes of presentation include several characteristic features, including prolonged fever, skin eruptions, neck stiffness, and gastrointestinal manifestations with pronounced abdominal pain. Shock and organ dysfunction on presentation are frequent but inconsistent, whereas respiratory distress is typically, and notably, absent. We have reviewed the recent published data aiming to better understand MIS-C, with a focus on its mucocutaneous manifestations.

A dermatologic perspective on multisystem inflammatory syndrome in children.

As of May 2020, an emerging immune-mediated syndrome mainly affecting children has been detected primarily in Europe and the United States. The incidence of this syndrome appears to mirror the initial infectious assault, with a delay of several weeks. This syndrome has been termed "multisystem inflammatory syndrome in children" (MIS-C) and is observed in association with the coronavirus disease 2019 (COVID-19). The phenotypes of presentation include several characteristic features, including prolonged fever, skin eruption, neck stiffness, and gastrointestinal manifestations with pronounced abdominal pain. Shock and organ dysfunction on presentation are frequent but inconsistent, whereas respiratory distress is typically and notably absent. We have reviewed recently published data aiming to better understand MIS-C, with a focus on its mucocutaneous manifestations.

Methotrexate treatment of generalized granuloma annulare: a retrospective case series.

BACKGROUND: Management of generalized granuloma annulare (GGA) poses challenges for both patients and dermatologists. Currently, there are no established first-line therapies for GGA and the available therapeutic modalities are based on individual case reports and a few small case series. Further, there are limited publications assessing the efficacy of methotrexate in treating GGA. OBJECTIVE: To evaluate the efficacy and adverse effects associated with methotrexate treatment of GGA. METHODS: Descriptive retrospective case series of 11 patients with GGA receiving methotrexate. RESULTS: Sixty four percent of patients receiving methotrexate noted improvement of their skin disease, of which 43% achieved complete clearance and 57% partial clearance. Initial dose of methotrexate ranged from 12.5 to 15 mg weekly, administered either orally or subcutaneously. The majority of patients tolerated the treatment well. However, 18% of patients experienced the adverse effects of either GI upset or hair loss. LIMITATIONS: This case series lacks a control group and therefore has low internal validity. The lack of a disease severity and therapy responsiveness measurement tool made quantifying disease improvement inexact. CONCLUSIONS: Methotrexate can be a successful and well-tolerated treatment option for patients with generalized GA.

Teledermatology: Kids are not just little people.

Teledermatology has emerged as a promising solution for pediatric and adult patients accessing dermatologic care in a health care environment fraught with barriers to access. Teledermatology has been extensively evaluated in terms of diagnostic accuracy, clinical outcomes, patient and provider satisfaction, and costs, relative to traditional health care delivery models. Current research indicates that teledermatology is effective and efficient in diagnosis and management of skin diseases. The majority of studies on the subject, however, rely on adult patient data. Pediatric patients, with their unique clinical features and challenges, may interact with telemedicine differently than their adult counterparts. Maximizing the benefits of teledermatology in pediatric dermatologic care is dependent on future research. We review and analyze the commonalities and differences between pediatric and adult patient care using teledermatology.

Clinical trials: Kids are not just little people.

Clinical trials are the backbone of modern evidence-based medicine. They are the vital bridge between research-based discovery and cutting edge patient care. Randomized, controlled clinical trials are the gold standard of medical research, providing a method for evaluation and discovery of novel therapies that improve and even save lives. Despite an increase in the number of pediatric and adult clinical trials over recent decades, this growth has not been equal among these populations. The volume of clinical trials involving children lags substantially behind their adult counterparts. Children are not simply little adults. As a result, extrapolating results from adult clinical trials to the treatment of children may be inappropriate and, possibly, harmful. In this review, we discuss the intricacies of performing clinical trials in all patients and stress the unique distinguishing characteristics of pediatric clinical trials.

Photodermatoses: Kids are not just little people.

Photodermatoses are a group of skin disorders caused by abnormal reaction to ultraviolet radiation. Photodermatoses are divided into four groups: (1) immunologically mediated photodermatoses; (2) chemical- and drug-induced photodermatoses; (3) photoaggravated dermatoses; and (4) hereditary photodermatoses. This contribution discusses differences in the approach and diagnosis of pediatric and adult patients with suspected photodermatoses, focusing on immunologically mediated photodermatoses and chemical- and drug-induced photodermatoses.