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At least 847 records · Page 47Linked to original sources
PubMed1999

[Methotrexate in dermatology: pharmacology, indications, applications and prudent use].

High dosage methotrexate is currently used in the treatment of malignancies. When used at low- or moderate doses, methotrexate has antiproliferative and antiinflammatory effects and is a useful drug in skin diseases. The aim of this review is to describe pharmacology, indications, adverse effects and practical use in Dermatology. Pharmacodynamics of methotrexate is especially related to antifolic activity. Methotrexate is officially approved in the treatment of severe psoriasis, but many other proliferative or inflammatory diseases with cutaneous manifestations may benefit from this drug, usually in association with corticosteroids. The use of methotrexate needs some precautions and a precise follow-up to minimise the risk of severe adverse effects. However, efficacy of methotrexate was reported in open and retrospective small size studies. Prospective and comparative trials are required to confirm the indications, advantages and tolerance of methotrexate in dermatology.

Anti-Inflammatory Agents↗
PubMed1998

Advances in dermatologic lasers.

Lasers continue to fundamentally redefine the nature of dermatologic practice. Recent advances in dermatologic lasers have focused on refining the process of selective photothermolysis, as well as evaluating new devices and treatment indications. Despite the current multiplicity of available lasers and associated marketing claims, what is perhaps most lacking are data comparing the efficacy of different lasers that can be used to treat the same condition, and data on the long term benefits of laser treatment.

Clinical Trials as Topic↗
PubMed2000

Growing impediments to the delivery of dermatologic care.

Government regulations have a broad and deep impact on the delivery of dermatologic health services. It is incumbent on dermatologists to be involved in the development and discussions of these issues and to educate government officials about the effects of existing and proposed regulations on the delivery of dermatologic health care.

Delivery of Health Care↗
PubMed2000

Organizing state dermatologic societies.

Each year state legislatures, boards of medicine, departments of insurance, and other authorities promulgate laws and rules that affect the daily practice of dermatology. It is critical that dermatologists in each state form and maintain a strong state dermatologic society. Specific suggestions for forming and strengthening such societies are described and available resources are reviewed.

Dermatology↗
PubMed2000

HIV and AIDS in inpatient dermatology. Approach to the consultation.

In the inpatient setting, the dermatologic consultant is called on to address the whole spectrum of cutaneous disease seen in HIV/AIDS patients, with severity varying from severe life-threatening to less serious conditions that dramatically affect quality of life. Rather than reviewing a "laundry list" of conditions associated with HIV/AIDS or the most severe conditions, this article aims to demonstrate a systematic approach to inpatient dermatology consultation in HIV/AIDS patients and to briefly review several common and interesting topics frequently addressed in the inpatient setting (e.g., medications issues, and phototherapy in HIV-infected patients).

AIDS-Related Opportunistic Infections↗
PubMed2001

Cyclosporine and tacrolimus in dermatology.

Immune modulators are being used with increasing frequency in dermatology. This article reviews two such agents, cyclosporine and tacrolimus. Discussion emphasizes the pharmacology, side effects, and uses of these two drugs in dermatologic disorders.

Cyclosporine↗
PubMed1997

Dermatologic drug use during pregnancy and lactation.

Physicians are often asked to prescribe medication for women during the childbearing years. This article reviews which dermatologic drugs have been reported to interfere with contraceptive efficacy, which should be avoided, and which have the fewest contraindications for use during pregnancy and lactation. Corticosteroids and tretinoin are discussed in detail. Sources and guidelines for choices of dermatologic drugs for women of childbearing age are presented.

Contraindications↗
PubMed2004

Validation of the Dermatology Life Quality Index as an outcome measure for urticaria-related quality of life.

BACKGROUND: Chronic idiopathic urticaria (CIU) is a debilitating skin disease that affects patients' quality of life (QOL). The Dermatology Life Quality Index (DLQI) assesses QOL parameters across several types of dermatologic conditions. However, an evaluation of the validity of the DLQI for use in CIU patients has not been undertaken, because CIU, unlike other chronic skin conditions, is subject to daily or weekly symptom fluctuations. OBJECTIVE: To test the reliability and validity of the DLQI in 2 samples of CIU patients treated with fexofenadine hydrochloride (20, 60, 120, or 240 mg twice daily). METHODS: Data were obtained from 2 similar multicenter, double-blind, randomized, placebo-controlled, parallel-group studies of CIU patients (n = 418 and n = 439). Patients completed the 10-item DLQI during 3 clinic visits (approximately 2 weeks apart). Clinic personnel also recorded patients' symptoms. RESULTS: The results of the DLQI items were similar to those obtained with other skin disease populations, indicating the presence of relatively symmetrical distributions. Reliability was high, demonstrating the lack of excessive random measurement error (alpha coefficient = .89 and .87 for samples 1 and 2). Factor analysis resulted in a unidimensional pattern, supporting the use of a total DLQI score. Most DLQI items distinguished patients with varying degrees of QOL impairment, highlighting the sensitivity of this instrument. Construct validity was moderate, providing evidence that the DLQI was responsive to changes in patients' clinical status. CONCLUSIONS: The DLQI is a valid, reliable, and clinically useful outcome measure for assessing QOL in CIU patients.

Chronic Disease↗
PubMed2002

On dermatological surgery, registrars and residents.

Training in aspects of skin surgery is now a requirement of general dermatology registrars and residents in the UK and USA, respectively. We compare this component of the training programmes at St John's Institute of Dermatology in London and at New York Medical College in New York City. Because of their understanding of cutaneous pathology, dermatologists are often best qualified to assess patients for skin procedures and should therefore be involved, directly or indirectly, in their surgical management. In our view, the curricula should be changed to place more emphasis on the supervised assessment and treatment of patients with skin tumours as well as to reflect the growing importance of laser treatments and the demand by patients for cosmetic interventions.

Dermatology↗
PubMed2001

Evaluating a telemedicine system to assist in the management of dermatology referrals.

BACKGROUND: Teledermatology systems fall into two categories: live video or store-and-forward. In the former, video-conferencing equipment is used to connect a patient with a remote consultant. This method has been evaluated as an aid to dermatology, but it is expensive both in terms of capital and running costs. Video consultations are generally longer than conventional ones and harder to schedule. Some authors have considered store-and-forward as an alternative to live video: instead of a consultation, specialists could make a rapid inspection of a transmitted still image. OBJECTIVES: A study was conducted to evaluate the role of telemedicine in the dermatology outpatients department of a district general hospital (Whittington Hospital NHS Trust, London, U.K.). METHODS: One hundred and ninety-four patients were seen by one of two consultant dermatologists. A nurse used a video camera to store digital images of each patient's problem and compiled a history from the GP's referral letter. The images were reviewed 13 months later by both dermatologists; they recorded a provisional diagnosis and an assessment of how urgent an appointment would have been made given the information provided by the system. A third consultant graded the level of agreement between the telemedicine diagnoses and the face-to-face consultations. RESULTS: High levels of agreement were found between the diagnoses of the dermatologists using the system to inspect images and those of the dermatologist who saw the patients (77%). Consultants using the system recommended fewer urgent appointments (32% compared with 64%) and felt that in 31% of cases the patient did not need to be seen. In 15% of these cases (5% of the total), however, their diagnosis differed significantly from that of the consultant who saw the patient. Had the system been in use, 14% of patients conventionally assigned a non-urgent appointment would have been seen urgently. CONCLUSIONS: The images allowed a reasonably accurate diagnosis. The software was not reliable (six cases could not be viewed), or easy to use (it took approximately an hour to view 20 cases) but an improved version could be used in triaging outpatient appointments.

Correspondence as Topic↗
PubMed2002

Randomized controlled trial of a single dermatology nurse consultation in primary care on the quality of life of children with atopic eczema.

BACKGROUND: Atopic eczema is mostly managed in primary care but there is often insufficient time for patient education; a nurse practitioner could help with this. OBJECTIVES: To evaluate the effects of a single consultation with a primary care nurse on the quality of life (QOL) of children with atopic eczema aged 0.5-16 years and the impact of the disease on their families. PATIENTS AND METHODS: Children with eczema were invited to join the trial. Volunteers were randomized to a control group or an intervention group who attended the nurse for a single 30-min session. Family impact was determined using the Family Dermatitis Index (FDI), and QOL was assessed using the Infant Dermatitis Quality of Life questionnaire (IDQOL) or, in children aged 4-16 years, the Children's Dermatology Life Quality Index (CDLQI). Baseline scores for family impact and QOL were compared with those at 4 weeks and 12 weeks post-intervention. RESULTS: Two hundred and thirty-five children were recruited over 12 months; 115 were aged 0.5-4 years and 120 were aged 4-16 years. Follow-up data were missing for 38 children (84% completion rate, n = 197). All measures of QOL or family impact at baseline were skewed. The median scores were IDQOL, 5, and CDLQI, 6. About 20% of children had zero scores for the FDI (no impact on family life); median FDI scores were 2 or 3. At baseline the FDI correlated with the IDQOL or CDLQI. In addition, the FDI and IDQOL were related to parental assessment of disease severity. Non-responders had, on average, worse QOL at baseline than those who provided complete data. In the children with complete data, the mean differences in CD < Q1 and 1DQO< scores between intervention and control children were small at 4 and 12 weeks (P > 0.05). The improvement in FDI at 4 weeks was slightly better in intervention than control children (P < 0.06). CONCLUSIONS: The impact on QOL of a single intervention by a dermatology nurse was marginal for family impact at 4 weeks and was not apparent for other measures, either in the short or longer term. The planned sample size was derived from data in hospital patients but in our population disease activity was milder and the effects on QOL were less. On this account the present study was of low statistical power for some measures. Further studies in larger populations using additional outcome measures are required before advocating the wider introduction of nurse specialists.

Adolescent↗
PubMed1998

Focus groups in dermatology.

Focus groups have considerable potential for study of the attitudes and experiences of patients and health care providers within dermatology. This article describes the use of such groups, using specific dermatological examples.

Attitude to Health↗
PubMed2002

Audit of admissions to dermatology beds in Greater Manchester.

We present the results of a prospective questionnaire-based audit of admissions to dermatology beds. We examined the admission practices of clinicians and the outcome in terms of benefit to patients. The majority of patients (90%) were admitted because of the severity of their skin disease but other contributing factors included: inability to cope (40%); need for further investigation or observation (33%); coexisting medical factors (17%); poor social support; transport and psychological factors. Most (87%) patients benefited from admission and the dermatology life quality index improved by 42%. We demonstrate that inpatient treatment is effective and improves patients' quality of life.

Adolescent↗
PubMed2002

The development of a time-based nursing information system in dermatology outpatients and day therapy areas.

Over the past 10 years the provision of dermatology services in Nottingham has moved away from inpatient care and towards nurse-led day therapy and outpatient care. The current nursing information system supplies nursing activity data for management information and is a ward-based patient dependency classification system. Recently, it became apparent that nursing activity in day therapy and outpatients was being measured with a tool that was not designed for the purpose and managers were using professional judgement to aid their decisions. An evaluative internal consultancy was conducted to investigate the situation and provide recommendations for the development of an appropriate system that would supply more accurate information for non-ward areas. The report recommended a 'time-based' system that avoided the fundamental philosophical mismatch between a reductionist, task-orientated system and the reality of holistic nursing care. The new system was developed on a departmental personal computer using Microsoft Excel spreadsheets. The full co-operation and input of the nursing staff was an essential ingredient in its success. The original consultancy concentrated on the day therapy unit but the time-based system was developed to include all dermatology non-ward areas.

Ambulatory Care Information Systems↗
PubMed2000

Frequency of oral conditions in a dermatology clinic.

BACKGROUND: Oral mucosal manifestations may be the initial feature, the most florid clinical feature, or the only sign of mucocutaneous diseases. METHODS: Sixty adult patients (48 women, 12 men) with oral mucous complaints were referred to and evaluated at a dermatology clinic in a tertiary care hospital in Mexico City between November 1996 and September 1998. RESULTS: The most frequent oral conditions observed were pemphigus vulgaris (18.3%), lichen planus (8.3%), candidiasis (8.3%), recurrent aphthous ulcers (6.7%), herpetic lesions (6.7%), xerostomia (6.7%), and traumatic lesions (6.7%). Oral affection in mucocutaneous conditions was observed in 21 (35%) patients; the diagnosis was based on oral signs in 10 (48%) of these patients. A large number of oral conditions had previously been misdiagnosed. CONCLUSIONS: The importance of the diagnosis of oral conditions in dermatology has been underlined in this study due to the frequency and diversity of oral lesions. The benefits of an interdisciplinary approach in the management of patients has been highlighted.

Adolescent↗
PubMed2004

[G-DRG Version 2004: changes in view of dermatology].

In the year 2004 the obligatory introduction of the new hospital funding system based on a Diagnosis Related Groups (DRG) system will become reality for all German hospitals. After all fundamental items of the new G-DRG version were made generally known, the possible consequences had to be considered. The first mandatory German case-based lump sum catalogue differs importantly from the previous payment models and requires intensive study. Economic considerations will increasingly play a role in the daily routine of hospitals and influence treatment patterns. Therefore, comprehensive knowledge of basic principles of G-DRG is essential. In the following aspects of the reimbursement system with special relevance to dermatology are reviewed in detail. Additionally, the revised classification system versions OPS-301 SGB V and ICD-10-GM 2004 and the German coding standards version 2004 must be appropriately applied for dermatologic purposes.

Dermatology↗
PubMed2002

Thalidomide in dermatology.

Thalidomide is an effective agent to treat over 25 seemingly unrelated dermatological conditions that have an inflammatory or autoimmune basis. The main side-effects of teratogenesis and peripheral neuropathy limit its use. Currently, in Australia no assurance is given as to the quality, safety and efficacy of thalidomide. The use of thalidomide for toxic epidermal necrolysis can lead to an increase in mortality, and its use as a prophylactic agent for the prevention of chronic graft-versus-host disease following bone marrow transplantation has raised more speculations as to the safety of this notorious drug. A review of the therapeutic indications for thalidomide in dermatology as well as the mechanisms of action and side-effects of this drug are presented. The current suggested guidelines for its use in clinical practice in Australia are discussed.

Dermatologic Agents↗
PubMed2003

Digital imaging in clinical dermatology across the UK in the year 2001.

Colour photography is an important tool in the daily practice of dermatologists. Digital photography promises quicker acquisition and handling of clinical images. Despite increasing availability and falling costs, dermatologists have been slow in adopting this new technique. To establish to what degree digital photography has found its way into routine practice in dermatology departments in the UK during the year 2001, we conducted a postal survey of all dermatology departments in the UK about usage of digital cameras. A total of 65.4% of the questionnaires were returned. The responses indicated that 71% of departments in teaching hospitals vs. 56% of departments in district general hospitals (DGH) had access to a digital camera. Reasons for not having a digital camera were satisfaction with conventional photography and lack of resources. In 48% of the departments of teaching hospitals or DGH with access to a digital camera, less than 10% of all photos were taken digitally. However, 24% of departments in DGH and 22% in teaching hospitals took more than 80% of their clinical photos digitally, indicating that in many departments digital photography is still in an early phase and only occasionally used, whilst in others a change from conventional photography towards digital photography as the mainly used technique has already taken place. Overall, the main drawbacks of digital photography were poorer resolution in comparison with conventional photography, problems with storage and filing images and time required for downloading and storing images.

Dermatology↗