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PubMed1984

A survey of skin disorders seen in pediatric general and dermatology clinics.

One-week surveys of office visits to a general pediatric clinic were carried out at monthly intervals over a six-month period. Skin complaints accounted for 24% of the primary and secondary reasons for initiating clinic visits. Six categories of dermatologic conditions accounted for 81.5% of the pediatric clinic visits, with skin infections comprising 38.5%. A survey of new referrals to a pediatric dermatology clinic over a similar seasonal span revealed that the same six categories made up 51.8% of diagnoses. The surveys indicate that skin disorders are common reasons for pediatric office visits and suggest some areas that should be emphasized in the training of physicians in dermatologic diagnosis and management.

Adolescent↗
PubMed1994

Dermatologic services provided to children and adolescents by primary care and other physicians in the United States.

To determine the frequency and types of pediatric dermatologic problems encountered by primary care physicians, dermatologists, and other physicians, we examined data from the 1990 National Ambulatory Medical Care Survey, a continuing study of physician practice in the United States. In 1990, 163.3 million physician office visits were made by patients 18 years of age or younger for all diagnoses; of these, 126.2 million were to primary care physicians. Among visits to these providers, a primary, secondary, or tertiary cutaneous concern or diagnosis was recorded in 12.3 million visits (9.7%). Of these patients with a primary cutaneous concern, 68% of visits were made to primary care physicians, 21% to dermatologists, and 10% to other physicians. For encounters in which primary care physicians reported a primary dermatologic diagnosis (9.6 million visits, 7.6%), the majority of diagnoses (86-93%) were in one of five categories: skin infections, dermatitis, parasitic infestations, acne, or urticaria. This analysis demonstrates the great frequency with which cutaneous disease occurs in ambulatory medicine, and reinforces the importance of dermatologic education in the training of primary care physicians.

Acne Vulgaris↗
PubMed2006

Low levels of emotional awareness predict a better response to dermatological treatment in patients with psoriasis.

BACKGROUND: Personality and emotional factors are thought to influence the onset of psoriasis, the occurrence of relapses, and the sensitivity of this condition to dermatological treatments. OBJECTIVE: To explore the relationships between emotional disorders and emotional information processing in the one hand, and psoriasis severity and response to treatment on the other. METHODS: We recruited 93 patients through an article in the local press. These patients attended three consultations. We evaluated psoriasis severity by Psoriasis Area and Severity Index (PASI) score and response to treatment by change in PASI score from baseline to the 3-month visit. We screened for comorbid mental disorders, using the Mini International Neuropsychiatric Interview. We used the Hospital Anxiety and Depression Scale to assess anxiety and depressive symptoms. Alexithymia (difficulty in identifying and expressing emotions) was evaluated with the 26-item version of the Toronto Alexithymia Scale (TAS-26) and the ability to integrate and differentiate emotions (emotional awareness) was assessed with the Lane and Schwartz Levels of Emotional Awareness Scale (LEAS). RESULTS: Forty patients presented at least one psychiatric diagnosis and 33 were considered alexithymic (TAS > or =73). No psychological score was associated with baseline PASI score, which was higher in men and positively correlated with disease duration. Patients who considered their disease to be stress-reactive tended to have lower LEAS scores (p = 0.052). At the 3-month visit, PASI scores had significantly improved in the subset of patients (n = 67) presenting severe psoriasis at inclusion (PASI >2); emotional awareness and anxiety scores had also improved in these patients (p < 0.001), but dermatological and psychological changes were not statistically related. Dermatological improvement at 3 months with respect to baseline PASI was predicted by longer disease duration (>20 years) and lower baseline LEAS score (p = 0.044 and p = 0.021, respectively). CONCLUSION: This study demonstrates the value of assessing the ability of patients with psoriasis to process emotional information, as defined by emotional awareness. Patients with low LEAS scores appear to be more reactive to stress, but also to be more responsive to treatment, suggesting the activation of a particular stress physiology by negative affective states that are not experienced.

Adult↗
PubMed1988

Dermatology training during the pediatric residency.

The diagnosis and treatment of disorders of the skin and subcutaneous tissue represents a significant aspect of general pediatric practice. A study was carried out to assess the status of training in dermatology among residents in pediatrics. Sixty five pediatric residents in seven different training programs were asked to identify color transparencies of 20 common dermatoses. Their mean score of 53.2 percent was considerably lower than that of an equivalent group of residents in dermatology (86.4%). A survey of pediatric residencies throughout the United States indicated that 67 percent of those responding offer an elective in pediatric dermatology.

Curriculum↗
PubMed1997

Dermatology: a useful tool in a depressed economy.

Dermatology is an aspect of medicine which can help produce a cheap and readily available tool for diagnosis, follow-up and epidemiologic study in a depressed economy such as in the developing countries of Africa and Asia. This would involve the provision of some dermatological training to students of medicine, nursing and other paramedical specialities, to allow maximum utilization of dermatology at the primary, secondary and even tertiary health institutions.

Dermatology↗
PubMed2002

The changing face of Canadian dermatology.

BACKGROUND: In 1986, Cosmair Canada, agent of the L'Oréal Group, sponsored a survey among Canadian dermatologists to measure the perceptions, attitudes, expectations, and needs of dermatologists regarding cosmetology. Fifteen years later, a new survey among Canadian dermatologists, again sponsored by L'Oréal, tries to capture the evolution and new trends. OBJECTIVES: This survey tries to capture the perceptions, attitudes, and expectations of Canadian dermatologists regarding cosmetology. METHODS: A questionnaire was sent to 394 members of the Canadian Dermatology Association; 99 responded (25%). The questionnaire, had 21 questions regarding cosmetology, future trends in Canadian dermatology, and how dermatologists acquire the information required for their practice. RESULTS: More than ever, dermatologists are asked to deal with maintaining healthy, youthful skin. Cosmetology is a greater part of everyday practice. Laser and cosmetic dermatology will become more important in the future. CONCLUSIONS: Dermatologists are asked to provide information on the maintenance of healthy, young-looking skin and feel they need more information relating to cosmetology

Attitude of Health Personnel↗
PubMed2005

Non-acne dermatologic indications for systemic isotretinoin.

Systemic isotretinoin has been used to treat severe acne vulgaris for 20 years. However, isotretinoin also represents a potentially useful choice of drugs in many dermatologic diseases other than acne vulgaris. Diseases such as psoriasis, pityriasis rubra pilaris, condylomata acuminata, skin cancers, rosacea, hidradenitis suppurativa, granuloma annulare, lupus erythematosus and lichen planus have been shown to respond to the immunomodulatory, anti-inflammatory and antitumor activities of the drug. Isotretinoin also helps prevent skin cancers such as basal cell carcinoma or squamous cell carcinoma. A combination of systemic isotretinoin and interferon-alpha-2a may provide a more potent effect than isotretinoin alone in the prevention and treatment of skin cancers.Systemic isotretinoin may be considered as an alternative drug in some dermatologic diseases unresponsive to conventional treatment modalities. However, randomized clinical trials aimed at determining the role of systemic isotretinoin therapy in dermatologic diseases other than acne vulgaris are required.

Acne Vulgaris↗
PubMed2006

Changes in quality of life in persons with eczema and psoriasis after treatment in departments of dermatology.

The objective of this study was to assess the impact of chronic dermatological diseases on quality of life (QoL) of Norwegian patients following in-patient management. QoL was measured by the Norwegian version of the Dermatology Life Quality Index, a validated, self-administered questionnaire. Adult in-patients with psoriasis and eczema were selected for one year from the dermatological departments in Norway. A total of 212 patients were included, and 126 patients (50% men, 85 with psoriasis and 41 with eczema, mean age 46 years) completed the questionnaires at time of hospital admission and one week after discharge. The patients reported adverse impact on QoL, but no differences between the psoriasis and eczema groups could be demonstrated. Patients with psoriasis improved from 18.3 (7.6) (mean (SD)) to 12.1 (8.2) (p < 0.01), and those with eczema improved from 20.0 (6.0) to 14.4 (7.8) (p < 0.01). Seventy percent of the patients showed improvement, 20% remained unchanged and 10% worsened. The parameters for which the most improvement was seen were those that were of most concern to the patients, i.e. their symptoms and embarrassment. In conclusion, the results are consistent with previous international studies.

Administration, Cutaneous↗
PubMed2001

[The current status of medical mycology in dermatology clinics in Japan].

To research the current status of mycological examinations in dermatology clinics in Japan, I sent out a questionnaire to 82 universities and 183 dermatologists in Miyagi and Gifu prefectures. A summary of the answers follows: a direct examination with potassium hydroxide solution is usually performed, but in a few university clinics and half of the private clinics in both prefectures it is only used for a differential diagnosis in atypical cases. Culture studies are performed sporadically, and at 3 universities no culture study of dermatophytoses is done at all. The ability to identify isolated fungi is reliable in half of the university clinics, but half of the professors of dermatology thought that these examinations should be left to a laboratory technician. The expertise needed to examine deep mycoses is generally quite poor. Based on these results the level of dermatomycology in Japan appeared to be gradually declining and may drop even lower in the near future. Therefore, I believe it is essential for the Japanese Society of Dermatology to establish an educational program of training courses of mycological examinations for young doctors and leaders. To raise the level of analyses of mycological examinations for rare pathogenic fungi, a system of consultation by specialists must be established.

Dermatology↗
PubMed2001

Caring for women with childbearing potential taking teratogenic dermatologic drugs. Guidelines for practice.

OBJECTIVES: Upon completion of this article, the reader should be able to: 1. Identify the dermatologic drugs with the highest risk of teratogenicity. 2. List the essential information to be obtained from a woman with childbearing potential being considered for treatment with a teratogenic dermatologic agent. 3. Discuss management principles for administration of teratogenic agents to women with childbearing potential. Dermatologic agents can be highly teratogenic, and the gynecologist must be aware of the issues involved in prescribing them. Prescribers should be aware of the risks and ensure that patients taking teratogens do not become pregnant during the course of therapy (or until the drug has been cleared from the body). This can involve taking menstrual and sexual histories and counseling the patient about sexual behavior and contraception.

Adult↗
PubMed1975

Ionizing radiation therapy in dermatology. Current use in the United States and Canada.

A comprehensive survey of the Task Force on Ionizing Radiation of the National Program for Dermatology was answered by 2,444 dermatologists in the United States and Canada (53.6% of 4,560 questionnaires). Computer analysis of the data showed that 55.5% of dermatologic offices are equipped with superficial x-ray machines and/or grenz ray units and that 44.3% of dermatologists use superficial x-ray or grenz rays regularly. Most respondents (65.8%) favor increased practical instruction in radiotherapy in training programs. A majority (63.4%) want examinations in radiation therapy by the American Board of Dermatology continued or increased. Data dealing with training in radiation therapy, reasons for non-utilization, alternate care, radiation safety, and economic considerations are presented in detail. Common indications for superficial x-ray therapy and grenz ray therapy are listed in order of frequency and percentage of use.

Canada↗
PubMed2002

[Survey on the activity of hospital departments of dermatology in France].

INTRODUCTION: The Collège des Enseignants de Dermatologie de France initiated a study to assess the activity of the departments of dermatology in French hospitals. We report the results of this survey. MATERIAL AND METHODS: The study was conducted during a randomly selected week in the year 2000. An anonymous questionnaire was sent to all the departments of dermatology in the hospitals in France and was completed for each patient leaving the hospital during that week. The data collected were: the type of establishment, admission method, hospitalization method, type of pathology, motive for hospitalization, length of hospitalization and type of treatment used. RESULTS: The response rate was of 96 p. 100 for the University hospital centers and 80 p. 100 for the non-university hospitals. The number of patients treated per year was of 65 628 for the University hospitals and of 16,000 for the others. Ninety percent of the hospitalizations corresponded to direct admissions. The pathologies at the origin of the majority of yearly hospitalizations were, for the University hospitals: melanoma, leg ulcers, highly specialized dermatoses and systemic diseases and for the other hospitals: leg ulcers, HIV infection, highly specialized dermatoses and erysipela. The pathologies requiring the greatest number of hospitalization days were melanoma, leg ulcers, erysipela and highly specialized dermatoses. DISCUSSION: This study shows that the activity in the departments of dermatology is centered on pathologies that are clearly severe in terms of Public Health (oncology, infectious diseases and angiology). It also shows the efforts made for the management of patients in out-patient settings.

Delivery of Health Care↗
PubMed2003

Dermatology nursing scope of practice.

The intent of this document is to conceptualize practice and provide education to practitioners, educators, researchers, and administrators, and to inform other health professionals, legislators, and the public about the participation in and contribution to health care by dermatology nursing. Through articulation of the elements of care, dimensions, boundaries, and intersection, the Dermatology Nursing Scope of Practice document defines the specialty practice of dermatology nursing.

Dermatology↗
PubMed2003

Contact dermatitis education in dermatology residency programs: can (will) the American Contact Dermatitis Society be a force for improvement?

BACKGROUND: Contact dermatitis accounts for a considerable portion of outpatient clinic visits to dermatologists. The state of education in contact dermatitis at the level of dermatology residency training in the United States has not been examined. OBJECTIVE: To assess the state of education in contact dermatitis in dermatology residency programs in the United States. METHOD: Cross-sectional survey of directors and chief residents of 105 dermatology training programs accredited by the American College of Graduate Medical Education. RESULTS: Seventy-seven percent of directors and 74% of chief residents responded to the survey. In general, both sets of respondents gave concordant responses although responses from directors were more positive. With respect to didactic education, the vast majority of programs (> 73%) held lecture conferences on contact dermatitis. Less than one-third included contact dermatitis-focused journals in journal club conferences. A bare majority of programs (57% of directors, 53% of chief residents) identified a faculty expert in contact dermatitis, with almost all experts conducting patch-test clinics and providing lectures on contact dermatitis. Seventy-five percent of experts were members of the American Contact Dermatitis Society (ACDS). Although residents in most programs (> 78%) performed patch tests to diagnose contact dermatitis, there were 14 programs in which none of their graduates performed such tests. Moreover, only 27% of programs had rotations dedicated to contact dermatitis and/or patch testing. Finally, directors and chief residents predicted that most graduates will incorporate the TRUE Test and not the more extensive or customized patch tests in their practices. CONCLUSIONS: Several opportunities for improving contact dermatitis education in residency programs were identified, including recruitment or development of more faculty experts in contact dermatitis, creation of rotations dedicated to contact dermatitis, and greater inclusion of contact dermatitis-focused journals in journal club conferences. As the principal interest group for contact dermatitis in the United States, the ACDS is the logical organization to spearhead improvement of contact dermatitis education in residency programs.

Clinical Competence↗
PubMedDate not supplied

[Study on the appropriateness of utilization of dermatological consultants in emergency unit].

The aim of this study is to evaluate the rate of appropriate use of dermatologist consultants, in order to identify its determinants and to define its economic impact. We analysed 1750 dermatological procedures performed in the emergency room of the Azienda Ospedaliera "Maggiore della Carità" in Novara. The 87,64% of the procedures were inappropriate. We also observed low rates of diagnostic agreement between emergency unit and dermatology unit; 40.88% of discordant diagnoses were due to severe mistakes. The rate of inappropriate dermatological procedures was related to the clinical diagnosis and to patient's access time. The economical analysis was performed using the Activity Based Costing methodology. We measured an average expenditure of euro 7 for procedure (total expenditure euro 9.850). As possible determinants of inappropriateness, we identified the lack of "filter action" by general practitioners, the incorrect behaviour of patients and the professional uncertainty phenomena.

Costs and Cost Analysis↗
PubMed2004

Audit of acute referrals to the Department of Dermatology at Waikato Hospital: comparison with national access criteria for first specialist appointment.

AIM: This audit was designed to compare current referral practice with the Ministry of Health elective services National Access Criteria for first Specialist Assessment (ACA) guidelines, to identify specific problems, and (if possible) to improve the use of acute dermatology services. METHOD: Information regarding referral source, information provided, urgency and diagnostic accuracy, time interval between referral and consultation date, and follow-up arrangements was collected via data sheet on each referral received. We confined the audit to acute referrals--ie, 'immediate and urgent cases' from general practitioners (GPs) that had been discussed with the dermatologist by phone, and internal referrals when an urgent consultation had been requested. RESULTS: More acute referrals came from other hospital departments (74%) than from general practitioners (26%). Acute referrers, especially hospital teams, tended to overestimate the urgency with which a dermatological condition needed to be seen. Information about inpatients was often considered inadequate for triage. GP referrals contained more useful information. GP referral diagnostic accuracy is in keeping with other studies (approximately 50%) but the diagnostic accuracy of hospital doctors is well below this level. All acute referrals were seen within the recommended timeframe. Follow-up patterns were similar (whether referrals came from general practitioners or hospital teams) but for both groups there was a relatively high failure to attend rate. CONCLUSIONS: Inappropriate referrals are time-consuming and reduce our capacity for seeing community patients on the waiting list. To improve referral triage, we recommend that a referral letter that clearly specifies the information that should be provided. The majority of acute referrals did not comply with the ACA guidelines. We recommend applying the ACA guidelines to internal acute dermatology referrals (as well as those from GPs) to reduce unnecessary inpatient reviews, and to provide a better urgent service for those persons who truly require it.

Acute Disease↗
PubMed2004

Implementation of dermato-epidemiology curriculum at Case Western Reserve University dermatology program.

Dermato-epidemiology curriculum has been identified by the American Academy of Dermatology (AAD) as an important foundation for dermatology residency training. However, no one has yet reported implementation of dermato-epidemiology curriculum. To evaluate and relate our experience carrying out a dermato-epidemiology resident education initiative, based on recommendations by the AAD Epidemiology Committee. Monthly lectures based on topics suggested by the AAD Epidemiology Curriculum. Pre- and post-test multiple choice and free-form question measures were employed to examine performance, assess resident enthusiasm, and solicit feedback from the initiative. Quantitative achievement on multiple-choice items improved slightly, but insignificantly, from 53 percent to 58 percent. Resident level of enthusiasm and perceived efficacy for the intervention varied from 3.3 to 4.0 on a 5-point Likert scale where "1" indicates strongly disagree and "5" indicates strongly agree with measures of effectiveness. Dermato-epidemiology curriculum is desirable and achievable even in dermatology programs without full-time epidemiologists. A successful epidemiology curriculum should be clinically and board-examination relevant, incorporating aspects of problem-based, interactive learning.

Curriculum↗