Taylor Braunberger

A systematic review of satisfaction with teledermatology.

Background The two most commonly used modalities of teledermatology (TD) are store-and-forward (SF) and live–interactive (LI) TD. Existing studies have not compared these tools with respect to patient and provider satisfaction. Objective To systematically review all published studies of patient and provider satisfaction with SF and LI TD. Methods PubMed, EMBASE, and Cochrane databases were systematically searched for studies on provider or patient satisfaction with SF or LI TD between January 2000 and June 2016. Results Forty eligible studies were identified: 32 with SF TD, 10 with LI TD, and 2 evaluating both. With SF TD, 96% of studies assessing patient satisfaction and 82% of studies assessing provider satisfaction demonstrated satisfaction (n = 24 and 17, respectively). With LI TD, 89% of studies assessing patient satisfaction and all studies assessing provider satisfaction revealed satisfaction (n = 9 and 6, respectively). Conclusion Patients and providers are satisfied with both SF and LI TD. Studies assessing satisfaction with LI have not been conducted in recent years, and have only been conducted in limited geographic patient populations. Further research assessing satisfaction with TD will help address any dissatisfaction with its uses and allow for increased support and funding of future programmes.

Minimal improvements in the global burden of skin disease from 1990 to 2013.

To the Editor: Skin disease often impairs quality of life and results in an increase in years lived with disability (YLDs). In 2010, skin diseasewas the fourth cause of nonfatal disease burden worldwide. Skin conditions ranked between the second and eleventh leading causes of YLDs globally. We investigated changes in the global burden of skin disease experienced in developed and developing countries between 1990 and 2013. We used the Institute for Health Metrics and Evaluation (IHME) reports of Leading Causes of YLDs, 1990 and 2013. The percent change in skin diseases between 1990 and 2013 was collected for each country listed. Of the 187 reported countries, we identified 47 developed countries according to the 2015 Human Development Index. The greatest improvements were seen in Portugal, with a 9% decrease in disability between 1990 and 2013. Israel, Spain, the Czech Republic, and Hungary followed the lead with a 7% decrease in YLDs. In addition, 6 of the 47 developed countries did not see any changes in YLDs from skin conditions, and 11 experienced an increase in their YLDs (Fig 1). The mean percent change seen in developed countries was a 1.85% improvement in disability (standard deviation

Disease Severity and Quality of Life Measurements in Contact Dermatitis: A Systematic Review 2005-2015.

BackgroundContact dermatitis (CD) has been assessed by numerous disease severity indices resulting in heterogeneity across published research. ObjectiveThis study aims to evaluate published CD severity scales and identify a criterion standard for assessment. MethodsScopus and Ovid MEDLINE were searched for human randomized controlled trials (RCTs) on CD severity measures published during a 10-year period. Eligible studies were English-language RCTs reporting disease severity outcome measures for CD in humans. Studies were excluded if they were duplicates, not available in English, not related to CD, not RCTs, not conducted on human subjects, or did not report relevant outcome measures. ResultsA total of 22 disease outcome measures were used in 81 included RCTs. Instrument-based measures were used in 40 (49.4%) studies, and visual assessments were used in 66 (81.5%) RCTs. Only 5 (6.2%) studies reported quality of life (QoL) outcomes. Two (2.5%) studies used a clinical severity scale, which combined both QoL and visual assessments. LimitationsThis study was limited by the exclusion of non-RCTs and gray literature. ConclusionsWide variation in CD outcome measures exists including instrument-based measures, visual assessments, and QoL outcomes. A standardized outcome measure must be generated to reduce heterogeneity.

Performance of a computer-aided digital dermoscopic image analyzer for melanoma detection in 1,076 pigmented skin lesion biopsies

Background: Digital dermoscopic image analysis of pigmented skin lesions (PSLs) has become increasingly popular, despite its unclear clinical utility. Unbiased, high‐powered studies investigating the efficacy of commercially available systems are limited. Objective: To investigate the diagnostic performance of the FotoFinder Mole‐Analyzer in assessing PSLs for cutaneous melanoma. Methods: In this 15‐year retrospective study, the histopathologies of 1076 biopsied PSLs among a total of 2500 imaged PSLs were collected. The biopsied PSLs were categorized as benign or malignant (cutaneous melanoma) based on histopathology. Analyzer scores (0‐1.00) for these PSLs were obtained and grouped according to histopathology. Results: At an optimized cutoff score of 0.50, a sensitivity of 56% and a specificity of 74% were achieved. The area under the receiver operating characteristics curve was 0.698, indicating poor accuracy as a diagnostic tool. Limitations: This study had a retrospective design and involved only a single institution. Conclusion: Our study reveals a low sensitivity of the scoring function of this digital dermoscopic image analyzer for detecting cutaneous melanomas. Physicians must apply keen clinical judgment when using such devices in the screening of suspicious PSLs.

Limb-Threatening Arterial Thrombosis in a Patient with Eosinophilic Granulomatosis with Polyangiitis

Eosinophilic granulomatosis (EGPA), or Churg-Strauss syndrome, is a rare and necrotizing systemic vasculitis, which affects small-to-medium-sized vessels and often manifests with severe asthma and eosinophilia. We report a case of a 72 year-old male with a two-year lung-biopsy proven history of EGPA who presented with retiform purpura and patchy necrosis on his bilateral shins, which progressed to sharply demarcated, stellate ulcerations with surrounding erythema within two weeks. Laboratory work up revealed elevated anti-Cardiolipin IgM, rheumatoid factor, erythrocyte sedimentation rate, and C-reactive protein, although P-neutrophil cytoplasmic antibody (P-ANCA) and C-neutrophil cytoplasmic antibody (C-ANCA) were negative. Vascular studies revealed long anterior tibial and dorsalis pedis artery occlusion and severe small vessel disease in plantar digital arteries. Despite treatment with intravenous cyclophosphamide, pulse-dose methylprednisolone, and pentoxifylline, the patient experienced disease progression and limb threatening arterial thrombosis. This case highlights the importance of vascular and neuropathic sequelae that may result from untreated or undertreated EGPA in P-ANCA-negative patients without active pulmonary symptoms.

Esophagitis Dissecans Superficialis Endoscopically Induced in a Patient With Pemphigus Vulgaris and Gastrointestinal Complaints

Esophagitis Dissecans Superficialis Endoscopically Induced in a Patient With Pemphigus Vulgaris and Gastrointestinal Complaints Pemphigus vulgaris (PV) is a rare immunobullous disorder characterized by acantholysis and intraepithelial blister formation involving the skin and mucous membranes. Esophageal involvement in pemphigus is relatively common yet often underrecognized.1 We present images in a case report of endoscope-induced esophagitis dissecans superficialis (EDS) in a patient with PV with gastrointestinal symptoms and absence of cutaneous disease.