SciCombinator

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Concept: Dermatology

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INTRODUCTION AND OBJECTIVES: Most Spanish hospitals do not have an on-call dermatologist. The primary objective of our study was to determine the profile of patients visiting our hospital’s emergency department for dermatologic conditions; our secondary objective was to analyze the case-resolving capacity of the on-call dermatologist. MATERIAL AND METHODS: Prospective study that included patients with dermatologic conditions treated in the emergency department of a hospital with an on-call dermatology resident during a 2-month period. We collected data on sex, age, diagnosis, days since onset, whether or not the emergency visit was justified, referral (self-referral or other), continued care, and the main reason for the visit. To analyze the case-resolving capacity of the on-call dermatologist we assessed the percentage of direct discharges, the diagnostic tests performed, and the percentage of revisits. RESULTS: The on-call dermatologist attended 861 patients (14.4 patients per day), of whom 58% were women and 42% men. In total, 131 different diagnoses were made; the most common were infectious cellulitis, acute urticaria, and herpes zoster. Only half of the visits were justifiable as emergencies (95% of patients <30 years of age had conditions that did not justify emergency care, compared to 6% of patients >65 years, P<.005). The on-call dermatologist discharged 58% of the patients directly and the revisit rate was 1%. In 4 of 5 emergency visits no diagnostic tests were required. CONCLUSIONS: The profile of patients seeking emergency dermatologic care is variable. Half of the emergency visits were not justified, and unjustified visits were especially common in younger patients. The case-resolving capacity of the on-call dermatologist was high.

Concepts: Medicine, Diagnosis, Hospital, Urgent care, First aid, Trauma center, Emergency department, Dermatology

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Mycophenolate mofetil (MMF) is used for prevention of allograft rejection in transplantation medicine. In dermatology it is used as a corticosteroid-sparing agent. The pharmacokinetics of MMF are known to vary by individual. Therapeutic dose monitoring of mycophenolic acid (MPA), the active metabolite of MMF, is used as a guide in transplantation medicine, but limited data exist on the benefit of measuring MPA levels in the management of dermatologic disease.

Concepts: Pharmacology, Medicine, Disease, Organ transplant, Cyclophosphamide, Mycophenolic acid, Mycophenolate mofetil, Dermatology

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OBJECTIVE: To analyze data corresponding to patients who underwent dermatological surgery in an operating room. MATERIAL AND METHODS: This was a descriptive, retrospective study of operating room activities in the dermatology department of Hospital Universitario de Fuenlabrada in Madrid between January 2005 and December 2010. We analyzed the relative frequency of a range of patient and procedure-related variables, as well as substitution and cancellation rates, the proportional risk of complications, and operating room efficiency. RESULTS: In the period analyzed, 11 516 patients underwent surgery: 9351 required minor surgery, 1998 major ambulatory surgery, and 167 surgery requiring hospitalization. Simple excision was the most common procedure (64.7%), and in the majority of cases (85%), the condition was benign. The mean number of patients treated per day was 9.7, and mean operating room efficiency was 71.9%. CONCLUSIONS: Accurate record-keeping is essential for analyzing operating room activities and comparing results with those from other centers. The analysis of patterns over time shows the effect of changes made on different indicators. In our case, a decrease in operating room efficiency was seen with an increase in the number of patients per day undergoing surgery.

Concepts: Medicine, Patient, Hospital, Surgery, Physician, Arithmetic mean, Dermatology

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Aesthetics continues to be a rapidly growing field within dermatology. In 2014, Americans spent 5 billion dollars on an estimated 9 million minimally invasive cosmetic procedures. Between 1997 and 2014, the number of aesthetic procedures performed on men increased by 273%. The approach to male aesthetics differs from that of females. Men have a squarer face, a more angled and larger jaw, and equally balanced upper and lower facial proportions. Facial muscle mass, subcutaneous tissue, and blood vessel density are also increased in men relative to women. While many of the same cosmetic procedures are performed in males and females, the approach, assessment, and treatment parameters are often different. Improper technique in a male patient can result in feminizing facial features and patient dissatisfaction. With an increasing number of men seeking aesthetic procedures, it behooves dermatologists to familiarize themselves with male facial anatomy and the practice of cosmetic dermatology in this population.

J Drugs Dermatol. 2015;14(9):1029-1034.

Concepts: Medicine, Male, Blood, Female, Gender, Sex, Boy, Dermatology

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There are several well-established guidelines for the treatment of psoriasis. Guidelines have been proposed in the United States by the American Academy of Dermatology (AAD), in Europe by the European S3, in the United Kingdom by the National Institute for Health and Care Excellence (NICE), and in Canada by the Canadian Dermatology Association. These guidelines are predominantly evidence-based, supported by expert panel consensus where evidence is lacking. Cyclosporine, a potent calcineurin inhibitor that acts selectively on T-cells, revolutionized the world of immunosuppression upon its discovery in 1970. Since its approval in 1997 by the U.S. Food and Drug Administration for the treatment of psoriasis, cyclosporine has been used with great efficacy in the treatment of not only psoriasis but also a wide consortium of dermatological diseases. However, in the past decade or so, many dermatologists have become increasingly hesitant to use this important drug because of its potent toxicity profile.
The purpose of this article is to review and compare the current evidence-based guideline recommendations for the use of cyclosporine in the treatment of psoriasis.
Although the various guidelines are similar in their initial treatment recommendations, significant differences exist in recommendations on maximal treatment duration (1 year versus 2 years), intermittent short-term versus continuous therapy, use in erythrodermic and palmoplantar psoriasis, as well as recommendations on managing cyclosporine-associated side effects. By following guideline recommendations, cyclosporine remains an excellent and indispensable tool for the dermatologist treating moderate-to-severe psoriasis.

J Drugs Dermatol. 2016;15(3):293-301.

Concepts: Medicine, United States, United Kingdom, Dermatology

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Acupuncture is a form of Traditional Chinese Medicine that has been used to treat a broad range of medical conditions, including dermatologic disorders. This systematic review aims to synthesize the evidence on the use of acupuncture as a primary treatment modality for dermatologic conditions.

Concepts: Medicine, Acupuncture, Alternative medicine, Han Dynasty, Traditional Chinese medicine, Qi, Moxibustion, Dermatology

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Prevalent among black women, traction alopecia (TA) is a type of hair loss that is often attributed to certain hairstyling practices. Although some of the hair care techniques common in the black community can promote ease of everyday hairstyling for black women, many of these practices have been implicated as risk factors for TA. Because of the limited literature on black hairstyling methods, hair loss in this patient population can present a diagnostic and therapeutic challenge for dermatologists. By increasing the knowledge and understanding of these practices and their risk of causing TA, clinicians can better manage this condition and stop the progression of hair loss before it becomes permanent. This information can be used to develop individualized recommendations for safer styling alternatives and improve patient education by identifying high-risk hairstyling habits. This review stratifies these hair care and styling practices into high-, moderate-, and low-risk categories, in addition to outlining a diagnostic approach for TA and detailed guidelines for conservative management.

Concepts: Medicine, Hospital, Black people, Dermatology, Alopecia, Traction alopecia, Hairstyle

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This viewpoint reviews the perspectives for dermatology as a specialty to go beyond the substantial impact of smoking on skin disease and leverage the impact of skin changes on a person’s self-concept and behavior in the design of effective interventions for smoking prevention and cessation.

Concepts: Medicine, Smoking, Specialty, Dermatology, Ammunition, Smoking ban, War

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The American Academy of Dermatology has developed an up-to-date national Burden of Skin Disease Report on the impact of skin disease on patients and on the US population. In this second of 3 manuscripts, data are presented on specific health care dimensions that contribute to the overall burden of skin disease. Through the use of data derived from medical claims in 2013 for 24 skin disease categories, these results indicate that skin disease health care is delivered most frequently to the aging US population, who are afflicted with more skin diseases than other age groups. Furthermore, the overall cost of skin disease is highest within the commercially insured population, and skin disease treatment primarily occurs in the outpatient setting. Dermatologists provided approximately 30% of office visit care and performed nearly 50% of cutaneous surgeries. These findings serve as a critical foundation for future discussions on the clinical importance of skin disease and the value of dermatologic care across the population.

Concepts: Health care, Medicine, Epidemiology, Death, Senescence, Demography, United States, Dermatology