Assessing the Application of Large Language Models in Generating Dermatologic Patient Education Materials According to Reading Level: Qualitative Study

BACKGROUND

Dermatologic patient education materials (PEMs) are often written above the national average seventh- to eighth-grade reading level. ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT are large language models (LLMs) that are responsive to user prompts. Our project assesses their use in generating dermatologic PEMs at specified reading levels.

OBJECTIVE

This study aims to assess the ability of select LLMs to generate PEMs for common and rare dermatologic conditions at unspecified and specified reading levels. Further, the study aims to assess the preservation of meaning across such LLM-generated PEMs, as assessed by dermatology resident trainees.

METHODS

The Flesch-Kincaid reading level (FKRL) of current American Academy of Dermatology PEMs was evaluated for 4 common (atopic dermatitis, acne vulgaris, psoriasis, and herpes zoster) and 4 rare (epidermolysis bullosa, bullous pemphigoid, lamellar ichthyosis, and lichen planus) dermatologic conditions. We prompted ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT to "Create a patient education handout about [condition] at a [FKRL]" to iteratively generate 10 PEMs per condition at unspecified fifth- and seventh-grade FKRLs, evaluated with Microsoft Word readability statistics. The preservation of meaning across LLMs was assessed by 2 dermatology resident trainees.

RESULTS

The current American Academy of Dermatology PEMs had an average (SD) FKRL of 9.35 (1.26) and 9.50 (2.3) for common and rare diseases, respectively. For common diseases, the FKRLs of LLM-produced PEMs ranged between 9.8 and 11.21 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). For rare diseases, the FKRLs of LLM-produced PEMs ranged between 9.85 and 11.45 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). At the fifth-grade reading level, GPT-4 was better at producing PEMs for both common and rare conditions than ChatGPT-3.5 (P=.001 and P=.01, respectively), DermGPT (P<.001 and P=.03, respectively), and DocsGPT (P<.001 and P=.02, respectively). At the seventh-grade reading level, no significant difference was found between ChatGPT-3.5, GPT-4, DocsGPT, or DermGPT in producing PEMs for common conditions (all P>.05); however, for rare conditions, ChatGPT-3.5 and DocsGPT outperformed GPT-4 (P=.003 and P<.001, respectively). The preservation of meaning analysis revealed that for common conditions, DermGPT ranked the highest for overall ease of reading, patient understandability, and accuracy (14.75/15, 98%); for rare conditions, handouts generated by GPT-4 ranked the highest (14.5/15, 97%).

CONCLUSIONS

GPT-4 appeared to outperform ChatGPT-3.5, DocsGPT, and DermGPT at the fifth-grade FKRL for both common and rare conditions, although both ChatGPT-3.5 and DocsGPT performed better than GPT-4 at the seventh-grade FKRL for rare conditions. LLM-produced PEMs may reliably meet seventh-grade FKRLs for select common and rare dermatologic conditions and are easy to read, understandable for patients, and mostly accurate. LLMs may play a role in enhancing health literacy and disseminating accessible, understandable PEMs in dermatology.

Prescribing Patterns of Isotretinoin for Acne Among Dermatologists in Central Jordan

INTRODUCTION

Prescribing practices among dermatologists play a crucial role in managing acne, particularly concerning medications like isotretinoin. In Jordan's central region, encompassing the Governorates of Amman, Balqa, Zarqa, and Madaba, dermatologists in both public and private sectors encounter diverse cases of acne. Understanding their prescription patterns and awareness regarding isotretinoin usage is essential for optimizing acne treatment outcomes and minimizing potential risks.

METHODS

This study aimed to evaluate dermatologists' practices in prescribing isotretinoin for acne. It relied on the descriptive analytical approach, with the study population including all dermatologists working in the public and private sectors in the central region of Jordan. Simple random sampling was used to include 147 male and female doctors. An online questionnaire was adopted to collect data from the study sample, which was distributed through social media platforms and messaging platforms such as Facebook, WhatsApp, and Instagram to dermatologists working in the central region.

RESULTS

 In this study of 147 dermatologists, 58 (39.45%) prescribed isotretinoin primarily for severe acne, and 53 (36.06%) prescribed isotretinoin to about 50-100 patients per year, with the initial dosage based on guidelines (n=102, 69.39%). The majority (n=115; 78.23%) refrained from prescribing if liver enzymes were elevated. Pregnancy tests were required by 42 (28.57%) in the first session, while 78 (53.07%) deemed it the patient's responsibility. Common precautions included sunscreen (n=77; 52.38%) and moisturizing cream (n=31, 21.09%). Only six of the dermatologists (4.08%) advised their patients not to use contact lenses, and only 17 (11.57%) prescribed moisturizing eye drops.

CONCLUSION

This study's findings emphasize how crucial physicians' experience is when it comes to prescribing isotretinoin for severe acne. Continued educational initiatives are imperative to address gaps in patient information and safeguards in order to optimize treatment outcomes and ensure patient safety.

Store-and-forward (asynchronous) doctor-to-dermatologist non-skin cancer specific teledermatology services in Australia: A scoping review

Store-and-forward teledermatology (SAFT) has become increasingly popular as a means to increase access to specialist care and address healthcare disparities such as those experienced by rural communities. A contemporary systematic overview of the Australian SAFT services and outcomes for all dermatological conditions is missing. This scoping review provides an overview of Australian SAFT models. Twelve studies were identified through web databases, grey literature sites and reference lists of eligible articles. Eligibility criteria included studies evaluating doctor-to-dermatologist Australian SAFT services provided to Australians for all skin conditions but excluded the studies that solely focused on skin cancers. Data on study design, setting, population, SAFT model, referral characteristics, patient, and general practitioner perspectives, diagnostic concordance, and measured outcomes such as follow up, investigation and waiting time were extracted. Quality of the included studies was assessed using CASP tools. Synthesis reveals that SAFT can be used for patients with any dermatological condition, provides more accurate diagnostics compared to cases without dermatologist input, may reduce waiting times for dermatological expertise, and users generally had positive experiences with SAFT. Although results are positive, this review reveals the heterogenous nature of the literature on SAFT in Australia and a need to establish a uniform approach to assessing the outcomes and impacts of such services.

An absence of imperfections: A proposed framework for defining, assessing, and achieving skin glow

BACKGROUND

Skin glow is a subcomponent of skin quality. It has become entrenched in the cosmeceuticals and aesthetics lexicons as a synonym for health and youth, but is not well-defined as a scientific metric.

AIMS

To examine the concept of skin glow and determine if it is an objective concept that can be defined and quantified.

METHODS

Literature review was used to develop a survey on current concepts relating to skin quality. The survey results were analyzed descriptively and presented to a focus group comprising five dermatologists and four aesthetic physicians. This group then discussed the concept of skin glow, how to define it and what metrics could be used to assess it.

RESULTS

Surveyed practitioners (n = 38) ranked skin quality as the fourth most important factor related to a person's overall aesthetic first impression. Almost all (95%) respondents reported routinely assessing skin quality, citing serial photography (83%), and visual inspection (67%) as the main means of achieving this. The focus group defined skin glow as even reflectance from an unaffected papillary and reticular dermal collagen layer, which is created only when skin does not exhibit any characteristics that detract from this even reflectance. Due to its complexity, the focus group proposed a hierarchal framework for assessment, encompassing patient self-rating, practitioner severity rating, and supplemental use of validated measurement devices.

CONCLUSIONS

Skin glow can be defined and quantified. More work is warranted to develop a practical skin glow assessment tool suitable for use in the clinic setting.

The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study

BACKGROUND

Given the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population.

OBJECTIVE

This quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients' digital health literacy requirements.

METHODS

We profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis.

RESULTS

The cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19%) and 2 (n=20, 17.2%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4%) and 7 (n=12, 10.3%), depended on traditional services. Groups 3 (n=27, 23.3%), 4 (n=23, 19.8%), and 5 (n=8, 6.9%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service.

CONCLUSIONS

By identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services.

Derm-ographics: The Australian Dermatologist and Social Media

Social media significantly affects how patients understand their health and choose their healthcare providers, yet Australian dermatologists have a limited online presence compared to their global peers.

Pain associated with psoriasis: a qualitative study

BACKGROUND

Pain is a major factor in the psychosocial impact of psoriasis. There is a paucity of qualitative reports of dermatologists' views on psoriasis-related pain.

OBJECTIVES

The aim of this study was to explore the views of dermatologists on the presence and importance of pain associated with psoriasis.

METHODS

This qualitative study, based on semi-structured interviews, included dermatologists from different cities working in the hospital and private sector in Croatia between May and July, 2022. We collected demographic and occupational data on participants and information about their experiences and attitudes toward psoriasis-related pain. Data were analysed by applying interpretative descriptive and thematic analysis using the 4-stage method for systematic text condensation.

RESULTS

We included 19 dermatologists, all women, aged 38 (range: 31 to 63 years). Most dermatologists acknowledged the presence of pain in patients with psoriasis. They indicated that they sometimes do not sufficiently address this pain in daily practice. Some indicated that pain was a neglected symptom in psoriasis, while for others it was not crucial. Most indicated that it is necessary to focus more on psoriasis-related pain in clinical practice, to disambiguate between skin pain and joint pain in psoriatic conditions, and to better educate family physicians about psoriasis-related pain. They emphasized the importance of considering pain during psoriatic patient assessment and management. Further research on psoriasis-related pain was suggested.

CONCLUSIONS

More emphasis is needed on psoriasis-related pain for effective management of psoriasis, informing decision-making in the context of patient-centric care and improving the quality of life in patients with psoriasis.

Cross-Sectional Assessment of Dermatologists' Knowledge and Attitude Towards Isotretinoin-Related Ocular Side Effects in Aseer, Saudi Arabia

BACKGROUND

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, which includes the hair follicle, hair shaft and sebaceous gland. The only treatment that has an effect on all the main aetiological causes of acne is isotretinoin. However, it may have a variety of negative side effects. The aim of this study was to evaluate the knowledge and attitudes of dermatologists regarding ocular effects following isotretinoin prescribing in the Aseer region, Saudi Arabia.

METHODOLOGY

An anonymous online cross-sectional survey was conducted in August 2022 to investigate dermatologists' knowledge and attitude regarding isotretinoin-related ocular side effects in Aseer, Saudi Arabia. Participants were recruited using convenience and snowball sampling methods.

RESULTS

A total of 48 dermatologists were included in this survey. The age distribution ranged from 25 to over 60 years. Sixteen (37.5%) were aged 31-40 years, 29 (60.4%) were male and 20 (41.7%) were specialists. All dermatologists reported that it can cause dry eye, 32 (66.7%) reported that it can cause contact lens intolerance, 10 (20.8%) reported that it can cause a decrease in dark adaptation and two (4.2%) thought that it can cause ectopia lentis and retinoblastoma. Regarding attitude, 43 (87.5%) thought that a course of isotretinoin is not recommended if the patient has recently undergone refractive surgery, 30 (62.5%) always inform patients about ocular side effects, 31 (72.9%) do not consider referring patients for ophthalmic examinations before initiating isotretinoin, 12 (25.0%) always prescribe lubricant eye drops, 15 (31.3%) always ask patients about recent refractive surgery, 17 (35.4%) always warn patients about avoiding refractive surgery during isotretinoin use and 19 (39.6%) always inform patients concerning discomfort with contact lenses.

CONCLUSIONS

The survey reveals that dermatologists in Aseer, Saudi Arabia, generally have good knowledge of isotretinoin related to some ocular side effects, especially dry eye and contact lens intolerance. However, there is some variation in their practices with regard to patient education, referrals for ophthalmic examinations, the use of lubricant eye drops and refractive surgery during isotretinoin treatment. Thus, dermatologists should receive educational training on the safety profile of isotretinoin while managing acne vulgaris.

Assessing Public Interest in Mpox via Google Trends, YouTube, and TikTok

Public response to the recent Mpox outbreak was analyzed using internet search trends and social media posts.

Using ChatGPT for Writing Articles for Patients' Education for Dermatological Diseases: A Pilot Study

Background

Patients' education is a vital strategy for understanding a disease by patients and proper management of the condition. Physicians and academicians frequently make customized education materials for their patients. An artificial intelligence (AI)-based writer can help them write an article. Chat Generative Pre-Trained Transformer (ChatGPT) is a conversational language model developed by OpenAI (openai.com). The model can generate human-like responses.

Objective

We aimed to evaluate the generated text from ChatGPT for its suitability in patients' education.

Materials and Methods

We asked the ChatGPT to list common dermatological diseases. It provided a list of 14 diseases. We used the disease names to converse with the application with disease-specific input (e.g., write a patient education guide on acne). The text was copied for checking the number of words, readability, and text similarity by software. The text's accuracy was checked by a dermatologist following the structure of observed learning outcomes (SOLO) taxonomy. For the readability ease score, we compared the observed value with a score of 30. For the similarity index, we compared the observed value with 15% and tested it with a one-sample t-test.

Results

The ChatGPT generated a paragraph of text of 377.43 ± 60.85 words for a patient education guide on skin diseases. The average text reading ease score was 46.94 ± 8.23 (P < 0.0001), and it indicates that this level of text can easily be understood by a high-school student to a newly joined college student. The text similarity index was higher (27.07 ± 11.46%, P = 0.002) than the expected limit of 15%. The text had a "relational" level of accuracy according to the SOLO taxonomy.

Conclusion

In its current form, ChatGPT can generate a paragraph of text for patients' educational purposes that can be easily understood. However, the similarity index is high. Hence, doctors should be cautious when using the text generated by ChatGPT and must check for text similarity before using it.

Prescription Pattern of Tofacitinib for Alopecia Areata Among the Dermatologists in Saudi Arabia: A Cross-Sectional Study

Introduction Alopecia areata (AA) is a complex autoimmune condition that causes nonscarring hair loss. In Saudi Arabia, AA accounts for 1-2% of new dermatological outpatient visits. It typically presents with sharply demarcated round patches of hair loss and may present at any age. Traditional medical therapies include corticosteroids and immunotherapy. Choosing the ideal treatment depends on multiple factors such as patient age, disease severity, efficacy, side effects, and remission rate. Recent medications that have been used for treating AA are Janus kinase inhibitors. Aim The aim of the study is to assess the awareness and attitude of dermatologists and their use of Tofacitinib in treating AA. Method A cross-sectional study was conducted in 2019 across 14 major cities in Saudi Arabia. A self-administered online questionnaire was specifically developed and used. Dermatologists from government hospitals and private clinics were included through non-probability convenience sampling. The collected data was entered into Microsoft Excel and analyzed using SPSS program version 24. Results In total, out of 546 Dermatologists across Saudi Arabia who responded to the questionnaire, 127 (23.2%) physicians prescribed Tofacitinib in their practice. Out of those who prescribed the drug for AA cases, 58 dermatologists (45.6%) prescribed Tofacitinib after the failure of steroid injections. Among the 127 dermatologists who have utilized Tofacitinib in their practice, 92 (72.4%) believe that Tofacitinib is effective in treating AA. Almost 200 (47.7%) Dermatologists who never prescribed Tofacitinib reported that the main reason was due to the unavailability of the drug in the clinic they were practicing. Conclusions To conclude, out of 546 dermatologists working in Saudi Arabia, 127 (23.2%) prescribe Tofacitinib to treat AA. Ninety-two (72.4%) of the participants reported the effectiveness of Tofacitinib. Two hundred (47.7%) dermatologists who never prescribe Tofacitinib reported that the main reason was due to the unavailability. However, this would raise the need for more research regarding JAK inhibitors generally and Tofacitinib specifically, focusing on the effectiveness versus the side effects of Tofacitinib.

Perception, understanding, and association between psychological stress and skin aging: Quantitative surveys of Asian women aged 18-34 years, dermatologists, and psychologists in China and Japan

BACKGROUND

Skin aging involves a variety of structural and functional changes, under the influence of various factors. Preaging skin is a relatively new concept describing self-perceived signs of skin aging that appear in the early 20s-30s and may be triggered by psychological stress. However, it is unclear how young women and healthcare professionals (HCP) understand the association between stress and skin aging.

AIMS

We sought to explore the perceptions of stress-related skin aging among young women and HCPs.

METHODS

We performed online surveys of 403 young women (18-34 years), 60 dermatologists, and 60 psychologists residing in major cities in China and Japan. Questions covered skin signs, understanding/perceptions of stress-aging connection, and demographics. Young women also completed DASS-21 to assess their stress level, which was dichotomized as normal or mild-extremely severe.

RESULTS

The stress level was normal in 52.6% or mild-extremely severe in 47.4% of young women. Greater proportions of women in the mild-extremely severe stress group reported skin manifestations associated with preaging, the top three being "rough skin" (39.3% vs. 24.1%), "slow metabolic rate" (28.8% vs. 14.2%), and "dull skin" (43.5% vs. 29.2%). The top three skin manifestations showing the strongest perceived associations with stress were: "dark eye circles," "slow metabolic rate," and "dull skin" (among young women); "acne," "dry skin," and "skin rash" (among HCPs).

CONCLUSIONS

Young women frequently report high levels of psychological stress and signs of skin aging. Perceptions of stress-skin aging association differ between young women and HCPs.

A comparison of family physician and dermatologist topical corticosteroid prescriptions: A population-based cross-sectional study

BACKGROUND

Topical corticosteroids (TCS) are commonly prescribed to treat inflammatory skin diseases, and appropriate prescription is necessary for treatment success.

OBJECTIVE

To quantify differences between TCS prescribed by dermatologists at consultation and family physicians for patients treated for any skin condition.

METHODS

Using administrative health data in Ontario, we included all Ontario Drug Benefit recipients who filled at least one TCS prescription from a dermatologist at consultation and a family physician in the year prior between January 2014 and December 2019. We estimated mean differences and 95% confidence intervals in amount (in grams) and potency between the index dermatologist prescription and the highest and most recent family physician prescription amounts and potencies in the preceding year using linear mixed-effect models.

RESULTS

A total of 69,335 persons were included. The mean dermatologist amount was 34% larger than the highest amount and 54% larger than the most recent amount prescribed by family physicians. There were small but statistically significant differences in potency using established 7-category and 4-category potency classification systems.

CONCLUSIONS

Compared to family physicians, dermatologists prescribed substantially larger amounts and similarly potent TCS at consultation. Further research is needed to determine the effect of these differences on clinical outcomes.

AI-Powered Diagnosis of Skin Cancer: A Contemporary Review, Open Challenges and Future Research Directions

Skin cancer continues to remain one of the major healthcare issues across the globe. If diagnosed early, skin cancer can be treated successfully. While early diagnosis is paramount for an effective cure for cancer, the current process requires the involvement of skin cancer specialists, which makes it an expensive procedure and not easily available and affordable in developing countries. This dearth of skin cancer specialists has given rise to the need to develop automated diagnosis systems. In this context, Artificial Intelligence (AI)-based methods have been proposed. These systems can assist in the early detection of skin cancer and can consequently lower its morbidity, and, in turn, alleviate the mortality rate associated with it. Machine learning and deep learning are branches of AI that deal with statistical modeling and inference, which progressively learn from data fed into them to predict desired objectives and characteristics. This survey focuses on Machine Learning and Deep Learning techniques deployed in the field of skin cancer diagnosis, while maintaining a balance between both techniques. A comparison is made to widely used datasets and prevalent review papers, discussing automated skin cancer diagnosis. The study also discusses the insights and lessons yielded by the prior works. The survey culminates with future direction and scope, which will subsequently help in addressing the challenges faced within automated skin cancer diagnosis.

Presentations to emergency departments in Melbourne, Australia diagnosed as allergic contact dermatitis

BACKGROUND

This study investigated cases diagnosed as allergic contact dermatitis (ACD) in emergency departments (EDs) and management.

METHODS

A multisite retrospective study of patients attending EDs in metropolitan Melbourne between July 2017 and June 2018 was performed. Using International Statistical Classification of Disease-10 (ICD-10) codes, the Victorian Agency for Health Information generated a list of cases of contact dermatitis (CD). Demographic and clinical data were analysed.

RESULTS

Two hundred twenty-eighty patients from 14 different sites were diagnosed with ACD. Hair dyes caused the most cases, and one such case was admitted to hospital. It was apparent from the specified causes that cases of irritant CD were misdiagnosed as ACD. There were significant differences in management with dermatology input, with dermatologists more often advising oral corticosteroids (33.3% vs. 14.5%, P = 0.004) topical corticosteroids (92.9% vs. 38.7%, P < 0.01), emollients (38.1% vs. 20.4%, P = 0.01) and less often advising antihistamines (16.7% vs. 44.6%, P < 0.001). With dermatology input, potent or very potent steroids were more likely to be prescribed (69.3% vs. 11.1%, P < 0.001); without, a mild potency steroid was more likely to be prescribed (63.9% vs. 4%, P = 0.01).

CONCLUSION

Improved understanding, diagnosis and management of CD are needed in EDs.

Attitudes Towards Artificial Intelligence Among Dermatologists Working in Saudi Arabia

INTRODUCTION

Artificial intelligence (AI) and its applications are among the most discussed modern technologies today. Despite the rapidly expanding use of AI in medicine, and specifically in dermatology, only a few studies have studied the attitude of physicians toward AI.

OBJECTIVE

To recognize the attitudes towards AI among dermatologists in the Kingdom of Saudi Arabia.

METHODS

A cross-sectional survey was done among dermatologists in Saudi Arabia. Questionnaires were distributed through several online channels.

RESULTS

Overall, 103 dermatologists filled out the survey. The majority saw very strong or strong potential for AI in the automated detection of skin diseases based on dermatological clinical images (50.9%), dermoscopic images (66.6%) and within dermatopathology (66.6%). In regard to results of attitudes towards AI, 56.6% and 52. 8% agreed that AI will revolutionize medicine and dermatology, respectively. However, many of the respondents disagreed that AI will replace physicians (41.5%) and human dermatologists (39.6%) in the future. Age did not impact the overall attitude of dermatologists.

CONCLUSION

Dermatologists in Saudi Arabia showed an optimistic attitude towards AI in dermatology and medicine. However, dermatologists believe that AI will not replace humans in the future.

Concordance and Accuracy of Teledermatology Using Mobile Phones in the Outpatient Clinic of Jose R Reyes Memorial Medical Center: Cross-sectional Study

BACKGROUND

Dermatologists rely on visual findings; thus, teledermatology is uniquely compatible to providing dermatologic care. The use of mobile phones in a store-and-forward approach, where gathered data are sent to a distant health provider for later review, may be a potential bridge in seeking dermatologic care.

OBJECTIVE

This study aimed to determine the agreement between face-to-face consultations and teledermatologic consultations through the store-and-forward approach using mobile phones and its accuracy compared to a histopathologic diagnosis.

METHODS

The study design was a cross-sectional study of participants consecutively recruited from dermatology patients who presented with skin or mucosal complaint and without prior dermatologist consultation. Photographs were taken using a standard smartphone (iPhone 6s Plus), and a 4-mm skin punch biopsy was taken on each patient-the gold standard to which the study result was compared to. The photographs were sent to 3 consultant dermatologists using a store-and-forward approach, for independent diagnosis and treatment plan.

RESULTS

A total of 60 patients were included, with a median age of 41 years. There was moderate-to-almost perfect agreement in terms of final diagnosis between the face-to-face dermatologic diagnosis and teledermatologic diagnoses. The third teledermatologist had the highest agreement with the clinical dermatologist in terms of final diagnosis (κ=0.84; P<.001). Among the 3 dermatologists, there was moderate-to-almost perfect agreement as well. Agreement between pairs of teledermatologists ranged from 0.45 to 0.84. The 3 teledermatologists had moderate-to-substantial agreement with the biopsy results, with the third teledermatologist having the highest accuracy (κ=0.77; P<.001). Overall, there was a moderate agreement in the diagnosis of patients across raters.

CONCLUSIONS

Teledermatology is a viable alternative to face-to-face consultations. Our results show moderate-to-substantial agreement in diagnoses from a face-to-face consultation and store-and-forward teledermatology.

Use of Potassium Hydroxide in Dermatology Daily Practice: A Local Study From Saudi Arabia

Introduction

Potassium hydroxide (KOH) is an inorganic keratolytic test. It is considered one of the most worldwide methods used in the dermatological field with reasonable reliability and sensitivity. One of its major uses is in identifying fungal elements in the skin, hair, nails, and different body secretions. In this study, we aimed to identify the prevalence of KOH usage in different hospitals in the Al-Ahsa region, Saudi Arabia. Additionally, we aimed to identify the dermatological conditions in which KOH is being used and practiced by physicians.

Methods

This was an anonymous questionnaire-based cross-sectional study that was distributed and carried out among dermatologists in Al-Ahsa city in the Eastern province of Saudi Arabia.

Results

A total of 30 dermatologists completed the study questionnaire. Participants’ ages ranged from 29 to 59 years old with a mean age of 39.5 ± 11.4 years old. 14 (46.7%) dermatologists reported that the KOH test is available in their clinic. Using KOH once a day was reported among 14.3% while 21.4% used it once a week. The most reported condition for KOH use was hair dermatophytes (100%).

Conclusion

There is a clear lack of usage and availability of KOH in clinics. The shortage of availability of diagnostic tools, including KOH might affect the diagnosis of several diseases and may cause a waste of resources, wrong prescriptions, and patient’s burden.

A Deep Learning-Based Facial Acne Classification System

Introduction

Acne is one of the most common pathologies and affects people of all ages, genders, and ethnicities. The assessment of the type and severity status of a patient with acne should be done by a dermatologist, but the ever-increasing waiting time for an examination makes the therapy not accessible as quickly and consequently less effective. This work, born from the collaboration with CHOLLEY, a Swiss company with decades of experience in the research and production of skin care products, with the aim of developing a deep learning system that, using images produced with a mobile device, could make assessments and be as effective as a dermatologist.

Methods

There are two main challenges within this task. The first is to have enough data to train a neural model. Unlike other works in the literature, it was decided not to collect a proprietary dataset, but rather to exploit the enormity of public data available in the world of face analysis. Part of Flickr-Faces-HQ (FFHQ) was re-annotated by a CHOLLEY dermatologist, producing a dataset that is sufficiently large, but still very extendable. The second challenge was to simultaneously use high-resolution images to provide the neural network with the best data quality, but at the same time to ensure that the network learned the task correctly. To prevent the network from searching for recognition patterns in some uninteresting regions of the image, a semantic segmentation model was trained to distinguish, what is a skin region possibly affected by acne and what is background and can be discarded.

Results

Filtering the re-annotated dataset through the semantic segmentation model, the trained classification model achieved a final average f1 score of 60.84% in distinguishing between acne affected and unaffected faces, result that, if compared to other techniques proposed in the literature, can be considered as state-of-the-art.

Psoriatic Arthritis: A Comprehensive Update for Dermatologists with Review of Literature

Psoriatic arthritis (PsA), an inflammatory seronegative spondyloarthropathy is the most common co-morbidity of psoriasis (PsO), in almost 30% of cases. Delayed diagnosis and treatment of PsA may result in irreversible joint damage, significant morbidity, impaired quality of life, and several cardiometabolic and cerebrovascular co-morbidities. Dermatologists are uniquely privileged to be able to diagnose latent PsA at an early stage, as almost 80% of these patients present with pre-existing cutaneous PsO. This review provides a detailed overview of PsA along with its salient clinical features, classification criteria, screening tools, simple physical examination maneuvers, imaging findings, and therapeutic options to acquaint dermatologists and other clinicians with this morbid musculoskeletal disorder. We hope to generate awareness about this condition among dermatologists to enable proactive screening of all PsO patients for early diagnosis, initiation of appropriate treatment, and prompt referral to a rheumatologist; thus, helping to arrest PsA disease progression, irreversible joint damage, and subsequent permanent disability.

Biologics for severe, chronic plaque psoriasis: An Australian cost-utility analysis

Background

Biologics are a good therapeutic option for severe, chronic plaque psoriasis; however, they come with significant cost to the health care system.

Objective

To conduct a cost-utility analysis of outpatient biologics (adalimumab, etanercept, guselkumab, ixekizumab, risankizumab, secukinumab, tildrakizumab, and ustekinumab) available to adults with severe, chronic plaque psoriasis from the perspective of the Australian health care system.

Methods

A Markov cohort model was constructed to estimate the quality-adjusted life years (QALYs) and costs accrued for treatment pathways commencing with different first-line biologics, over a 96-week time horizon. The model adhered to the Australian Pharmaceutical Benefits Scheme eligibility criteria and guidelines.

Results

A biologic treatment pathway commencing on tildrakizumab was the most cost-effective first-line treatment (Australian dollar 39,930; total utility of 1.57 QALYs over 96 weeks). First-line secukinumab and risankizumab had incremental cost-utility ratios of Australian dollar 194,524/QALY and Australian dollar 479,834/QALY, respectively, when compared with first-line tildrakizumab.

Limitations

The efficacy and utility input parameters were derived from international randomized control trials and patients from the United Kingdom, respectively. Findings from this study cannot be generalized beyond Australia.

Conclusion

Tildrakizumab may be considered as first-line treatment for adult patients with severe, chronic plaque psoriasis embarking on biologic therapy, from the economic perspective of the Australian health care system.

Skin of color images in pediatric dermatology textbooks

Due to globalization, dermatologists routinely see patients of different ethnicities and skin tones. Surveys from the US have shown that dermatologists felt that their training was lacking in diagnosing dermatoses in skin-of-color patients. Underrepresentation of skin of color in dermatology textbooks has been reported. We evaluated clinical images in selected pediatric dermatology textbooks with regard to skin color.

Prevalence and Associations of General Practice Registrars' Management of Atopic Dermatitis: A Cross-Sectional Analysis from the Registrar Clinical Encounters in Training Study

Introduction

Atopic dermatitis (AD) is a chronic inflammatory condition which imposes substantial burden upon patients and their families. As a frequent primary care presentation, general practice (GP) trainees must develop adequate skills in AD diagnosis and management.

Objectives

We aimed to explore the prevalence and associations of GP registrars' management of patients with AD.

Methods

This study used data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study of the clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors were independent variables in multivariable logistic regression with outcome factor 'diagnosis/problem being AD'.

Results

From 2010-2019, 2,783 registrars (96% response rate) provided data from 381,180 consultations. AD was encountered in 0.6% of consults. AD was more likely to be seen in patients aged 0-1 years and patients from a non-English speaking background. AD was less likely to be seen in Aboriginal or Torres Strait Islander patients. Learning goals were more likely to be generated for AD and these consultations were associated with registrars seeking information or assistance. AD was strongly associated with a medication being prescribed, of which the most prescribed medications were mild or moderate potency topical corticosteroids.

Conclusions

Our findings suggest that, similar to other dermatological presentations, registrars find AD challenging to manage. There may be some gaps in AD management knowledge and application.

COVID-19 and Healthcare Worker: What We Need to Know

COVID-19 pandemic has challenged and overwhelmed most healthcare institutions and healthcare workers, across the world. Despite being unprepared for this pandemic, frontline workers have worked relentlessly to provide the much-needed care to these patients. Doctors from different branches of medicine, including dermatologists, came forward and played a substantial role in mitigating the impact of this pandemic on the general population. Sadly, in the process, these healthcare workers faced many personal, social, psychological, economic, and health-related issues. The psychological burden and health-related issues received due attention in the main-stream news as well as scientific research papers. With most frontline workers isolated from their families, social media became the new platform to reduce the sense of isolation and share their anxiety, insomnia, and fatigue. This article is aimed at highlighting various challenges faced by healthcare workers during the ongoing COVID-19 pandemic.

Conflicts of Interest in "Throwaway" Dermatology Publications: Analysis of the Open Payments Database

BACKGROUND

Dermatology journals, periodicals, editorials, and news magazines are influential resources that are not uniformly regulated and subject to influence from the pharmaceutical industry. This study evaluates industry payments to physician editorial board members of common dermatology publications, including "throwaway" publications.

OBJECTIVE

The aim of this study was to characterize the extent and nature of industry payments to editorial board members of different dermatologic publications in order to ascertain differences in payments between different types of publications.

METHODS

A list of editorial board members was compiled from a collection of clinical dermatology publications received over a 3-month period. Data from the Open Payments database from 2013 to 2019 were collected, and analysis of payments data was performed.

RESULTS

Ten publications were evaluated, and payments data for 466 physicians were analyzed. The total compensation across all years was US $75,622,369.64. Consulting, services other than consulting, and travel or lodging payments constituted most of the payments. A fraction of dermatologists received the majority of payments. The top payers were manufacturers of biologic medications. Payment amounts were higher for throwaway publications compared to peer-reviewed journals.

CONCLUSIONS

Editorial board members of dermatology publications received substantial payments from the pharmaceutical industry. A minority of physicians receive the lion's share of payments from industry. "Throwaway" publications have more financial conflict of interest than do peer-reviewed journals. The impact of these conflicts of interest on patient care, physicians' practice patterns, and patient perception of physicians is noteworthy.

The impact of social media on dermatologists and in captivating their patients: a cross-sectional study

BACKGROUND

Dermatology practice has been impacted in the modern era of connectivity and social media (SM). Users' choice of dermatology practice may be influenced by SM. This study surveyed dermatologists for the use of SM as part of their practice, and the general population to assess the effect of SM on the practice of dermatology.

METHODS

This nationwide, cross-sectional study among dermatologists and the general population used two questionnaires, with the first (S1) targeting a random sample of the Saudi general population and the second (S2) addressing dermatologists.

RESULTS

Out of 965 participants in the first questionnaire. 53.78% (n = 519) of the responders followed dermatologists on SM, 57.8% did so to learn about treatment of dermatologic diseases. On the other hand, the S2 was completed by 58 dermatologists. Of them, 82.8% believed that SM had changed the practice of dermatology, 98.3% (n = 57) believed that it changed their own practice. When following a dermatologist on SM, a main reason (26.5%) was to evaluate before-and-after images.

CONCLUSION

SM plays a significant role in a physician's reputation and the practice of dermatology. It is a new era that is mainly fueled by technology; keeping pace with these advancements is an essential way to thrive.

The communicative paradigm shift of the digital age: The skinny on social media

In this editorial, we explore several relevant issues pertaining to social media use including influencers and photo-editing software. The aforementioned topics are discussed vis-à-vis their profound positive and negative effects on both patients and aesthetic physicians. The reader is invited to appreciate the importance of social media use in aesthetic medicine and the pitfalls its use presents.

Use of Methotrexate in the Treatment of Moderate to Severe Plaque Psoriasis in France: A Practice Survey

Purpose

To evaluate the modalities of methotrexate prescription for moderate to severe psoriasis by dermatologists in France.

Patients and Methods

We performed a national online practice survey between October and December 2020.

Results

A total of 254 dermatologists responded, 237 reported prescribing methotrexate for moderate to severe psoriasis in adults, of which 57% as a first line systemic treatment. Nineteen percent reported performing a test dose at the initiation of treatment. Methotrexate was prescribed orally in 54.7% of cases, subcutaneously in 44.8% of cases and intramuscularly in 0.4% of cases. The initial weekly dose of methotrexate was <15 mg for 30% of the dermatologists and ≥15 mg for 70% of them. Two hundred and three dermatologists had already change the route of administration for methotrexate from the oral to injectable form due to poor tolerance (48.3%), lack of efficacy (35%) or lack of compliance (16.7%). Two hundred thirty-four dermatologists (98.7%) reported prescribing folic acid with methotrexate, and 79.3% reported prescribing tests evaluating the risk of hepatic fibrosis. Forty-three percent of dermatologists have not initiated or have reduced their prescriptions since the beginning of the pandemic of COVID-19. Prescribing patterns were different according to the type of practice (private practice versus hospital/mixed practice).

Conclusion

Methotrexate is used by the majority of dermatologists interviewed for moderate to severe psoriasis in adults, with heterogeneity of practices.

Diagnostic tools used for melanoma: A survey of Australian general practitioners and dermatologists

BACKGROUND/OBJECTIVE

Diagnostic tools such as dermoscopy, sequential digital dermoscopy imaging (SDDI), total body photography (TBP) and automated diagnostic tools are available to assist in early melanoma diagnosis. The use, accessibility and barriers of dermoscopy have been well studied; however, there are few similar studies regarding SDDI, TBP and automated diagnostic tools. We aim to understand the use of these diagnostic aids amongst Australian general practitioners (GPs) and dermatologists.

METHODS

Between June 2019 and January 2020, GPs and dermatologists across Australia were invited to participate in an online survey. Surveys were distributed through GP and dermatology organisations.

RESULTS

A total of 227 survey responses were received, 175 from GPs and 52 from dermatologists. Amongst GPs, 44.6% worked in a skin cancer clinic. Dermoscopy was used at least occasionally by 98.9% of all GPs. SDDI was used by 93.6% of skin cancer GPs, 80.8% of dermatologists and 45.3% of generalist GPs. TBP was used or recommended by 77.1% of generalist GPs, 82.3% of skin cancer GPs and 86.5% of dermatologists. The most common barriers to the use of TBP were cost, limited accessibility, poor patient compliance, and time required for both patients and doctors. Very few clinicians reported using automated diagnostic tools. There was an interest in future diagnostic aids for melanoma in 88% of GPs and dermatologists.

CONCLUSION

Dermoscopy, SDDI and TBP were commonly used by responding Australian skin cancer GPs and dermatologists in this survey. Automated diagnostic tools were not reported to be used routinely. Several barriers were identified for use of TBP.

Is the quality of skin cancer screening in Germany related to the specialization of the physician who performs it?: Results of a nationwide survey among participants of skin cancer screening

BACKGROUND

Skin cancer screening (SCS) is an important measure for secondary prevention of skin cancer, which is the most common cancer type worldwide. This study aimed to describe patient-reported quality of SCS in Germany according to the specialization of the performing physician and different patient characteristics.

METHODS

Data from 1260 participants 35-65 years of age (54.4% female) who underwent SCS and participated in National Cancer Aid Monitoring in 2019 were evaluated using chi-squared tests.

RESULTS

Waiting times for SCS from a dermatologist were significantly longer than those for other physicians (31.1 versus [vs.] 15.7 days; P < .001). Each body area examined during the standardized inspection was examined significantly more frequently by dermatologists than by other physicians (eg, upper body, 96.6% vs. 91.7%; P < .001). Dermatologists more often offered consultation for skin cancer prevention (74.0% vs. 67.6%; P = .026) and provided written information (47.8% vs. 34.8%; P < .001). Patients with statutory insurance had to pay more frequently for additional services during SCS from a dermatologist than from other physicians (24.7% vs. 17.1%, P = .012).

CONCLUSION

Results of this study revealed differences in the provision of preventive information and the quality of visual examination during SCS between dermatologists and other physicians. These results highlight the need for quality assurance measures.

CME suggestions for pediatricians, allergists, and dermatologists, directed by an online survey on urticaria knowledge

BACKGROUND

The Mexican Guidelines for the diagnosis and treatment of urticaria have been published. Just before their launch, physicians' knowledge was explored relating to key issues of the guidelines.

OBJECTIVE

The aim of this study was to investigate the opinion of medical specialists concerning urticaria management.

METHODS

A SurveyMonkey^® survey was sent out to board-certified physicians of three medical specialties treating urticaria. Replies were analyzed per specialty against the evidence-based recommendations.

RESULTS

Sixty-five allergists (ALLERG), 24 dermatologists (DERM), and 120 pediatricians (PED) sent their replies. As for diagnosis: ALERG 42% and PED 76% believe cutaneous mastocytosis, urticarial vasculitis, and hereditary angioedema are forms of urticaria, versus DERM 29% (P < 0.005). Most of the specialties find that the clinical history and physical examination are enough to diagnose acute urticaria, except DERM 45% (P < 0.01). DERM 45% believe laboratory-tests are necessary, as opposed to <15% ALLERG-PED (P < 0.005). However, PED 69% did not know that the most frequent cause of acute urticaria in children is infections, versus ALLERG-DERM 30% (P < 0.005). Many erroneously do laboratory testing in physical urticaria and ALLERG 51%, DERM 59%, and PED 37% do extensive laboratory testing in chronic spontaneous urticaria (CSU); many more PED 59% take Immunoglobulin G (IgG) against foods (P < 0.005). More than half of non-allergists do not know about autologous serum testing nor autoimmunity (P < 0.05). As for treatment, there were a few major gaps: when CSU was controlled, >75% prescribed antihistamines pro re nata, and >85% gave first-generation antiH1 for insomnia. Finally, >40% of DERM did not know that cyclosporine A, omalizumab, or other immunosuppressants could be used in recalcitrant cases.

CONCLUSION

Specialty-specific continuous medical education might enhance urticaria management.

The Influence of Modern Social Media on Dermatologist Selection by Patients

Objective

Social media have become the platform of choice for people seeking immediate access to information. They have become so ubiquitous and pervasive that many people are using them to research health care providers and communicate with them about their issues. This study looks into this phenomenon, focusing on how it affects people’s thinking when deciding which doctor to see for skin-related concerns.

Methodology

A cross-sectional study was conducted among patients at Derma Clinic in Riyadh, Saudi Arabia. Data were collected using a validated self-administered questionnaire. A total of 365 patients were included in the analysis.

Results

Out of 365 participants, 44.9% visited the center for medical purposes, while 45.8% visited for cosmetic purposes. Sixty-six percent of the participants (n=241) went to a dermatologist they knew, and only 21% of those participants knew their dermatologist from social media (Twitter, Instagram, Snapchat, Facebook, and Telegram). About 44.54% preferred to know more about their dermatologists from Twitter, followed by Instagram 27.96%, Snapchat 24.64%, and Facebook 2.84%. A significant proportion of Instagram users came to the dermatology clinic for cosmetic purposes.

Conclusion

As per the findings of this study, we found the highest preferred way of knowing the doctor for medical or cosmetic purposes was through a friend, followed by a family member and social media. Although most of the participants still preferred to visit a dermatologist based on their friend’s recommendation, social media offer patients a platform upon which to launch their search for a dermatologist. Among social media users, patients who visit dermatology clinics for medical reasons preferred Twitter, while those who came for cosmetic reasons preferred Instagram to follow their doctors, underlining the importance of aesthetic dermatology as a visual field.

Comparative analysis of perceived stress in dermatologists and other physicians during national lock-down and COVID-19 pandemic with exploration of possible risk factors: A web-based cross-sectional study from Eastern India

Since the declaration of coronavirus disease 2019 (COVID-19) as global pandemic, several countries including India have enforced a national lock-down. We aimed to compare the perceived stress of dermatologists and nondermatologists, due to lock-down and COVID-19 pandemic and analyze the role of possible risk factors. We conducted a web-based cross-sectional study to determine the perceived stress of doctors using the Perceived Stress Scale-10 and evaluate possible risk factors. Among 384 valid responders, we had 37.5% dermatologists and 62.5% nondermatologists. Perceived stress was more in nondermatologists compared to dermatologists, but not statistically significant (P = 0.1). Degree of stress was also comparable (P = 0.5). Higher stress was significantly associated with females and unmarried individuals in both groups. Risk of infecting self or colleagues or family members and lack of protective gear at work place were top causes of stress. Perceived stress is increased in all doctors due to COVID-19 pandemic and lock-down. Even dermatologists have developed high stress due to current situation, comparable to nondermatologists, despite being traditionally considered an outpatient speciality with minimum stress. Thus, proper mental health care policies should be adopted for all doctors, including dermatologists.

Regional differences in medical needs and care for skin cancer across Bavaria: confronting the gap

BACKGROUND

The management of keratinocyte carcinoma (KC) and actinic keratosis (AK) as well as the number of dermatologists differ across the Bavarian counties in Germany.

OBJECTIVES

To determine regions with low utilization rates of dermatological care and a high medical need due to AK and KC burden.

MATERIALS AND METHODS

A cross-sectional study of 2,483 people was carried out during the Munich Oktoberfest in September 2016. Participants from urban, semi-urban and rural areas completed a questionnaire and received a medical examination on site by dermatologists.

RESULTS

The rate of previous skin cancer screening and previous treatment by dermatologists ranged from 18.8% to 58.6% and from 34.3% to 75.4% for all regions, respectively. Over 60% of people living in the environs or rural areas would consult a dermatologist first if they found a visible skin condition. Thus, people living in urban areas were twice as likely as people living in rural areas to consult a dermatologist first (odds ratio = 2.16; 95% CI: 1.38-3.39). Comparing the three different locations, dermatologists detected the highest AK burden among people living in rural areas (27.3% of the participants) and the highest KC burden among people living in urban areas (3.4% of the participants).

CONCLUSION

In rural areas, a high AK burden coupled with a low utilization rate of dermatological care was observed. To effectively address these problems, a broader implementation of alternative medical resources, such as teledermatology, might improve access to health care.

Dermatopathologist assessment of "pathologist-to-dermatologist" communication for dermatopathology services

BACKGROUND

While patients are the ultimate beneficiaries of pathology services, pathologist to clinician communication is an essential component of excellent patient care.

OBJECTIVE

To survey dermatologists on how well pathologists communicate with them and to assess which aspects of pathologists' communication skills are deemed most significant to dermatologists, stratified by practice type.

METHODS

A survey-based instrument was developed and sent to dermatologists through various email listservs. Of the approximately 400 potential Association of Professors of Dermatology respondents, 64 returned the survey questionnaire (response rate 16%). Of the 79 state and regional dermatologic societies, seven agreed to distribute the survey on their listservs (response rate 9%).

RESULTS

Surveyed dermatologists believe that the pathologists with whom they work are meeting expectations in the areas of diagnostic accuracy, communicating pertinent information in a timely fashion, integrating written pathology reports into the electronic medical record, and making a clinically meaningful histopathologic interpretation. Discussion of cost of ancillary testing is an area of improvement. University affiliated dermatologists are more likely to use electronic medical records as their predominant mode of communication compared to community dermatologists with and without academic affiliations. Community dermatologists are more likely to use faxed written pathology reports as their predominant mode of communication.

CONCLUSION

Physician-to-physician communication is a key component of effective patient care. When it comes to dermatopathology services, dermatologists appear overall satisfied with the indicators examined, however, potential opportunities for improvement exist.

Dermatological conditions encountered in The Independent State of Samoa and an exploration of possible strategies to manage dermatological health-care needs in this resource-poor setting

This report adds to the limited existing literature concerning dermatoses in Samoa. Conditions encountered during a 4-day private clinic are reported. Amongst the 75 patients reviewed, eczema was the most frequent condition diagnosed. This was followed by infective dermatoses particularly pityriasis versicolor and tinea infections. Reassuringly, in 97% of cases, suitable medications were available locally.

Comparison of treatment standards in Atopic Dermatitis management across selected geographies prior to emerging targeted therapies onset

Atopic Dermatitis (AD) is a chronic inflammatory disease persisting predominantly in the pediatric population. Treatment is generally supervised by various medical specialists, including primary care practitioners, allergists, and dermatologists. This divergence in disease management allows various therapeutic approaches to be administered to patients by supervised physicians. This article covers etiology of the disease and summarizes dermatologic treatment standards of selected countries binding prior to the registration of dupilumab by both the European Medicines Agency (EMA) and Federal Drug Administration (FDA) in 2017. Before recent development in targeted therapies (small molecules and biologic agents), standards in AD treatment remained unchanged for years with extensive similarities across a sample group of countries in particular geographic and economic regions. The spectrum of available and popular therapeutic options can be categorized into three dominating groups: non-pharmacologic, pharmacologic, and systemic interventions. Their prescription, in principle, was historically driven by disease severity and previous treatment history. However, advances in targeted therapies may change AD management guidelines and medical care standards.

The Clinical Trials of Mesenchymal Stem Cell Therapy in Skin Diseases: An Update and Concise Review

The skin is one of the crucial body organs with anatomy and physiology linked to various disorders including congenital and acquired diseases. Nowadays, mesenchymal stem cell (MSCs)- based therapy has appeared as a promising therapeutic field, in which many see opportunities to cure the costliest and incurable diseases. However, one question to be asked is that if the use of MSCs in clinical trials studies and diseases treatment has improved. In this study, the clinical trials using MSCs in skin diseases were reviewed. A remarkable number of clinical trial studies are in progress in this field; however, only a few of them have led to tangible benefits for patients. The relevant papers and ongoing clinical trials that address MSC's therapeutic goals for various skin disorders were examined. This review can be very useful for both the dermatologists and basic skin researchers interested in contributing to stem cell-based therapeutic researches in the area of skin disorders.

Physician attitudes about non-medical switching to biosimilars: results from an online physician survey in the United States

OBJECTIVE

This study was designed to understand the level of familiarity of US rheumatologists, gastroenterologists and dermatologists with biosimilar therapies, their experience with non-medical switching (switching medications for reasons unrelated to patient health) of patients between biologics and their attitudes towards switching from a biologic to a biosimilar.

METHODS

A total of 297 US physicians who currently prescribe biologics for their patients completed a 15-minute online survey. Rheumatologists, dermatologists and gastroenterologists were included.

RESULTS

The majority of physicians (84%) did not want stable patients undergoing a non-medical switch to a biosimilar. While 60% of physicians believed non-medical switching to biosimilars may have a positive impact on healthcare system costs, multiple negative impacts were also expected. A majority of physicians anticipated a negative impact on patient mental health (59%), treatment efficacy (57%), patient safety (53%) and physician office management (60%).

CONCLUSIONS

The majority of physicians had concerns regarding non-medical switching to biosimilars and the impact such switching would have on patient care and physician practice.

Using health insurance administrative data to explore patch testing utilization in Ontario, Canada-An untapped resource

BACKGROUND

Patch testing is the key diagnostic test for diagnosing allergic contact dermatitis, but there is limited information on the use of patch testing at the population level.

OBJECTIVES

To utilize Ontario Health Insurance Plan (OHIP) data to analyse trends in the rate of patch testing in Ontario.

METHODS

Patch testing billing data submitted to the OHIP between 1992 and 2014 were analysed. Two patch test billing codes were investigated: one for work-related testing (G198), and one for non-work-related testing (G206). Rates of patch testing overall were calculated, and trends over time were described.

RESULTS

There were 51 576 patch test billings: 48 416 non-work-related and 3160 work-related. The annual rate of non-work-related patch testing (G206) ranged from 11.9 per 100 000 people to 25.9 per 100 000 people, increasing over time. The rate of work-related patch testing (G198) ranged from 0.17 to 2.32 per 1 000 000 people, and was relatively stable. The overall distribution of billing by specialty was 70% dermatology, 19% other medical subspecialties, and 10% paediatrics and family medicine.

CONCLUSIONS

Administrative health data can contribute to a more complete understanding of patch test utilization at the population level and, over time, can be used to track patch testing practices.

Vitamin D status in Thai dermatologists and working-age Thai population

This study aimed to determine the prevalence of vitamin D insufficiency among Thai dermatologists compared with the general working-age population in Bangkok. A cross-sectional study was conducted in healthy Thai physicians who had at least 1 years' experience in dermatology practise and a subsample of the general Thai population from the Fourth National Health Survey. Serum 25-hydroxyvitamin D (25[OH]D), a combination of 25(OH)D2 and 25(OH)D3, levels in both groups were measured using liquid chromatography coupled with mass spectrometry. The majority of dermatologists were of Fitzpatrick skin type III (n = 61, 61.3%) or IV (n = 32, 33.3%). The mean serum 25(OH)D and 25(OH)D3 levels were 18.9 and 18.2 ng/mL, respectively, whereas the corresponding levels in the general population were 26.5 and 25.8 ng/mL. None of the dermatologist had serum 25(OH)D sufficiency (>30 ng/mL), 38 (38.78%) had vitamin D insufficiency (20-30 ng/mL) and 60 (61.22%) had vitamin D deficiency (<20 ng/mL). The frequency of vitamin D deficiency in dermatologists was significantly higher than in the general population (61.2% vs 19.2%, P < 0.001). Ninety percent of dermatologists used sunscreen daily and spent time mostly indoors. Dermatologists used physical sun-protection more than half of the time when outdoors, for example, a book or paper as a sunshade (70.3%), an umbrella (48.4%), a long-sleeved shirt (20.4%) or a hat (9.7%). In conclusion, dermatologists showed a remarkably high prevalence of vitamin D deficiency which may be due to inadequate exposure to sunlight, regular use of sunscreen and practicing various sun-protection activities.

Topical corticosteroid concerns from the clinicians' perspective

PURPOSE

Topical corticosteroids concerns (TCC) are common in dermatology patients, possibly leading to non-adherence to topical corticosteroids (TCS) and poor disease control. Clinicians play a key role in that context, as they can reduce or reinforce these concerns. It is unknown, if clinicians have accurate knowledge of TCC to appropriately address this issue and whether they have concerns themselves to use TCS. This questionnaire-based study aimed to assess these two aspects.

MATERIALS AND METHODS

Accuracy of knowledge was defined by how close the clinicians' estimates were to reference values of our previous study, in which we had examined TCC in dermatology outpatients. Moreover, clinicians indicated whether they have concerns themselves to use TCS.

RESULTS

Totally 202 clinicians participated. They underestimated both the prevalence of TCC and the resulting non-adherence. Whereas most clinicians correctly estimated characteristics of patients with TCC and the impact of patient information, only 31% of clinicians knew that skin atrophy was the leading concern, and only 30% correctly ranked the reasons for TCC. 74% of the clinicians had at least minor concerns themselves.

CONCLUSION

The majority of clinicians may have inaccurate knowledge of certain aspects of TCC and own concerns to use TCS.

Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: Systematic review and meta-analysis

BACKGROUND

Skin psoriasis precedes the onset of psoriatic arthritis (PsA) in 84% of patients with psoriasis. Dermatologists have an important role to screen psoriasis patients for PsA. The efficiency of PsA screening remains unknown.

OBJECTIVE

We sought to determine the point prevalence of undiagnosed PsA in patients with psoriasis using a systematic search of the literature and meta-analysis.

METHODS

PubMed, Cochrane, and Embase database searches yielded 394 studies for review. No study aimed to determine the prevalence of undiagnosed PsA in patients with psoriasis. We assumed that the prevalence of newly diagnosed PsA in patients with psoriasis at the time they seek medical care could be a sound estimate of this value. Seven epidemiological studies and 5 studies on PsA screening questionnaires allowed us to clearly identify patients with newly diagnosed PsA and were selected for review.

RESULTS

The prevalence of undiagnosed PsA was 15.5% when all studies were considered and 10.1% when only epidemiological studies were considered.

LIMITATIONS

Data were obtained from studies not designed to address the question at hand. Heterogeneity was high (I(2) = 96.86%), and therefore a random effects model was used.

CONCLUSION

The high prevalence of undiagnosed PsA in patients with psoriasis adds to the recommendation that dermatologists need to screen all patients with psoriasis for PsA.