Needs survey of Canadian rosacea patients.

BACKGROUND: In 1995, a Rosacea Awareness Program (RAP) was initiated in Canada to make available educational resources for physicians and rosacea patients. Material is in French or English, and is accessible though physician offices and by toll-free telephone. Information was communicated to the public via noncommercial, editorial media. The RAP created a database of rosacea patients in Canada. OBJECTIVE: We investigated if individuals in the database had a confirmed diagnosis of rosacea, how they perceived their treatment by the medical system, and identified their needs. METHODS: A two-page questionnaire was mailed to 7874 individuals registered with the RAP. Thirty percent of these individuals responded. Where comparisons were made a chi-squared statistic was used. RESULTS: Over 70% learned of the RAP via public media. It took patients an average of 5 years to have a diagnosis made after the first symptoms appeared. In the majority of patients (53%) the diagnosis was ultimately made by a specialist. Fifty-eight individuals said they had not discussed their condition with their doctor. Patients were likely to continue on medication that was prescribed (60%) and topical metronidazole was the most common medication used, mostly the gel formulation. Most patients used these twice daily. Patients were very satisfied with treatments and almost 90% had reduced symptoms. Despite receiving explanations and written material, patients expressed a strong interest in more information being available on skin care, make-up, and psychological aspects of rosacea. CONCLUSIONS: The RAP provides a needed educational service and is a useful database. Patients are very knowledgeable about their disease, but despite this and excellent therapeutic responses, the patients demand more information.     

Parental knowledge and practice of primary skin cancer prevention: gaps and solutions

Over the past two decades there have been significant efforts in the United States to heighten awareness about skin cancer. Our goal was to assess parental knowledge, practice, and source of information about sun protection for their children. A questionnaire was administered to 158 parents of children at a dermatology clinic and 96 parents of children at a pediatric clinic (n=254). The survey included four parts: demographics, knowledge about skin cancer, sun protection practices, and sources of sun protection information. The mean knowledge score was 61% correct. Independent predictors of a higher score were fewer children and being a health care or other professional (p < 0.03). Independent predictors of parental sunscreen use were higher knowledge score, younger age, and fewer lifetime sunburns (p < 0.03); predictors of sunscreen use for children were higher knowledge score and fairer skin (p < 0.03). The top sources of sun protection information ranked by respondents were television and magazines; the top desired sources were primary care physicians and dermatologists. The knowledge results suggest the need for increased education about skin cancer prevention. Because the media is a major information source, it is important to ensure that messages about sun risks/protection are correct. The respondents' desire to learn more from primary care physicians emphasizes the need to educate physicians about sun protection.     

Hand eczema in geriatric nurses in Germany – prevalence and risk factors

Background and objectives:  The aim of this cross-sectional study was to collect data on the prevalence of hand eczema and relevant risk factors in geriatric nurses in Germany.
Methods:  1375 geriatric nurses from 86 nursing homes were investigated by 41 occupational physicians.
Results:  Hand eczema was diagnosed in 243 nurses, corresponding to a point prevalence of 18% [95% confidence interval (CI) 16–20%]. In most cases (71%), the skin changes were only mild. Two thirds of the geriatric nurses who reported skin changes stated that they had developed hand eczema after starting this profession. In most cases (85%), the clinical course was described as chronic. Risk factors associated with hand eczema were a lifelong tendency for dry skin [odds ratios (OR) 2.76; 95% CI 2.02–3.76] and a history of allergic rhinoconjunctivitis (OR 1.50; 95% CI 1.03–2.18). There was no association between the amount of wet work and hand eczema (OR 1.18; 95% CI 0.76–1.86).
Conclusions:  Our study indicates that it is necessary to provide geriatric nurses with specific skin care advice as part of their training. This might help to identify trainees at increased risk of developing eczema, encouraging the initiation of appropriate skin protection measures, thus preventing chronic disease.     

Sources of online information utilized by caregivers of pediatric patients with atopic dermatitis

There is limited information on the use of websites and social media platforms among dermatology patients. This survey study of 210 children with atopic dermatitis and their caretakers who attended dermatology clinic from 6/1/2020 through 5/1/2021 revealed that 83.8% had used online sources for information related to their condition. There was wide variation in the sources used and the participants' perceived trustworthiness of these. This study highlights the importance of physicians actively engaging with the online sources used by patients with atopic dermatitis and their caregivers during counseling in clinic.     

北京市小学生日晒危害认知和防晒行为的调查

目的调查北京市小学生对日晒危害的认知及其防晒措施。方法以问卷调查形式,了解北京市部分小学生对有关日晒引起皮肤损害、采取的防晒措施,以及获得日晒危害和防护知识的渠道。结果共有560人完成问卷调查,平均年龄(10±1)岁。大部分小学生知道过度日晒可以引起皮肤灼伤、晒黑,50%的学生知道过度日晒可致皮肤老化、皮肤肿瘤。大部分小学生在进行户外活动时采取防晒措施,但仅有18.5%的小学生外用防晒化妆品。电视传媒是北京市小学生获得日晒对皮肤危害及其防护知识的主要来源。结论北京市小学生对有关日晒引起皮肤危害的认知及防护知识还不太满意,需要加强这方面的宣传和教育,以获取相关信息。     

Skin cancer prevention and detection practices among siblings of patients with melanoma

BACKGROUND: Family members of patients with melanoma have an increased risk of the disease, and families with multiple affected members account for about 10% of melanoma cases. These statistics suggest that first-degree relatives of patients with melanoma, who are at particularly high risk, warrant targeted public health action. OBJECTIVE: We sought to document rates for dermatologist examinations for cutaneous lesions, the practice of skin self-examination, and sunscreen use in this at-risk group. METHODS: Before participation in a randomized trial, 404 siblings of recently diagnosed patients with melanoma completed a survey on beliefs and practices regarding skin cancer prevention and detection. RESULTS: Sixty-two percent of participants had carefully examined their skin, 54% routinely used sunscreen, and 27% had received a skin cancer examination by a dermatologist during the past year; 47% had never received a dermatologist examination. Multivariate analysis found modifiable positive predictors for skin self-examination and dermatologist examinations, including having a clinician with whom to talk about melanoma and believing in the importance of regular skin examinations by a physician. Significant modifiable negative predictors included enjoyment of being tanned, not being sure what to look for when examining moles, and feeling uncomfortable having others look at their skin. CONCLUSIONS: Skin self-examination rates among these high-risk siblings are markedly higher than in population-based studies. However, many siblings were not screened for skin cancer by a dermatologist despite having strong risk profiles, being nearly fully insured, and being under care of primary care physicians. Improvements in communication between physicians and high-risk families and changes in office systems to assess family history of melanoma could increase screening rates for the estimated 1 million siblings of patients with melanoma.     

Skin cancer screening in primary care: prevalence and barriers.

BACKGROUND: Skin cancer incidence is increasing, but whether primary care providers routinely screen for skin cancer is not known. OBJECTIVE: We assessed whether primary care practitioners are performing skin cancer screening within the context of primary care and whether barriers exist that might act as impediments to the implementation of this practice. METHODS: A total of 465 primary care providers belonging to their respective county medical societies in either New Haven County, Connecticut, or Miami-Dade County, Florida were randomly selected and surveyed by mailed questionnaire regarding their skin cancer screening practices. RESULTS: Only 31% of responding physicians reported performing skin cancer screening on all of their adult patients. Of those not performing skin cancer screening on all adult patients, only 31% report performing screening on high-risk patients. Almost half of physicians reported that they do not perform skin cancer screening. We found that physicians' lack of confidence in identifying suspect lesions was a common barrier. Fear of patient embarrassment, inadequate lighting, or lack of studies demonstrating mortality benefits were not frequent deterrents. Furthermore, there was no statistical difference in screening rates between the more northern latitude and the more southern latitude. CONCLUSION: Skin cancer screening is not being performed within the context of primary care visits. Barriers exist that may impede skin cancer screening.     

The impact of measures for secondary individual prevention of work-related skin diseases in health care workers: 1-year follow-up study

Background:  Specific instruction courses as a tool for secondary prevention of occupational skin disease (secondary individual prevention, SIP courses) affecting individuals have been introduced in Germany. Little is yet known about the outcome of occupational disease and related behavioural patterns following these courses.
Objectives:  To investigate the outcome of occupational skin disease in health care workers (HCW) 1 year after attendance of a SIP course.
Patients/methods:  Two hundred and fifty-three HCW participated in SIP courses and were contacted by telephone 1 year after attendance. Patients were interviewed about skin lesions, medical treatment, sick leave, change of occupation, skin protection, skin care and skin cleansing, and the impact of skin disease.
Results:  The follow-up rate was 81%. The proportion of participants reporting skin lesions decreased significantly (68% at follow-up compared with 77% at baseline; P  = 0.02). Seventy-two per cent reported that their skin lesions had improved. Nine per cent reported having left their occupation due to their skin disease. Skin care and skin protection had improved, while the frequency of reported hand washing was reduced. Twenty-seven per cent said their quality of life was impaired due to the skin disease, compared with 54% at baseline ( P  < 0.001).
Conclusions:  Outcome parameters, including behavioural parameters, indicate a positive impact of courses for SIP on skin health of HCW 1 year after attendance.     

Self‐Reported Help‐Seeking Behaviors and Treatment Choices of Adolescents Regarding Acne

Abstract: Acne vulgaris is a common condition affecting adolescents that they often choose to treat on their own rather than seek out and follow medical advice. Using data from an anonymous survey administered to 1,214 students in public middle and high schools in New Jersey, we compared the self‐reported acne frequency, severity, and beliefs of students based on their help‐seeking behaviors, treatment choices, and treatment adherence. Chi‐square analyses were performed for data comparison. A large proportion of students in this sample (57%) treated their own acne, and a much smaller proportion (17%) have sought medical care. Students who saw a health professional reported acne of higher frequency and severity than those who did not (p = 0.01). Severity also appeared to affect treatment adherence, with students who adhered to recommended treatments reporting more frequent (p < 0.001) and more severe (p = 0.02) acne than those who chose to self‐treat. Beliefs and knowledge varied most significantly according to treatment adherence. In conclusion, most adolescent students treat their own acne. Self‐assessment of acne severity plays a significant role in the tendency to seek out and adhere to medical treatment. Beliefs and knowledge may also affect adherence, suggesting a role for physicians to influence adherence rates through patient education. Because the majority of students are getting information from nonphysician sources, there may be a need to evaluate the resources they are using to make sure they are receiving appropriate, helpful information.     

Results of the 'Euromelanoma Day' screening campaign in Sweden 2008

Background  The 'Euromelanoma Day' skin cancer screening campaign is organized annually in several European countries since the year 2000. The national results have not been analysed in a Scandinavian country.
Objective  Our objective was to analyse the demographic characteristics and risk factors of the screened population during the 'Euromelanoma Day' in Sweden 2008. We also aimed to describe the clinical diagnoses found, the melanomas confirmed histopathologically and the treatments performed.
Methods  A public health education campaign to promote awareness of skin cancer risk factors and warning signs was carried out. Patients with suspicious lesions were advised to attend the screening. Questionnaires were used to collect relevant demographic, epidemiological and clinical data.
Results  In total, 2659 patients were screened. Women accounted for 62.3% of all patients; the median age was 57 years (range: 5–100 years); and 91.2% had skin phototypes II–III. Previous skin cancer was reported by 18.4% of all patients and 14.8% had a family history of melanoma. In total, 456 patients were diagnosed clinically with non-melanoma skin cancer. Twenty-four patients had histopathologically confirmed melanomas. Ten were in situ and 8 of the 14 invasive melanomas had a Breslow thickness that was less than 1 mm. Treatment or future medical care was carried out in 45.4% of all patients.
Conclusion  The 'Euromelanoma Day' campaign attracted many individuals at risk for skin cancer. The detection rate of non-melanoma skin cancer and melanoma was relatively high compared to similar campaigns in other European countries. Most melanomas found had a favourable prognosis.     

Interactive medicine: resources in dermatology and dermatologic surgery

The Internet has proved to be a useful resource in various fields of medicine. Within the field of Dermatology, Internet sites appeal to specialists in dermatology, non-specialist physicians, medical students, and the lay public. In the past 2 years, United States physicians' regular Internet use has increased 300%, according to an ongoing study conducted by the Santa Clara-based Healtheon Corporation. The phenomenon of increased Internet usage is explainable. Patients have access to the Internet and often consult net sources before they see their physician; therefore, it is very important that physicians are likewise "connected" to enhance patient communication. Careful study of approximately 300 Internet sites has yielded a reader-friendly presentation of only the sites that should be most useful to practitioners, medical students, and the lay public. The objective is to promote public health through doctor-patient communication and through the use of valuable interactive medical resources.     

Physicians involved in the care of patients with high risk of skin cancer should be trained regarding sun protection measures: evidence from a cross sectional study

Background Knowledge, regarding sun protection, is essential to change behaviour and to reduce sun exposure of patients at risk for skin cancer. Patient education regarding appropriate or sun protection measures, is a priority to reduce skin cancer incidence. Objective The aim of this study was to evaluate the knowledge about sun protection and the recommendations given in a population of non‐dermatologists physicians involved in the care of patients at high risk of skin cancer. Materials and methods This study is a cross‐sectional study. Physicians were e‐mailed an anonymous questionnaire evaluating the knowledge about risk factors for skin cancer, sun protection and about the role of the physician in providing sun protection recommendations. Results Of the responders, 71.4% considered that the risk of skin cancer of their patients was increased when compared with the general population. All the responders knew that UV‐radiations can contribute to induce skin cancers and 71.4% of them declared having adequate knowledge about sun protection measures. A proportion of 64.2% of them declared that they were able to give sun protection advices: using sunscreens (97.8%), wearing covering clothes (95.5%), performing regular medical skin examination (91.1%), to avoid direct sunlight exposure (77.8%), avoiding outdoor activities in the hottest midday hours (73.3%) and practising progressive exposure (44.4%). Conclusion Non‐dermatologist physicians reported a correct knowledge of UV‐induced skin cancer risk factors. The majority of responders displayed adequate knowledge of sun protection measures and declared providing patients with sun protection recommendation on a regular basis. Several errors persisted.     

Decision support software to help primary care physicians triage skin cancer: a pilot study

OBJECTIVE: To determine whether decision support software can help primary care physicians proficiently triage lesions suggestive of basal cell and squamous cell carcinoma. DESIGN/MEASURES: Physicians selected triage options for 15 digitized images of skin lesions, with and without use of the decision support software. PARTICIPANTS/SETTINGS: Twenty primary care physicians practicing in a health maintenance organization or a city health clinic. INTERVENTION: Decision support software designed to help physicians arrive at a triage recommendation consisted of a clinical information form, a decision tree, and support features (teaching points, example images, and diagrams). RESULTS: Without using the decision support software, physicians chose the wrong triage decision 36.7% of the time; using the decision support software, they chose the wrong response only 13.3% of the time. Not using the decision support software, they failed to correctly perform a biopsy on or refer patients with cancerous lesions 22.1% of the time; using the software, they failed to correctly perform a biopsy on or refer patients with cancerous lesions only 3.6% of the time. Physicians scored an average of 3 points (of a possible 15 points) higher when they used the software (signed rank, 101.0; P<.001). They scored an average of 1 point higher on the 7 cancerous lesions when they used the software (signed rank, 65.5; P<.001). CONCLUSIONS: Use of decision support software could improve primary care physicians' triage decisions for lesions suggestive of nonmelanoma skin cancer, and potentially reduce morbidity and health care costs. We are designing a larger study to evaluate the accuracy and utility of the software with patients seen in clinical practice.     

The gatekeeper model is inefficient for the delivery of dermatologic services

BACKGROUND: Gatekeeper-paradigm managed care systems may discourage the use of dermatologists in the management of skin conditions by limiting direct access. This may limit the quality of care patients with skin disorders receive and may be an inefficient use of medical resources. OBJECTIVE: The purpose of this study was to determine the likelihood that patients with dermatologic conditions who see a primary care provider will be referred to a dermatologist. METHODS: Data on the disposition of outpatient visits to primary care physicians for one and only one dermatologic diagnosis were obtained from the 1990-1994 National Ambulatory Medical Care Survey. These data were used in an econometric model to estimate the likelihood of referral to a dermatologist for an episode of care. RESULTS: Of all visits for a single dermatologic diagnosis, 39% were to primary care physicians. The disposition of referral was more common for these dermatology-related visits than for all office visits to primary care physicians (5.8% vs 4.5%, P < .001). The most frequent diagnoses associated with referral were common dermatologic problems, not rare disorders. The number of visits per episode of care was highly dependent on the assumptions of the analysis, resulting in estimate ranges for referral rates per episode between 6.8% and 18.5% for pediatricians, 8.2% and 23% for family and general practitioners, and 16.6% and 46.5% for internists. CONCLUSION: The relative difficulty for primary care providers of managing skin problems is reflected by their frequent need to refer patients with common skin problems and by the greater likelihood of referral for skin disorders than for other medical conditions. The high rates of referral per episode of care supports the cost-effectiveness of direct access to dermatologists.     

Primary care physician attitudes regarding sexually transmitted diseases

BACKGROUND: Primary care physicians see the majority of patients with sexually transmitted diseases (STDs), but little is known about their attitudes regarding STD-related issues. GOAL: The study goal was to determine the attitudes of primary care physicians toward STD-related issues, to determine physicians' characteristics associated with attitudes, and to examine the relationship of attitudes to STD counseling practices. STUDY DESIGN: A cross-sectional survey was mailed to randomly selected primary care physicians in Pennsylvania. RESULTS: Of 1054 eligible physicians, 541 (51%) responded. Although most physicians were comfortable discussing sex-related issues with their patients (89%), many believed their STD counseling was ineffective (70%), their medical school STD training was inadequate (48%), or that they were not responsible for STD preventive services for their patients (43%). Overall, STD-related attitudes were more positive among physicians who were female, worked in clinic settings, and received adequate training in STDs. More positive attitude scores were significantly associated with performance of six specific risk-assessment and counseling behaviors. CONCLUSIONS: Many physicians reported low confidence, limited responsibility, and time barriers that may affect their STD-prevention practices. Interventions that influence STD-related attitudes may improve STD-prevention practices by primary care physicians.     

P51Occupational contact dermatitis among operating room nurses

Background:  Occupation related dermatitis is a common problem in health care workers, especially in nurses, who are exposed to a wide variety of allergenic and irritant substances. The aim of this study was to assess the prevalence rate of skin symptoms among personnel handling chemical disinfectants and to examine which allergens were important.
Methods:  We investigated 460 randomly selected health care workers (HCW), who had constant contact with chemical disinfectants during their work. The study was performed by means of a questionnaire, a medical examination, skin patch test using Finn chambers and glutaraldehyde, benzalkonium chloride, hydrogen peroxide and chlorine compounds at 0,1, 0,5 and 1,0% wat.
Results:  241 HCW (52,5%) described various skin symptoms they attributed to disinfectant exposure. Generally, these symptoms were mild and ranged from pruritis to hand eczema. Of these 66 (14,4%) tested were skin patch test positive. Of the 460 HCW tested, 37 (8%) had positive patch test reactions to benzalkonium chloride, 22 (4,8%) to chlorine compounds, 18 (4%) to glutaraldehyde, 6 (1,2%) to hydrogen peroxide. 5 HCW (7,6%) testing positive to disinfectants gave no history of reactivity to them. History of atopic dermatitis was found in 50 (10,9%) and it was associated with diagnosis of allergic contact dermatitis and positive patch test reactions to benzalkonium chloride. Also positive patch tests reactions were associated with frequent use of latex gloves in contrast to those, which used latex gloves while working constantly or didn't use them at all.
Conclusions:  1. Skin symptoms related to work with chemical disinfectants are common, but mostly mild. 2. Benzalkonium chloride is one of the strongest sensitizing disinfectants used in health care professions, especially for atopic persons who do not take measures of protection during exposure to it.     

Effects of lipid nanocarriers on the performance of topical vehicles in vivo

Background/aims  Nanocarrier systems have been extensively studied for their suitability in personal care formulations. Theoretically, they could enhance skin delivery of active compounds, thereby improving in vivo efficacy of the products. As such the aim of this study was to evaluate the effect of a lipid nanocarrier (LNC) system loaded with tocopheryl acetate (TA) on the hydration, biomechanical properties, and antioxidant capacity of human skin, when used in two different vehicles, and compare it with a non-LNC formulation.
Methods  TA-loaded lipid nanocarriers (TA-LNCs) were produced by the phase inversion method, using physiological lipids and purified by ultra-centrifugation. They were incorporated into a hydrophilic gel and foam, and their performance compared with a saturated TA solution in silicon oil. Skin hydration and biomechanical properties were measured by means of a corneometer and a cutometer, respectively, while a high-resolution spectrophotometer was used to assess skin redness after stimulation by methyl nicotinate in a micro-inflammatory test. Both short-term (3 h) and long-term trials (4 weeks) were performed.
Results  The results confirmed that the LNCs enhanced skin hydration in both studies, while skin viscoelastic parameters remained practically unchanged during the 4-week study. The antioxidant assessment failed to show significant difference between the test sites.
Conclusions  TA-loaded LNCs exhibited the ability to enhance skin hydration, while their effect on skin biomechanical properties and on antioxidant efficacy could not be statistically proved.     

Prevention of occupational skin disease: a workplace intervention study in geriatric nurses

Background  Health care workers have an increased risk of occupational dermatosis.
Objectives  To determine whether a skin care programme reduces skin disease on the hands of geriatric nurses and increases protective behaviour and the provision of skin care products at the workplace. The intervention was based on a 2-h skin care training session and an occupational advisory service.
Methods  The study design was a randomized intervention study with a control group. Three hundred and eighty-eight geriatric nurses were included in the intervention group exposed to a skin care programme (IG; n  =   146) and in the control group (CG; n  =   242). Both groups completed questionnaires on exposure and underwent clinical examinations of their hands at the beginning and after a 12-month period. Preventive measures initiated by the employer at the workplace were documented at baseline and at 3 months after the intervention.
Results  At baseline, no difference between the IG and the CG was found with respect to skin changes or work-related behaviour. At follow-up, the frequency of skin disease was significantly reduced in the IG, from 26% at baseline to 17% at follow-up, whereas the frequency remained almost unchanged in the CG. Effects on behaviour in the IG included significant increases in the use of moisturizers and hand disinfection instead of hand washing. The provision of cotton gloves and barrier cream products increased at intervention workplaces.
Conclusions  Effective implementation of an occupational skin care programme for geriatric nurses should include both the training of the nurses and an occupational advisory service for management.