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PubMed1976

[Dermatological complications after renal transplantation (author's transl)].

58 renal transplant patients were submitted to dermatological check-up investigations at regular intervals over a mean period of 26.2 months after surgery. 98% of the case material showed dermatological complications. In an analysis of the findings in 55 patients with infectious complications, viral infections occurred in 40, bacterial in 30 and mycotic infections in 20 patients. Dermatological manifestations of non-dermatological complications were mainly due to immunosuppressive therapy. The data stress the necessity of optimum cooperation between dermatologists and the attendant physician in the case of renal transplant patients.

Adolescent↗
PubMed2005

Malassezia yeast species isolated from patients with dermatologic lesions.

INTRODUCTION: Yeasts of the genus Malassezia form a normal component of skin flora, but are also associated with several dermatological disorders. Since 1996, the description of new species in this genus have led to new questions about their epidemiology and pathogenicity. OBJECTIVE: Herein, the frequency of Malassezia species in individuals with pityriasis versicolor, atopic dermatitis, seborrhoeic dermatitis, seborrhoeic dermatitis was compared in HIV patients and healthy individuals. Three body sites were selected for examination--head, thorax, and upper and lower extremities. MATERIAL AND METHODS: The 154 Malassezia species were isolated from 112 individuals and grouped as follows: 39 with seborrhoeic dermatitis (20 were HIV-positive patients), 18 with pityriasis versicolor, 18 with atopic dermatitis and 37 without dermatological leisions. HIV patient samples were examined microscopically, and specimens from both patients and healthy subjects were cultured on modified Dixon agar medium. Subsequently, isolates were identified by macroscopic, microscopic and physiological characteristics. RESULTS: The most commonly isolated species were Malassezia globosa (37.5%), M. sympodialis (31.3%) and M. furfur (31.3%). Malazzerzia globosa predominated in patients with pityriasis versicolor (67%) and in HIV-positive patients with seborrhoeic dermatitis (85%). In non-HIV patients with atopic dermatitis or seborrhoeic dermatitis, M. furfur and M. restricta were isolated in 72% and 26% of the cases, respectively. CONCLUSION: Several conclusions were evident. First, Malassezia species was present in subjects with and without dermatological pathologies. Second, the species frequency in the sampled population differed from frequencies reported from other geographic areas. Third, Malassezia globosa was involved at high frequency in patients with dermatological pathologies, suggesting a higher pathogenicity of this species. Additional studies on each species are recommended to clarify their pathogenic roles in association with HIV-positive and normal subjects.

Adolescent↗
PubMed2005

Cardiac devices and electromagnetic interference revisited: new radiofrequency technologies and implications for dermatologic surgery.

BACKGROUND AND OBJECTIVE: As the number of patients with implantable cardiac devices escalates, inadvertent electromagnetic interference (EMI) by electrosurgery carries increasing concern for patient safety. Given the trend for dermatologic care delivery by nonphysician providers, supervising physicians must carefully consider the adequacy of perioperative evaluation in elective or cosmetic settings. Rapidly evolving technology also calls into question potential EMI of new therapeutic modalities (radiofrequency resurfacing, electrochemotherapy, and endovenous ablation). The most recently published recommendations (1998) for care of dermatologic patients with cardiac devices do not differ significantly from guidelines proposed in 1975. These recommendations, based on complications experienced during noncutaneous surgery, are exceedingly conservative and do not take into consideration the different electrosurgical modalities and varying degrees of EMI risk. In addition, modern cardiac devices have evolved significantly with increased sophistication in protection from EMI. A survey of dermatologic surgeons demonstrated low compliance with these existing guidelines. METHODS, RESULTS, AND CONCLUSIONS: Based on a review of the literature and current electrosurgical and cardiac devices, we discuss the potential impact of conventional dermatologic electrosurgery and new technologies. We propose that new perioperative guidelines are needed to provide appropriate safety, facile implementation, and cost-effective care for patients with modern implantable cardiac devices.

Cardiac Pacing, Artificial↗
PubMed1990

Dermatological symptoms among visual display unit operators using plasma display and cathode ray tube screens.

A questionnaire survey was conducted to determine the prevalence of dermatological complaints in 672 full time visual display unit (VDU) operators in Singapore. Two hundred and sixty-nine operators worked with plasma display (PD) screens, while the other 403 used cathode ray tube (CRT) monitors. The overall one year period prevalence rate for dermatological complaints was 12%. Thirty-six (13%) PD operators and 46 (11%) CRT operators had skin complaints. The age and sex distribution of persons in the two groups were similar. Twenty-eight (10.4%) PD workers and 24 (6.0%) CRT workers had symptoms of itch, tingling, or the feeling of being stroked by a feather after working with the VDU for some time. Furthermore, 19 (7.1%) PD and 14 (3.5%) CRT workers stated that their skin problems improved during weekends or when they were off duty. The difference between these rates were not statistically significant. Operators with dermatological complaints in the past year were more likely to have a personal history of atopy, complain about their work environment, and have musculoskeletal symptoms of the shoulder and low back. The results indicate that the prevalence and nature of dermatological symptoms among operators using either type of VDU monitor are similar.

Adult↗
PubMed1989

Pediatric dermatology in primary care medicine.

Dermatologic conditions in children pose a special dilemma to primary care physicians. On the one hand, dermatologic problems are so common in childhood that the primary care physician is forced to become involved with many of them; on the other hand, the scope of dermatologic conditions found in children is so broad as to be beyond the skills of most primary care physicians. The secret to managing dermatologic problems in children within a primary care setting is to recognize that a relatively small group of conditions encompass the vast majority of reasons for which a primary care physician will be consulted. By recognizing those conditions and becoming expert in the treatment of those well-defined areas, the primary care physician can perform a true service. Critical to this approach, however, is to establish clear limits and to practice within the framework of one's competence. Recognizing the importance of early referral of those cases that fall outside one's expertise is an important measure of the primary care physician's competence as seen by patients and their families. This article attempts to assist primary care physicians in developing their own set of guidelines.

Adolescent↗
PubMedDate not supplied

Dermatologic complications following heart transplantation.

A total of 107 consecutive heart transplant recipients at Stanford University Medical Center were prospectively screened for dermatologic disease as part of their routine postoperative evaluation over a 6-month period. The incidence of nonmelanotic skin tumors and premalignant lesions was approximately 25-fold greater than expected in a normal population. Skin infections were seen in 55% of the patients and dermatologic drug side effects were almost universal including xerosis, hypertrichosis, and steroid acne. Successful excision or cryotherapy of all neoplastic lesions was achieved with no evidence of recurrence to date, a mean of 11 months. The skin infections responded to appropriate antiviral, antibacterial, and antifungal agents and the xerotic and acneiform lesions were successfully treated with emollients and topical retinoic acid, respectively. In addition, patients were instructed in preventive measures including the use of sunscreen agents and protective clothing. We conclude that heart transplant recipients have a significantly increased incidence of neoplastic, infectious, and drug-induced skin diseases. Routine dermatologic screening resulted in early identification and successful treatment of these lesions. We suggest that dermatologic screening is both feasible and valuable in this setting.

Adult↗
PubMed1988

Use of a support group for dermatologic patients.

Hospital nurses led weekly group sessions to provide dermatologic inpatients a supportive climate in which to share common concerns about skin disease and a forum for dissemination of dermatologic information. Session leaders kept a journal, noting themes and group dynamic patterns for each meeting. Participants also responded to a session evaluation questionnaire. Data from the journal and questionnaires were collected for one year to describe the issues and concerns raised in a support group for dermatologic patients and to assess the effectiveness of this approach in overall patient management. Three themes were consistently discussed: problems with stress, self-esteem, and social interaction; concerns with medical treatment; and coping with loss. Participants indicated that support and encouragement had been given and received. Need for a dermatologic patient support group was demonstrated. Location of such a group in an outpatient day-care setting was recommended.

Adaptation, Psychological↗
PubMed1997

The most common dermatologic problems identified by family physicians, 1990-1994.

BACKGROUND AND OBJECTIVES: Because all family physicians see numerous patients with dermatologic complaints, their education in skin disorders is important. Data are needed to help program directors know which areas of dermatology deserve the most time and emphasis. This study determined what types of skin problems family physicians most commonly diagnose. METHODS: Study researchers analyzed National Ambulatory Medical Care Survey data from 1990 to 1994 for dermatologic diagnoses. We then compared physicians specializing in family practice and its related fields (general practice, family practice sports medicine, and family practice geriatrics) with dermatologists and other physicians. RESULTS: The most common skin disorders diagnosed by family physicians were dermatitis (16.4% of all diagnoses), pyoderma (13.7%), wart (8%), tinea infection (5.4%), and epidermoid cyst (5.1%). The top 10 most common diagnoses accounted for 65% of all skin-related diagnoses, and the top 20 most common diagnoses accounted for 81.8%. Family physicians more commonly saw patients for infectious processes, infestations, and insect bites, while dermatologists were more likely to see patients for psoriasis, alopecia, and rosacea. CONCLUSIONS: Skin disorders diagnosed by family physicians differ considerably from those diagnosed by dermatologists. Because dermatologists do much of the dermatology teaching of family practice residents, it is important to recognize these dissimilarities to place emphasis on the proper areas of study. Some common or serious conditions, such as psoriasis and melanoma, are not often diagnosed by family physicians and also deserve attention in family practice training programs.

Clinical Competence↗
PubMed1998

Dermatological uses of high-dose intravenous immunoglobulin.

High-dose intravenous immunoglobulin (hdIVIg) is increasingly used to treat a range of inflammatory and autoimmune diseases. The current dermatological uses of hdIVIg include the treatment of dermatomyositis and the autoimmune bullous disorders, epidermolysis bullosa acquisita, pemphigoid, and pemphigus. Numerous immunomodulatory mechanisms for hdIVIg have been proposed, and they are discussed alongside treatment protocols and adverse effects. Increasing use of this therapy has helped to establish its excellent safety record, without the many adverse effects of steroids and other immunosuppressive agents. This safety record makes hdIVIg an attractive therapeutic option; however, in view of the time required to administer the infusions, the cost, and the urgent need for controlled trials of hdIVIg in patients with specific dermatological disorders such as pemphigus, patients must be carefully selected. Unfortunately, current dermatological uses of hdIVIg have been limited to either uncontrolled trials or anecdotal case reports, except for a single controlled trial of hdIVIg as adjunctive therapy in patients with dermatomyositis, which documented a significant benefit. Further trials in dermatomyositis should be established to confirm these data and to clarify the dose and frequency of therapy required for patients with dermatomyositis. When using hdIVIg, liaison between the dermatologist and the immunologist is helpful because it allows the use of both the nursing and the medical expertise of an existing immunotherapy unit. If appropriate, the patient may be entered into an hdIVIg home therapy training program, such as the one that exists for primary immunodeficiency and some neurologic indications, with clear benefits in quality of life and inpatient costs.

Adjuvants, Immunologic↗
PubMed1979

The challenge of biophysics to dynamic dermatology.

Dermatologic biophysics has much to offer both clinical and investigative dermatology. For the clinician, the radiation biophysicist can provide accurate measurements of ionizing and nonionizing outputs, including those for PUVA, and critical evaluation of radiation safety measures. In optics, there is a need for accurate measurements of skin color and examination of the skin at moderate magnification. The biophysicist, with the biomedical engineer, can improve all the physical modality instrumentation used in practice. In investigative dermatology, there is the cellular biophysics of radiation. Doppler techniques for skin circulation, spectroscopy of living cells, and many other applications are suggested for current and future studies.

Biophysical Phenomena↗
PubMed1998

The Cochrane Skin Group. Preparing, maintaining, and disseminating systematic reviews of clinical interventions in dermatology.

In 1979, Prof Archie Cochrane challenged the medical profession to produce a critical summary of randomized controlled clinical trials according to specialty, which should be updated periodically. The Cochrane Collaboration, an international voluntary group of reviewers and researchers from a range of professional backgrounds dedicated to producing systematic reviews, was established in 1992 in response to Cochrane's challenge. Systematic reviews produced by the Cochrane Collaboration start with individuals who formulate questions that are important to the care of patients. Every effort is then made to locate published and unpublished evidence to answer the question, and explicit criteria are used to select studies for inclusion in the review and to assess their quality. If appropriate, meta-analysis is used to combine results from several smaller studies to produce an overall result. Reviews are published in the Cochrane Library, an electronic publication (CD-ROM or diskette form), and the reviews are updated quarterly. In December 1997, a Cochrane Skin Group was registered with the Cochrane Collaboration to prepare, maintain, and disseminate reviews on the effects of health care for people with dermatological conditions. Currently, 25 titles and 9 review protocols have been registered with the Cochrane Skin Group, and the first set of dermatological reviews will be available before the end of 1999. The Cochrane Skin Group aims to become the best source of unbiased external evidence for summarizing the effects of dermatological care.

Dermatology↗
PubMed2000

How well are randomized controlled trials reported in the dermatology literature?

OBJECTIVE: To assess the methodological quality of the design and reporting of randomized controlled trials published in one major dermatology specialty journal. DESIGN AND DATA SOURCES: In a survey of all published parallel group randomized controlled trials, we found 73 reports with allocation described as randomized from all issues of Clinical and Experimental Dermatology from its inception in 1976 through 1997. MAIN OUTCOME MEASURES: Direct and indirect measures of the adequacy of randomization, trial sample size, baseline comparisons, and intention-to-treat analysis. RESULTS: Hand searching identified 73 randomized controlled trials, but only 31 of these were found by searching MEDLINE for the publication type clinical trials. Of the 73 randomized controlled trials, 68 contained sufficient information to include in the analysis. Only 1 study (1%) reported the method of random sequence generation, and only 5 studies (7%) reported adequate concealment of allocation. Among 38 trials that used simple randomization, the sample sizes in the comparison groups were identical in 22 occasions, raising the possibility that simple randomization might not have been adequately generated or concealed. Most trials (88%) excluded some randomized participants from their analysis. The median sample size was 23 per trial. Only 1 trial reported sample size and statistical power considerations and had an a priori main hypothesis. CONCLUSIONS: Hand searching is important for locating all relevant trials. There is the need for higher methodological quality in clinical trial reporting in dermatology journals. The adoption of the CONSORT (Consolidated Standards of Reporting Trials) statement and checklist for the reporting of trials should enhance the validity of and strengthen the evidence from clinical trials reports.

Data Collection↗
PubMed2004

Gender and parenting significantly affect work hours of recent dermatology program graduates.

BACKGROUND: The increased proportion of female physicians over the last 30 years may have important implications for future physician workforce needs. OBJECTIVE: To assess the roles of gender, marital status, and parenting in employment choices. DESIGN, SETTING, AND PARTICIPANTS: Anonymous surveys were distributed to recent dermatology residency graduates taking a board examination review course from 1999 through 2002. MAIN OUTCOME MEASURES: The number of hours respondents saw patients per week and the number of hours they spent in each field of dermatology per week. RESULTS: There were 191 respondents to the survey in 2002, which represented 54% of the 2002 residency graduates. For clarity, this article focuses on the 2002 results except where trends over time become apparent. Of the respondents, 57% were women and 43% were men. Women saw patients a mean of 26 hours per week while men saw patients a mean of 31 hours (P =.01), although women spent more time practicing medical dermatology. Marital status did not significantly affect the number of work hours. Men and women who were not parents worked almost the same number of hours per week, but male parents saw patients a greater number of hours than female parents (34 vs 24; P<.01). Men who were parents spent more hours per week seeing patients than men who were not. In contrast, women who were parents spent fewer hours seeing patients than women who were not.Conclusion Parenting, in combination with gender, greatly influences workforce choices for professionals with young families while gender alone has little impact on those choices.

Adult↗
PubMed1996

The role of the part-time physician-teacher in dermatology.

As we approach the 21st century, specialty training programs in dermatology are feeling increasing pressures that have begun to erode clinical teaching. Full-time faculty members are being asked to spend more time in patient care to support an increasing portion of their income or are spending more time to develop laboratory data and write grant applications to survive in a brutally competitive academic world. Other faculty members are leaving academic medicine for private practice having decided that the risk-reward ratio is no longer acceptable. In California, the state government has implemented a plan that decreases specialty residency positions and their funding in favor of primary care positions. Third-party payers are becoming more restrictive in paying for inpatient and outpatient dermatologic services. Dermatologic inpatient services in some university teaching programs have been eliminated. Third-party payers are also balking at subsidizing teaching and research activities at teaching hospitals.

Dermatology↗
PubMed2003

[Possibilities and limits of early photography in dermatology. The "Clinique photographique de l'hôpital Saint-Louis" von 1868].

Photographic images are an intrinsic part of modern dermatology, essential for documentation, publication and teaching. Although there were no strong technical obstacles to prevent the use of black and white photographs in the atlases of the late 19th century, famous works such as Kaposi's "Handatlas der Hautkrankheiten" still utilized hand-colored copper etchings for illustration. Nevertheless, M.A. Hardy and M.A. de Montméja made an effort to introduce photography into dermatology as early as 1868. In their "Clinique photographique de l'hôpital Saint-Louis" of 1868 we find a variety of dermatological diseases, discussed and illustrated with 50 black and white photographs. The majority of these pictures were then modified with hand coloring in various shades of intensity. The authors insisted on this technique to assure the diagnostic value of the pictures. Besides an extensive review of the Atlas, we discuss the limits and perspectives of early photographic images in the "Clinique photographique" compared to the detailed hand-colored copper etchings of that time, as well as to modern color photographs.

Dermatology↗
PubMed2003

[Demographic changes in Germany. Consequences in health policy and dermatology].

During the last century the median life expectancy increased by about 30 years in Germany. According to recent prognoses, this trend will continue over the next decades. Not only the number of people older than 60 years but also its percentage within the population has and will continue to increase dramatically. This has important socio-economic, political and health-economic consequences. The increasingly older population has an important impact on dermatology. The incidence of many skin diseases increases with age because of long-term exposure to exogenous factors such as UV irradiation. Aging processes especially affect the skin. Last not least, the distinction between skin disease and "cosmetic" skin problems has changed in the last decades in our society. Even a small reduction in the threshold of what the public and health professionals regard as a skin complaint worthy of medical attention could lead to a large increase in future dermatology service requirements. The demographic changes in our society are becoming an important issue in dermatological health care research.

Adolescent↗
PubMed2004

[DRGs in dermatology. A critical assessment].

The obligatory implementation of the DRG system in 2004 represents a fundamental change in German hospital financing. Since the first version of G-DRG catalogue was published, the final adaptation of the system to German clinical reality has consumed much time and energy. This adjustment has been very challenging for dermatology for a variety of reasons. A DRG evaluation project conducted by the German Society of Dermatology made possible improvements in the G-DRG catalogue 2004 from the perspective of dermatology. The hospitals now have to adjust to the new situation and to find their position in this system. A high coding quality is of greatest importance. When developing their clinical priorities, hospitals should not make the mistake of pursuing the temptations presented by the latest version of the DRG catalogue. Strategies of the practical use of the DRG system in hospitals are reviewed.

Cost-Benefit Analysis↗
PubMed1995

[120 years Dresden-Friedrichstadt Dermatology Clinic].

The dermatology clinic in Dresden-Friedrichstadt this year celebrates 120 years of existence. It is one of the oldest dermatology clinics in Germany. The contribution presents an overview of the major events from the clinic's foundation as "External Section for Dermal and Venereal Diseases and Minor Surgery" in 1874 up to the present time. The clinic has played an important part in the development of the field of dermatology in Dresden. A brief account of the most important medical superintendents and of their scientific activities is given.

Dermatology↗