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PubMed1999

Development of in vivo bioequivalence methodology for dermatologic corticosteroids based on pharmacodynamic modeling.

BACKGROUND: Dermatologic corticosteroid products produce skin blanching that is related to clinical potency and dose. (For application of the vasoconstrictor assay to bioavailability and bioequivalence assessment, dose is defined in terms of duration of treatment exposure [dose duration], so the terms dose and dose duration have been used interchangeably). The vasoconstrictor assay is the method of choice to assess dermatologic corticosteroid products bioequivalence if dose-response is validated. This article examines dose-response validation to meet objectives of US Food and Drug Administration (FDA) bioequivalence guidance for dermatologic corticosteroid products. METHODS: An exploratory dose-response study was conducted to determine applicability of the empirical maximum effect (Emax) model to the individual subject and population dose-response relationships of six dermatologic corticosteroid product creams that varied from the most to the least potent classes. Products were applied to the skin of 10 healthy subjects in each of two dosing periods for dose durations of 0.5, 1, 2, and 6 hours. Skin blanching was measured by reflectance colorimeter through 24 hours after application. Area under the effect curve (AUEC) was determined for each dose duration. An Emax model was fitted to the AUEC versus dose duration data. A similar analysis was conducted for a bioequivalence study on two formulations of a dermatologic corticosteroid product in 40 healthy subjects. RESULTS: In the exploratory study, the number of individual subject data sets for which the Emax model provided an acceptable fit generally increased with the potency of the dermatologic corticosteroid product. On the basis of population modeling, dose-response data of all products, except the lowest potency cream, were adequately described by the Emax model. Values for population ED50 (the dose duration required to achieve 50% of the fitted AUECmax value) decreased with increase in dermatologic corticosteroid product potency. CONCLUSIONS: Acceptable model fits to all individual subject dose-response data were not achieved for any dermatologic corticosteroid product. However, population dose-responses were adequately described by the Emax model. On the basis of these data, the optimal dose duration used for comparison of multisource dermatologic corticosteroid products is recommended to be equal to the ED50 based on population modeling of pilot dose-response study data.

Adrenal Cortex Hormones↗

PubMed1998

Korean Dermatological Association.

The Korean Dermatological Association (KDA) was founded on October 27, 1945. The first annual meeting was held on November 15, 1947, and meetings have been held twice a year since 1975. The KDA 50th Annual Spring Meeting was on April 15-16, 1998. Korean Journal of Dermatology, the official journal of the KDA, was first published in 1960 and has been published bimonthly since 1978. Annals of Dermatology (Seoul), the English journal, was first published in 1989 and has been published quarterly since 1995. The American residency and specialty board system was introduced in 1954. Board specialty examination of dermatology candidates by the KDA requires four years of residency. Three hundred and twenty residents are now in the training course in the fifty-nine resident training approved hospitals this year. KDA has seven regional dermatological societies; Seoul, Pusan, Taegu, Honam, Chungchong, Jeonbuk, and Kangwon. KDA has had eleven research subcommittees since 1981. There are two associated societies of the KDA; the Korean Society for Investigative Dermatology was founded in 1991, and the Korean Society for Medical Mycology was founded in 1994. The Korea-Japan Joint Meeting of Dermatology has been held every two years since 1979 and the Korea-China Joint Meeting of Dermatology and Mycology has been held since 1996. About three hundred papers were presented at the 49th Annual Autumn Meeting on October 21-23, 1997. These included special lectures, invited lectures, educational lectures, oral presentations, and posters. About five hundred dermatologists participated in that meeting. KDA joined the International League of Dermatological Societies in 1973 with forty-seven members. There are around 1200 members of the KDA including 320 residents in 1998.

Dermatology↗

PubMed2005

Dermatological findings following acute traumatic spinal cord injury.

STUDY DESIGN: Prospective study. OBJECTIVE: To identify and define dermatological conditions following acute traumatic spinal cord injury (ATSCI) during inpatient rehabilitation. SETTING: Spinal Cord Injury Unit, The Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Israel. METHODS: During a 1-year study, all patients following ATSCI were prospectively studied for new dermatological findings during their inpatient rehabilitation. Every new dermatological finding was defined concerning its location with regard to the patient's neurological level, the time from injury to appearance and the exact dermatological diagnosis. RESULTS: During the study year, 46 ATSCI patients were hospitalized in our department, of whom were 38 (82.6%) males and eight (17.4%) females (mean age 30.2 years). A total of 21 (45.6%) patients were tetraplegic and 25 (54.3%) paraplegic. Of the patients, 28 (60.9%) had complete neurological injuries and 18 (39.1%) incomplete. In all, 14 (30.4%) patients developed a dermatological condition. There was no significant age or sex correlation to the development of these complications. There was a greater likelihood of paraplegia (48 versus 9.5%, P=0.005) and being neurologically complete (42.9 versus 11.1%, P=0.02). The dermatological findings appeared on an average of 80.3 days after the initial neurological insult. There were a total of 22 different dermatological findings: 11 (50%) were local fungal infections, two (9.1%) psoriatic lesions, two (9.1%) hyperkeratotic lesions, two (9.1%) bacterial infections (one folliculitis, one impetigo) and single cases of seborrheic dermatitis, acne, alopecia, scabies and allergic reaction. Of the findings, 14 (63.6%) were below the neurological level, including all of the fungal infections. CONCLUSIONS: Dermatological findings are common during rehabilitation of ATSCI. The clinical impact of these findings is low, but nevertheless, they are troublesome to the patient. The most common dermatological disorder was a local fungal infection below the neurological level. Paraplegic patients are more susceptible to the development of this condition. Patient and staff education regarding proper skin care may reduce these infections.

Acute Disease↗

PubMed2001

Dermatologic manifestations of relapsing polychondritis. A study of 200 cases at a single center.

Dermatologic manifestations of relapsing polychondritis (RP) have been relatively poorly studied compared to other manifestations. In this study we describe dermatologic manifestations in a large series of patients with RP and the corresponding pathologic findings. In this retrospective, single-center review of 200 patients diagnosed with RP according to Michet's criteria, we analyzed separately those suffering from associated diseases with potential dermatologic involvement or chronic dermatitis. Skin or mucosal biopsies taken from 59 patients were examined without knowledge of the clinical data. Among the 200 patients with RP, 73 had chronic dermatitis or associated diseases with potential dermatologic involvement, especially hematologic disorders (n = 24) and connective tissue diseases (n = 22). Among the other 127 patients, 45 (35.4%) had dermatologic manifestations: aphthosis (n = 21; oral in 14 and complex in 7), nodules on the limbs (n = 19), purpura (n = 13), papules (n = 10), sterile pustules (n = 9), superficial phlebitis (n = 8), livedo reticularis (n = 7), ulcerations on the limbs (n = 6), and distal necrosis (n = 4). Dermatologic manifestations were the presenting feature of RP in 15 cases (12%), and appeared concomitantly (n = 23) or not (n = 22) with attacks of chondritis. Histologic findings included vasculitis (n = 19, leukocytoclastic in 17 and lymphocytic in 2), neutrophil infiltrates (n = 6), thrombosis of skin vessels (n = 4), septal panniculitis (n = 3), and minor changes (n = 2). Patients with and without dermatologic manifestations did not differ with regard to male/female ratio; age at RP onset; frequency of auricular, nasal, or tracheobronchial chondritis; or frequency of rheumatologic, ocular, audiovestibular, renal, arterial, or venous involvement. The frequency of dermatologic manifestations (91% versus 35.4%; p < 0.0001), sex ratio (18 male/4 female versus 44 male/83 female, p < 0.0001), and age at first chondritis (63.3 +/- 14 yr versus 41.4 +/- 17 yr; p < 0.0002) were significantly higher in the 22 patients with myelodysplastic syndrome than in the 127 patients without any associated disease. In conclusion, although dermatologic manifestations occur frequently in patients with RP, especially in association with myelodysplasia, they are nonspecific and sometimes resemble those observed in Behçet disease or inflammatory bowel diseases. Their presence in the elderly warrants repeated blood cell counts to detect a smouldering myelodysplasia.

Adolescent↗

PubMed2005

Dermatological conditions during TNF-alpha-blocking therapy in patients with rheumatoid arthritis: a prospective study.

Various dermatological conditions have been reported during tumor necrosis factor (TNF)-alpha-blocking therapy, but until now no prospective studies have been focused on this aspect. The present study was set up to investigate the number and nature of clinically important dermatological conditions during TNF-alpha-blocking therapy in patients with rheumatoid arthritis (RA). RA patients starting on TNF-alpha-blocking therapy were prospectively followed up. The numbers and natures of dermatological events giving rise to a dermatological consultation were recorded. The patients with a dermatological event were compared with a group of prospectively followed up RA control patients, naive to TNF-alpha-blocking therapy and matched for follow-up period. 289 RA patients started TNF-alpha-blocking therapy. 128 dermatological events were recorded in 72 patients (25%) during 911 patient-years of follow-up. TNF-alpha-blocking therapy was stopped in 19 (26%) of these 72 patients because of the dermatological event. More of the RA patients given TNF-alpha-blocking therapy (25%) than of the anti-TNF-alpha-naive patients (13%) visited a dermatologist during follow-up (P < 0.0005). Events were recorded more often during active treatment (0.16 events per patient-year) than during the period of withdrawal of TNF-alpha-blocking therapy (0.09 events per patient-year, P < 0.0005). The events recorded most frequently were skin infections (n = 33), eczema (n = 20), and drug-related eruptions (n = 15). Other events with a possible relation to TNF-alpha-blocking therapy included vasculitis, psoriasis, drug-induced systemic lupus erythematosus, dermatomyositis, and a lymphomatoid-papulosis-like eruption. This study is the first large prospective study focusing on dermatological conditions during TNF-alpha-blocking therapy. It shows that dermatological conditions are a significant and clinically important problem in RA patients receiving TNF-alpha-blocking therapy.

Adult↗

PubMed2003

Quality of abstracts in 3 clinical dermatology journals.

BACKGROUND: Structured abstracts have been widely adopted in medical journals, with little demonstration of their superiority over unstructured abstracts. OBJECTIVES: To compare abstract quality among 3 clinical dermatology journals and to compare the quality of structured and unstructured abstracts within those journals. DESIGN AND DATA SOURCES: Abstracts of a random sample of clinical studies (case reports, case series, and reviews excluded) published in 2000 in the Archives of Dermatology, The British Journal of Dermatology, and the Journal of the American Academy of Dermatology were evaluated. Each abstract was rated by 2 independent investigators, using a 30-item quality scale divided into 8 categories (objective, design, setting, subjects, intervention, measurement of variables, results, and conclusions). Items applicable to the study and present in the main text of the article were rated as being present or absent from the abstract. A global quality score (range, 0-1) for each abstract was established by calculating the proportion of criteria among the eligible criteria that was rated as being present. A score was also calculated for each category. Interrater agreement was assessed with a kappa statistic. Mean +/- SD scores were compared among journals and between formats (structured vs unstructured) using analysis of variance. MAIN OUTCOME MEASURES: Mean quality scores of abstracts by journal and by format. RESULTS: Interrater agreement was good (kappa = 0.71). Mean +/- SD quality scores of abstracts were significantly different among journals (Archives of Dermatology, 0.78 +/- 0.07; The British Journal of Dermatology, 0.67 +/- 0.17; and Journal of the American Academy of Dermatology, 0.64 +/- 0.15; P =.045) and between formats (structured, 0.71 +/- 0.11; and unstructured, 0.56 +/- 0.18; P =.002). The setting category had the lowest scores. CONCLUSIONS: The quality of abstracts differed across the 3 tested journals. Unstructured abstracts were demonstrated to be of lower quality compared with structured abstracts and may account for the differences in quality scores among the journals. The structured format should be more widely adopted in dermatology journals.

Abstracting and Indexing↗

PubMed2005

Misnomers in dermatology.

BACKGROUND: Dermatology lexicon is rich with descriptive terminology. However, for a variety of reasons, it also includes a number of misnomers. OBJECTIVE: To review the more commonly encountered and critically appraised misnomers in dermatology. METHODS: A search of MEDLINE (1966 - 2004), eMedicine dermatology text and electronic versions of two standard dermatology texts, Fitzpatrick's Dermatology in General Medicine and Dermatology, was performed using the permutations of the terms: dermatology, skin, cutaneous, and misnomer. RESULTS: Greater than 40 misnomers were identified. CONCLUSIONS: Misnomers in dermatology stem largely from lack of appreciation of underlying etiology or histopathological features of certain skin conditions, imprecise historical observations and erroneous eponymous credit. Historical, clinical, or histopathological explanations are used to clarify the nature of the misnomers, and in some cases suggestions for improved terminology are provided.

Dermatology↗

PubMed2006

Dermatology Internet Yellow Page advertising.

BACKGROUND: Patients may use Internet Yellow Pages to help select a physician. OBJECTIVE: We sought to describe dermatology Internet Yellow Page advertising. METHODS: Dermatology advertisements in Colorado, California, New York, and Texas at 3 Yellow Page World Wide Web sites were systematically examined. RESULTS: Most advertisements (76%; 223/292) listed only one provider, 56 listed more than one provider, and 13 listed no practitioner names. Five advertisements listed provider names without any credentialing letters, 265 listed at least one doctor of medicine or osteopathy, and 9 listed only providers with other credentials (6 doctors of podiatric medicine and 3 registered nurses). Most advertisements (61%; 179/292) listed a doctor of medicine or osteopathy claiming board certification, 78% (139/179) in dermatology and 22% (40/179) in other medical specialties. Four (1%; 4/292) claims of board certification could not be verified (one each in dermatology, family practice, dermatologic/cosmetologic surgery, and laser surgery). Board certification could be verified for most doctors of medicine and osteopathy not advertising claims of board certification (68%; 41/60; 32 dermatology, 9 other specialties). A total of 50 advertisements (17%) contained unverifiable or no board certification information, and 47 (16%) listed a physician with verifiable board certification in a field other than dermatology. LIMITATIONS: All Internet Yellow Page World Wide Web sites and all US states were not examined. CONCLUSION: Nonphysicians, physicians board certified in medical specialties other than dermatology, and individuals without verifiable board certification in any medical specialty are advertising in dermatology Internet Yellow Pages. Many board-certified dermatologists are not advertising this certification.

Advertising↗

PubMed2003

Legal claims in Scottish National Health Service Dermatology Departments 1989-2001.

BACKGROUND: An area of current National Health Service (NHS) interest is risk management as it is one of the requirements of clinical governance. If there are aspects of dermatological practice prone to mishap or dispute then a review of legal claims in dermatology may highlight these areas. This would then allow input into these specific areas of practice to try and minimize future risk. OBJECTIVES: To review all legal claims relating to NHS Dermatology in Scotland and characterize the main areas of risk. METHODS: Staff at the Central Legal Office in Edinburgh reviewed all legal claims in NHS Dermatology between 1989 and 2001. Details provided were general, and claimants, staff, hospitals and regions of Scotland could not be identified. RESULTS: Thirty claims were identified relating to five main areas of dermatological practice: (i) phototherapy (eight claims); (ii) therapeutics (eight); (iii) cryosurgery/cryotherapy (six); (iv) surgery (four); and (v) misdiagnosis (three) and one alleged neurological problem after fainting. As well as consultants, nurses featured in phototherapy claims and junior medical staff in cryosurgery claims. Twelve of the 30 (40%) claims have reached settlement; three claims are presently outstanding. CONCLUSIONS: Given the numbers of patients seen annually at Scottish NHS Hospital Dermatology units the absolute number of claims is low. Five main areas within dermatology were highlighted as at risk of litigation and this has implications for all U.K. dermatology departments with regard to funding, staff training and patient information and consent.

Adolescent↗

PubMed2006

Food and Drug Administration surveillance of dermatology-related and nondermatology-related prescription drug advertising in the USA, 2000-2003.

BACKGROUND: Spending on advertising of prescription medicines in the U.S.A. is increasing by nearly a billion dollars yearly. The Food and Drug Administration (FDA) is legally mandated to regulate pharmaceutical advertising in the U.S.A. Prior studies have documented inaccuracies in pharmaceutical advertisements, in the U.S.A. and the rest of the world. OBJECTIVES: To assess trends in FDA surveillance of dermatology-related prescription drug advertising, and to investigate pharmaceutical companies' responses to FDA regulatory actions. METHODS: We analysed all FDA citations of prescription drug advertisements issued during 2000-2003, and responses from cited companies to our mailed requests for follow-up information. RESULTS: Twenty-four dermatology-related drugs from 21 companies accounted for 30 (15.2%) of the 198 letters sent by the FDA; of these, 18 letters cited advertisements or promotions of these medications for dermatology-related uses. The most common violation cited overall was insufficient communication of risk (32.4% overall, 33.9% dermatology-related). Most FDA letters cited physician-targeted advertising (71.6% overall, 62.1% dermatology-related). The number of dermatology-related letters sent declined by 69.2% from 2000 (n=13) to 2003 (n=4), paralleling the 69.6% decline in the total number of letters sent (n=79 in 2000, n=24 in 2003). Compared with 2000, the FDA took longer to issue citation letters in 2003 for advertisements overall [hazard ratio (HR) 0.47, 95% confidence interval (CI) 0.27-0.72, P=0.001], although this trend was not present for dermatology-related advertisements (HR 1.12, 95% CI 0.39-3.29, P=0.83). Eight of the 16 companies (50%) that received requests from the authors for information replied. Seven of the eight (87.5%) reported complying with FDA requests to discontinue the cited advertisements, while one (12.5%) reported disagreeing with the citation and successfully clarifying the issue with the FDA. CONCLUSIONS: Dermatology-related advertisements accounted for 15.2% of FDA citations of pharmaceutical advertisements between 2000 and 2003. Recent controversy over pharmaceutical advertising may lead to changes in pharmaceutical advertising practices and surveillance of pharmaceutical advertising in the U.S.A.

Advertising↗

PubMed1996

Restructuring dermatology education at Cleveland medical centers affiliated with Case Western Reserve University.

We describe our response to the changing needs for dermatologic education and training at Cleveland medical centers affiliated with Case Western Reserve University School of Medicine (CWRU) located in Cleveland, Ohio. Our departmental plan for change is a multifaceted approach that alters the number of dermatology residents we train and also the way we interact with and educate our generalist colleagues. Like many other dermatologists, we have both idealistic and practical reasons for increasing our involvement in interdisciplinary education. One of our primary objectives is maximizing quality of care for dermatologic patients in our community. Traditionally, the majority of skin care in the United States has been provided by nondermatologists, and with the growth of managed care, this proportion is increasing. This has motivated us to increase our medical student teaching activities and to support the American Academy of Dermatology in its current efforts to develop a dermatology core curriculum for students. We should also be involved in the education of generalist physicians, since prior studies have suggested that their knowledge of dermatology needs improvement. Our goals should be both to improve the direct patient care skills of primary care physicians and to teach clinically appropriate referral thresholds. The American Academy of Dermatology has recently issued guidelines for the referral of dermatology patients in managed care settings to help ensure that our specialty has input into this process. In addition, teaching gatekeeper physicians to use appropriate referral criteria is important to many dermatologists in capitated managed care systems who often prefer limited as opposed to unrestricted access to their services.

Curriculum↗

PubMed1997

Psychiatric illness in patients referred to a dermatology-psychiatry clinic.

There is a recognized psychiatric morbidity among those who attend dermatology clinics. We aimed to determine the pattern of psychological and social problems among patients referred to a liaison psychiatrist within a dermatology clinic. Notes from 149 patients were reviewed and more detailed assessments performed in a subgroup of 32 consecutive referrals. All but 5% merited a psychiatric diagnosis. Of these, depressive illness accounted for 44% and anxiety disorders, 35%. Less common general psychiatric disorders included social phobia, somatization disorder, alcohol dependence syndrome, obsessive-convulsive disorder, posttraumatic stress disorder, anorexia nervosa, and schizophrenia. Classical disorders such as dermatitis artefacta and delusional hypochondriasis were uncommon. Commonly, patients presented with longstanding psychological problems in the context of ongoing social difficulties rather than following discrete precipitants. Psychiatric intervention resulted in clinical improvement in most of those followed up. Of the dermatological categories 1) exacerbation of preexisting chronic skin disease; 2) symptoms out of proportion to the skin lesion; 3) dermatological nondisease; 4) scratching without physical signs, the commonest were dermatological nondisease and exacerbation of chronic skin disease. Anxiety was common in those from all dermatological categories. Patients with dermatological nondisease had the highest prevalence of depression. Skin patients with significant psychopathology may go untreated unless referred to a psychiatrist. The presence of dermatological nondisease or symptoms out of proportion to the skin disease should particularly alert the physician to the possibility of underlying psychological problems.

Adolescent↗

PubMed2002

Hepatitis B and hepatitis C virus infections in dermatological patients in west Sicily: a seroepidemiological study.

OBJECTIVES: To evaluate the relative frequencies and molecular epidemiological features of viral hepatitis types B and C in dermatological patients in our geographical area. METHODS: We determined the hepatitis B virus (HBV) and hepatitis C virus (HCV) antibodies and the hepatitis B virus surface antigen (HBsAg) in a cohort of 677 dermatological patients admitted to the Department of Dermatology of Palermo. An 8-mL blood sample was taken from all subjects. The following assays were used: HBsAg, anti-HB core (antigen) (anti-HBc), anti-HB surface (antigen) (anti-HBs), anti-HB early (antigen) (anti-Hbe) and anti-HCV antibodies using enzyme-linked immunosorbent assay. RESULTS: One hundred and eighty-nine (27.91%) of the 677 dermatological patients were positive for anti-HBc, anti-HBs, anti-HBe and/or anti-HCV antibodies. In particular 22% (149 patients) were anti-HBc, anti-HBs or anti-HBe positive, reflecting exposure to HBV, and six patients (0.88%) were chronic carriers of HBsAg; 2.36% of the dermatological patients (16 persons) were anti-HCV positive. Tests showed that 24 subjects (3.52%) were infected with hepatitis B or C. The peaks in the age bands were in the 55-80-year-old age groups. CONCLUSIONS: This study confirms a high rate of HBV and HCV exposure with chronic carriers in our dermatological patients. We assume that the high prevalence of HCV and HBV in dermatological patients is more likely to be age related than to represent a true and direct association with dermatological diseases in general. Definite conclusions will only be available after large epidemiological studies that can establish or refute an aetiological and pathogenetic role of HBV and HCV in certain skin diseases associated with liver infection.

Adolescent↗

PubMed1998

A method to select an instrument for measurement of HR-QOL for cross-cultural adaptation applied to dermatology.

OBJECTIVE: The objective of this study was to develop a process to obtain an instrument to measure dermatology specific health-related quality of life (HR-QOL), and to adapt it into another culture, namely the Spanish-speaking community. DESIGN AND SETTING: By consensus, a multi-disciplinary team determined the qualities of an 'ideal' questionnaire as follows: need (absence of any such instrument), utility, multi-dimensionality, psychometric development, simplicity, high degree of standardisation, and accessibility. A bibliographic search was conducted on Medline, EMBASE and IME (Spanish Medical Index), using 'dermatology' and 'quality of life' as the key words, from January 1990 through to September 1997, supplemented by a second level reference search, to identify the instruments already in existence. Rather than develop a questionnaire ex novo, it was decided to make a cultural adaptation of an existing one. The questionnaires identified in the literature search were classified according to their generic or specific scope and it was decided to adapt a dermatology specific instrument. To select and compare the instruments, a model was developed which would provide an Adaptation Index (ADAPT), which includes the degree of development of psychometric properties, the formal design and the degree of standardisation at a given moment in time. RESULTS: Six dermatology specific scales were identified: Impact of Skin Disease Scale (IMPACT), Dermatology Life Quality Index (DLQI), Skindex, Dermatology Quality-of-Life Scales (DQOLS), Dermatology Specific Quality of Life (DSQL) and Qualita di Vita Italiana in Dermatologia (QUAVIDERM). The ADAPT Index for each of the above was determined at the time of the study and the DLQI was chosen for adaptation (ADAPT = 77, October 1997). CONCLUSIONS: The study showed the utility of ADAPT Index to assist in the selection process of the questionnaire to adapt. The results of the analysis indicate that in order to introduce and systematically use dermatology specific HR-QOL instruments, the indices require consolidation and improvement. There is a special need for an effort to be made in developing transculturally equivalent instruments suitable for international research.

Cross-Cultural Comparison↗

PubMed1995

Murray River water, raised cyanobacterial cell counts, and gastrointestinal and dermatological symptoms.

OBJECTIVE: To investigate whether exposure to Murray River and allied water sources during a period of raised cyanobacterial cell counts was associated with gastrointestinal and dermatological symptoms. DESIGN: A case-control study selecting gastrointestinal and dermatological cases and controls from subjects attending 21 general practitioners in eight Murray River towns. The association between the proportion of consultations for such symptoms and mean log cyanobacterial count was also examined. SUBJECTS: 102 gastrointestinal cases, 86 dermatological cases and 132 controls. MAIN OUTCOME MEASURE: The relative odds of gastrointestinal and dermatological symptoms, respectively, as opposed to no such symptoms, according to water-contact history during the week preceding the medical consultation. RESULTS: After adjusting for concurrent risk factors, subjects drinking chlorinated river water rather than rain water had a raised risk of gastrointestinal symptoms (P = 0.008), and those using untreated river water for domestic purposes rather than rain water had a raised risk of gastrointestinal (P = 0.034) and of dermatological (P = 0.048) symptoms. The proportion of consultations for gastrointestinal and dermatological symptoms correlated on a weekly basis with the mean log cyanobacterial cell count, although statistical significance was not achieved for the correlation with dermatological consultations or for separate reaches of the river. CONCLUSIONS: The raised risks of gastrointestinal and dermatological symptoms in those using Murray River water for drinking and other domestic purposes are consistent with causal relationships. However, the evidence for adverse health effects is, at best, only suggestive. Further research is indicated.

Abdominal Pain↗

PubMed2000

Top-cited dermatology authors publishing in 5 "high-impact" general medical journals.

BACKGROUND: In addition to publishing in the dermatologic literature, some dermatologists also publish articles in the general medical journals, which enjoy wide circulation and whose articles are often cited. OBJECTIVE: To identify articles and citations to these articles that the most frequently cited authors in the dermatologic literature published in highly cited general medical journals. DESIGN: We obtained a citation database from the Institute of Scientific Information, Philadelphia, Pa, that identified all articles published by the top-cited authors in the dermatologic literature in 5 "high-impact" general medical journals. SETTING: The 5 high-impact general medical journals with the historically highest impact factors. SUBJECTS: Two hundred top-cited authors in dermatology journals and their coauthors. MAIN OUTCOME MEASURE: Number of citations to articles published in 5 high-impact general medical journals. RESULTS: From 1981 to 1998, 120 of the 200 top-cited dermatology authors published a total of 674 papers in the 5 most highly cited general medical journals. Original articles published in these high-impact general medical journals were cited an average 7.5 times more often than articles published in dermatology journals. CONCLUSIONS: Top-cited authors in dermatology journals also frequently publish in the leading 5 high-impact general medical journals. Publications in these journals by dermatologists are often highly cited.

Databases as Topic↗

PubMed1998

Most common dermatologic problems identified by internists, 1990-1994.

BACKGROUND: Internists in all settings see many patients with skin conditions. Thus, their education in dermatology is important. Information on which areas of dermatology are most commonly seen in internal medicine practices is necessary for designing effective educational programs on skin disease. OBJECTIVE: To determine what types of dermatologic problems internists most commonly diagnose. METHODS: National Ambulatory Medical Care Survey data from 1990 to 1994 were analyzed for dermatologic diagnoses. Physicians specializing in internal medicine and all its subspecialties were compared with dermatologists and with other physicians. RESULTS: The most common skin disorders diagnosed by internists were dermatitis (15.8% of all diagnoses) and bacterial skin infections (14.0% of all diagnoses). Combined, bacterial, fungal, and viral infections included 28.3% of the most common dermatologic diagnoses made by internists. The top 10 most common diagnoses accounted for 57.9% of all skin-related diagnoses and the top 20 most common diagnoses accounted for 72.8%. Internists were more likely to see patients for bacterial skin infections, herpes infection, exanthem, urticaria, and insect bites while dermatologists more commonly saw patients for actinic and seborrheic keratoses, warts, benign and malignant skin tumors, and psoriasis. CONCLUSIONS: The most common dermatologic diseases diagnosed by internists differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of internal medicine residents, it is important to recognize these differences to place emphasis on the proper areas of study. Some common or serious skin conditions not often diagnosed by internists such as psoriasis and melanoma also deserve attention in internal medicine training programs.

Adolescent↗

PubMed2002

[Perspectives for dermatology in the 21st century].

During the last decades dermatology has been profoundly transformed from its descriptive origin into an important part of modern medicine and biosciences. Areas of interest and expertise in the future will likely be focused on major topics on clinical dermatology (psoriasis, atopic dermatitis, skin infections including those sexually transmitted), dermatologic oncology (squamous cell carcinoma, malignant melanoma), gene technology in biopharmacy and dermatopharmacology, and also the areas dealing with the aging of the skin and its appendages (dermatologic endocrinology, cosmetic dermatology). Increasing knowledge in dermatology is not only relevant for treating skin disease but also for helping our patients to maintain healthy and appealing skin, thus improving their requirements for beautification and their quality of life. While this is an important aim, it should not become our main task. Overall, the perspectives for dermatology are promising; in the end, its further development will depend on how modern societies will recognize its significance and reward its efforts.

Dermatology↗