Alexander L. Fogel

Advances in the therapeutic use of mammalian target of rapamycin (mTOR) inhibitors in dermatology

Significant developments in the use of mammalian target of rapamycin (mTOR) inhibitors (mTORIs) as immunosuppressant and antiproliferative agents have been made. Recent advances in the understanding of the mTOR signaling pathway and its downstream effects on tumorigenesis and vascular proliferation have broadened the clinical applications of mTORIs in many challenging disorders such as tuberous sclerosis complex, pachyonychia congenita, complex vascular anomalies, and inflammatory dermatoses. Systemic mTORI therapy has shown benefits in these areas, but is associated with significant side effects that sometimes necessitate drug holidays. To mitigate the side effects of systemic mTORIs for dermatologic applications, preliminary work to assess the potential of percutaneous therapy has been performed, and the evidence suggests that percutaneous delivery of mTORIs may allow for effective long-term therapy while avoiding systemic toxicities. Additional large placebo-controlled, double-blinded, randomized studies are needed to assess the efficacy, safety, duration, and tolerability of topical treatments. The objective of this review is to provide updated information on the novel use of mTORIs in the management of many cutaneous disorders.

Digital medicine's march on chronic disease

Digital medicine offers the possibility of continuous monitoring, behavior modification and personalized interventions at low cost, potentially easing the burden of chronic disease in cost-constrained healthcare systems.

A survey of direct-to-consumer teledermatology services available to US patients: Explosive growth, opportunities and controversy.

Introduction Direct-to-consumer (DTC) teledermatology is radically changing the way patients obtain dermatological care. Now, with a few clicks, patients can obtain dermatological consultations and prescription medications without a prior physician-patient relationship. To analyse all DTC teledermatology services available to US patients. Methods We performed Internet searches to identify DTC teledermatology services available through Internet webpages or through smartphone applications. For each service, the scope of care provided, cost, wait times, prescription policies and other relevant information were recorded. Results Twenty-two DTC teledermatology services are available to US patients in 45 states. Six (27%) services offer care from international physicians. Sixteen (73%) services allow patients to seek care for any reason, while six (27%) limit care to acne or anti-aging. The median reported response time for DTC teledermatology services is 48 hours from the time of patient request. The median consultation fee for companies providing care from US board-certified physicians is US

mHealth advances clinical research, bit by bit

59. Across all services, consultation fees range from US

Genetic diseases associated with an increased risk of skin cancer development in childhood

1.59 to US

Social Media Use in Pediatric Dermatology.

250. Conclusions DTC teledermatology services are readily available to patients in most states. These services may reduce the cost of patient visits, expand access to care and increase patient convenience. However, the presence of services staffed by physicians who are not US board-certified, as well as the use of incautious language regarding prescription medications, is concerning.

Medicaid acceptance among pediatric dermatologists

Monitoring the symptoms of a large cohort of asthma patients is made possible by a smartphone app created using Apple ResearchKit.

Collagen Vascular Diseases

Purpose of review Childhood skin cancers are relatively rare and may indicate an underlying genetic disorder. The increasing elucidation of genetic pathways is changing the diagnosis and management of genetic skin cancer susceptibility syndromes. In this review, we provide an overview of genetic conditions that predispose to skin cancer development in childhood and signs that providers should assess when evaluating affected individuals. Recent findings In basal cell nevus syndrome (BCNS), the patched2 (PTCH2) and suppressor of fused (SUFU) genes have been implicated in disease pathogenesis. The sonic hedgehog (SHH) pathway inhibitor vismodegib was shown in a placebo-controlled phase III randomized trial to reduce the tumor burden in patients with BCNS. Epidermolysis bullosa (EB) has been classified into four major types and more than 30 subtypes based partly on specific mutations, and best clinical practice guidelines for the management of cutaneous squamous cell carcinoma in EB have been developed. Oculocutaneous albinism (OCA) has been associated with new mutations in genes named OCA5, OCA6, and OCA7, bringing to the total number of culprit genes to seven (OCA1–OCA7). Summary Advances in our understanding of genetic conditions that predispose to childhood skin cancer include new disease classification systems, management guidelines, and treatment options.

Factors influencing and modifying the decision to pursue genetic testing for skin cancer risk

Social media is predicted to become increasingly important in dermatology because of its potential to serve as a platform for public health campaigns, aid in participant recruitment for clinical trials, increase public engagement in health care, and facilitate scientific discourse. No study of social media use in pediatric dermatology has been performed, so we analyzed the use of the seven leading social media platforms in pediatric dermatology, with a focus on patient advocacy groups, professional societies, research journals, and research institutions. We observed that 89% of patient advocacy groups, 100% of professional societies, 62.5% of research journals, and 0% of academic pediatric dermatology departments maintained one or more social media accounts. Our observations suggest that all stakeholder groups, and in particular members of the research community, have the potential to further their engagement, connections, and communications through social media.

Benefits and Risks of Machine Learning Decision Support Systems

a small, but significant, 2% decrease in risk on NMSC (P 1⁄4 .010). In this large cohort of older Caucasian women, we observed lower odds of both melanoma and NMSC among current smokers compared with lifelong nonsmokers. These results corroborate previous research suggesting an inverse relationship between cigarette smoking and melanoma while differing from null findings of past studies. An inverse relationship of smoking to skin cancer seems counterintuitive, given smoking’s positive association with many other cancers; however, this relationship persisted despite controlling for age, education, alcohol use, sun-exposure variables, and other potential confounders. One explanation for the lower odds of MM and NMSC in current smokers could be that ‘‘cancer-prone’’ individuals may succumb to other cancers at an earlier age than required for developingMM andNMSC and this fact maymask or skew the true rate of skin cancers in smokers (if all would have survived). We hypothesize that the observed lower skin cancer risk in smokers may be caused by detection bias related to lower screening for skin cancer in smokers. In fact, current smokers in the Women’s Health Initiative are less likely to have medical insurance and are less likely to see physicians for cancer screening. Fewer current smokers ever had a mammogram (78% smokers vs 93% never smokers, respectively) or colonoscopy (46% of current smokers vs 56% of never smokers) (P value\ .0001), similar to past studies on colorectal screening rates. Current smokers had lower rates of screening compared with never and past smokers despite having a current care provider and having insurance. In conclusion, smoking does not increase risk of skin cancer. Current smokers are associated with a lower risk of MM andNMSC possibly as a result of detection bias related to lower screening for skin cancer in smokers.