Therapeutic implications of prevalence and predictor risk factors for burn out syndrome in Egyptian dermatologists: A cross sectional study

Burnout among physicians and dermatologists is gaining a wide attention in the recent decade. The aim of this cross sectional study was to assess the prevalence and predicting factors for burnout among Egyptian dermatologists. A cross sectional study was designed and data were collected using structured open access survey. A total of 144 dermatologists completed the full questionnaire. The majority of dermatologists completing the survey 85 (59%) were between 30 and 40 years age group while those above 50 years of age represented a minority 10 (6.9%). The Mean score of emotional exhaustion was 29.24 ± 12.73 (high) while that of personal accomplishment was 29.14 ± 9.24 (moderate) and for depersonalization was 10.07 ± 6.46 (moderate). We demonstrated high burnout prevalence among Egyptian dermatologist that needs to be further verified by other randomized studies. Being a resident dermatologist living in a rural locality and with more than 8 daily working hours were significant predictors of increased burnout rates.

Bupropion in dermatology: A brief update

There is currently an interest in evaluating the role that antidepressants may play in the treatment of primary cutaneous disorders. It has been proposed that antidepressants could have anti-inflammatory effects, but the clinical relevance of this effect has not been adequately established. In the case of bupropion, evidence for its specific use in dermatologic conditions currently come only from a pilot study and a case report. While this level of evidence is unlikely to be sufficient to guide clinical practice, the authors of this brief update hope to sort the available information to serve as a guide and provide a structure for future research.

Effectiveness of psychopharmacotherapy in psoriasis patients with associated anxiety and depression

Psoriasis is associated with psychological comorbidities. We evaluated the effectiveness of additional psychopharmacotherapy on the clinical severity and associated anxiety and depression in psoriasis. 173 patients were enrolled with psoriasis and associated anxiety and depression. Spielberger State-Trait Anxiety Inventory (STAI) and The Beck Depression Scale (BDI) were used to assess anxiety and depression parameters. The IA main group included patients with anxiety disorders who received Mebicar. The IB main group consisted of patients with anxiety and depressive disorders who received Mianserin. The II group comprised patients with anxiety disorders (IIA comparison group) and patients with anxiety and depressive disorders (IIB comparison group), who received only traditional therapy. The level of anxiety in patients of the IA and IB main groups decreased by 2.1 times. The level of depression in the IB main group significantly decreased by 1.7 times, while in the IIB comparison group, this indicator remained almost at the same level. Patients of the IA and IB main groups had PASI50 on average on 15 to 16 days of treatment. PASI50 was achieved in the both comparison groups only at 21 to 22 days. PASI75 occurred in the IA and IIB main groups almost simultaneously on 28 to 29 days of treatment. But in the IIA and IIB comparison groups, these positive changes occurred significantly later than in patients of the main groups (on 34-35 days of treatment). Additional psychopharmacotherapy significantly reduced anxiety and depression in both groups IA and IB, as compared to patients in groups IIA and IIB who received only traditional therapy.

Psychodermatology knowledge and awareness: A cross-sectional Egyptian perspective

The merging of psychiatry and dermatology has resulted in a relatively newer emerging field known as psychodermatology (PD). The aim of this cross sectional study was to assess knowledge, attitudes, and practice patterns of Egyptian dermatologists towards psychodermatology. A cross sectional study was designed and data were collected using structured self-administered online questionnaires. A total of 212 dermatologists completed the full questionnaire. Those with incomplete or partially answered responses were excluded. 171 (81.1%) were females and 40 (18.9%) were males. The majority (n = 109;51.4%) of dermatologists completing the survey were between 30 and 40 years age group while those between 40 and 50 years of age accounted for 48 (22.6%). The vast majority of respondent dermatologists never referred (n = 87; 41%) or very rarely referred (n = 58; 27.5%) any psychocutaneous patients to a psychiatrist. Almost 75% of responding dermatologists were not aware of available community or educational resources for PD and 157 (74.1%) expressed interest in receiving continuing medical education (CME) programs. In conclusion, psychodermatology training among dermatologists shall enhance and improve their approach to psychocutaneous conditions.

COVID-19 and immunosuppressive therapy in dermatology

Coronavirus 2019 (COVID 19) was first detected in December 2019 in China. It has become a pandemic. With concern about therapies that may decrease immunity and enhance the severity of an individual's COVID‐19 infection, leading to a possibly fatal outcome, use of immunosuppressants has become an important concern. This work focuses on management of various skin diseases individuals lacking immunity to COVID‐19 but requiring a systemic immunosuppressant, keeping in view the challenge of the COVID 19 pandemic and that our knowledge of this virus and its effects on the immune system are incomplete including knowledge as to an individual's immunity after COVID‐19 infection.

Therapeutic implications of immunohistochemical expression pattern of the cancer stem cell marker (nestin) in basal and squamous cell carcinomas

Cancer stem cells (CSC) are populations of cells responsible for tumor initiation, progression and therapeutic resistance in many cancers. In the present study, we aimed to investigate the expression pattern and clinical significance of the stem cell marker nestin, in Squaous cell carcinoma (SCC) and basal cell carcinoma (BCC). The samples (23 cases of BCC and 22 cases of SCC) were immunohistochemically examined for the expression of nestin and its correlation with the corresponding clinical and pathological parameters. Nestin was expressed in four out of the 23 cases of BCC (17.4%) and was expressed in 10 out of the 22 cases of SCC (45.5%). Nestin expression between the two tumors was statistically significant (P = .042). Although a direct relationship was found between the tumor grade and nestin expression, the results were statistically insignificant (P = .495). The results of this study suggest that BCC and SCC may share some cellular origin but with different biologic behavior. The relation of nestin expression to the grade of SCC, although statistically insignificant, may suggest its role in predicting the biologic behavior of this tumor.

Nonsteroidal anti-inflammatory drugs (NSAIDs) consideration by dermatologists during the COVID19 pandemic

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been an important therapy in the treatment of a large number of cutaneous pathologies for more than three decades. Concerns have been raised that NSAIDs may be associated with an increased risk of adverse effects when used in patients with acute viral respiratory infections. Given the current SARS-CoV-2 (COVID-19) pandemic, the availability of reliable information for clinicians and patients is of extreme importance Although accumulating evidence support the existence of a harmful effect of NSAIDs in some infectious settings, no clinical studies demonstrating that such risk applies in case of COVID-19. Pending further research, a pragmatic and cautionary approach would be to avoid regular NSAID use or as first line option in suspicion of COVID19 symptoms.

"The unfair drive to be fair": Psychosocial aspects and implications of the use of skin lightening agents

The quest to be fair is not a concept of the new world. For centuries untold, having a lighter skin tone has been considered as a trait of beauty and supremacy. Society implicates fairness as a factor for getting a prospective life partner. Media portrays fair skin tone as a predecessor for success. These subtle influences affect young minds and drive them towards wanting fair skin. Physicians observe that it is one of the most common forms of body dysmorphic disorder. This article aims to highlight the psychosocial factors that mold this mentality and the possible ill effects it can have on a person, both psychologically as well as physically.

Management of psychocutaneous disorders: A practical approach for dermatologists

Psychodermatology is a growing specialty which is gaining momentum in different parts of the world. It focuses on the connection between skin and psyche. Psychocutaneous conditions are characterized by those disorders where stress is the key element in exacerbating skin conditions or flare ups of dermatoses like psoriasis and atopic dermatitis. There is a direct relationship of stress with the course, and prognosis of the skin disease. In some situations, there is no skin condition but the lesions are self-inflicted and such disorders are always associated with underlying psychopathology or psychological conflicts. Sometimes emotional problems are more prominent as a result of having skin disease, and the psychological consequences may be more severe than the physical symptoms. Management of these conditions require a combination of psychpharmacology, psychotherapy, and liaison clinics of psychiatry and dermatology. This review focuses on the common management approach which can be adopted by dermatologists in treating patients with psychodermatological disorders, improving doctor-patient relationship and therapeutic bond.

Psychological aspects of COVID-19

BACKGROUND

COVID-19 pandemic has affected the world from every aspect. Individuals are drained from social, financial, and emotional percussion of this pandemic. Psychosocial consequences are far greater than are being perceived. It is anticipated that once the pandemic is over the psycho-emotional turbulence would shake the whole populations of affected countries.

AIMS AND OBJECTIVES

To review the psychological consequences of COVID-19 pandemic.

METHODS

A literature search was conducted on major databases from January 2020 to April 2020 with the search terms of Covid-19, Corona virus, psychological, depression, anxiety, phobias, obsessive behaviors, paranoia, parental relationship, marital life and maternal and fetal bond.

CONCLUSION

Patients with COVID-19 infection are more likely to suffer from a myriad of psychological consequences, and this infection may have profound effect on parenting, relationships, marital life, elderly, and maternal-fetal bond.

Relaxation therapy in the management of psoriasis

Several studies have demonstrated a direct link between psoriasis, stress and psychiatric comorbidity. We assessed the effect of relaxation therapy on psoriasis severity, quality of life, stress level and psychiatric comorbidity. Patients were assessed for stress, anxiety, depression, quality of life and severity of disease, using standard instruments. Patients were divided into two as cases and pair matched controls. The first group was given relaxation therapy in addition to the standard dermatology treatment and the second group was given only the standard dermatology treatment. The patients were followed up on first week, second week, first month and second month. Twenty one out of 30 cases (70%) achieved PASI 50 at the end of 2 months. While only 4 out of 30 (13.3%) of the control group achieved the same at the end of the study. There was statistically significant difference between cases and controls in PASI, DLQI, HADS scores with a P value of .000 each at the end of the study. But there was no statistically significant difference in perceived stress score between cases and controls. Psoriasis has significant impact in the quality of life and psychiatric comorbidity. Psychological interventions like relaxation therapy can decrease disease severity and improve quality of life.

Awareness of psychodermatology in Indian dermatologists: A South Indian perspective

This study was aimed to survey the awareness, knowledge, practicing patterns, and attitudes of dermatologists toward psychocutaneous disorders in a South Indian State. The questionnaire-based study was performed from August 1 to October 31, 2019. Study participants included 123 dermatologists. The questionnaire consisted of nine multiple-choice questions and two open-ended questions regarding knowledge, practicing patterns, and attitude to psychodermatology. Forty five (36.6%) dermatologists completed this online survey. Out of them 73% were women and 40% were trainees. Nine respondents (20%) had frequent experience with psychodermatology, but only 6 (13.3%) were very comfortable in diagnosing and treating psychodermatology patients. Vitiligo was the disease with maximum respondents reported encountering >10 patients monthly with psychologic co morbidities (30, 66.7%). The most common diagnoses which required psychiatric referral were delusion of parasitosis (22.2%), trichotillomania (20%) and neurodermatitis (8.9%). Thirty six respondents (80%) were unaware of any patient or family resources on psychodermatology. Thirty-nine respondents (86.7%) expressed interest in attending educational events on psychodermatology. Survey results showed high need of liaison clinics of dermatology and psychiatry. Many dermatologists lack proper training in treating psychodermatology cases while they may be the sole service provider to the patients. We propose incorporation of psychodermatology curriculum in residency training programs.

RETRACTED: 5G Technology and induction of coronavirus in skin cells

This article has been retracted at the request of the Editor. After a thorough investigation the Editor-in-Chief has retracted this article as it showed evidence of substantial manipulation of the peer review.

RETRACTED: 5G Technology and induction of coronavirus in skin cells

Ahead of Print article withdrawn by publisher.

Psychodermatology in Iran: A survey on knowledge, awareness, and practice patterns in Iranian dermatologists

Psychodermatology is an interdisciplinary field in dermatology which involves the interaction between mind and skin. Studies from various parts of the world demonstrate generalized lack of knowledge regarding psychocutaneous disorders among dermatologists. We provide this survey to evaluate the knowledge, awareness, and practice patterns of Iranian dermatologists about psychodermatology. A survey questionnaire on the topic of this study was randomly distributed among Iranian dermatologists in a national dermatology conference and also by mail. All collected data were entered into SPSS software version 20.0 and were analyzed using descriptive statistics. The questionnaires were filled out by 65 dermatologists aged 30 to 60 years. From this group, 60% (39) were male and 40% (26) were female. About 86% of the dermatologists saw more than 30 psychodermatology patients weekly and about 43% mentioned they felt somewhat comfortable managing psychodermatology patients. Alopecia, vitiligo, and acne were the most common primary dermatology diseases with secondary psychiatric problems. More than half of our responders mentioned that they did not take any psychodermatology courses during their training program. However, about 66% of the dermatologists expressed interest in participating in psychodermatology continuing medical education programs. Further collaboration between dermatologists and psychiatrists can shape a brilliant future in psychodermatology and improve the quality of life of patients. We highly recommend educational courses in psychodermatology for both dermatologists and psychiatrists.

Treatment of vascular soft tissue malformations: A retrospective study of 90 patients from Albania

Vascular malformations (Vascular Malformation) of soft tissue are a consequence of abnormal development of vascular elements during embryogenesis. They are named after the vessel responsible. Their presence at birth raises the hypothesis of an intrauterine etiology of Vascular Malformation, but the influence of other factors may play an important role in their appearance, localization, and size. The literature suggests that treatment of Vascular Malformation is rarely surgical. Surgery is applied in cases of voluminous malformations and in cases of possible hemorrhagic complications. Meanwhile, patient outcomes have improved with new discoveries in laser technology for the treatment of Vascular Malformation, especially those of capillaries and the results are, in most of the cases, quite satisfactory and without significant complications. After institutional review board approval, we collected and analyzed the medical records of 90 patients diagnosed with Vascular Malformation, between January 2015 and December 2019 at the service of Burns and Plastic Surgery, "Mother Teresa" University Hospital Center of Tirana, Albania and from another private clinic in Tirana. Data were collected from the medical records on patient's charts. The aim of this study is to analyze different treatment modalities and the outcomes achieved for each group.

Postherpetic neuralgia and recalcitrant cystic lesions following herpes zoster: A case report and review of treatment options

Acute herpes zoster lesions in most cases are self-limited except in older and immunocompromised patients, wherein the pain can cause significant suffering. Postherpetic neuralgia is a painful situation for patients that can compromise the quality of life. Here, we report a 30-year-old healthy young man who developed treatment-resistant postherpetic neuralgia after herpes zoster (fourth/fifth thoracic segment) without any underlying immunocompromised state. He also developed some cystic lesions, which were removed by aspiration and surgery. The skin lesions improved 2 weeks after the surgery and postherpetic neuralgia was completely cured after 5 months, however cystic lesions recurred multiple times and were excised completely during each visit. Postherpetic neuralgia has a significant impact on the health-care cost borne by the society and affected individual, hence, it is essential to select appropriate treatment to manage the pain of postherpetic neuralgia.

Therapeutic implications of assessment of serum zinc levels in patients with vitiligo: A patient controlled prospective study

Vitiligo is an autoimmune disease characterized by patches of depigmentation. Zinc is an antiapoptotic molecule that exhibits antioxidant properties. The study aimed to investigate the serum levels of zinc in vitiligo patients compared to healthy controls and to whether exists a correlation between disease severity and serum levels of zinc. Fifty patients with vitilgo (group A) and 50 age and sex matched healthy controls (group B) were recruited and serum zinc level was measured using atomic absorption spectrophotometry and results were compared and correlated to each other and to disease severity and extension. The mean serum zinc levels in group A was 50.93 ± 11.02 in comparison to a mean of 77.09 ± 12.16 in group B (P = .049, T = -1.993). Vitiligo area severity index (VASI) scores in the vitiligo group ranged from 0.5 to 27 with a mean ± SD of (9.19 ± 4.47). A high statistically significant negative correlation was demonstrated between serum zinc levels and the extension of vitiligo (P value = .0001 and R value = - 0.835). A significant association exists between vitiligo and serum zinc levels. Serum zinc levels correlated negatively with vitiligo disease severity and extension. Zinc supplementation and use can be of potential importance in setting vitiligo treatment protocols.

Combined chemical peels versus trichloroacetic acid (TCA) for treating melasma: A split face study

Melasma is common skin condition presenting with hyperpigmentation. To evaluate the efficacy, tolerance, and complications of one session of combined chemical peels compared to traditional serial sessions of trichloroacetic acid (TCA) peeling in treating melasma. One session of combined chemical peels was carried out at the left side of the face, while six sessions of TCA 15% peel were carried out at the right side of the face every 10 days. The Modified Melasma Area and Severity Index (MASI) score was calculated at baseline (before starting peeling sessions), after one month (at the fourth TCA peeling session), and after three months (one month after the last TCA peeling session). Both sides of the face showed gradual reduction in modified MASI score throughout sessions. By the end of the study, the TCA-treated side showed slightly lower mean modified MASI score than the combined chemical peels-treated side of the face; however this difference was not statistically significant, (p = 0.405). A single session of combined chemical peels is as effective as six sessions of TCA peel in treatment of melasma. Combined chemical peels can be used as a convenient, tolerable and time saving safe procedure for treating melasma.