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PubMed2001

Inpatient dermatology. A prescription for survival.

Currently, only a minority of dermatologists participate in the primary hospital care of patients with severe skin disease. However, an opportunity exists to alter this course. We believe the current course is a detriment to our specialty, and as a specialists we should provide the care for the full spectrum of dermatologic diseases. Moreover, by not delivering complete dermatology care, our specialty also stands to lose respect from both our patients and peers. Our experience at UM suggests that the creation of a cadre of dermatology hospitalists at selected academic medical centers would allow improved patient hospital care, education, and research.

Clinical Protocols↗
PubMed2002

Cytokine therapy in dermatology.

Cytokines have been in the focus of scientific interest for some years now. Analysing their expression permitted a better understanding of the pathogenesis of various diseases, including in dermatology. Moreover, they are now far beyond the stage when they were of interest only to the pathophysiological research sector: some cytokine therapies are already being employed as part of the clinical practice. In fact, several cytokines are used for the treatment of malignant, inflammatory and infectious skin diseases. Their stage of development ranges from advanced, already approved and well established therapies (e.g. IFN-alpha and IL-2 for melanoma) to early explorative trials (e.g. IL-4 and IL-10 for psoriasis). Some of the new approaches currently under investigation will actually lead to registration of new drugs for dermatological treatment and to supplement existing therapeutic options. Beside this, the results of clinical trials with cytokines are significantly contributing to our understanding of the pathophysiology of diseases. They will give a better insight into which mechanisms play a greater or lesser part in their development and may generate momentum for still better targeted pharmacological approaches. Here we would like to give an overview about the current stage of cytokine therapy and the prospects for dermatological indications. The terminology and immunobiology of cytokines are also briefly discussed, since for a sensible interpretation of the relevant findings a basic knowledge of these biologically highly active messenger substances is essential.

Chronic Disease↗
PubMed2004

A catalog of dermatology utilities: a measure of the burden of skin diseases.

Utilities are measures of quality of life that reflect the strength of individuals' preferences or values for a particular health outcome. As such, utilities represent a measure of disease burden. The aim of this article is to introduce the concept of utilities to the dermatology community and to present a catalog of dermatology utilities obtained from direct patient interviews. Our data are based on 236 total subjects from Grady Hospital (Atlanta, GA), Stanford Medical Center (Palo Alto, CA), and Parkland Hospital (Dallas, TX). The mean time trade-off utilities ranged from 0.640 for blistering disorders to 1.000 for alopecia, cosmetic, and urticaria. The mean utility across all diagnoses was 0.943. We present utilities for 17 diagnostic categories and discuss the underlying reasons for the significant disease burden that these utilities represent. We also present these dermatology categories relative to noncutaneous diseases to place the cutaneous utilities in perspective and to compare the burden of disease. We have demonstrated that skin diseases have considerable burden of disease and provided a preliminary repository of utility data for future researchers and policy makers.

Cost of Illness↗
PubMed1998

Prescribing for out-patients by nursing staff in a dermatology department.

Nurse prescribing for a small range of products has been introduced in primary care, but not in hospitals, in the U.K. We have evaluated the benefits, costs, practicality and patient satisfaction with the formal introduction of dermatology nurse prescribing in the out-patient treatment facility of a district general hospital dermatology department with a wide geographical catchment area. Over a 6-month period, 91 items were prescribed to 47 patients on 72 occasions (items/patient: range 1-8, mean 2, median 1). The cost to the department was 249.04 Pounds (cost per patient: range 0.39 Pound-24.61 Pounds, mean 5.30 Pounds). A small number of patients appeared to use nurse prescribing as a substitute for medical consultations. A total of 33 of 45 adult patients replied to a questionnaire. In 15 respondents, the prescription was necessitated by a change in the skin condition and in 10 by the exhaustion of supplies of the current medication, and both of these factors applied in six patients. All had understood the instructions for the use of the treatment prescribed, and only three felt that it had failed to work as anticipated. Only one patient had (unspecified) side-effects, caused by a prescription for a topical antipruritic. Eight patients were able to defer appointments with their general practitioner as a result of the nurse-prescribed item being supplied. Prescribing by appropriately trained nurses therefore appears to be a safe and effective development in dermatology.

Adult↗
PubMed1999

The value of in-patient dermatology: a survey of in-patients in Scotland and Northern England.

Dermatology in-patient units are frequently threatened with reduction or closure, yet there are few objective data regarding the nature and use of in-patient management with which to assess their value. We have surveyed 300 patients admitted during March 1997 to dermatology units throughout Scotland and Northern England, to establish their clinical and social profile, and the outcome of admission. All departments provided phototherapy and out-patient treatment services, and 84% of those admitted lived within an hour's travel of one of these. Three diagnostic groups (psoriasis, eczema and leg ulcers) accounted for 83% of in-patient days. Patients were admitted principally because of disease severity but many, including half of those with psoriasis, had concurrent medical problems such as alcohol abuse, psychiatric disorder or arthropathy. Many patients with psoriasis and leg ulcers were from socially deprived areas, as defined by low Carstairs index scores, and a similar proportion received income support. Eighteen per cent of patients, mainly those with acute disorders, would have needed admission irrespective of dermatology bed availability. Out-patient management was considered the next best alternative for only 28% of patients, and many patients would have been expected to treat themselves. By contrast, 84% of patients admitted were cleared or substantially improved, or had procedures completed as planned, and another 12% were partially improved. Outcomes were particularly good in psoriasis, eczema and infection groups. We have demonstrated that in-patient management is highly effective in providing remission in chronic skin disease, and our survey also suggests that concomitant disability or social factors mean that for many such patients ambulatory care cannot replace this service.

Dermatology↗
PubMed2003

Scalp ringworm in south-east London and an analysis of a cohort of patients from a paediatric dermatology department.

BACKGROUND: Scalp ringworm or tinea capitis has become an increasingly important public health issue in the past decade in Great Britain. Recently, certain dermatology departments in London have seen a large increase in tinea capitis in all its forms. OBJECTIVES: The aim of this paper is to present the detailed analysis of a cohort of 277 patients with tinea capitis seen during a 2-year period together with the latest local figures of tinea capitis cases from an inner city paediatric dermatology service. Methods Demographic, clinical and laboratory data were collected prospectively over 2 years from all cases of ringworm in patients seen in a paediatric clinic specially set up for scalp problems. RESULTS: Sixty-two per cent of 277 cases of scalp ringworm were caused by Trichophyton tonsurans, occurring mainly (91%) in patients with Afro-Caribbean hair type, more often in boys (68%), and in the 3-8 year olds (70%). Only 7% of the patients had received appropriate treatment with oral griseofulvin. An additional 156 cases from the general paediatric dermatology clinic showed 91%T. tonsurans infections. CONCLUSIONS: The prevalence of scalp ringworm appears to be reaching epidemic proportions in certain areas that include south-east London. The clinical problem is not yet well recognized by local general practitioners.

Age Distribution↗
PubMed2003

Pattern analysis, not simplified algorithms, is the most reliable method for teaching dermoscopy for melanoma diagnosis to residents in dermatology.

BACKGROUND: Simplified algorithms for dermoscopy in melanoma diagnosis were developed in order to facilitate the use of this technique by non-experts. However, little is known about their reliability compared with classic pattern analysis when taught to untrained observers. OBJECTIVES: To investigate the diagnostic performance of three different methods, i.e. classic pattern analysis and two of the most used algorithms (the ABCD rule of dermoscopy and the seven-point check-list) when used by newly trained residents in dermatology to diagnose melanocytic lesions. Methods Five residents in dermatology (University of Florence Medical School) were submitted to a teaching programme in dermoscopy based on both formal lessons and training and self-assessment using a newly developed, interactive CD-ROM on dermoscopy. The performance of the three diagnostic methods was analysed in a series of 200 clinically equivocal melanocytic lesions including 44 early melanomas (median thickness 0.30 mm; 25th-75th percentile 0.00-0.58 mm). RESULTS: Pattern analysis yielded the best mean diagnostic accuracy (68.7%), followed by the ABCD rule (56.1%) and the seven-point check-list (53.4%, P = 0.06). The best sensitivity was associated with the use of the seven-point check-list (91.9%), which, however, provided the worst specificity (35.2%) of the methods tested. The interobserver reproducibility, as shown by kappa statistics, was low for all the methods (range 0.27-0.33) and did not show any statistical difference among them. CONCLUSIONS: Pattern analysis, i.e. simultaneous assessment of the diagnostic value of all dermoscopy features shown by the lesion, proved to be the most reliable procedure for melanoma diagnosis to be taught to residents in dermatology.

Algorithms↗
PubMed2002

Dermatology practice in primary health care services: where do we stand in the Middle East?

BACKGROUND: There has been a distinct expansion of the primary health care services in the Middle East over the past two decades. As a consequence, the exposure of primary care physicians (PCPs) to skin disorders has increased. However, information is lacking regarding the level of proficiency of PCPs in this field. OBJECTIVE: The purpose of our study is to assess the ability of the primary care physicians, with or without training in dermatology, to identify, diagnose and manage skin disorders. MATERIAL AND METHODS: Physicians at university-hospital primary-care clinics were asked to answer a multiple-choice questionnaire regarding various dermatoses. These were grouped into: common, infrequent and rare. Questions included identification of the correct description of the skin lesion, diagnosis, treatment and the desirability of referral. Demographic characteristics of the physicians were also assessed. RESULTS: Nineteen PCPs were included. The eight PCPs who had had specific training in dermatology showed performance superior to that of the PCPs who did not (P = 0.04). Not surprisingly, PCPs were able to make the correct diagnosis more frequently for the common dermatoses than for the infrequent or rare dermatoses (P = 0.001). On the other hand, when asked to recognize a correct description of the skin lesion, the PCPs were most often correct with rare dermatoses, and least often correct with common dermatoses (P = 0.04). CONCLUSION: PCPs with a short period of specific clinical training in dermatology perform better in identifying, diagnosing and managing skin disorders than those without. Such training for PCPs should be considered to provide more effective delivery of health care.

Adult↗
PubMed2002

Pattern of admissions to a tertiary dermatology unit in South Africa.

BACKGROUND: There is worldwide recognition of the need to control the rising costs of health-care. As a result there is a trend away from inpatient treatment of people with non-life-threatening skin disorders. In the developing world there is a conflict between the inadequacy of home and community facilities and the need to limit expenditure. AIM: The aims of this study were to assess the current indications for admission to a dermatology ward, the level of domestic and community facilities among those admitted, and the apparent benefits obtained from such admissions. METHODS: Over a 6-month period all patients admitted to the tertiary dermatology unit at Groote Schuur Hospital were recruited and a questionnaire was completed by the admitting doctor. On discharge, patients and doctors were asked to assess the level of improvement in the patient's skin disorder. RESULTS: There were 133 people admitted, with a mean age of 34.1 years (range 1-88). Diagnoses recorded most often were atopic dermatitis (44), other forms of dermatitis (18), psoriasis (21), severe drug reaction (10), leg ulcer (7), skin infection (7) and bullous disease (6). Overall, the extent and severity of the skin involvement was the major indication for admission, although psychosocial problems and a lack of home facilities were contributing factors. A group of 25 people had been admitted to the ward on 2 or more occasions over the preceding 2 years. This group did not differ from the rest of the patients in terms of diagnosis, home circumstances or level of employment. CONCLUSIONS: Most admissions to a tertiary dermatology unit in Cape Town are for extensive eczema or psoriasis. Most people experience great short-term benefit from inpatient care. The group of people who require repeated admissions do not appear to differ from the total group by diagnosis or available facilities, but may represent a psychosocially vulnerable subset.

Adolescent↗
PubMed2004

[Dermatology at the University Hospital of Mbarara, Uganda].

The Georg Klingmüller Clinic is part of Mbarara University Teaching Hospital (MUST) in south-western Uganda. Established in 1999, this clinic cares for about 6,000 dermatological patients per year. We review the disease spectrum, available diagnostic tools, and therapeutic options in this clinic. In addition, the importance of dermatology for the fight against HIV/AIDS is discussed with respect to the socio-economic background of a sub-Saharan country. Co-operation with dermatology departments in Germany may not only help to diagnose skin diseases in Mbarara, but may also be valuable for the visiting dermatologist to manage the increasing numbers of patients with dark skin at home.

Dermatology↗
PubMed2001

The majority of dermatology services occur within managed care systems.

Our aim was to document how much managed care has penetrated dermatology based on dermatologists' experience. We conducted an anonymous survey at an East Coast dermatology conference in March 1998. One hundred thirty-two dermatologists responded. The response rate was 29%. The mean percentage of managed care in dermatology practices was 55%. Dermatologists expected the proportion of managed care to increase to 65% of their practices by 2001.

Data Collection↗
PubMed2002

The future of academic dermatology in the United States: report on the resident retreat for future physician-scientists, June 15-17, 2001.

Fewer and fewer residents appear to be choosing careers in academic dermatology and research. Recognizing the impact that this trend would have on the future of our specialty, the Society for Investigative Dermatology invited a group of dermatology residents and academic dermatologists to participate in a retreat whose aim was to identify the reasons behind this trend and to begin to address these issues.

Adult↗
PubMed2002

Dermatology and the Americans With Disabilities Act: a review of the case law.

The Americans With Disabilities Act (ADA) defines disability as a physical or mental impairment that substantially limits one or more major life activities. Although dermatology has received relatively little attention in the context of disability law, dermatologic diseases are properly covered by the ADA and are subject to the same criteria as other medical conditions. A Lexis-Nexis search of federal court decisions covering the ADA produced 23 cases dealing with dermatologic impairments as disabilities. In Cehrs v Northeast Ohio Alzheimer Research Center, a federal appeals court held that psoriasis constituted a disability under the Act. Skin diseases not only cause physical and mental impairments, but they are also visible to others. Persons with skin diseases may be "regarded as" disabled, and this can constitute discrimination under the law.

Dermatology↗
PubMed2003

Dermatology: a unique case of specialty workforce economics.

Physician workforce economics in the United States have changed substantially over the past few years as a result of oversupply in many specialties and the emergence of managed care as the predominant health care delivery system. Some newly graduating residents have reported difficulty in finding jobs, unsatisfactory compensation levels, and low job satisfaction. However, dermatology as a specialty has experienced surprisingly prosperous employment opportunities. Recent studies have affirmed that recent dermatology residency graduates have had less difficulty than their colleagues in securing desirable positions. This article examines 4 different factors that may have set dermatology apart from the rest of the medical specialties: the supply of new dermatologists, the impact of managed care and shifting health care systems, the impact of changing professional demographics, and the changing scope of practice. Trends in these 4 areas have tightened the supply and increased the demand for dermatologists. Whether future residents will enjoy a similarly open market remains to be seen as the US health care system evolves.

Dermatology↗
PubMed2003

The first 15 years of the American Academy of Dermatology skin cancer screening programs: 1985-1999.

BACKGROUND: In response to the precipitous increase of melanoma, the American Academy of Dermatology (AAD) has coupled melanoma/skin cancer education with free skin cancer screening programs throughout the United States since 1985. The purpose of this analysis is to investigate the risk factors, access to dermatologic services, and screening results of participants in AAD-sponsored programs during the first 15 years that this service was available to the US public. METHODS: Before screening, participants completed a standardized AAD screening form. Screening forms were counted in the AAD central office and recorded in annual summaries. Forms were sent for keypunching and returned to the AAD on a computer disk annually. In 1999, disks were sent to Boston University and a master file was created. RESULTS: Computerized records were available for 819,019 screening forms and 639,835 individuals. In all, 65% of screenees had at least 1 risk factor and 33% had at least 2 risk factors. Of screenees, 33% reported a changing mole and 37% had skin type I or II. Among all screenees, nearly 80% did not have a regular dermatologist, 78% reported no prior AAD skin cancer screening, 60% had never had their skin checked by any doctor, and 51% would not have seen a doctor for skin cancer without the free screening. Nearly 30% of screenees had a presumptive diagnosis of skin cancer or a precursor lesion. Melanomas confirmed by postscreening biopsy were more likely than those in population-based registries to be less than 1.50 mm in thickness. CONCLUSIONS: AAD national screening and educational programs have expanded to all 50 states, provided educational messages about sun protection and early detection to millions, and served many US citizens with an above average risk for skin cancer and suboptimal access to dermatologic care. Screenees had a disturbingly high point prevalence of malignant and premalignant skin lesions. Sustained commitment by the AAD leadership and membership to the screening program is critical to reducing the morbidity and mortality of skin cancer.

Adolescent↗
PubMed2026

The emerging applications of JAK inhibitors in dermatology - a systematic review.

BACKGROUND: Janus kinase (JAK) inhibitors are established treatments for selected dermatologic conditions, but their off-label use has expanded across refractory skin diseases. METHODS: We systematically searched MEDLINE, Embase, and Web of Science from inception to October 1, 2025, for studies reporting off-label JAK inhibitor use in dermatologic disorders beyond approved or late-phase trial indications. RESULTS: Of 9,182 records screened, 277 studies met the inclusion criteria, comprising 210 case reports, 55 case series, and 12 retrospective studies involving 764 patients. Owing to substantial clinical heterogeneity, findings were narratively synthesized using a structured disease-family framework. Off-label use most commonly involved lichenoid, neutrophilic, and granulomatous dermatoses. Overall, 725/764 (94.88%) patients experienced clinical benefit, including complete or near-complete response in 209/764 (27.35%) and significant or partial improvement in 516/764 (67.53%). Thirty-five patients (4.58%) showed no clinical change, and four (0.52%) experienced disease worsening. A total of 154 adverse events were reported, most commonly with tofacitinib; most were mild to moderate, although six were serious and 25 resulted in treatment discontinuation. CONCLUSION: JAK inhibitors demonstrate promising therapeutic potential across a broad spectrum of refractory dermatological diseases. The predominance of uncontrolled case-based evidence, heterogeneous dosing, and frequent combination therapy limits attribution of efficacy and safety to JAK inhibitor monotherapy. Prospective controlled studies are needed to better define their therapeutic role.

Humans↗
PubMed2000

Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward.

OBJECTIVE: To compare two strategies for screening methicillin-resistant Staphylococcus aureus (MRSA) carriers in a high-risk dermatology ward: systematic screening of all admitted patients versus selective screening of patients at risk. DESIGN: The two strategies were applied prospectively during two consecutive periods. In period A (8.5 months), only patients transferred from other wards, or with a history of prior hospitalization, or presenting chronic wounds or disease with denuded skin were considered at high risk of MRSA carriage and sampled. In period B (7.5 months), all admitted patients were systematically screened. End-points were the number of patients having a MRSA-positive screening sample on admission during period B and having none of the risk factors used in period A, the rate of imported MRSA cases, and the rate of acquired cases. SETTING: A 1,032-bed university hospital with a 19-bed inpatient dermatology ward, a referral center for toxic epidermal necrolysis and severe extensive dermatoses. PATIENTS: The study included 729 dermatology inpatients (370 in period A and 359 in period B). RESULTS: During period A, screening samples were obtained on admission for 30% of patients (77% of the patients at risk) and identified 25 MRSA carriers. During period B, 90.5% of admitted patients were screened, and 26 MRSA carriers were detected on admission; all of these patients belonged to at least one predefined category at risk for carriage. Overall rates of imported and acquired cases were similar between the two periods (6.8% vs 7.5%, and 2.9% vs 2.4%, respectively). CONCLUSIONS: A screening strategy targeted to patients at risk of harboring MRSA has similar sensitivity and is more cost-effective than a strategy of systematic screening to identify MRSA carriers on admission.

Cross Infection↗
PubMed2002

Teledermatology's impact on time to intervention among referrals to a dermatology consult service.

The aim of this study was to determine if a teledermatology consult system, using store-and-forward digital imaging technology, results in patients achieving a shorter time from referral date to date of initial definitive intervention when compared to a traditional referral process. Patients being referred to the dermatology consult service from the primary care clinics at the Durham VA Medical Center were randomized to either a teledermatology consultation or usual care. A usual care consultation consisted of a text-based electronic consult request. A teledermatology consultation included digital images and a standardized history, in addition to the text-based electronic consult. Time to initial definitive intervention was defined as the time between referral date and the date the patient was scheduled for a clinic visit for those patients that the consultant requested a clinic-based evaluation, or the time between referral date and the date the consult was answered by the consultant if a clinic visit was not required. Patients in the teledermatology arm of the study reached a time to initial definitive intervention significantly sooner than did those patients randomized to usual care (median 41 days versus 127 days, p = 0.0001, log-rank test). Additionally, 18.5% of patients in the teledermatology arm avoided the need for a dermatology clinic-based visit compared to zero patients avoiding a dermatology clinic visit in the usual care arm of the study (p < 0.001, z-test). Teledermatology consult systems can result in significantly shorter times to initial definitive intervention for patients compared to traditional consult modalities, and, in some cases, the need for a clinic-based visit can be avoided.

Aged↗