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At least 613 records · Page 34Linked to original sources
PubMed1998

Characteristics of users and nonusers of alternative medicine in dermatologic patients attending a university hospital clinic: a short report.

OBJECTIVES: To study the characteristics of users of alternative medicine in dermatologic outpatients attending a university clinic. DESIGN: A cross-sectional study analyzed by using a case-control methodology. SETTING, SUBJECTS, AND STUDY MEASURES: 118 dermatologic patients attending an outpatient university clinic responded to a structured questionnaire concerning demographic data, medical history, experience with alternative medicine, health beliefs, lifestyle, and locus of control. RESULTS: Thirty-five percent of the patients reported having used some form of alternative medicine. Use was related to disease duration, but not to patients' beliefs regarding whether or not they could influence their own health, nor to dissatisfaction with orthodox medicine. The most common reason for trying alternative medicine was that they "wanted to try everything" in an attempt to cure the skin disease. Users stated to a greater extent than nonusers, that they exercised sufficiently, possibly indicating that they are more health conscious. CONCLUSIONS: The study suggests that dermatologic patients using alternative medicine in general do not differ with regard to personal characteristics from nonusers. Rather, it appears that patients with long-standing skin disease turn to alternative medicine as a complement to orthodox treatment.

Case-Control Studies↗
PubMed2003

The prevalence of ocular signs in acne rosacea: comparing patients from ophthalmology and dermatology clinics.

PURPOSE: To describe and compare the ocular signs in patients diagnosed with acne rosacea by the ophthalmologist with the ocular signs in the patients diagnosed with rosacea by the dermatologist. METHODS: We reviewed the medical records of 176 randomly selected patients diagnosed with rosacea at the University of California, Davis, Medical Center: 88 patients each from the Department of Dermatology and the Department of Ophthalmology. Of the 88 patients diagnosed with acne rosacea by a dermatologist, 22 (25%) had an ophthalmologic evaluation done prior to the study. In those patients without an ophthalmologic assessment, ocular complaints noted by the dermatologist were recorded. We recorded ocular signs including lid, conjunctival, corneal, episcleral, and scleral manifestations as well as charted observations of the iris, lens, intraocular pressures (IOPs), best corrected visual acuity (VA), and funduscopic examination. Age and sex were recorded from the initial ophthalmologic evaluation. The analysis was designed to compare the prevalence of signs and symptoms in two clinical settings. RESULTS: The prevalence of documented meibomian gland dysfunction (p < 0.001), telangiectasia (p = 0.004), and anterior blepharitis (p = 0.008) was significantly higher in ophthalmology patients when compared with dermatology patients. Of the conjunctival signs evaluated, only the presence of interpalpebral conjunctival hyperemia (p = 0.005) was found to be significantly higher in ophthalmology patients. The corneal, episcleral, scleral, and lens findings did not demonstrate a statistically significant difference between groups. CONCLUSION: The major and most easily observable ocular problems in rosacea patients presenting either to ophthalmology or dermatology are lid disease-related manifestations. As might be expected, eye signs and symptoms are more commonly noted in the eye clinic. A clinician's increased awareness of the common ocular findings of rosacea, however, may aid in earlier diagnosis and treatment of ocular rosacea.

Adult↗
PubMed2002

Use of and beliefs about dermoscopy in the management of patients with pigmented lesions: a survey of dermatology residency programmes in the United States.

Dermoscopy is a non-invasive technique that can be utilized for the clinical diagnosis of pigmented lesions. The aim of this study was to assess the utilization and beliefs about the usefulness of dermoscopy in the evaluation of pigmented lesions by physicians in dermatology residency programmes, and to determine the extent of dermoscopy training received by residents in these programmes. Questionnaires were sent to the directors of all the accredited dermatology residency programmes in the United States (n = 105). A follow-up postcard questionnaire was sent to the chief resident of all the responding programmes. Eighty-three physicians responded to the questionnaire (79%). Fifty-one per cent of the respondents (n = 42) reported utilizing dermoscopy. Reported reasons for using dermoscopy by respondents included the fact that it helps detect melanoma early (74%), leads to fewer biopsies (74%) and reduces patient anxiety (64%). Lack of training (51%) and lack of usefulness (42%) were amongst the reported reasons for not utilizing dermoscopy. Sixty-seven per cent of respondents reported an increase of approximately 50% in the use of dermoscopy over the past 5 years, and 45% anticipated an increase in use over the next 5 years. Thirty-eight per cent of chief residents from the responding programmes reported receiving training in dermoscopy during residency. In conclusion, half of the dermatology residency programmes currently use dermoscopy in the evaluation of pigmented lesions. The main reason for not using dermoscopy was a lack of training. Respondents anticipated a future increase in the use of dermoscopy.

Dermatology↗
PubMed1990

Dohi memorial lecture. Laser medicine and laser dermatology.

As laser devices become smaller, more reliable, and less expensive, dermatology will benefit from new laser-based therapeutic and diagnostic methods. Already there are simple, non-scarring, and relatively painless techniques for removal of pigmented lesions, tattoos, and vascular lesions. Because much of the basic and applied research in photobiology is grounded in dermatology research, dermatology will continue to be a major contributor to advances in laser medicine and photomedicine. An increase in understanding and ability to manipulate laser-tissue interactions will add greatly to the future of medicine and surgery, especially in applications utilizing pulsed lasers. We are learning how to: 1) vary wavelength, pulse duration, and energy to influence the nature of microscopic injury and host response in order to achieve a net therapeutic benefit; 2) utilize exogenous chromophores to increase the selection of targets for laser radiation; and 3) capture optical technology developed for industrial and military use, in order to benefit mankind with new medical and surgical techniques.

Animals↗
PubMed1994

Accuracy in the clinical diagnosis and pattern of malignant melanoma at a dermatological clinic.

The diagnostic pattern of malignant melanoma and clinical suspicion rate has been investigated at a dermatological university clinic. Of 174 histologically proven malignant melanomas, 60 (34%) were not clinically suspected as melanomas. The accuracy of clinical diagnosis increased with level of experience. Physicians with < 1 year experience in dermatology were able to detect malignant melanoma as the first diagnosis in 31% of the cases in contrast to 63% for those with > 10 years experience. Of 50 patients immediately referred from the dermatologic clinic to surgery departments, 12 did not have melanoma.

Dermatology↗
PubMed2000

Lasers in dermatology--a critical update.

Lasers are accepted for treating nevus of Ota, other pigmented lesions, hair removal, vascular lesions, leg veins, tattoos, and for skin resurfacing. These are photothermal treatments, in which certain skin "targets" are heated, followed by selective wound healing. Small pigmented targets such as the dermal melanocytes in nevus of Ota, are best treated with short (< 1 microsecond) laser pulses. Large targets, such as hair follicles, have long thermal relaxation times and are best treated with longer pulses. In general, the ideal pulse duration is about equal to the thermal relaxation time for pigmented targets. However, sometimes the actual target is not pigmented and is at some distance from a pigmented structure. For example the follicular stem cells, which are not pigmented, line the outer root sheath far away from the pigmented hair shaft. These cells appear to be an important target for permanent hair destruction. Pulses longer than the thermal relaxation time of the hair shaft allow heat conduction and better damage of follicular stem cells. Epidermal cooling works far better with pulses longer than about 10 ms, delivered through a cold medium (e.g., cold sapphire in contact with the skin). Thus, the combination of cooling and long near-infrared laser pulses allows safe and effective pigmented hair removal in all skin types. In contrast, epidermal protection from short pulses is best with dynamic pre-cooling (e.g., cryogen spray), for example during portwine stain treatment. A major challenge for the future of photothermal laser treatments is to develop ways of treating non-pigmented skin "targets". New uses for lasers are emerging. Diagnostic laser imaging and spectroscopy will soon emerge in dermatology. A near-infrared laser confocal microscope provides histology-like images of human skin. Imaging is painless and takes only a few minutes. Lesions including melanoma, basal cell and squamous cell carcinoma, microvascular and inflammatory lesions, dermatophytes, verrucae, etc, have distinct appearances. However, sensitivity and specificity of laser-based diagnostic imaging has not yet been compared with histopathology. Laser phototherapy is also emerging in dermatology. The 308 nm excimer laser has recently been shown to clear psoriasis faster than conventional phototherapy. Scalp psoriasis may soon be treated by fiber-optic delivery of this UV laser. The variety and utility of lasers in dermatology will probably continue to grow.

Dermatology↗
PubMed2006

A history of Japanese dermatology: past, present and future.

On the occasion of the 14th Korea-Japan joint meeting of dermatology, the founding of the Japanese Dermatological Association, its activities and relationship to neighboring societies were presented to let both Korean and Japanese participants know the current status of Japanese dermatology. It is felt that one central meeting in Asia will be necessary to make a strong impact on not only Asian but also Western colleagues. We should make more of an effort to get used to our common international language, English, so that we can communicate with other Asian colleagues more closely and in more depth in this era of increasing globalization.

Dermatology↗
PubMed1990

The changing face of dermatology out-patient referrals in the south-east of Scotland.

A study of out-patient dermatological services (NHS and private) in the south-east of Scotland was carried out by medical staff in the Department of Dermatology in Edinburgh during the month of November 1988. The aim was to assess changes in referral patterns and workload compared with the findings of an identical investigation undertaken in November 1981. Of particular interest were the possible effects of recent publicity campaigns aimed at increasing public awareness about skin cancer. The medical complement of the dermatology department had changed minimally since 1981 and the population increase in the south-east of Scotland over the same period was 1.5%. During November 1988 1592 new patients and 2037 review patients were seen. This represented an increase of 29.2% and 28.3%, respectively, since 1981. The most striking changes in diagnostic groups were a 173% rise in new cases presenting with benign tumours (excluding viral warts) and a 106% increase in new patients with malignant tumours. Viral warts and eczema were, as in 1981, the second and third most common diagnostic categories amongst new patients. There was a 98% increase in the number of surgical procedures performed on new patients compared with 1981. We conclude that the substantial increase in numbers of both benign and malignant tumours and the consequent doubling in surgical treatments was due to increased public awareness and concern about skin cancer.

Dermatology↗
PubMed2006

Cochrane Skin Group systematic reviews are more methodologically rigorous than other systematic reviews in dermatology.

BACKGROUND: The Cochrane collaboration aims to produce high-quality systematic reviews. It is not known whether the methods used in producing Cochrane Skin Group (CSG) reviews result in higher quality reviews than other systematic reviews in dermatology. OBJECTIVES: To determine how the methodological quality of dermatological CSG reviews published in The Cochrane Library and in peer-reviewed journals compare with non-Cochrane systematic reviews. METHODS: Two blinded investigators independently assessed review quality using the 10-item Oxman and Guyatt scale. RESULTS: Thirty-eight systematic reviews (17 Cochrane reviews published in The Cochrane Library, 11 Cochrane reviews published in peer-reviewed journals and 10 non-Cochrane reviews published in peer-reviewed journals) were examined. The Cochrane Library reviews included quality of life (11/17 vs. 1/10, P = 0.014) and adverse outcomes (14/17 vs. 2/10, P = 0.003) more often than non-Cochrane reviews published in peer-reviewed journals. Cochrane reviews published in both peer-reviewed journals and The Cochrane Library were more likely to include comprehensive search strategies (11/11 and 17/17 vs. 6/10, P-values = 0.04 and 0.01), take steps to minimize selection bias (11/11 and 16/17 vs. 3/10, P-values = 0.003 and 0.001) and appropriately assess the validity of all included trials (10/11 and 16/17 vs. 4/10, P-values = 0.04 and 0.007) than non-Cochrane reviews. Overall, Cochrane reviews published both in peer-reviewed journals and in The Cochrane Library were assigned higher quality scores by reviewers than non-Cochrane reviews (median = 6.0 and 6.5 vs. 4.5, P-values = 0.01 and 0.002). CONCLUSIONS: The Cochrane Library systematic review methodology leads to higher quality reviews on dermatological topics.

Dermatology↗
PubMed1994

Dermatology examination performance: wide variation between different teaching centres.

Three hundred and one clinical medical students in four universities took the same 50 question MCQ dermatology examination after their dermatology teaching. In one centre, half the students had had additional teaching; these students performed better (mean score 47.5%, n = 29) than those who had no extra teaching (mean score 40.9%, n = 29). In another centre, the students' mean score improved from 24.1 (SD = 6.7) before to 41.6 (SD = 7) (n = 46, P < 0.001) after their dermatology teaching. The different subject areas covered by the examination were analysed separately. In the lowest scoring centre (mean score 34.0, SD = 9.4) the students scored lowest in 9 of the 14 subject areas. In the highest scoring centre (mean score 47.5, SD = 9.9) students scored highest in 7 of these 14 subject areas. This study enabled questions of high discriminatory value to be identified for future use. The use of the same examination in different centres provides feedback for the centres concerning strengths and weaknesses of their teaching.

Dermatology↗
PubMed1996

Evaluation of cutaneous reactivity to recently marketed dermatologic products.

BACKGROUND: Reports of purported sensitization reactions to widely used prescription dermatologicals have raised questions concerning the clinical significance of these reports. The current study was designed to compare irritant and sensitization potentials of such marketed products and to evaluate the risks involved in their usage. METHODS: One hundred and eight healthy adult volunteers were evaluated for primary irritation and hypersensitivity following application under a double-blind paradigm of eight leading prescription dermatologic products and the vehicle cream of one product according to an intensified version of the Shelanski and Shelanski "Repeated Insult Patch Test." RESULTS: No clinically significant irritant or sensitization reactions were associated with applications of topical formulations containing clobetasol propionate, doxepin hydrochloride, metronidazole, mupirocin, oxiconazole nitrate, and terbinafine hydrochloride. The doxepin hydrochloride cream vehicle was also found to be nonirritating and nonsensitizing. Both calcipotriene and ketoconazole were moderate irritants and possible sensitization reactions were also associated with ketoconazole. CONCLUSION: Although every topically applied chemical has the potential to cause an adverse response in some individuals, the data obtained in this study for eight commercially available prescription dermatologic products indicate that most are quite safe and have very low risks of clinically significant irritation or sensitization.

Adult↗
PubMed2005

Assessing diagnostic skill in dermatology: a comparison between general practitioners and dermatologists.

This retrospective study was conducted to assess and compare the diagnostic accuracy between referring general practitioners and dermatologists with regard to skin conditions. Six hundred and fifty-six consecutive general practitioner referrals to a private dermatology practice and a dermatology outpatient department were assessed. The concordance rate in diagnoses from a wide spectrum of dermatological diseases was compared between general practitioners and dermatologists. Referring general practitioners agreed with dermatologists' clinical diagnosis and histology (when available) in 42% of cases. The concordance between general practitioners and dermatologists in the setting of non-biopsied cases is 45%. One hundred and fifty-one of 656 (23%) conditions had histological confirmation. Overall, general practitioners agreed with the histological diagnosis in 24% of cases and dermatologists agreed with the histological diagnosis in 77% of cases.

Clinical Competence↗
PubMed2007

The additive value of second opinion teleconsulting in the management of patients with challenging inflammatory, neoplastic skin diseases: a best practice model in dermatology?

BACKGROUND: Telemedicine is the practice of healthcare using interactive processes of communication to facilitate healthcare delivery, including diagnosis, consultation and treatment, as well as education and transfer of medical data. The aim of teledermatology, just as telemedicine, is to promote best practice procedures and to improve the consistency and competence of health care. AIM: To investigate the diagnostic additive value of second opinion teleconsulting in patients with challenging dermatoses, among dermatologists working in two different dermatology departments. SETTING: Thirty-three cases of patients with challenging inflammatory and neoplastic skin diseases at the University of L'Aquila Department of Dermatology were sent for teleconsultation to the Department of Dermatology, Medical University of Graz, Austria. METHODS: All cases were selected in the outpatient service in L'Aquila. After face-to-face consultation with a local colleague had been completed, images were sent using a store-and-forward (SAF)-based system (http://www.telederm.org) to Graz. Histopathological examination together with follow-up of the patient represents the diagnostic gold standard for this study. RESULTS: Telediagnosis was correct in 26 of 33 (78.8%) cases. Sixteen of 33 cases (48.5%) had already been diagnosed face-to-face by at least one of the two dermatologists in L'Aquila. In 10 of 33 cases (30.3%), the correct diagnosis was made in teleconsultation only. CONCLUSIONS: Second opinion teleconsulting may represent an additive value in the diagnosis of numerous challenging inflammatory and neoplastic skin diseases. It may be particularly useful as a best practice model for smaller departments in order to discuss and/or to confirm diagnoses and also for the management of patients with unusual difficult dermatoses.

Benchmarking↗
PubMed1990

Current trends in the practice of dermatologic surgery.

In a 1984 survey, 2750 members of the American Academy of Dermatology were asked which dermatologic surgery procedures they performed and which procedures they expected to be performing in 5 years. A similar survey was completed by the American Society for Dermatologic Surgery in 1988. In this article, the results of the 1988 survey are presented and compared to that of 1984.

Cryosurgery↗
PubMed1994

Oral transmucosal fentanyl citrate premedication in patients undergoing outpatient dermatologic procedures.

BACKGROUND: Oral transmucosal fentanyl citrate (OTFC) is a novel lozenge dosage form of fentanyl used for premedication. Many dermatology patients undergoing surgical procedures could benefit from such a medication. OBJECTIVE: The study compared the safety and efficacy of 400-vs 800-micrograms dosage forms for their sedative and anxiolytic effects in adults undergoing a variety of dermatologic outpatient surgical procedures. METHODS: Patients received OTFC 30 minutes before the procedure. Vital signs, oxygen saturation, sedation, and anxiety scores were measured before OTFC administration and every 15 minutes thereafter. RESULTS: Significant sedation and anxiolysis developed in both dosage groups. No clinically significant changes in respiratory rate, heart rate, or blood pressure occurred during the study period. Common drug-induced side effects included dizziness, nausea, pruritus, and vomiting. CONCLUSION: OTFC is safe and effective for outpatient dermatologic procedures; however, the risk of opioid-related side effects must be carefully weighed against the benefits when deciding to use OTFC in an outpatient setting.

Administration, Oral↗
PubMed1995

Postoperative wound infection rates in dermatologic surgery.

BACKGROUND: Multiple factors related to the nature of the surgical procedure can influence the risk of wound infection in dermatologic surgery. Despite that, wound infection rates in dermatologic surgical procedures are believed to be low. OBJECTIVE: This study was conducted: 1) to determine wound infection rates in Mohs and excisional surgery; and 2) to investigate if factors such as lesion type, anatomic location, postoperative defect size, number of Mohs stages required to achieve a tumor-free plane, and the type of reconstructive procedure influence the rate of surgical wound infections. RESULTS: Wound infection rate for 530 Mohs procedures and 517 excisions combined was 2.29%, falling within the predicted range for "clean" surgical procedures. In addition, Mohs procedures performed on the ear as well as large postoperative defects were found to have a higher rate of wound infections. CONCLUSION: Dermatologic surgery can be safely performed in an outpatient setting without a significant risk of infection. Certain anatomic sites, such as the ear, as well as size of postoperative defect, are important factors in predicting the risk of postoperative wound infection.

Boston↗
PubMed2005

Dermatologic surgery practice and skin cancer treatment in Canada: results of a national survey.

BACKGROUND: Although traditionally considered a medical subspecialty, dermatology has rapidly evolved over the past two decades to encompass a wide variety of cutaneous surgical procedures. OBJECTIVE: The study was carried out to evaluate the status of dermatologic surgery practice and skin cancer treatment in Canada. METHODS: In 2003, 550 practicing Canadian dermatologists were surveyed. RESULTS: Two hundred fifty-one dermatologists responded to the questionnaire, with the majority practicing in an urban part-time academic, part-time private setting. Statistics are presented on the types and demographics of dermatosurgical and cosmetic procedures performed, as well as on the specific dermatosurgical therapies used in the treatment of various cutaneous malignancies. CONCLUSIONS: The survey provides a current picture of dermatologic surgery practice and skin cancer treatment in Canada. The data suggest that Canadian dermatologists are further embracing surgical and cosmetic procedures.

Adult↗
PubMed2005

Confidence intervals in procedural dermatology: an intuitive approach to interpreting data.

BACKGROUND: Significant differences observed in therapeutic trials in procedural dermatology are typically denoted by p values of less than .05. Alternatively, significance can be conveyed by use of confidence intervals. OBJECTIVES: The purpose of this article is to clarify how confidence intervals convey the same information about outcomes as p values, albeit in a slightly different manner. METHODS: (1) Selective review of textbooks and other relevant literature and (2) presentation of a brief tutorial describing confidence interval determination for therapeutic clinical trials comparing differences between means of two groups. RESULTS: Routine use of confidence intervals is an intuitively satisfying means for conveying the statistical significance of results and can be used in combination with p values for understanding these results. Specifically, confidence intervals are a useful tool for indicating the size, spread, and direction of the observed differences. Unfortunately, dermatologic surgery trials tend to have low sample sizes, which frequently result in outcomes below the threshold of statistical significance (p > .05, or confidence intervals including 1.00). In the absence of statistical significance, neither p values nor confidence intervals yield definitive results. CONCLUSION: Confidence intervals can complement p values as a means for explaining statistical significant differences. When differences are not statistically significant but are clinically significant and approach statistical significance, neither p values nor confidence intervals can definitively establish whether the observed trends are indicative of an underlying difference. In these cases, common in procedural dermatology, larger, better designed, randomized prospective trials are needed.

Confidence Intervals↗