Management of vitiligo patients and attitude of dermatologists towards vitiligo

As vitiligo does not cause any physical impairment, it is often considered unimportant by physicians. Vitiligo patients repeatedly experience disinterest from the medical world regarding their skin problem. A questionnaire survey was used to assess the management of vitiligo patients and the attitude of dermatologists towards vitiligo in Belgium. Vitiligo patients (n = 244) visiting an academic affiliated dermatology department were included and 454 out of 558 Belgian dermatologists returned a mailed questionnaire. Vitiligo patients do not often visit a doctor concerning their disease and do not often treat their disease. Disease severity as reported by the patient is correlated with the number of doctor visits (p = 0.001) but not to treatment of the disease. Information about the treatment and physician's encouragement to treat seem important in motivating patients to treat their vitiligo, but 50% of the patients were not adequately informed about their disease and its treatment during their first doctor visit. Today, nearly all the dermatologists report widely informing their patients, but only 36% of them encourage their patients to treat their disease, being pessimistic concerning expected treatment results. Interestingly, two thirds of the patients who ever treated their disease find it worthwhile.     

The incidence of erythroderma: a survey among all dermatologists in The Netherlands

BACKGROUND: Erythroderma is a rare skin disorder, and studies on its incidence and causes are lacking. The annual incidence has been estimated to be 1 to 2 patients per 100,000 inhabitants. OBJECTIVE: We investigated the incidence and cause of erythroderma in an unselected population and evaluated the referral pattern of erythrodermic patients by nonacademic dermatologists. METHODS: A survey was performed among all nonacademic dermatologists in The Netherlands, using a mailed questionnaire. Questions dealt with the number of patients diagnosed with erythroderma in the year 1997, the cause of the erythroderma, and whether these patients were referred to a university hospital. A questionnaire was also sent to all university hospitals. RESULTS: Seventy-eight percent of the nonacademic dermatologists answered the questionnaire, and all 8 university hospitals responded. In the year 1997, 141 patients were diagnosed with erythroderma in The Netherlands. The annual incidence of erythroderma based on these figures is 0.9 patients per 100,000 inhabitants. Compared with the university hospitals, erythroderma was more often diagnosed as an exacerbation of preexisting dermatoses (61% vs 51%; P =.37) and less often as idiopathic (14% vs 31%; P =.04) among the nonacademic dermatologists. Cutaneous T-cell lymphoma was rarely the cause, occurring in only 1% of patients diagnosed by the nonacademic dermatologists but in 6% of patients at the university hospitals. Overall, only 37% of nonacademic dermatologists referred patients with erythroderma to a university hospital. CONCLUSIONS: The incidence of erythroderma in The Netherlands is slightly lower than the earlier estimate in the literature. Moreover, the cause of erythroderma is different among patients diagnosed in an academic and a nonacademic setting. The majority of dermatologists in The Netherlands treat patients with erythroderma themselves and do not refer these patients to university hospitals.     

A survey of vitiligo management among dermatologists in Saudi Arabia

Background  There are concerns that there is no uniform approach towards the management of vitiligo.
Objectives  To explore attitudes and strategies for the management of vitiligo among dermatologists.
Methods  A self-administered questionnaire containing 22 questions was distributed to 160 dermatologists attending a national dermatology conference in 2007.
Results  One hundred and twelve dermatologists responded to the questionnaire (70% response rate). We had 105 completed questionnaires (seven were excluded due to incompleteness). Active treatment of vitiligo was recommended by 96% in more than half of patients, while 79% recommended treatment at non-visible sites. Repigmentation was regarded as main treatment goal by 54%. Mid-potent topical steroids were widely prescribed for focal vitiligo (72% in children and 65% in adults). Use of tacrolimus and pimecrolimus was limited. The most common used phototherapy was 'narrowband ultraviolet B' (NBUVB; 36% and 40% for generaliased vitiligo in children and adults, respectively). The use of oral psoralen plus UVA (PUVA) was limited (8% for generalized vitiligo in adults). Few respondents (1–8% for different types of vitiligo) prescribed outdoor topical PUVA. Vitiligo surgery was advised mainly for segmental type (18% in adults and 5% in children). Depigmentation was the first option for universal vitiligo by 50% and 30% in adults and children, respectively.
Conclusions  Most dermatologists are enthusiastic about active treatment of vitiligo even in hidden sites. Overall, the most two common treatment modalities were topical steroids and NBUVB. Vitiligo surgery is underutilized. Development of national practice guidelines is needed.     

Dermatologic care of institutionalized elderly patients: a survey among dermatologists in the Netherlands

Background

dermatologists are expected to be increasingly confronted with institutionalized elderly patients, due to the rapidly ageing world population.

Objective

to determine the proportion of dermatologists visiting patients in nursing homes, together with the reasons for consultation, barriers to perform these visits and diagnostic and treatment patterns.

Materials and Methods

a web-based questionnaire regarding dermatologic care in nursing home patients was developed by a multidisciplinary group of dermatologists, residents and elderly care physicians. A cover letter containing a link to the final questionnaire was sent by e-mail to all 661 dermatologists and dermatology residents in the Netherlands.

Results

a total of 130 eligible questionnaires were returned (19.7%). Most respondents (79.2%) never had contact with an elderly care physician concerning a nursing home patient. However, only 30.0% of the respondents ever visited a patient within a nursing home. The most common reasons for nursing home visits were cutaneous (pre)malignancies (51.4%), eczema/dermatitis (25.7%) and (pressure) ulcers (8.6%). The most important barriers mentioned to perform nursing home visits were a lack of time and indistinct and/or inadequate financial compensation. Diagnostic and treatment patterns often differed from the outpatient clinic due to various patient-related and logistic factors.

Conclusions

dermatologists are frequently confronted with nursing home patients but only a minority visits patients within nursing homes. Lack of time and/or financial compensation seem important barriers.

     

Results of a cosmetovigilance survey in The Netherlands

Background. Cosmetic products contribute considerably to the incidence of contact dermatitis. In response to a resolution of the Council of Europe, the National Institute for Public Health and the Environment (RIVM) in The Netherlands set up a pilot project to report undesirable effects attributed to cosmetic products. Objectives. To provide an overview of undesirable effects attributed to cosmetic products and to identify the ingredients involved. The information could contribute to the assessment of whether current EU legislation on cosmetics provides adequate protection. Patients/methods. General practitioners, dermatologists and consumers in The Netherlands completed questionnaires on reported undesirable effects of cosmetics. Dermatologists also carried out patch tests and, where necessary, tests with specific batch ingredients of the associated cosmetic product. A website and a public awareness campaign were launched to encourage consumers to report undesirable effects. Results. Between July 2009 and May 2011, the RIVM received more than 1600 reports. Severe undesirable effects were claimed in 1–4% of the cases. The most frequently reported cosmetic products were make‐up and moisturisers, and the most frequently identified allergens were isothiazolinones and fragrance ingredients. Three patients tested positive for co‐polymers/cross‐polymers. Conclusions. Further investigations are recommended on the prevalence of isothiazolinone‐induced allergic contact dermatitis and the allergenic potential of co‐polymers/cross‐polymers.     

Treatment policy for psoriasis and eczema: a survey among dermatologists in the Netherlands and Belgian Flanders

Today, many therapies are available for the treatment of psoriasis and eczema. One of the oldest topical therapies is coal tar. Coal tar has been used for decades, but over the past years, the use of coal tar has decreased for several reasons, including the supposed carcinogenicity of coal tar.We investigated the current and past treatment policies for psoriasis and eczema with special emphasis on the use of tar products; a postal survey was conducted among all dermatologists in two European countries: the Netherlands (n = 360) and the Flemish speaking part of Belgium (Flanders) (n = 328). This study was conducted as part of the ongoing LATER-study ("Late effects of coal tar treatment in eczema and psoriasis; the Radboud study").All practising dermatologists received a questionnaire. Dermatologists were asked to describe their treatment policies in mild/moderate psoriasis, severe psoriasis, mild/moderate eczema and severe eczema.The response rate to the questionnaire was 62.5% for the Dutch dermatologists and 45.7% for the Flemish dermatologists. Almost all dermatologists prescribe topical corticosteroids. In eczema, most of the dermatologists prescribe the recently introduced calcineurin inhibitors (95%). Coal tar is a second choice topical therapy. Dutch dermatologists mainly use tar in the treatment of eczema (72% vs. 48% in Flanders), whereas in Flanders, tar is mainly prescribed in psoriasis (60% vs. 41% in Holland). Flemish dermatologists very frequently prescribe PUVA in psoriasis (93% vs. 63%).Topical treatment, especially topical corticosteroids, is the mainstay in psoriasis and eczema. Coal tar still is an important (second choice) therapy for the topical treatment of psoriasis and eczema, but its use varies from country to country. Despite the carcinogenicity of PUVA, this photochemotherapy is frequently prescribed by dermatologists, mainly in Flanders.     

Management of childhood psoriasis in France. A national survey among general practitioners,pediatricians, and dermatologists

Psoriasis affects 0.5–2% of children. Severe forms required use of systemic treatments. Few studies are published on efficiency and tolerance of systemic treatments in children. We conducted a survey in France to better understand management of children with psoriasis. A survey on childhood psoriasis management was sent by e‐mail to GPs, pediatricians, and dermatologists. The survey included 384 physicians. Respectively 53.1%, 49.8%, and 83.3% of GPs, pediatricians, and dermatologists declare to have seen at least one child with psoriasis during the 3 previous months. Less than 5% of GPs and pediatricians used severity score versus 23.7% of dermatologists. If most of physicians declare to use local treatments, less than 5% of GPs and pediatricians used systemic treatments. 32.4% of dermatologists declared to use at least one systemic treatment, but only 2.9% to use the 4 systemic treatments available in France. This survey shows that only half of GPs and pediatricians see children with psoriasis, but most of dermatologists. However, the management of severe forms seems limited by the underuse of severity scores and systemic treatments. These results should stimulate dermatology societies to promote prospective studies and guidelines in young populations with psoriasis.     

Results of a nationwide dermoscopy survey investigating the prevalence, advantages and disadvantages of dermoscopy use among Australian dermatologists

Background/Objectives: The primary objective of this survey was to assess the prevalence of use of dermoscopy by Australian dermatologists. The secondary objective was to understand the perceived advantages and disadvantages of dermoscopy use. Methods: Invitation letters were sent to all 282 Australian dermatologists belonging to the Australasian College of Dermatology in 2008. The survey, investigating prevalence and perceptions of dermoscopy use, was completed either online or on paper. Results: Ninety‐nine of the 283 (35%) dermatologists completed the survey eligibly. A total of 98% of dermatologists reported using dermoscopy and 95% had received formal training. Only 2–3% found it not useful for the diagnosis of pigmented lesions, melanoma or atypical naevi, whereas 12% found it not useful for the diagnosis of non‐pigmented tumours. Eighty‐five percent found it improved diagnosis compared to naked eye examination; and 57% of dermatologists used baseline dermoscopy to follow up changes in lesions, of which 78% used some image capture device. Conclusions: In the sample of Australian dermatologists agreeing to be surveyed, there was a high prevalence rate of dermoscopy use. The factors supporting the use of dermoscopy are explored in this foundational database of dermoscopy use among Australian dermatologists.     

Psychodermatology knowledge and awareness in Chinese dermatologists: Results of a survey study

To assess the knowledge, awareness, practice patterns, and attitudes of Chinese dermatologists toward psychocutaneous disorders and explore their interest in continuing medical education (CME) of psychodermatology. An online survey study was conducted from October to November 2019. The survey questionnaire link was sent to the members of the national and local association of dermatology through a social media App. After confirming the informed consent to enrol in the study, the participants filled out the online questionnaire anonymously. About 1047 dermatologists completed the survey. The most common diagnoses referred to the psychiatrist from Chinese dermatologists were venereal phobia (51.77%), delusion of parasitosis (44.03%), and trichotillomania (32.28%). Compared with dermatologists, Traditional Chinese Medicine (TCM) dermatologists had less training experience on psychodermatologic CME (4.21% vs 8.34% who had attending more than twice CME, P < .05). Although TCM dermatologist experience more frequency with psychodermatology (24.21% TCM vs 15.71% dermatologists), they had lower comfort level in treating psychodermatologic patients (51.58% TCM vs 58.89% dermatologist) (P > .05). While 818 (78.13%) dermatologists never received any training course, 84.53% of the dermatologists expressed interest in attending CME events on psychodermatology. The most popular CME themes of psychodermatology were emotional disorders related to skin diseases, delusion of parasitosis, and trichotillomania. Chinese dermatologists have insufficient knowledge and awareness toward psychodermatology. TCM dermatologists have higher awareness on psychocutaneous diseases compared with dermatologists. Psychodermatology continuing medical education programs should be carried out as soon as possible.     

Comprehensive survey of vitiligo patients in the northeast of China using a predesigned questionnaire

To assess the sociodemographic data and clinical information of outpatients affected by vitiligo in the northeast of China, vitiligo patients or guardians who presented to the clinic were invited to participate in an exploratory questionnaire. The questionnaire consisted of two sections related to vitiligo, including sociodemographic data and clinical information. A total of 983 vitiligo patients answered the questionnaire. The rates of female and male patients were comparable. The investigated patients were mostly young and middle‐aged. Most patients suffered from vitiligo in childhood or young adulthood. Vitiligo vulgaris was the most common type of vitiligo in clinic and 53.0% of patients were categorized as body surface area (BSA) of 10% or less. In response to the latest treatment, 43.6% of patients achieved good response (completely stopped or almost disappeared). More patients at active stage showed good response than the patients at stable stage (χ² = 7.866, P < 0.05). Chronic comorbid condition(s) were observed in 12.6% of patients with BSA of more than 10%, whereas those were seen in 6.0% of patients with BSA of 10% or less (χ² = 12.969, P < 0.05). In conclusion, active vitiligo seems to respond better than stable vitiligo and complications with other autoimmune diseases more frequently observed in severe patients than mild patients. The current study presented a comprehensive understanding of vitiligo in the northeast of China.     

Management of external genital warts by dermatologists: a French survey

BACKGROUND: External genital wart is the most frequent sexually transmitted disease. While there are guidelines for management and treatment, no data about primary care of this viral disease is available in France. So, we conducted a survey on French dermatologists'management of external genital warts. METHODS: In July and August 2001, a questionnaire - including questions on physicians and patients, sexually transmitted diseases, partners, clinical and viral evaluations, treatments, and follow-up - was mailed to 652 French dermatologists (randomization of 20 p. 100 of French dermatologists). RESULTS: Three hundred and fifty (53 p. 100) responses were returned. Dermatologists were mainly exclusively office practitioners (58 p. 100). Thirty-six percent of them were taking care of more than 3 patients per month with external genital warts. Patients were essentially men and immunocompetent. Only 52 p. 100 of physicians systematically performed a sexually transmitted disease evaluation, 38 p. 100 a partner evaluation, and 17 p. 100 a local evaluation for external genital warts. Biopsy was occasionally performed by 48 p. 100 of physicians, mainly in order to confirm diagnosis. Viral genotyping was rare. Cryotherapy (84 to 93 p. 100) and podophyllotoxin (40 to 55 p. 100) were the two treatments used as first line therapy, while laser (61 to 71 p. 100), and imiquimod (39 to 48 p. 100) were second line therapies. Sixty-three percent of physicians proposed a systematic clinical control after clinical recovery. CONCLUSION: This large survey represents an overview on general practice concerning external genital warts among French dermatologists. Our study points out the lack of global management (loco-regional, partner, and STD evaluation) of the disease by dermatologists.     

Management of Spitz nevi: a survey of dermatologists in the United States

BACKGROUND: There is no consensus concerning management of Spitz nevi. OBJECTIVE: This study was carried out to ascertain how dermatologists manage Spitz nevi. METHODS: A questionnaire was sent to 997 fellows of the American Academy of Dermatology, 284 pediatric dermatologists, and 27 directors of pigmented-lesion clinics. The results are based on the 381 questionnaires returned. RESULTS: The vast majority of responding dermatologists (93%) recommend biopsies of suspected Spitz nevi. Of this group, 43% recommend total biopsies and 55% recommend partial biopsies; 2% would recommend either total or partial biopsies, depending on the clinical situation. Sixty-nine percent of physicians would completely excise a lesion that was histologically diagnosed as an incompletely removed Spitz nevus. Seventy percent of general dermatologists and 80% of pediatric dermatologists would recommend excision with a 1- to 2-mm margin of normal-appearing skin around a Spitz nevus. Nine percent of general dermatologists would recommend margins of 4 mm or more; however, all pediatric dermatologists surveyed would recommend margins less than 4 mm. Physicians were less likely to monitor patients whose Spitz nevi were completely removed. Three fourths (74%) of respondents believe Spitz nevi are entirely benign, 4% believe they are precursors to melanoma, and 22% are not sure. Seven percent of general dermatologists and 4% of pediatric dermatologists have seen metastatic melanomas arise at sites of lesions initially diagnosed histologically as Spitz nevi; 40% of pigmented-lesion clinic directors have seen such lesions. CONCLUSIONS: We believe that the lack of consensus, both in our survey and in the medical literature, reflects to some extent the lack of certainty in the histologic differentiation of Spitz nevi from melanomas and that concern about melanoma influences management. At the pigmented-lesion clinic of the New York University Skin and Cancer Unit, because of this concern about melanoma, it is usually recommended that Spitz nevi be completely excised.