Ryan G. Gamble

Collodion baby: An update with a focus on practical management

Collodion baby is an uncommon clinical presentation of several genetic conditions, primarily disorders of cornification. The severely compromised epidermal barrier presents the greatest challenge during the newborn period and advances in neonatal care have significantly improved the prognosis. This review summarizes the clinical characteristics, complications, outcomes, and differential diagnosis of the collodion baby. A practical approach to management based on the literature and clinical experience is presented.

Nonmelanoma Skin Cancer Chemoprevention

&NA; The authors have indicated no significant interest with commercial supporters.

Sun damage in ultraviolet photographs correlates with phenotypic melanoma risk factors in 12-year-old children

BACKGROUND Ultraviolet (UV) photography has been used to motivate sun safety in behavioral interventions. The relationship between sun damage shown in UV photographs and melanoma risk has not been systematically investigated. OBJECTIVE To examine the relationship between severity of sun damage in UV photographs and phenotypic melanoma risk factors in children. METHODS UV, standard visible and cross-polarized photographs were recorded for 585 children. Computer software quantified sun damage. Full-body nevus counts, skin color by colorimetry, facial freckling, hair and eye color were collected in skin examinations. Demographic data were collected in telephone interviews of parents. RESULTS Among 12-year-old children, sun damage shown in UV photographs correlated with phenotypic melanoma risk factors. Sun damage was greatest for children who were non-Hispanic white and those who had red hair, blue eyes, increased facial freckling, light skin and greater number of nevi (all P values < .001). Results were similar for standard visible and cross-polarized photographs. Freckling was the strongest predictor of sun damage in visible and UV photographs. All other phenotypic melanoma risk factors were also predictors for the UV photographs. LIMITATIONS Differences in software algorithms used to score the photographs could produce different results. CONCLUSION UV photographs portray more sun damage in children with higher risk for melanoma based on phenotype. Therefore sun protection interventions targeting those with greater sun damage on UV photographs will target those at higher melanoma risk. This study establishes reference ranges dermatologists can use to assess sun damage in their pediatric patients.

Internet social networking sites and the future of dermatology journals: Promises and perils

To the Editor: As society increasingly connects through social networking sites, unique interactions occur between healthcare professionals and the public that raise new issues regarding privacy, liability, communication, and marketing. This study focused on the role of dermatologists and dermatology journals on Facebook, YouTube, and Twitter. Between September 29 and October 13, 2010, one senior medical student (A. H.) searched YouTube (http://www.youtube.com) videos using the keywords ‘‘acne,’’ ‘‘warts,’’ ‘‘psoriasis,’’ and ‘‘melanoma,’’ Twitter (http://www.twitter.com) accounts using the keywords ‘‘derm’’ and ‘‘dermatology’’ as well as Facebook (http://www.facebook.com) pages using the keywords ‘‘dermatology,’’ ‘‘psoriasis,’’ ‘‘acne,’’ and ‘‘melanoma.’’ Results were updated by a second senior medical student (R. G. G.) on April 4 and 5, 2011 and discrepancies were resolved by consensus. Search terms were selected to represent a commonly searched term (acne, warts, psoriasis) and areas of high clinical importance (melanoma). The authors

Imiquimod vs Cryotherapy for Molluscum Contagiosum: A Randomized Controlled Trial

Ryan G. Gamble, MD; Kathryn F. Echols, BSA; Robert P. Dellavalle, MD, PhD, MSPH; Department of Dermatology, School of Medicine (Drs Gamble and Dellavalle), and Department of Epidemiology, Colorado School of Public Health (Dr Dellavalle), University of Colorado Denver, Aurora; and Department of Dermatology, Denver Veterans Administration Hospital, Denver, Colorado (Dr Dellavalle). Ms Echols was a medical student at the School of Medicine, Medical College of Georgia, Augusta.

Tanning and Sun-Protection Portrayal in Magazine Images

E xposure to UV radiation is the most common environmental risk factor for the development of melanoma and nonmelanoma skin cancer. It has also been established that cutaneous melanoma is correlated with number of lifetime sunburns. While adults and adolescents have become more aware of this link, tanning remains prevalent, and use of effective sun protection remains low in the United States, particularly among young women. Previous studies of magazine images have come to contradictory conclusions regarding younger models and portrayal of tanned skin and use of sun protection.

Online videos to promote sun safety: results of a contest

Seventy-percent of Americans search health information online, half of whom access medical content on social media websites. In spite of this broad usage, the medical community underutilizes social media to distribute preventive health information. This project aimed to highlight the promise of social media for delivering skin cancer prevention messaging by hosting and quantifying the impact of an online video contest. In 2010 and 2011, we solicited video submissions and searched existing YouTube videos. Three finalists were selected and ranked. Winners were announced at national dermatology meetings and publicized via a contest website. Afterwards, YouTube view counts were monitored. No increase in video viewing frequency was observed following the 2010 or 2011 contest. This contest successfully identified exemplary online sun safety videos; however, increased viewership remains to be seen. Social media offers a promising outlet for preventive health messaging. Future efforts must explore strategies for enhancing viewership of online content.

Dermatology information on the Internet: An appraisal by dermatologists and dermatology residents

To the Editor: Patients increasingly seek health information on the World Wide Web both for personal knowledge and to facilitate patientephysician discussion at the timeofmedical consultation. In January 2008, approximately 44% of all health-related Web site traffic was on pages found via search engines, an increase of 3% in health-related traffic share from the previous year. Google.com received the greatest portion of this Internet traffic. The Internet provides an easily accessible forum through which health information, with varying accuracy, can be spread. This holds especially true with the development of Web 2.0, which is comprised of Web sites that are geared toward the facilitation of communication between Internet users (Wikipedia, blogs, etc). We sought to assess the content, accuracy, and quality of dermatologic health information on the Internet. The top three Web sites found through a query of the top eight dermatologic diagnoses using Google were analyzed by six board-certified dermatologists and three dermatology residents for accuracy, content, and completeness. Each Web site was given a positive, neutral, or negative rating according to the evaluators’ overall impression of the Web site, the accuracy of its disease description, treatment description, and photographic depiction, and its user-friendliness. Web sites were also categorized according to target audience, sponsorship or affiliation, number of languages, presence of reliability certification (ie, Health on the Net Foundation), and types and extent of consumer advertising. FlescheKincaid grade levels for readability were calculated for all Web sites using Microsoft Office Word software (Microsoft; Redmond, WA). Twenty-four Web sites were found by searching for the top eight dermatologic diagnoses on the search engine Google. There were no duplicate Web sites or broken links among the returned search results. Common Internet domains included: Wikipedia.org (8 Web sites), MayoClinic.com (2), and MedicineNet.com (2). Six additional Web sites were represented by dermatology-specific organizations (one each from AOCD.org, SkinCarePhysicians.com, SkinCancer.org, Psoriasis.org, Acne.org, and Acne.com), and five additional Web sites were represented by organizations with a general medical focus (one each from WebMD.com, eMedicine.com, Medline [NIH.gov], FamilyDoctor.org, andMerck.com). One Web site (About.com) was not specifically healthrelated. No Web sites were excluded. Dermatologists and dermatology residents rated dermatology Web sites found through Google as generally accurate (Table I). Importantly, Web 2.0 Web sites that were evaluated were found to be generally equal in accuracy and completeness to their noneWeb 2.0 counterparts. Furthermore, each Web site was categorized according to the various criteria mentioned above (Table II). Web sites found through Google are generally targeted for a lay patient audience, represent a wide variety of types of sponsorships and affiliations (Web 2.0 developments being the most common), have a number of language translations, possess some version of health reliability certification, and contain a fair amount of advertising. In general, however, Web sites had a FlescheKincaid grade level well above the recommended sixth grade level. While Internet resources regarding health information are subject to misinformation, dermatologic Web sites are relatively accurate and complete according to dermatologists and dermatology residents. However, our findings also suggest that Internet-based information may be too difficult for comprehension by a substantial portion of the patient population. Patients who want to know more about specific dermatologic conditions may benefit seeking information from reliable Web sites found through Google.com.

Impact of Ultraviolet Photography on Sun Safety Practices of Snow Sport Industry Conference Attendees

Studies have established ultraviolet (UV) exposure with increased melanoma skin cancer risk. The combination of UV exposure, high altitude, and reflection of UV rays on the snow may create a particularly relevant and high-risk population amongst those who participate in snow sports. The current study aims to determine the effectiveness of a UV-photography and personalized counseling-based intervention to improve sun protection awareness on the snow sport enthusiast population. Participants were recruited at the 2013 SnowSports Industries American (SIA) Snow Show in Denver to complete a 14 question pre-survey assessing sun-safety awareness followed by a Faraghan Medical Elise Digital UV Camera photograph of their face and counseling regarding individual results. Participants were contacted one to two months later by telephone to complete a ten question post-survey. Forty-one percent of participants (46/112) completed both pre- and post-surveys. The UV photography based intervention influenced the opinions and behaviors of sun protection in 78% of male and 62% of female participants with sunscreen use identified as the most frequently modified behavior (53%). While valid barriers to UV photography use include a current lack of reimbursement and lack of public knowledge of its utility, our study indicates the potential impact of UV photography-based interventions among high-risk populations who avidly participate in snow sports.

Dermatologists wearing white coats on practice websites: current trends.

Physicians wearing white coats are perceived as having more authority, being more friendly and being more attractive than those not wearing white coats, and patients report that they prefer their dermatologist to wear a white coat. The aim of the study was to determine the prevalence of dermatologists wearing white coats on practice websites. We searched Google for dermatology practice websites in six states representing distinct geographic regions in the United States. The first one hundred search results were evaluated, and photographs of dermatologists on these websites were examined for the presence or absence of white coats. Most (77%) of dermatologists did not wear white coats. The highest prevalence was in the eastern states of Massachusetts and South Carolina, with 29% and 39%, respectively. Colorado had the lowest rate at 13%. Rates were essentially equal when segmented by gender. Although patients report that they prefer their dermatologist to wear a white coat, dermatologists often do not wear a white coat on their practice websites.