Teledermatology in times of COVID‐19 Stadler, Pia‐Charlotte; Senner, Sonja; Frey, Surina ...
Journal of dermatology,
20/May , Letnik:
48, Številka:
5
Journal Article
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Remote consultations are likely to grow in importance in the following years, especially if the coronavirus disease 2019 (COVID‐19) pandemic continues. Patients’ opinions on teledermatology have ...already been analyzed, but a current analysis during the COVID‐19 pandemic is lacking. The purpose of this survey was to investigate the satisfaction of patients who had received dermatological advice via telephone during the COVID‐19 pandemic and to analyze their general opinion about eHealth as well as possible limitations for a broad implementation. Ninety‐one patients managed in the dermatology department using telephone consultation during the COVID‐19 pandemic were interviewed. An anonymous questionnaire, including the established quality of life questionnaire (Dermatology Life Quality Index DLQI), was used. It was found that men were more satisfied with telephone consultations than women (p = 0.029), educational level and age did not correlate with satisfaction (p = 0.186 and 388, respectively), and the longer the waiting time for a telephone consultation, the lower the satisfaction (p = 0.001). Grouped analysis of all participants showed that the majority (54.0% n = 38/71) were “very happy” with the telephone consultation. Higher disease burden (DLQI) was associated with lower satisfaction (p = 0.042). The main stated reasons for using telemedicine were shorter waiting times (51.6% n = 47/91) and no travel requirement (57.1% n = 47/91). Almost one‐quarter (23.1% n = 21/89) of patients would use teledermatology in the future, 17.6% (n = 16/89) would not, and 57.1% (n = 51/89) would only use it in addition to a traditional consultation with personal contact. In conclusion, most patients in the study group still preferred traditional face‐to‐face medical consultations to telephone consultations, but also desired an add‐on telemedical tool. Dermatological care using more modern telemedicine technologies than telephone conferencing is needed to better address patients’ desires, especially in times of the COVID‐19 pandemic.
Background and objectives
Ocular rosacea is a special manifestation of rosacea with unknown etiology. Eye involvement in rosacea patients is surprisingly common; however, it is often underdiagnosed, ...resulting in inappropriate treatment. We aimed to provide an updated epidemiologic perspective on ocular rosacea in Germany to improve patient care.
Patients and methods
Data of 777 rosacea patients were assessed using a detailed online questionnaire regarding ocular and skin symptoms, previous dermatological and ophthalmological consults, presence of type 1 hypersensitivities, and Demodex testing. All data were statistically analyzed.
Results
Most patients reported ocular symptoms (399/777, 51.4%), including red eyes (179/399, 44.9%), itching (187/399, 46.9%), sty or chalazion (309/399, 77.4%), and dryness (108/399, 27.1%). Ocular rosacea was confirmed in 149/309 cases who consulted an ophthalmologist (45.3%). A total of 159/399 (39.8%) had no pre‐existing allergies. Eye involvement was significantly associated with the presence of skin symptoms (P < 0.05), impacting patients' general well‐being and overall treatment satisfaction. About half of Demodex‐positive patients (21/45, 46.7%) showed ocular symptoms.
Conclusions
Eye involvement in rosacea patients was common, often presenting with unspecific symptoms.
Summary
Background and objectives: The corona pandemic affects many aspects of life – with challenges in medical treatment undoubtedly of paramount importance. However, continuing medical education ...needs to be consistently provided. During a semester with lockdown‐phases and limited student‐to‐patient‐contact availability, we supplied silicone models of primary skin lesions to every student and asked them to evaluate this teaching tool.
Methods: In two anonymous online surveys, we asked students enrolled in dermatology (n = 222) at the Medical Facility of the Ludwig Maximilian University of Munich in the winter semester 2020/2021 – subsequent to online teaching – about their understanding and self‐assessment of primary skin lesions before and after receiving silicone models for practice. The models were produced by layering different types of silicone into negative 3D printed molds made from polylactide to attain different degrees of hardness and colors.
Results: Data from 211 (95.0 %) and 213 (95.9 %) of the 222 students were analyzed before and after receiving the silicone models, respectively. In all questions the students stated a highly significant improvement in their skills (P < 0.001). The majority of students evaluated the silicone models positively and reported a better understanding and learning of primary skin lesions.
Conclusions: This study demonstrates the benefit of haptic experience in dermatology teaching not only in the time of COVID‐19, but also thereafter.
S2k guideline: Rosacea Clanner‐Engelshofen, Benjamin M.; Bernhard, Dominik; Dargatz, Sonja ...
Journal der Deutschen Dermatologischen Gesellschaft,
August 2022, 2022-08-00, 20220801, Letnik:
20, Številka:
8
Journal Article
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Summary
This updated and upgraded S2k guideline deals with the diagnosis and treatment of rosacea, which is a common, chronic inflammatory skin disease mostly affecting the face. Initially, rosacea ...is characterized by recurrent erythema, telangiectasia and flushing. Later, the inflammatory component predominates, with persistent erythema with follicular papules, papulopustules and pustules. The development of phyma, which usually occurs on the acral localizations, is the most severe manifestation. For the treatment of rosacea, the interdisciplinary guideline committee, with representatives of the German Dermatological Society (DDG), the Professional Association of German Dermatologists (BVDD), the German Opthalmological Society (DOG), the Society for Dermopharmacy (GD), the Swiss Society for Dermatology and Venereology (SGDV) and the German Rosacea Aid e. V., recommends the avoidance of trigger factors and topical applications of metronidazole, azelaic acid or ivermectin. For symptomatic treatment of persistent centrofacial erythema, the topical vasoconstrictors brimonidine or oxymetazoline can also be used. Systemic therapy is recommended for therapy‐resistant and severe forms of rosacea papulopustulosa. The drug of choice is low‐dose doxycycline. Alternatively, low‐dose isotretinoin can be recommended. Ocular rosacea should be treated with lid margin hygiene. For topical treatment, ciclosporin eye drops, azithromycin, ivermectin or metronidazole are suggested.
Demodex mites are related to some inflammatory diseases such as rosacea and blepharitis and could be harmful in patients with immunodeficiency or immunosuppression, especially notable in patients ...using biologic like dupilumab. In order to have an objective observation of different anti-Demodex strategies, we conducted this study, based on interventional clinical evidence with quantified Demodex mite data.
We used the PubMed, Embase, ClinicalTrials.gov, Medline, and International Clinical Trials Registry Platform (ICTRP) as databases. To assess the risk of bias, the RoB2 and ROBINS-I tools were used. The certainty of evidence was assessed following the GRADE guideline. Furthermore, the effect sizes (ESs) of different strategies were compared in different time periods (0-1, 1-2, 2-3, >3 months), as well as Demodex decrease rates.
1,618 studies were identified in the databases, with 21 of which included in the final quantitative synthesis. Interventions in these studies included ivermectin, tea tree oil (TTO), permethrin, crotamiton, metronidazole, light therapies, combined therapies, and other therapies. During 0-1 month, the ES varied from 0.07 (cleanser) to 1.95 (systemic ivermectin-metronidazole). During 1-2 months, the ES varied from 0.88 (topical permethrin) to 4.40 (topical ivermectin). During 2-3 months, the ES varied from 0.79 (topical permethrin) to 8.37 (topical ivermectin). During the time of 3 months, the ES varied from 0.59 (topical permethrin) to 2.25 (intense pulsed light IPL). In terms of Demodex decrease rates, topical ivermectin, TTO, permethrin, IPL, and baby shampoo had achieved a nearly 100% decrease. The reported adverse events were mostly mild, without severe adverse events reported in any of the studies.
We found ivermectin (topical and systemic), ivermectin-metronidazole (topical), and TTO (topical) are promising anti-Demodex interventions. In addition to traditional pharmacotherapy, light therapies, especially IPL and skin cleansing, could also be considered as effective methods to control Demodex mite infestation.
Background
Seborrheic keratoses (SK) are the most common acquired benign tumor that affects middle‐aged or older adults with great cosmetic concern. Clinical and histopathological similarities of SK ...and common warts have been addressed by investigating the possible presence of human papillomavirus (HPV) DNA in SK. Previous studies suggested the association between α‐genus HPV and SK located on genital skin, whereas the causal relationship between α‐HPV and non‐genital SK remains controversial.
Aim
This study aimed to clarify the pathogenic involvement of α‐HPV in the development of non‐genital SK.
Methods
We analyzed α‐HPV DNA prevalence and HPV genotypes using a PCR‐based microarray on 51 skin samples presenting with histologically confirmed SK without any malignant changes. Correlation between the histological subtype of SK and their HPV DNA‐positive reactivity was also evaluated.
Results
Of 51 non‐genital SK, two (3.9%) skin samples were positive for α‐HPV DNA; high‐risk HPV 31 and low‐risk HPV 42 were found. Evaluation of HPV prevalence in different histological types of SK showed that both HPV‐positive cases were acanthotic type; 14.3% of acanthotic SK lesions were positive, while all of the other types were negative for α‐HPV.
Conclusions
This study demonstrates that α‐HPV positivity is very rare in common non‐genital SK. The rare α‐HPV‐positive SK lesions histologically belonged to the acanthotic type, implying a potential impact of HPV infection on epidermal hyperproliferation. Although a possible association cannot be excluded, our findings suggest that α‐HPV is not a major causative factor for non‐genital SK.
Summary
Background
Rosacea is a common chronic inflammatory cutaneous disorder affecting nearly 5.5 % of the adult population. Our aim was to evaluate the prevalence and epidemiology of rosacea and ...perioral dermatitis (POD) in an ambulatory care setting.
Methods
We retrospectively analyzed medical data of patients with a confirmed diagnosis of rosacea or perioral dermatitis (POD) presenting at our university hospital outpatient clinic during a 3‐year period.
Results
Out of 1032 patients, 81.5 % were diagnosed with rosacea and 18.5 % with POD. Overall prevalence was 1.4 % for rosacea and 0.3 % for POD. 69.3 % of the analyzed patients were female. Overall mean age was 49.3 ± 7.7 (1–92) years; the women’s average age was less than the men’s. Patients with POD were younger and predominantly female, whereas patients with phymatous rosacea were older and predominantly male. The most common phenotypes were papulopustular rosacea (68.4 %), erythematotelangiectatic rosacea (22.5 %), and phymatous rosacea (8.0 %). Special forms of rosacea were diagnosed in 15.8 % of the patients; the most frequent were ocular rosacea (6.9 %) and steroid‐induced rosacea (5.4 %).
Conclusions
The large patient cohort analyzed in our study provides a good estimate of the frequency of the rosacea subtypes, special forms and of perioral dermatitis in a hospital‐based outpatient care setting.
Background
Rosacea is a common inflammatory skin disorder with centrofacial erythema, flushing, telangiectasia, papules/pustules, and possible ocular or phymatous manifestation. Patients’ skin is ...particularly sensitive to chemical and physical stimuli leading to burning, stinging, dryness, and skin tightness.
Objective
Dermatological evaluation of the efficacy and safety of skin care products designed for centrofacial erythema in rosacea patients, in comparison with a control group using objective measurements. Rosacea symptoms (itching, tension, warmth, burning, dryness) and quality of life were examined.
Methods
Sixty Caucasians with centrofacial erythema were enrolled in an 8‐week prospective study, fifty of them exclusively using the study products (micellar water, cream, and serum) with ten participants randomly assigned to a control group. Patients were evaluated at baseline (V0), at 4 weeks (V1), and at 8 weeks (V2). Three‐dimensional objective measurements (VECTRA®) as well as standardized questionnaires were used.
Results
Results were compared with the control group. A significant reduction of 16% in skin redness as indicated by VECTRA® analysis was seen in the intervention group comparing V0‐V2. Furthermore, rosacea‐associated symptoms diminished by 57.1%, while life quality of affected patients within the intervention group improved by 54.5% comparing V0‐V2, respectively.
Conclusions
A skin care regime suitable for sensitive and redness‐prone skin led to an enhanced clinical appearance, to a decrease of associated symptoms in rosacea patients, and to an improved life quality.
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