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PubMed1986

Office-based care of dermatologic disease.

From 1974 to 1981 the number of visits to office-based physicians for dermatologic complaints remained relatively constant. During this period, dermatologists increased their share of patients with such complaints from one third to one half. As a result of the growth in the number of practicing dermatologists, the average number of visits per dermatologist fell during this period. Nearly half of all visits to dermatologists in the 1980-1981 period were for one of three diagnoses: diseases of the sebaceous glands (principally acne), warts, and skin tumors. Competition between dermatologists and other physicians for patients with these three diagnoses is likely to increase. Changes in medical practice structure, a projected increase in the number of dermatologists, and an aging population may make it difficult for dermatologists to preserve the volume of patients they currently see.

Acne Vulgaris↗

PubMed1986

National survey of dermatologists and residency training program directors on dermatology's role in treating sexually transmitted diseases.

Sexually transmitted diseases have increased in both prevalence and public concern over recent years; however, current treatment of sexually transmitted diseases remains fragmented among several specialty groups. In this study, dermatologists, who historically were the leaders in the treatment of sexually transmitted disease, were surveyed to assess their training, practice activity, and attitudes toward sexually transmitted disease. An overwhelming majority of dermatologists and training program directors stated that most sexually transmitted diseases should be treated primarily by dermatologists. Factors that restricted dermatologists' involvement in sexually transmitted diseases included inadequate public awareness of dermatology's role in treating these diseases, the limited number of direct patient visits, and limited physician referrals. This study indicates that dermatologists want to increase their role in sexually transmitted disease and favor making the public aware of their interest and ability.

Dermatology↗

PubMed1988

Survey of sterile technique used by dermatologic surgeons.

A survey was made of the sterile technique practices of dermatologists interested in dermatologic surgery. The steam autoclave is the most popular method for sterilizing surgical instruments. Dry heat sterilization is often used, as is cold, chemical sterilization. The most popular agent for chemical sterilization continues to be quaternary ammonium compounds despite warnings to the contrary. Gas sterilization is rarely used. Alcohol is the most popular agent for prepping the skin and iodophors are also quite popular. Dermatologists are now wearing gloves for most procedures. Prophylactic antibiotics are used minimally in surgical cases, as is recommended by established standards.

Dermatology↗

PubMed1988

The status of electrosurgery in dermatologic practice.

A survey was made of the electrosurgical practices of the members of the American Society of Dermatologic Surgery. Results showed that the majority prefer the traditional electrosurgical units, with the Hyfrecator (Birtcher Corp.) being by far the most popular. The most common forms of high-frequency electrosurgery are electrocoagulation and electrodesiccation. Very few dermatologists use cutting current, although many own machines with this capability. The majority do not use a strict sterile technic when performing electrosurgery. However, there appears to be an increasing awareness of contamination risks, and many dermatologists have started using disposable or sterilizable treatment electrodes. High-frequency electrosurgery is by far the most common method of electrosurgery. Electrocautery and surgical galvanism are very rarely used.

Dermatology↗

PubMed1988

Local anesthesia in dermatologic surgery.

With the growth of dermatologic surgery the appropriate use of local anesthesia is becoming an important issue. Thoughtful use of local anesthesia can improve the patient's experience and facilitate the surgical procedure. In this review we discuss historical and pharmacologic aspects of local anesthetic agents. Emphasis is placed on clinical considerations, including contraindications, toxic reactions, and detailed descriptions of anesthetic use.

Anesthesia, Local↗

PubMed1989

Nail disease and dermatology.

Onychology (the study of nails) is an important area in dermatology. We discuss the dermatologists' opportunity to educate their patients and colleagues about nail disorders, review the diagnostic techniques for evaluating nails, and describe some of the possible topics for additional research.

Biopsy↗

PubMed1994

Planning for the future: a prescription for dermatology's survival.

The specialty of dermatology has reached its current position of esteem through a combination of superior practice standards and organizational skills displayed by persons such as Clarence S. Livingood. In the next few years, as unpredictable changes occur in the health care system, our specialty, with fewer than 2% of U.S. practicing physicians, and without a significant hospital base, will face unique challenges. We must meet these by continuing to interact with organized medicine. The major focus of this article will be on who are the important players in this area and what can we expect to accomplish through collaborative and cooperative interchanges.

Certification↗

PubMed1996

Physical enhancement of dermatologic drug delivery: iontophoresis and phonophoresis.

Iontophoresis and phonophoresis are emerging technologies capable of enhancing drug penetration through the stratum corneum, the principal barrier to percutaneous absorption. With utilization of applied electric current or ultrasonic waves, respectively, iontophoresis and phonophoresis have shown efficacy in an increasing number of clinical applications. This article reviews the underlying principles, current status, and potential of iontophoresis and phonophoresis in dermatologic therapy.

Anesthetics, Local↗

PubMed1996

Evaluation of the American Academy of Dermatology's National Skin Cancer Early Detection and Screening Program.

BACKGROUND: Increasing incidence and mortality rates from cutaneous melanoma are a major public health concern. As part of a national effort to enhance early detection of melanoma/skin cancer, the American Academy of Dermatology (AAD) has sponsored an annual education and early detection program that couples provision of skin cancer information to the general public with almost 750,000 free skin cancer examinations (1985-1994). OBJECTIVE: To begin to evaluate the impact of this effort, we determined the final pathology diagnosis of persons attending the 1992-1994 programs who had a suspected melanoma at the time of examination. METHODS: We directly contacted all such persons by telephone or mail and received pathology reports from those who had a subsequent biopsy. RESULTS: We contacted 96% of the 4458 persons with such lesions among the 282,555 screenings in the 1992-1994 programs. We obtained a final diagnosis for 72%, and the positive predictive value for melanoma was 17%. Three hundred seventy-one melanomas were found in 364 persons. More than 98% had localized disease. More than 90% of the confirmed melanomas with known histology were in situ or "thin" lesions (< or = 1.50 mm thick). The median thickness of all melanomas was 0.30 mm. The 8.3% of AAD cases with advanced melanoma (metastatic disease, regional disease, or lesions > or = 1.51 mm) is a lower proportion than that reported by the 1990 Surveillance, Epidemiology and End Result Registry. The rate of thickest lesions (> or = 4 mm) and late-stage melanomas among all participants was 2.83 per 100,000 population. Of persons with a confirmed melanoma, 39% indicated (before their examination) that without the free program, they would not have considered having a physician examine their skin. CONCLUSION: The 1992-1994 free AAD programs disseminated broad skin cancer educational messages, enabled thousands to obtain a free expert skin cancer examination, and found mostly thin, localized stage 1 melanomas (usually associated with a high projected 5-year survival rate). Because biases impose possible limitations, future studies with long-term follow-up and formal control groups should determine the impact of early detection programs on melanoma mortality.

Adult↗

PubMed1997

Reliability of dermatology teleconsultations with the use of teleconferencing technology.

BACKGROUND: Recent advances in telecommunications technology allow physicians to consult on patients at a distance via an interactive video format. Few data exist as to the reliability of this form of consultation. OBJECTIVE: Our purpose was to measure the degree of concordance between a dermatologist seeing a patient in a clinic and another dermatologist seeing the same patient over a commercially available videoconferencing system. METHODS: Patients referred to a general dermatology clinic were seen by both a "live" dermatologist and a "teledermatologist" via a T1 connection. Diagnosis and recommendations were recorded by both physicians and compared. The physicians were also asked to rate the degree of confidence they had in their diagnosis. RESULTS: Seventy-nine diagnoses were made on 60 patients. The two physicians were in absolute agreement on 61 of the diagnoses (77.2%). Race or sex of the patient, nature of the skin problems, or which of the two physicians was the teledermatologist did not statistically correlate with the concordance of the two physicians. CONCLUSION: There was a reasonable degree of agreement between the two examining physicians. Despite the relatively high degree of concordance the teledermatologist had a significantly lower degree of confidence in his diagnoses.

Adolescent↗

PubMed1999

The uses of digital photography in dermatology.

Digital photography is a powerful tool that is transforming the specialty of dermatology by integrating patient and practice management. The fundamentals of digital imaging are discussed, and an approach to the selection of a digital camera and its associated hardware and software is provided. The applications of this technology to patient and practice management are addressed, and the ethical implications of digital tampering are also discussed.

Dermatology↗

PubMed1999

Participant satisfaction and value in American Academy of Dermatology and American Cancer Society skin cancer screening programs in Massachusetts.

BACKGROUND: More than 1 million Americans have attended the American Academy of Dermatology's Melanoma/Skin Cancer Screening Programs since 1985. However, there have been no reports of the participants' perceived value, satisfaction, and benefits of skin cancer screening. OBJECTIVE: We attempted to measure the benefits and subsequent screening practices of persons with presumptive positive screening diagnoses. METHODS: A self-administered questionnaire was sent to participants with positive screening diagnoses in Massachusetts. RESULTS: Of the 643 respondents, 81% rated their satisfaction as high and 84% had similar ratings for the value of the screening. Screenings apparently led to an increase in self-screening (60% before screening compared with 84% after screening). CONCLUSION: Although screening appears to have relatively strong benefits, further studies should be conducted nationally.

Adult↗

PubMed1999

New drugs in veterinary dermatology.

This article discusses several different new drugs currently being used in dermatology. Most of the drugs discussed showed some promise as being a useful therapy in veterinary medicine, but a few have questionable efficacy (nonsedating antihistamines). The majority of these drugs have not had any pharmacokinetic or clinical trials conducted on them in small animals. Hopefully, in the future, more studies are funded so that we can determine the clinical therapeutical efficacy and appropriate doses for these drugs.

Animals↗

PubMed2002

An evaluation of direct orthogonal signal correction and other preprocessing methods for the classification of clinical study lots of a dermatological cream.

Different preprocessing methods (direct orthogonal signal correction (DOSC), standard normal variate (SNV), multiple scatter correction (MSC), first and second derivation, offset correction and detrend correction) are applied to two sets of NIR spectra of a dermatological cream with different concentrations of an active compound. The influence of these preprocessing methods on the classification of the samples into the right concentration class is evaluated using 1 and 3 nearest neighbour method (with Euclidean distance and correlation coefficient as distance parameters) as classification method. PLS and PCR modelling are also used to make a prediction of the concentration of the active compound. The direct orthogonal signal correction gives best results in most of the classification methods.

Dermatologic Agents↗

PubMed1998

Immunosuppressive agents in dermatology. An update.

Azathioprine, cyclophosphamide, methotrexate, and cyclosporine are the immunosuppressive agents most commonly used by dermatologists. Azathioprine has a relatively good safety profile and is therefore often preferred for the treatment of chronic eczematous dermatitides and bullous disorders. Awareness of the role of genetic polymorphisms in its metabolism can increase the efficacy and safety of this drug. Cyclophosphamide is an antimetabolite that has a more rapid onset of immunosuppressive effect than azathioprine, but has significant short-term and long-term toxicity. It is of use in fulminant, life-threatening cutaneous disease. Methotrexate is an antimetabolite that has significant anti-inflammatory activity. Despite its hepatotoxicity, its role in inflammatory dermatoses is broadening. Likewise, the role of cyclosporine is being expanded. This drug has potent T-cell inhibitory effects secondary to interference with intracellular signal transduction. Given the evidence for cumulative renal toxicity, it currently has a role in the short-term treatment of refractory psoriasis and atopic dermatitis, as well as in select inflammatory dermatoses. Familiarity with disease-specific clinical efficacy, side-effect profile, and dosage allows the successful and judicious use of these drugs in dermatologic disorders.

Azathioprine↗

PubMed1998

Interferons in dermatology. Present-day standard.

Since the first clinical trials in the early 1980s with recombinant interferon, it was possible to show for a variety of indications that cytokines, especially interferons, at certain doses and at respective intervals, when applied in combination with other pharmaceutical compounds open new powerful therapeutic possibilities. Worldwide, recombinant interferon is licensed, especially in dermato-oncology, for the indication of HIV-associated Kaposi's sarcoma, cutaneous T-cell lymphoma, and recently for adjuvant therapy of high-risk malignant melanoma. Recombinant interferon is at present not licensed for dermatologic indication (septic granulomatosis). At the end of our century the indication spectrum for interferons as monotherapy and as combination therapy will undoubtedly be extended. Larger and controlled studies will prove the importance of interferons in dermato-oncology as well as in inflammatory and infectious dermatoses. The combination of interferons with standard therapies will surely be of the utmost importance in dermatotherapy.

Clinical Trials as Topic↗

PubMed1999

Advanced laboratory techniques at the Armed Forces Institute of Pathology applicable to diagnosis and research in dermatology.

The Armed Forces Institute of Pathology (AFIP) is well known for providing expert pathology in many specialties and educational courses for civilian and military personnel. Some of the departments at the AFIP have also developed expertise in various advanced laboratory techniques for diagnosis and research that are applicable to dermatology and are not available at most medical centers.

Dermatology↗

PubMed2000

Dermatology in the developing world. Needs and solutions.

Dermatologists, who have assets far in excess of most of the people of the world, have the opportunity to contribute globally to the forces of social progress. This article addresses the dermatologic needs of the developing world and discusses how the needs of these areas, including rural areas in the United States, should be addressed.

Dermatology↗