Expert opinions in dermatology

Apart from their medical responsibilities relating to the diagnosis, treatment and prevention of skin diseases, dermatologists may also be asked to provide expert medical opinions. In their role as medical experts, dermatologists provide their services not only to public institutions and courts but also to private clients. Expert dermatological opinions involve the application of medical knowledge and experience to an individual case as regards a specific legal question. The dermatological expert thus becomes an “assistant” to administrative and public agencies or courts. In addition to providing the required expert knowledge, the expert must maintain strict neutrality and avoid any bias. Expert opinions play a significant role in the field of occupational dermatology. In this context, it is important to make a distinction between scientific expert opinions – commissioned to determine whether the criteria for an occupational skin disease are met or to assess the degree of reduction in earning capacity – and the much more common “small expert opinions” relating to disease prevention (“dermatologist's procedure”). Moreover, expert medical opinions have become increasingly important with respect to medical malpractice issues, both in court proceedings and for investigations conducted by State Medical Chambers. For quality assurance of expert dermatological opinions, the Working Group for Occupational and Environmental Dermatology in particular offers certification courses. The same group also provides guidelines for expert opinions in occupational dermatology (Bamberg Recommendations).     

¿Cuánta carga asistencial supone la enfermedad tumoral cutánea en la actividad ambulatoria en la Dermatología española? Resultados del muestreo aleatorio nacional DIADERM

Introduction and objectiveA significant part of a dermatologist's activity involves the diagnosis and management of tumors. The aim of this study was to analyze the caseload at public and private dermatology outpatient clinics in Spain to determine the proportion of tumor diagnoses.Material and methodObservational cross-sectional study of diagnoses made in dermatology outpatient clinics during 2 data-collection periods in the DIADERM study, an anonymous survey of a random, representative sample of dermatologists across Spain. Diagnoses made during the 2 periods were coded according to the CIE-10. There were 165 tumor-related codes, classified into 24 groups. For the purpose of this study, these groups were then reduced to benign melanocytic lesions, malignant melanocytic lesions, benign nonmelanocytic lesions, and malignant nonmelanocytic lesions.ResultsTumors accounted for 46.2% of all diagnoses; 18.5% of the tumors were malignant (a category that included in situ forms of keratinocyte cancers). Four of the 10 most common diagnoses were of malignant tumors: in situ keratinocyte cancers, basal cell carcinoma, melanoma, and squamous cell carcinoma. Significant differences were observed between malignant and benign tumors according to type of practice (public vs. private) and geographic region.ConclusionSkin cancer accounts for a significant part of the dermatologist's caseload in Spain. Differences can be observed depending on the public/private healthcare setting and other factors.     

Das Zertifikat „Tropen- und Reisedermatologie (DDA)“

Under the conditions of economic pressure in the medical system and the DRG system for hospitals in Germany, so-called “uneconomic” services and fields of specialized dermatologic competence such as pediatric dermatology, trichology, occupational dermatology and tropical dermatology are increasingly being neglected. While hospitals tend to train fewer residents in these subspecialties, there is a demand for additional high-quality training opportunities that are certified by the German Dermatologic Academy (DDA). Tropical and travel-related skin diseases are more frequently observed in Germany which can be explained by the increased world-wide travel activities, but also by the international migration from developing countries into Europe. Furthermore, dermatologists trained in Germany are working more and more also internationally. Thus, they require knowledge and experience in tropical and travel-related dermatology. The certificate “Tropical and Travel Dermatology (DDA)” was developed and published in 2013 in a cooperation between the International Society for Dermatology in the Tropics in cooperation with the German Academy of Dermatology (DDA). It consists of 3 full day teaching modules (basic, additional and special seminar). The first seminar cycle in 2013/2014 showed a high demand from dermatologists in hospitals and private practices. While the basic and the special seminars were held in Germany, the additional seminar took place in cooperation with the Regional Dermatology Training Center (RDTC) in Moshi, Tanzania. Many attending dermatologists fulfilling the requirements for the new certificate have practiced in developing countries or plan to do so. In order to gain practical experience on the basis of the knowledge acquired in the qualifying seminars, the International Society for Dermatology in the Tropics supports dermatologists to find internships and work placements in dermatological units in developing countries.     

DRGs in der Dermatologie: Ergebnisse des DRG‐Evaluationsprojektes der Deutschen Dermatologischen Gesellschaft

Background: The implementation of a DRG system in Germany – voluntarily since January 1^st, 2003, and obligatory after January 1^st, 2004 – has led to uncertainty, particularly in the hospitals. There are fears that current well‐accepted German diagnostic and therapeutic services may not be properly financed by the new system. In response, the German Dermatologic Society (DDG) in cooperation with the DRG Research Group of the University Hospital Muenster and the German Medical Association carried out a DRG evaluation project in order to investigate the medical and economic homogeneity of the case groups. Patients and methods: 19,403 dermatological cases from 19 hospitals – ten university hospitals and nine non‐university hospitals – were collected over a period of four months and then evaluated with regard to their performance, length of stay and cost homogeneity. Results: The data provided the background needed to indicate suspected potential deficiencies for mapping dermatology cases within the German DRG system. Based on the data 10 modifications were formulated and submitted to the InEK by the deadline of March 31^st, 2003. Conclusions: The results of the DRG Evaluation Project show that the G‐DRG‐Variant Version 1.0 does not offer the necessary possibilities of differentiation to map the broad spectrum of various dermatology services in Germany.     

The influence of exposome on acne

Background

Acne vulgaris is one of the main reasons for dermatological consultations. Severity and response to treatment may be impacted by various external factors or exposome.

Aim

To assess the impact of environmental factors on acne and to provide a comprehensive overview of the acne exposome.

Methods

Two consensus meetings of five European dermatologists and a comprehensive literature search on exposome factors triggering acne served as a basis for this review.

Results

Acne exposome was defined as the sum of all environmental factors influencing the occurrence, duration and severity of acne. Exposome factors impact on the response and the frequency of relapse to treatments by interacting with the skin barrier, sebaceous gland, innate immunity and cutaneous microbiota. They may be classified into the following six main categories: nutrition, psychological and lifestyle factors, occupational factors including cosmetics, as well as pollutants, medication and climatic factors. Moreover, practical considerations for the dermatologist's clinical practice are proposed.

Conclusion

Exposome factors including nutrition, medication, occupational factors, pollutants, climatic factors, and psychosocial and lifestyle factors may impact on the course and severity of acne and on treatment efficacy. Identifying and reducing the impact of exposome is important for an adequate acne disease management.     

Multicenter study „Medical‐Occupational Rehabilitation Procedure Skin – optimizing and quality assurance of inpatient‐management (ROQ)”

Scientifically based prevention and patient management concepts in occupational dermatology have substantially improved during recent years. Currently the public statutory employers' liability insurance bodies fund a multi‐step intervention approach designed to provide quick preventive help for all levels of severity of occupational dermatoses. An administrative guideline (hierarchical multi‐step intervention procedure for occupational skin diseases –“Stufenverfahren Haut”) insures professional support and optimal patient orientation by the statutory insurers' representatives. For secondary prevention, the so‐called dermatologist's procedure (“Hautarztverfahren”) was recently updated in order to provide more rapid dermatologic consultations which are covered for by the public statutory employers' liability insurance bodies. Additionally, combined outpatient dermatologic and health‐educational intervention seminars (“secondary individual prevention”[SIP]) are offered to affected employees in a nationwide scheme. For those cases of occupational dermatoses in which these outpatient prevention measures are not successful, interdisciplinary inpatient rehabilitation measures have been developed (“tertiary individual prevention”[TIP]). TIP requires 3 weeks inpatient treatment including intensive health care instruction and psychological counseling, followed by outpatient treatment by the local dermatologist. In 2005, a German prospective cohort multicenter study (“Medical‐Occupational Rehabilitation Procedure Skin – optimizing and quality assurance of inpatient‐management”–“Medizinisch‐Berufliches Rehabilitationsverfahren Haut – Optimierung und Qualitätssicherung des Heilverfahrens”[ROQ]) started which will further standardize TIP and evaluate scientific sustainability in depth (3‐year dermatological follow‐up of 1,000 patients). The study is being funded by the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung [DGUV]).     

Pediatric teledermatology: A review of the literature

Skin complaints are common among pediatric patients, yet as of 2020, fewer than 400 board‐certified pediatric dermatologists currently practice in the United States. Pediatric teledermatology may address barriers to dermatologic care in children, assisting with distant geographic locations and long wait times. A review of the literature was conducted to synthesize important features of teledermatology for pediatric dermatologists. We summarize types of telemedicine platforms, common dermatologic conditions seen by pediatric teledermatologists, diagnostic accuracy and concordance, and guidelines from the American Academy of Dermatology and the American Telemedicine Association regarding teledermatology. This report highlights the utility of pediatric telemedicine in both the outpatient and inpatient dermatology setting to increase access to high‐quality dermatologic care.     

Presentation of pseudohypoparathyroidism and pseudopseudohypoparathyroidism with skin lesions: Case reports and review

We report three cases of patients with pseudohypoparathyroidism or pseudopseudohypoparathyroidism. These diseases are considered GNAS inactivating mutation syndromes that are characterized by a diversity of alterations among which a particular phenotype and specific endocrine or ossification abnormalities may be found. These patients may present with hard cutaneous nodules, which can represent osteoma cutis. The presence of these lesions in pediatric patients should prompt the dermatologist's consideration of this group of diseases when reaching a diagnosis. A multidisciplinary team of pediatricians, endocrinologists, geneticists, and dermatologists should carefully evaluate these patients.     

Carcinoma basocelular cutáneo: diagnóstico y tratamiento en atención especializada dermatológica. Guía de Práctica Clínica de la AEDV

Background and objectiveBasal cell carcinoma (BCC) is the most common skin cancer in the general population. BCC is managed in a variety of ways, and available international guidelines are difficult to put into practice in Spain. This guideline aims to improve the management of BCC based on current evidence and provide a point of reference for Spanish dermatologists.Material and methodsMembers of the Spanish Oncologic Dermatology and Surgery Group (GEDOC) with experience treating BCC were invited to participate in drafting this guideline. The drafters used the ADAPTE collaboration process to develop the new guideline based on existing ones, first summarizing the care pathway and posing relevant clinical questions. They then searched for guidelines, assessed them with the AGREE II (Appraisal of Guidelines for Research and Evaluation) tool, and searched the selected guidelines for answers to the clinical questions. Finally, the recommendations were drafted and submitted for external review.ResultsThe highest-scoring guidelines were from the Association of Dermatologists, the National Comprehensive Cancer Network, the European Dermatology Forum, and the European Academy of Dermatology and Venereology. A total of 11 clinical questions were answered.ConclusionsThis new guideline answers the working group's clinical questions about the routine management of BCC in Spain. It provides dermatologists with a tool they can use for decision-making while taking into consideration the resources available and patient preferences.     

The role and duties of scientific medical societies: The German Society of Dermatology from the member's perspective

Background: The German Society of Dermatology is a scientific medical society that represents the interests of German‐speaking dermatology. One recommendation of a strategic planning mission was to increase the involvement of society members. Methods: Based on an empirical approach (questionnaire survey) a systematic member inquiry was performed which focused on the motives for membership, the image of the society,the use of provided services,and expectations and needs. Items regarding profession and health politics, continuous education and specialist training, and scientific representation and research promotion were considered in equal measure. Results: In total, 931 usable questionnaires were available with a response rate of 28.4%. Various single results could be integrated in a subsequent strategic dialogue.The German Society of Dermatology is regarded as active and powerful in scientific issues and promotion of research. However, numerous expectations have been expressed to strengthen future activities in professional and health care related issues. Needs and demands differ if members are scientifically active or rather not. Conclusions: A scientific society in general acts in a permanent area of conflict and has to deal with multiple positions and interests.Thereby members’ needs and demands may vary dependent on individual and professional backgrounds. Members who are not scientifically active should be more integrated in the society while at the same time the society's aims should be coordinated with that of the Berufsverband (organization of practicing dermatologists). Better networking is required both within the society and with outside groups. In addition, the primary aims and objectives of the society should be made even clearer to all interested parties.     

Retinaldehyde/hyaluronic acid fragments: a synergistic association for the management of skin aging

Background Retinaldehyde (RAL) was proven effective in treating photodamaged skin. Topical treatments with specific intermediate‐size hyaluronate fragments (HAFi, 50–400 kDa) have been shown to stimulate keratinocytes proliferation and epidermal hyperplasia. The aim of this open, multicentric, international study was to assess the efficacy of the combination RAL–HAFi in the correction of skin photoaging. Patients/Methods Either RAL 0.05%–HAFi 0.5% (Eluage^® cream; group 1) or RAL 0.05%–HAFi 1% (Eluage^® antiwrinkle concentrate; group 2) or both products (group 3) were applied daily to the 1462 subjects during 90 days. Overall photoaging severity was evaluated in the three groups by the dermatologists at D0, D30, and D90 based on the Larnier’s scale. Wrinkles and/or furrows and clinical signs of aging were evaluated using a 4‐point scale. The skin microrelief of the crow’s feet, evaluated by optical profilometry, was performed in subjects from group 3. Results The 3‐month application significantly improved overall photoaging through decrease of the Larnier’s score in the three groups (P < 0.001). At D90, significant improvement of wrinkles was shown in groups 2 and 3 [forehead wrinkles (?19% and ?10%, respectively, P < 0.001), nasolabial folds (?20% and ?16%, P < 0.001), crow’s feet (?27% in the two groups, P < 0.001), and perioral wrinkles (?34% and ?23%, P < 0.001)]. Clinical signs of photoaging on the entire face improved significantly in groups 1 and 3 [elasticity (?32% and ?33%, respectively, P < 0.001), hyperpigmentation (?34% and ?31%, P < 0.001), and ptosis (?18% and ?22%; P < 0.001)]. Results were confirmed using an optical profilometry technique. Products were very well tolerated. Conclusion This clinical study showed the efficacy and value of the RAL–HAFi combination in the management of aging skin in a large cohort of patients.     

‘Fish matters’: the relevance of fish skin biology to investigative dermatology

Please cite this paper as:‘Fish matters’: the relevance of fish skin biology to investigative dermatology. Experimental Dermatology 2010. Abstract: Fish skin is a multi‐purpose tissue that serves numerous vital functions including chemical and physical protection, sensory activity, behavioural purposes or hormone metabolism. Further, it is an important first‐line defense system against pathogens, as fish are continuously exposed to multiple microbial challenges in their aquatic habitat. Fish skin excels in highly developed antimicrobial features, many of which have been preserved throughout evolution, and infection defense principles employed by piscine skin are still operative in human skin. This review argues that it is both rewarding and important for investigative dermatologists to revive their interest in fish skin biology, as it provides insights into numerous fundamental issues that are of major relevance to mammalian skin. The basic molecular insights provided by zebrafish in vivo‐genomics for genetic, regeneration and melanoma research, the complex antimicrobial defense systems of fish skin and the molecular controls of melanocyte stem cells are just some of the fascinating examples that illustrate the multiple potential uses of fish skin models in investigative dermatology. We synthesize the essentials of fish skin biology and highlight selected aspects that are of particular comparative interest to basic and clinically applied human skin research.     

How dermatology got its name

The name “dermatology” began to appear in the medical literature around 1813. It was not until the 1860s and 1870s, however, that “dermatology” was used to denote academic ranks in the United States; for example, in 1867, Foster Swift was appointed “Professor of Dermatology” at Bellevue Hospital Medical College, New York, and Faneuil Dunkin Weisse became “Professor of Dermatology” in the Medical Department of University of the City of New York. In England, Erasmus Wilson popularized the name “dermatology” in 1870 by founding and occupying the first Chair of Dermatology at the Royal College of Surgeons. The term “dermatology” also began to be used in the titles of academic publications during the 1870s, such as Erasmus Wilson's Lectures on Dermatology or as in The American Journal of Syphilography and Dermatology, the first dermatology journal published in the United States. The English term “dermatology” comes from the Greek “dermatologia,” which has been semantically traced back to 1777.     

Actas Dermo-Sifiliográficas,año 1, número 1

The first issue of Actas Dermo-Sifiliográficas appeared in May-June of 1909. Although not the first Spanish dermatology journal, it did provide a lasting forum where dermatologists could publish in Spanish at the same time as opening a window to the practice of dermatology throughout the world. Initially, the journal only included minutes of the Spanish Society of Dermatology (currently the Spanish Academy of Dermatology and Venereology [AEDV]), certain obituaries, and a section on foreign journals.The first issue of the journal is a good snapshot of the situation of the specialty in Spain 100 years ago. The proportion dedicated to venereology was substantial—more than half the total content. Venereology itself was dominated by syphilis, explaining why the journal retains the word «sifiliográfica» in its title.The catalyst for starting the journal was Juan de Azúa, who was also president of the society, with the help of Sánchez-Covisa as recording secretary, and Miguel Serrano as the society's treasurer and journal manager. The first collaborators were drawn almost entirely from the now defunct Hospital San Juan de Dios in Madrid.     

S2k guidelines for the treatment of psoriasis in children and adolescents – Short version part 2

The present guidelines are aimed at residents and board‐certified physicians in the fields of dermatology, pediatrics, pediatric dermatology and pediatric rheumatology as well as policymakers and insurance funds. They were developed by dermatologists and pediatric dermatologists in collaboration with pediatric rheumatologists using a formal consensus process (S2k). The guidelines highlight topics such as disease severity, quality of life, treatment goals as well as problems associated with off‐label drug therapy in children. Trigger factors and diagnostic aspects are discussed. The primary focus is on the various topical, systemic and UV‐based treatment options available and includes recommendations for use and treatment algorithms. Other aspects addressed herein include vaccinations in children and adolescents with psoriasis as well as various disease subtypes such as guttate psoriasis, diaper psoriasis, pustular psoriasis and psoriatic arthritis. Finally, we also provide recommendations for imaging studies and the diagnostic workup to rule out tuberculosis prior to initiating systemic treatment. Note: This article constitutes part 2 of the Sk2 guidelines for the treatment of psoriasis in children and adolescents. Part 1 was published in last month's issue. It contained introductory remarks and addressed aspects of diagnosis and topical treatment.     

Impact of COVID-19 on medical practice: A nationwide survey of dermatologists and health care providers in Iraq

The coronavirus disease 2019 (COVID-19) pandemic has dramatically changed medical practice worldwide. It posed a significant impact on different health services, including dermatology. A cross-sectional observational study of 200 health care providers and 100 dermatologists (survey 1 and 2, respectively) were conducted to determine the prevalence of occupational skin diseases among health care providers working amid the pandemic, and to show the outbreak's impact on dermatology practice.     

Estudio retrospectivo de los datos demográficos,los motivos de derivación y los datos diagnósticos de las primeras visitas llevadas a cabo en las consultas de Dermatología del Complejo Hospitalario de Navarra durante el año 2018

IntroductionThere are not many long term studies on most frequent conditions attended at dermatology consults. This article’s objective is to analyze referrals and diagnostics made at Dermatology Service in Navarra’s Hospital Complex during 2018.MethodologyA retrospective analysis of first visits attended at our dermatology department during 2018 has been made, evaluating the following items: sex, age, patient’s origin, referral code for primary care and diagnosis code of the dermatology department (International Classification of Diseases – ICD).ResultsReferral rate to our department during 2018 was 45.5 face-to-face consultation/1,000 population, with a face-to-face/teleconsultation rate 12:1. Most common diagnosis (ICD) was melanocytic nevus (15%), followed by seborrheic keratosis (12%) and actinic keratosis (9%). Forty seven per cent of diagnosis made in face-to –face consultation was benign and malignant neoplasms.ConclusionsDespite its limitations, coding is an essential activity in order to better understand the attended population, its real needs and optimization of resource allocation. We believe it is very important to invest in clinical and dermoscopic diagnosis of pigmented lesions in primary care in order to improve referral to specialist consults. Nowadays, with the available information we have, we cannot propose to screen or to prioritize referrals based on the analysis of the referral code for primary care.     

The dermatology outpatient discharge decision: understanding a critical but neglected process

Discharge from dermatology outpatients is a critical endpoint of patient care. Despite this, there has been very little research concerning the discharge process and factors influencing the discharge decision. To identify the factors influencing discharge decisions, articles from 1970 to April 2013 were searched in MEDLINE via Ovid, CINAHL, PROQUEST and Google Scholar using the keywords ‘patient discharge’, ‘discharge decision’, ‘factors influencing discharge’, ‘clinical decision making’, ‘discharge decision making’, ‘process of discharge decision’, ‘outpatient’, ‘follow up’, ‘skin disease’ and ‘dermatology’. Only articles describing outpatient discharge decisions were included. Seventeen outpatient discharge articles were identified, 12 from the U.K. (seven dermatology) and five from the U.S.A., Canada, Australia and Taiwan (all nondermatology). The main influences on outpatient discharge identified were diagnosis and disease severity, clinician's level of experience and perception, patient's preferences, patient's behaviour and quality of life. These influences affected the clinician's judgement on discharge decisions both in appropriate and in inappropriate ways. Little is known concerning discharge decision making in dermatology. Given the central importance of such decisions in the appropriate care of patients and the efficient running of any dermatology service, greater understanding of the influences on discharge decision making is needed. It is therefore critical for dermatologists to be aware of these influences and to ensure that decisions are taken only in the best interests of patients. Further research is required to inform the training of dermatologists on how to take the most appropriate discharge decisions.     

Malformaciones arteriovenosas: un reto diagnóstico y terapéutico

Many dermatologists are largely unfamiliar with arteriovenous malformations (AVMs). This is partly due to the low prevalence of these lesions and to the fact that they are generally managed by other specialists, in particular, interventional radiologists and pediatric, maxillofacial, and plastic surgeons. In this article, we review the recommended nomenclature for AVMs and look at their clinical manifestations and diagnosis, as well as the ideal type and time of treatment. AVMs should be managed from a multidisciplinary approach, and the dermatologist's primary goal should be to make a proper diagnosis and thereby avoid unnecessary treatments.