Fan Di Xia

Diversity in Dermatology Clinical Trials: A Systematic Review

Importance Though there have been significant shifts in US demographic data over the past 50 years, research cohorts lack full racial and ethnic representation. There is little data available regarding the diversity of dermatology research cohorts with respect to sex, race, and ethnicity. Objective To characterize and assess the representation of racial and ethnic minorities and women in randomized controlled trials across a range of dermatologic conditions. Evidence Review All randomized clinical trials (RCTs) were identified between July 2010 and July 2015 within the PubMed database using the following keywords: “psoriasis,” “atopic dermatitis,” “acne,” “vitiligo,” “seborrheic dermatitis,” “alopecia areata,” and “lichen planus.” Diverse study populations were defined as including a greater than 20% racial or ethnic minority participants based on US census data. The distributions of sex and race groups in studies were compared by journal type, disease type, and funding source. Findings Of the 626 articles reporting RCTs included in this analysis, 532 (85.0%) reported the sex of study participants. Overall, 52 of 626 international (11.3%) studies and 58 of 97 studies (59.8%) conducted exclusively within the United States reported on the racial or ethnic demographics of study participants. Across all RCTs exclusively recruited within the United States that reported race, 74.4% of study participants were white. Disease type was significantly associated with the degree of racial diversity (P < .001) within a study cohort: 30.0% of US-based psoriasis had more than 20% racially or ethnically diverse research participants as compared with 73.9% of acne studies and 91.7% of eczema studies. Conclusion and Relevance Dermatologic clinical trials within the United States reflect the growing diversity of the US population. Reporting of both sex and racial/ethnic diversity of research cohorts is still lacking, especially among studies conducted outside of the United States.

Outcomes of Early Dermatology Consultation for Inpatients Diagnosed With Cellulitis

Importance Many inflammatory skin dermatoses mimic cellulitis (pseudocellulitis) and are treated with antibiotics and/or hospitalization, leading to unnecessary patient morbidity and substantial health care spending. Objective To evaluate the impact of early dermatology consultation on clinical and economic outcomes associated with misdiagnosed cellulitis. Design, Setting, and Participants This prospective cohort study enrolled patients with presumed diagnosis of cellulitis in the emergency department, in the emergency department observation unit, or within 24 hours of admission to an inpatient unit of a large urban teaching hospital between February and September 2017. Patients were provided with telephone and clinic follow-up during the 30-day postdischarge period. We screened 165 patients with the primary concern of cellulitis. Of these, we excluded 44 who required antibiotics for cutaneous, soft-tissue, and deeper-tissue and/or bone infections irrespective of cellulitis status, and 5 who were scheduled to be discharged by the emergency department. Interventions Early dermatology consultation for presumed cellulitis. Main Outcomes and Measures Primary outcomes were patient disposition and rates of antibiotic use. Results Of 116 patients (63 [54.3%] women; 91 [78.4%] non-Hispanic white; mean [SD] age, 58.4 [19.1] years), 39 (33.6%) were diagnosed with pseudocellulitis by dermatologists. Of these, 34 (87.2%) had started using antibiotics for presumed cellulitis as prescribed by the primary team at the time of enrollment. The dermatology team recommended antibiotic discontinuation in 28 of 34 patients (82.4%), and antibiotics were stopped in 26 of 28 cases (92.9%). The dermatologists also recommended discharge from planned observation or inpatient admission in 20 of 39 patients with pseudocellulitis (51.3%), and the primary team acted on this recommendation in 17 of 20 cases (85.0%). No patients diagnosed with pseudocellulitis experienced worsening condition after discharge based on phone and clinic follow-up (30 of 39 [76.9%] follow-up rate). Extrapolating the impact of dermatology consultation for presumed cellulitis nationally, we estimate 97 000 to 256 000 avoided hospitalization days, 34 000 to 91 000 patients avoiding unnecessary antibiotic exposure, and

Generational Influence on Patient Learning Preferences in Dermatology

80 million to

Estimated Cost of Emergency Sunburn Visits—Validation of ICD-9-CM Search Criteria

210 million in net cost savings annually. Conclusions and Relevance Early consultation by dermatologists for patients with presumed cellulitis represents a cost-effective intervention to improve health-related outcomes through the reduction of inappropriate antibiotic use and hospitalization.

Cost of Routine Herpes Simplex Virus Infection Visits to U.S. Emergency Departments 2006-2013

REFERENCES 1. Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev. 2004;17:863-893. 2. Storr J, Twyman A, Zingg W, et al. Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations. Antimicrob Resist Infect Control. 2017;6:6. 3. Hoarau G, Mukherjee PK, Gower-Rousseau C, et al. Bacteriome and mycobiome interactions underscore microbial dysbiosis in familial Crohn’s disease. MBio. 2016;7. 4. Berardesca E, European Group for Efficacy Measurements on Cosmetics and Other Topical Products. EEMCO guidance for the assessment of stratum corneum hydration: electrical methods. Skin Res Technol. 1997;3:126-132. 5. Zapka C, Leff J, Henley J, et al. Comparison of standard culture-based method to culture-independent method for evaluation of hygiene effects on the hand microbiome. MBio. 2017;8.

Development and pilot-testing of the Alopecia Areata Assessment Tool (ALTO)

expected and have been supported by the work of others.3 It was not our intention to promote immunohistochemical staining of melanoma in situ. As Rodic and Glusac point out, survival for patients diagnosed with melanoma in situ essentially matches that of healthy individuals. Given the extremely small tumor burden in the cases with occult invasion, a similar survival curve could be expected. This lack of prognostic utility, on a large scale, argues against an exhaustive search for microinvasion. It is also impractical and cost-ineffective to stain all melanoma in situ cases with melan-A. Our findings simply serve as a proof of principle that, owing to the innate limitations of routine histologic examination, a diagnosis of melanoma in situ does not always exclude invasion. Perhaps a comparable scenario would be the finding of isolated melanoma cells in sentinel lymph nodes by immunohistochemicalanalysis.Whiletheclinicalsignificanceremainsasubjectofdebate,mostlaboratoriesroutinelyperformimmunostains on melanoma sentinel lymph nodes, and it is not uncommon to identify tumor cells that are otherwise not detected on H&E.4 The ultimate goal of our study was to raise awareness of the extremely low (but not zero) risk of metastasizing melanoma in situ by providing plausible mechanisms for this rare phenomenon. Given the current evidence, we respectfully argue that the concern for metastasis is not totally unwarranted, and that telling the patients they are absolutely cured without educating and monitoring them for the very low risk of metastasis may in fact be doing them a disservice.

The ALT-70 Predictive Model Outperforms Thermal Imaging for the Diagnosis of Lower Extremity Cellulitis: A Prospective Evaluation

Introduction Little is known about emergency department (ED) utilization for herpes simplex viruses (HSV) types 1 and 2 in the United States. Our goal was to determine the utilization and cost burden associated with HSV infection visits to U.S. EDs in recent years from 2006–2013. Methods We analyzed the Nationwide Emergency Department Sample (NEDS) database, the largest national database of hospital-based ED visits in the U.S., to determine the number of visits and the cost associated with HSV visits from 2006–2013. We also analyzed trends across years. Results From 2006–2013, there were 704,728 ED visits with a primary diagnosis of HSV infection. Of these, 658,805 (93.5%) resulted in routine discharges without inpatient admission, amounting to a total ED charge of

Local radiation and phototherapy most cost-effective treatments for stage IA mycosis fungoides: a comparative decision-analysis model in the United States

543.0 million. After adjusting for inflation, there was a doubling of total ED spending for HSV from 2006 to 2013 (

Factors Influencing Patient Decisions Regarding Treatments for Skin Growths: A Cross-Sectional Study

45.0 million to

Low risk of hemorrhagic complications after obtaining diagnostic skin biopsy specimens in a cohort of thrombocytopenic inpatients

90.7 million) and a 24% increase in number of visits (73,227 visits in 2006, vs. 90,627 visits in 2013). ED visits for genital herpes have increased while visits for herpes gingivostomatitis have decreased. Conclusion HSV-associated ED use and associated costs have increased between 2006–2013. Most of these cases could likely be managed in non-emergent outpatient settings as 93.5% of visits resulted in routine discharges without admission. Our findings add to knowledge regarding HSV utilization and epidemiology in the U.S. and highlight the need for continued prevention, patient education, and emphasis of care in non-emergency settings to prevent unnecessary ED utilization.