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The Department of Dermatology in Erfurter Street was founded in 1924. A short report is given about the early years of dermatology and the history of the clinic building in Jena. Its foundation is closely associated with Bodo Spiethoff, the first chairman of the Department of Dermatology at Jena University.
The situation of women in dermatology was evaluated with the aid of questionnaires in spring 1994. A questionnaire was sent to 33 clinics in Germany and 46 in other European countries, asking about the proportions of male and female physicians in each department. In addition, individual department members were asked in another questionnaire about their reasons for choosing dermatology and about possible sex discrimination. The clinic questionnaires were returned from 22 German and 37 other European clinics and the individual questionnaires by 548 German physicians and 1164 physicians from the other countries (overall 52% women). We found that 41.8% of the dermatologists in German clinics were women, as against 43.4% in the other countries. Women made up about half of the fully qualified specialists, but accounted for only a small percentage of those in higher positions (10.8% in Germany, 27.9% in other countries). Of the 1712 physicians who answered the individual questionnaire, the majority had chosen dermatology because of their interest in the specialty. Slightly more women than men gave other reasons, such as more free time--mostly for family matters--or less physical strain. Clearly more women than men felt they were discriminated against professionally because of their sex. The reasons for this related primarily to the biological and social role of women in society. Overall, women are thus well represented in our specialty, except in leading positions.
The dermatological clinic in Homburg was founded in 1945. In 1947 it was integrated into the Saarland University as a dermatology department. A review of the history of the clinic documents advances and challenges in clinical dermatology, as well as new developments in related basic research during the last 50 years.
BACKGROUND: Any scientific discipline needs a sharply defined set of words for exact and reproducible communication. Surprisingly this has never been a strong point in dermatological science, especially as regards the living gross pathology of skin disease. OBJECTIVE: This article briefly reviews the four editions of a dermatological dictionary of words and phrases and gives some thoughts on their usefulness. CONCLUSION: My conclusions are twofold: we need a new dictionary; at the very least, we need a reprinting of the fourth edition of "A Dictionary of Dermatologic Terms" by Carter.
Progress in dermatological research during the last years has provided new insights into the mode of action of additives to dermatological baths. The present paper reviews the pharmacokinetics of dermatological bath therapy additives such as sulfur, salts and trace elements, tars and ichthyol, lipids, antiseptics, astringents, plant extracts, surface-active agents and proteins.
Antibiotic prophylaxis is generally administered either to prevent wound infection or to hinder the development of endocarditis. Although the use of antibiotics in certain circumstances to prevent wound infection can be straightforward, there are other circumstances in which the decision to use antibiotics is much less clear. Endocarditis prophylaxis has traditionally been based on the American Heart Association's guidelines, which do not cover dermatologic surgery. This article discusses the rationale and controversies surrounding the use of antibiotic prophylaxis for prevention of both wound infection and endocarditis, reviews the few studies that pertain to dermatology, and provides recommendations for antibiotic prophylaxis on a case-by-case basis for those who perform dermatologic surgery.
In this article we discuss the recent surge in activity in digital imaging in dermatology. The key role of digital imaging as an adjunct to detection of early malignant melanoma, with application in following patients with the dysplastic nevus syndrome, is explored. Other current and future uses of digital imaging in image archiving, in clinical studies such as hair growth studies, and in telediagnosis are reviewed. We review the varying research activities of image analysis laboratories participating in the dermatology image researching group. Research laboratories included in this group are at Oregon Health Sciences University, Xerox Corporation, University of Arizona, University of Cincinnati, University of Munich, University of Wurzburg, University of Arkansas, Harvard University, Southern Illinois University-Edwardsville, Johns Hopkins University, National Institutes of Health, and University of Missouri at Columbia and Rolla. The role of new imaging devices in dermatology including the "nevoscope" and the dermatoscope is explored. Goals and challenges for the new technology are discussed.
Psychosomatics describes any aspect of dermatology with psychologic or psychiatric elements. Dermatologists know that a significant proportion of their practice involves patients for whom psychologic elements either partially or sometimes entirely dominate their presenting chief complaints. This article explores the role of psychosomatic factors in dermatologic disorders. The authors discuss the clinical interface between psychiatry, psychology and dermatology and the interpretation of possible relationships between cutaneous diseases, the role of the mind, and psychotherapeutic interventions.
BACKGROUND: With the recent trend for nondermatologists to treat dermatologic disorders, this retrospective biopsy study reviews the accuracy of the clinical diagnosis of physicians of different specialties performing surgical dermatologic procedures. OBJECTIVE: We assessed the diagnostic abilities of nondermatologist physicians who performed various types of skin biopsies and compared them with those of dermatologists. METHODS: The clinical diagnoses of family physicians, plastic, general, and orthopedic surgeons, and internists and pediatricians versus dermatologists were correlated with the histopathologic diagnoses. In total, 4451 cases were analyzed. RESULTS: Dermatologists diagnosed twice the number of neoplastic and cystic skin lesions correctly (75%) than nondermatologists (40%). The clinical diagnosis rendered by family practitioners matched the histopathologic diagnosis in only 26% of neoplastic and cystic skin lesions. Plastic surgeons, who performed the largest number of cutaneous surgical procedures among the nondermatologists, did better in the recognition of skin tumors than family physicians, but still had a diagnostic accuracy rate of only 45%. Inflammatory skin diseases were correctly diagnosed in 71% of the cases by dermatologists but in only 34% of the cases by nondermatologists. LIMITATIONS: A limitation of this retrospective, unblinded study is the use of the clinical data from the pathology requisition form as a surrogate for clinical diagnostic accuracy. CONCLUSIONS: The overall accuracy of the clinical diagnosis depends heavily on the clinicopathologic correlation. Without sufficient clinical data, the histopathologic diagnosis will be limited or restricted. This review concludes that without basic dermatology knowledge, clinicopathologic correlation is compromised.
The bioterrorism-related anthrax outbreak generated unanticipated demand for dermatologic services. In this study we sought to perform rapid, efficient, cost-effective evaluation of patients suspected of having cutaneous anthrax. During the outbreak, we developed an anthrax evaluation system featuring clinical field examination by nondermatologist physicians, followed by rapid referral of selected high-risk patients to a centralized dermatology center. We excluded anthrax in 29 previously screened high-risk patients. All were examined within 24 hours, costing $272.07 per patient. Diagnoses were established quickly (median, same day; range, 0-15 days). Among 2259 at-risk postal workers, 144 (6.4%) self-identified new (< or =14 days) skin lesions and were examined in the field; 8 (5.6%) were referred to our system. Our system was not the only local dermatologic resource available during the outbreak. A system featuring initial nondermatologist examination with minimal laboratory evaluation, followed by rapid centralized referral of high-risk patients, functioned efficiently in this outbreak.
BACKGROUND: Educational debt levels are outpacing inflation. OBJECTIVE: To determine whether debt levels influence career choices of graduating dermatology residents. METHODS: Anonymous surveys of graduating dermatology residents. RESULTS: The presence of debt was associated negatively with pursuing fellowship training in 1999 and 2004 (P < .05) but did not affect choices about entering solo practice or job dissatisfaction levels. LIMITATIONS: This study relies on self-reported data, and some surveys were incomplete. CONCLUSION: Debt levels do not appear to significantly influence the career choices of dermatology residents.
In this paper, we focused on selected problems of integrating and presenting medical images organised in a World Wide Web (WWW) database. To solve these problems we developed a prototype of a bilingual (Slovenian and English) WWW database of medical images for the field of dermatology. This dermatology database includes a graphic interface with four modes of access: (1) browsing, (2) searching, (3) comparison of images, and (4) self-testing. The quantity and quality of requests to this WWW database was estimated with log file analysis. There was a steady increase in the number of users and volume of data transferred from the dermatology WWW database.
UNLABELLED: The combination of light and chemicals to treat skin diseases is widely practiced in dermatology. Within this broad use of light and drugs, in recent years the concept of photodynamic therapy (PDT) has emerged. PDT is a promising modality for the management of various tumors and nonmalignant diseases, based on the combination of a photosensitizer that is selectively localized in the target tissue and illumination of the lesion with visible light, resulting in photodamage and subsequent cell death. Moreover, the fluorescence of photosensitizing compounds is also utilized as a helpful diagnostic tool for the detection of neoplastic tissue. Intensive basic and clinical research culminated in the worldwide approval of PDT for bladder, esophageal, and lung cancer. The expanding use of this relatively new therapeutic modality in dermatology at many centers around the world has revealed its efficacy for the treatment of cutaneous precancer and cancer, as well as selected benign skin disorders. The following article summarizes the main principles of PDT considering the most recent developments and provides a comprehensive synopsis of the present status of the use of PDT in dermatology. (J Am Acad Dermatol 2000;42:389-413.) LEARNING OBJECTIVE: At the conclusion of this learning activity, participants should be able to describe the basic concepts of PDT, including fundamental knowledge of the most relevant photosensitizers, the light sources, the mechanisms involved in PDT-mediated cell destruction, as well as the indications and limitations of photodynamic treatment of skin diseases.
The International Committee of Dermatology (ICD) is the Executive Committee of the International League of Dermatological Societies (ILDS). It is composed of twelve regular and six ex officio members, of whom no fewer than ten are going to be replaced at the next Congress in Tokyo. Since the last Congress in Mexico City in 1977, the Committee has met every year but 1981. Most of the activities of the ICD have been concentrated on the preparations of the scientific program for the XVI International Congress in Tokyo in 1982. In order to strengthen the collaboration among the member societies, a "Manual" of the ILDS as well as two "Bulletins" of the ICD have been published. For the purpose of encouraging the advancement of dermatology, special committee for extracongressional matters has been appointed. During the years, important material concerning the activities of the ILDS and the ICD have been accumulated. An archive for this material is planned to be organized in Stockholm. For many reasons, a thorough revision of the present rules and regulations of the ILDS has seemed essential. A proposal for new bylaws will be presented at the Assembly Meeting at the Tokyo Congress.
We review the medical issues and emergencies potentially encountered in the practice of general or surgical dermatology. Traditional guidelines have largely consisted of dated extrapolations from the nondermatologic literature concerning procedures that are primarily irrelevant to dermatology. This article outlines a rational approach to organizing an office emergency plan for anaphylaxis, stroke, status epilepticus, myocardial infarction, and hypertensive crisis. We discuss the literature that has influenced current office behavior regarding endocarditis prophylaxis, the use of electrosurgery with pacemakers, arrhythmogenic drug interactions, vasovagal syncope, lidocaine "allergy," and bleeding complications from oral anticoagulants. Recommendations for managing these issues in a dermatologic context are provided.
BACKGROUND: Same-day cancellation of appointments and nonattendance by patients can disrupt management of certain aspects of medical delivery and lead to inefficient allocation of resources and lost revenue. The frequency of cancellation and nonattendance at dermatology clinics has not been well documented. OBJECTIVE: We measured same-day cancellation and nonattendance in a university dermatology clinic. METHODS: We tabulated clinic attendees, same-day cancellations, and nonattendance for a 6-month period. We examined distribution by gender, type of payer, and clinic visit type (initial or follow-up). RESULTS: Total same-day cancellation rate was 8.3%. Female patients canceled more frequently than male patients (9.2% vs 7.3%, P = .02). Cancellation rates were similar for initial and follow-up visits. The nonattendance rate was 17% with the highest rates found in state-supported categories (26%) and the lowest in commercial insurance programs (13%). Nonattendance rates did not vary significantly by gender or visit type. CONCLUSION: Same-day cancellation and clinic nonattendance is a significant factor in the efficient fiscally sound management of a busy dermatology clinic. The risk of nonattendance is assumed by physicians and seems to be correlated with payer type.
It is well known that African Americans are at low risk for one of the most serious diagnoses in dermatology--skin cancer. A consequence of this lower cancer risk has been an undervaluing of the importance of appropriate dermatologic care in this population. In fact, there are many other skin diseases and disorders that not only cause significant morbidity among this population but also emotional and psychological sequelae. This article examines barriers and challenges to providing dermatologic care among African Americans and provides recommendations and suggestions for improving care delivery in this population.
Common dermatologic conditions and skin signs of systemic disease are routinely present in hospitalized patients. Rapid detection and identification of these changes can have a significant impact on the patient's hospital course. Inpatient dermatology consultation can improve diagnostic accuracy, efficiency, and treatment of hospitalized patients with cutaneous findings. This article discusses the clinical aspects of inpatient dermatology consultation and the features of effective consultation.