Erectile dysfunction in patients with psoriasis: increased prevalence,an unmet need,and a chance to intervene

Background Male erectile dysfunction (ED) is common, frequently caused by pelvic arterial atherosclerosis, and is a predictor of future cardiovascular disease. There is an emerging association between psoriasis, the metabolic syndrome and atherosclerotic disease. We hypothesized that ED occurs more commonly in patients with psoriasis, at least in part due to incipient atherosclerosis, which may offer an opportunity for early intervention. Objectives To determine the prevalence of, and risk factors for, ED in patients with psoriasis in comparison with a heterogeneous dermatology outpatient control group. Methods We conducted a pilot study with a prospective observational cross‐sectional design, recruiting consecutive adult male dermatology outpatients diagnosed with psoriasis or any other skin condition. Sexually active participants completed a questionnaire, a Dermatology Life Quality Index and the validated five‐item version of the International Index of Erectile Function (IIEF‐5). Results Fifty‐three of 92 (58%) patients with psoriasis recorded an IIEF‐5 score indicative of ED, compared with 64 of 130 (49%) control patients, reflecting an age‐adjusted odds ratio of 2·007 (95% confidence interval 1·088–3·701; P = 0·026). A multivariable logistic regression model indicated that increasing age and hypertension, but not a diagnosis of psoriasis, were independent risk factors for ED in our study population. Conclusions We present the largest survey of ED in patients with skin disease, and the first to posit the potential link between psoriasis, ED and atherosclerosis. We suggest that an assessment of sexual function should be part of the routine holistic care provided for dermatology outpatients, and highlight the need to screen for cardiovascular risk factors in those with documented ED.     

Prevalence of acne keloidalis nuchae in Nigerians

BACKGROUND: The prevalence of acne keloidalis nuchae (AKN), a chronic inflammatory process of the hair follicles resulting in keloidal papules and plaques at the nape of the neck, is increasing in our environment. METHODS: A prospective hospital-based observational study was conducted at the adult medical dermatologic outpatient department of Irrua specialist teaching hospital, Edo State, Nigeria. All patients referred to the dermatology clinic with symptoms and signs of AKN were recruited. RESULTS: Thirty patients presented to the adult dermatologic unit with AKN over a period of 22 months, giving a gross incidence of 9.4% of dermatologic consultations. The common etiologic factor was secondary to trauma from an electric razor whilst having a haircut, followed by spread of keloid from the beard area. CONCLUSIONS: Minimization of trauma during hair cutting or shaving and personalization of haircare instruments may reduce the recently increased incidence of this condition in our environment.     

Which dermatology patients attend to Dermatology Outpatient Clinics during the SARS‐CoV‐2 outbreak in Turkey and what happened to them?

Coronavirus disease, first emerged in Wuhan, rapidly spread all over the world since December 2019. There are concerns about elective dermatology appointments and its results. Herein, we aimed to find out which type of dermatologic patients attended to dermatology outpatient clinic. The patients visiting the clinics for elective dermatologic diseases between March 11 and 18, 2020, were included in this study. Their age, sex, diagnosis of disease, requirement for emergent intervention, and their medical records about COVID‐19 were obtained. There were 390 patients attending to the dermatology outpatient clinic in this period. The most common disease was acne (N: 94, 24%), only 19% of patients need emergent interventions or dose adjustment. There were 40 (10%) patients over the age of 65. After their visits, five patients were diagnosed as COVID‐19 in 2weeks. Dermatologic examinations may be a vector for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) transmission since being closed to the patient. Five of our patients were diagnosed as COVID‐19 after their elective visit to hospital. Since the asymptomatic course of some young patients, most of our patients were not screened for COVID‐19. Our findings support the concerns of elective physician examinations.     

The effect of the “stay‐at‐home” policy on requests for dermatology outpatient clinic visits after the COVID‐19 outbreak

The Coronavirus Disease 2019 (COVID‐19) emerged late in Turkey but it showed a rapid progression later. We aimed to investigate the changes in the number of patients who requested a dermatology outpatient clinic visit due to the increased social and medical burden caused by COVID‐19 in Turkey during the first days of the pandemic. We also examined the most common dermatologic diseases diagnosed during the COVID‐19 outbreak. A statistically significant negative correlation was found between the number of COVID‐19 patients in the country and the number of patients requesting a dermatology outpatient clinic visit in the secondary and tertiary care hospitals during self‐quarantine. In the first 10 days after the COVID‐19 outbreak, acne (28.2%), urticaria (12.8%), scabies (12.8%), irritant contact dermatitis (10.3%), and xerosis cutis (10.2%) were the most common diseases seen in the dermatology clinic at the secondary care hospital, while acne (23.3%), warts (5.4%), seborrheic dermatitis (4.5%), urticaria (3.8%), and psoriasis (3.32%) were the most common diseases seen in the dermatology clinic at the tertiary care hospital. This is our first study on the frequency and nature of outpatient dermatology visits during this novel coronavirus pandemic. Understanding the trends and impacts of dermatologic diseases on patients and health systems during this pandemic will allow for better preparation of dermatologists in the future.     

Dermatology outpatient population profiling: indigenous and non-indigenous dermatoepidemiology

Background: Little is known about the population using Australian dermatology outpatient services, in particular, Indigenous patients. This information is important to direct the strategic planning of dermatology services. Methods: This study is a multicentre, retrospective audit of all patients attending public, outpatient dermatology clinics over 7 months across four Perth tertiary hospitals. The patient population (4873 patients) was profiled by age, gender, Indigenous status and rural/urban status. Medical records of the Indigenous patient population (104 patients) were reviewed to reveal the most common skin conditions. Results: The population using public, outpatient services had a median age of 48 years, 51.4% were male and 13.6% were from rural areas. Male patient median age was 50 years compared to 45 years for female patients (P = 0.002). Indigenous patients had a median age of 22 years, a female to male ratio of 3:2 and 26.9% were from rural areas. Over 50% of Indigenous patient appointments were missed. Skin infections, eczematous conditions and naevi were the most common skin conditions in Indigenous patients. Conclusions: This data can guide strategies towards improving the provision of dermatology services for the Australian population. Particular attention is required towards improving Indigenous Australians' capacity to access dermatology services.     

Suspected skin malignancy: a comparison of diagnoses of family practitioners and dermatologists in 493 patients

BACKGROUND: In the Irish health system, dermatology patients present to their family practitioner for diagnosis and treatment, and are referred to a dermatologist for a second opinion where diagnosis is in doubt or when there has been therapeutic failure. The level of expertise in dermatology amongst family practitioners varies considerably. AIM: To compare the diagnoses of general practitioners and dermatologists over a selected period in patients with a possible diagnosis of skin cancer. METHODS: Four hundred and ninety-three patients were seen by one of two dermatologists over a 1-year period at a rapid referral clinic for patients suspected by their family practitioners of having unstable or possibly malignant skin lesions; 213 of these patients had a diagnosis made on clinical examination by the dermatologist, while 264 had diagnostic or therapeutic biopsies performed; 16 patients defaulted on surgery. RESULTS: The diagnoses of the family practitioners agreed with the diagnoses of the dermatologists on patients diagnosed clinically in 54% of cases. Thirty-eight patients had histologically proven skin malignancy. These were diagnosed accurately by the referring family practitioner in 22% of patients, while the dermatologists made the correct diagnosis prior to biopsy in 87%. CONCLUSIONS: In over 50% of cases diagnosed clinically, the dermatologist and family practitioner agreed. Histologically proven skin cancers were diagnosed accurately in only 22% of cases by family practitioners, compared to 87% of cases by dermatologists. Specific areas of diagnostic difficulty for family practitioners include benign pigmented actinic and seborrheic keratoses, squamous cell carcinoma, and melanoma. Postgraduate education for family practitioners should be directed towards these areas of deficiency. Dermatologists had difficulty distinguishing pigmented actinic keratoses from melanoma.     

南昌地区7251例门诊皮肤黏膜真菌病及病原菌分析

目的 了解南昌地区皮肤科门诊真菌感染性疾病的构成情况。方法 统计我院门诊2006—2008年期间诊断的所有皮肤和黏膜真菌病,分析病种和致病菌种与年龄、性别和发病季节的关系。结果 皮肤和黏膜真菌病共7251例,男女比为2.3 ∶ 1。股癣2702例占37.3%、花斑糠疹1505例占20.8%,手癣727例占10.0%,分别居第1 ~ 3位。除花斑糠疹未进行培养外,培养阳性菌株4953株,优势菌为红色毛癣菌（69.9%）、念珠菌（20.4%）和紫色毛癣菌（4.5%）。不同年龄段、性别及季节的病种和病原菌分布差异具有统计学意义。结论 南昌地区皮肤门诊中皮肤和黏膜真菌病以股癣病例数最多,致病菌主要为红色毛癣菌,头癣致病菌主要为紫色毛癣菌,与其他地区报道不尽相同。     

Better, sooner, more convenient: a successful teledermoscopy service

Background/Objectives: A virtual lesion clinic (VLC) using store‐and‐forward teledermoscopy was introduced to reduce waiting times and improve access for skin lesion assessment by dermatologists. We aimed to review the efficiency and patient acceptance of a new community‐based teledermoscopy service by comparing it to hospital‐based face‐to‐face (FTF) skin lesion clinics. Methods: A prospective study compared patient flow through a community‐based VLC and a tertiary hospital FTF dermatology clinic. Surveys were sent to patients and their referring doctors after attendance. Waiting times, diagnosis, outcomes, financial costs, patient acceptability and convenience were compared. Results: A total of 300 patients were assessed; 200 were seen in the VLC and 100 in the conventional FTF clinic. Of the 200 patients seen in the VLC, 88% did not require a subsequent FTF clinic assessment to establish the diagnosis. Mean waiting times for first assessment were reduced by two thirds (from 114 days to 39 days) in those seen by the VLC compared to FTF. Financial analysis demonstrated cost savings of 14%. Surveyed patients were highly satisfied and confident in the VLC service. Conclusions: A community‐based teledermoscopy service may allow improved management of outpatient referrals while providing a better, quicker and more convenient service. It may also provide cost savings, as teledermoscopy assessment can be cheaper than traditional assessment.     

临床诊断湿疹患者400例的病理诊断分析

【摘要】 目的 根据临床诊断为湿疹的患者的病理诊断,分析误诊情况。探讨临床容易误诊为湿疹的皮肤病及容易导致误诊的相关因素。 方法 回顾性分析我院皮肤科门诊2006年8月到2013年4月间临床以湿疹为诊断并做组织病理检查的所有病例,收集临床数据,重新阅片确定病理诊断,对获得的资料进行分析。 结果 400例临床诊断为湿疹的患者中,110例病理诊断为非湿疹皮炎,占27.5%。误诊病种包括银屑病16例,大疱性类天疱疮13例,扁平苔藓11例,皮肤淀粉样变9例,蕈样肉芽肿8例,恶性肿瘤14例等,其他39例。60 ~ 79岁年龄段及生殖器部位误诊率最高,分别为33.9%和46.2%。 结论 湿疹临床上容易误诊,易误诊疾病包括银屑病、大疱性类天疱疮、扁平苔藓、皮肤淀粉样变、蕈样肉芽肿以及皮肤恶性肿瘤等。老年人及生殖器部位误诊率最高,对于此类患者应积极采取皮肤病理检查。     

Complete skin examination is essential in the assessment of dermatology patients: findings from 483 patients

Background Dermatological teaching has traditionally stressed that complete skin examination is essential in the assessment of patients with potential skin disease. Objectives To determine whether complete skin examination results in increased diagnoses of skin malignancies that would not have been discovered otherwise. Methods New patients (n = 483) attending a dermatology clinic in a university teaching hospital and private dermatology practice had a complete skin examination, as is our normal practice. These patients were seen over a 9‐month period (January–September 2009). All patients were examined by the same consultant dermatologist. Data were collected on patients’ sex, age, presenting complaint and findings on complete skin examination. Results Two nodular malignant melanomas with mean Breslow thickness of 0·6 mm (0·4%) and one melanoma in situ were identified at sites distant from the patient’s presenting complaint. Sixteen patients (3·3%) had a basal cell carcinoma that would not have been discovered if the presenting lesion alone had been examined. Thirty‐three patients (6·8%) had actinic keratoses or squamous cell carcinoma in situ and nine (1·9%) had dysplastic naevi. A further 21 patients (4·3%) had a suspicious lesion biopsied or excised with subsequent benign histology. Seventy‐three patients (15·1%) had other benign dermatological diagnoses requiring treatment or investigation. Conclusions In a 9‐month period, in a sample of 483 new patients, three patients (0·6%) had potentially lethal skin malignancies identified that would not have been diagnosed without a complete skin examination. Sixteen (3·3%) patients had basal cell carcinomas that would have been missed without complete skin examination. This study confirms the traditional teaching that complete skin examination has the potential to reduce morbidity and mortality from cutaneous malignancy.     

Abstract No. 4Many patients receiving high-dose phototherapy are not being reviewed

Patients receiving high‐dose psoralen plus ultraviolet (UV) A (PUVA) have an increased risk of nonmelanoma skin cancer (Lim JL, Stern RS. High levels of ultraviolet B exposure increase the risk of non‐melanoma skin cancer in psoralen and ultraviolet A‐treated patients. J Invest Dermatol 2005; 124 : 505–13). The skin cancer risk associated with narrowband (NB) phototherapy is not yet known although mathematical models have been created to quantify the risk (Diffey BL. Factors affecting the choice of a ceiling on the number of exposures with TL01 ultraviolet B phototherapy. Br J Dermatol 2003; 149 : 428–30). Until recently, > 150 lifetime PUVA treatments and > 300 NB‐UVB treatments constituted a high dose of phototherapy. PHOTONET protocols suggest that an annual skin cancer check is carried out for patients in this category. The audit aims were to assess: (i) the number of patients receiving high‐dose phototherapy; (ii) if annual checks are being carried out in these patients; (iii) the numbers of skin cancers diagnosed in the group; and (iv) the number of patients on third‐line medication. Sixty‐six patients receiving high‐dose phototherapy were identified from the PHOTONET database; 60 case notes were available for review: 38 PUVA, 22 UVB. Sixteen of 60 are currently on third‐line therapy; an additional 30 of 60 have previously been on third‐line therapy. Six of 60 patients have developed skin cancer, all from the PUVA group. Four patients have developed nine squamous cell carcinomas, one of which has metastasized to regional lymph nodes. Two further patients have had one basal cell carcinoma each. Fourteen of 60 patients attend the photodermatology clinic for high‐dose checks, 14 of 60 attend general dermatology outpatients, three of 60 attend both clinics and 29 of 60 have no dermatology follow up. We have found that nearly 50% of patients receiving high‐dose phototherapy are not being reviewed at any dermatology clinic. Of the group being followed up 10% (16% of patients receiving PUVA) have had at least one skin cancer; this raises concerns about the group that has not been followed up. An annual high‐dose check at a dedicated clinic has a number of potential benefits. The consultation has a skin cancer focus and a full body examination including the genitals is carried out. We can take the opportunity to educate patients on skin self‐examination and early reporting of suspicious lesions. Finally, there should be a more focused approach to follow up of regular nonattendees, with correspondence to both patient and the general practitioner where necessary. In view of these findings, each patient receiving high‐dose phototherapy has been invited to attend for screening. The photodermatology clinic has been restructured to allow a monthly, dedicated high‐dose phototherapy clinic. We plan to repeat the audit cycle annually. This audit has demonstrated the use of the PHOTONET database in facilitating audit and highlighting clinical governance issues.     

Longitudinal Antibiotic Susceptibility Profiles of Staphylococcus aureus Cutaneous Infections in a Pediatric Outpatient Population

This longitudinal update on Staphylococcus aureus prevalence and antibiotic resistance patterns surveyd 291 cultures from 188 patients in a pediatric outpatient dermatology clinic with suspected skin and soft tissue infections. The prevalence of methicillin‐resistant Staphylococcus aureus remained stable at 24%. Staphylococcus aureus resistance to tetracyclines modestly but demonstrably increased in the interval since 2009.     

The changing face of dermatological practice: 25 years' experience

Background In order to plan appropriate delivery of dermatology services we need periodically to assess the type of work we undertake and to examine changing trends in the numbers and type of referrals and the workload these referrals generate. Objectives To quantify outpatient workload in hospital‐based and private practice; to assess reasons for referral to secondary care and to examine the changes over 25 years in the diagnostic spectrum of conditions referred. Methods During November 2005, all outpatient dermatological consultations in the south‐east of Scotland were recorded. Demographic data, source of and reason for referral, diagnoses, investigations performed, treatment administered and disposal were recorded, and comparisons made with four previous studies. Results During the 1‐month study, attendances were recorded for 2118 new and 2796 review patients (new/review 1 : 1·3, female/male 1·3 : 1, age range 0–106 years). Eighty‐nine per cent of new referrals came from primary care and 11% from secondary care. Fifty‐seven per cent of referrals were for diagnosis and 38% for management advice. Benign tumours accounted for 33·4%, malignant tumours 11·6%, eczema 16% and psoriasis 7·4% of new cases. For return patients, 20% had skin cancer, 16·5% eczema, 13·4% psoriasis and 9% acne. The referral rate has risen over 25 years from 12·6 per 1000 population in 1980 to 21 per 1000 in 2005, with secondary care referrals increasing from 61 in November 1980 to 230 in November 2005. Conclusions Attendances for benign and malignant skin tumours have increased sixfold since 1980. Patients with eczema and psoriasis account for one third of clinic visits. New referrals have risen by 67%, with those from other hospital specialties almost quadrupling since 1980 to 11% of the total in 2005. These results confirm the demand from both primary and secondary care for a specialist dermatology service.     

Change in pattern of skin disease in Kaduna, north-central Nigeria

BACKGROUND: We report our experience on the pattern of skin disease in Kaduna, north-central Nigeria over a 6-year period, and compare it with a similar survey conducted in the same area 30 years ago and with surveys from Nigeria and from other parts of Africa. METHODS: The medical records of new patients attending the dermatology outpatient clinics of Barau Dikko Specialist Hospital and Habbat Medical Center from March 2000 to December 2005 were retrieved. Demographic data (age and sex) and the diagnoses of skin disease were extracted and analyzed. RESULTS: A total of 5982 cases was seen. Forty-nine per cent were males and 51% were females. One-third of the patients were aged under 20 years, and three quarters were aged below 40 years. Eczematous dermatitis was the most common skin disorder seen, making up 35% of cases, and had replaced dermatophyte infections and scabies, which were the most dominant skin diseases 30 years previously (now constituting 6% and 1.4% of cases, respectively). Atopic dermatitis had more than doubled in frequency (13.8% vs. 5.2%), and contact dermatitis had tripled in frequency (5.8% vs. 1.8%). Acne vulgaris (6.7%), pigmentary disorders (3.9%), urticaria (3.6%), papular urticaria (3.6%), hair disorders (3.3%), lichen simplex chronicus (3%), viral warts (2.9%), and drug eruptions (2.7%) had also increased. Human immunodeficiency virus-related skin disease constituted 4.3% of cases, with pruritic papular eruption being the most common condition. CONCLUSION: These changes in skin disease can be attributed mainly to an increase in urbanization and improved socio-economic conditions.     

山西省某三甲医院黏膜念珠菌病病原菌和耐药性分析

目的了解太原地区皮肤科门诊黏膜念珠菌病的构成情况和病原菌耐药性。方法收集山西白求恩医院皮肤科门诊2019—2020年期间真菌培养阳性的172例黏膜念珠菌病患者临床资料, 并对病原菌进行分子生物学鉴定和体外药敏实验。结果 172例黏膜念珠菌病患者中外阴阴道念珠菌病142例(82.6%), 念珠菌性包皮龟头炎24例(14.0%), 口腔念珠菌病6例(3.5%);≤ 18岁3例、19 ～ 59岁155例、≥ 60岁14例, 分别有2例、134例(86.45%)和6例外阴阴道念珠菌病患者, 各年龄组占比差异有统计学意义(χ2 = 14.29, P < 0.05)。分离的172株菌均为念珠菌属, 包括白念珠菌165株(95.9%), 光滑念珠菌5株(2.9%), 近平滑念珠菌2株(1.2%);对常用抗真菌药物氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑、伏立康唑的敏感性分别为95.9%、100.0%、62.2%、47.1%和56.4%。结论本院皮肤门诊黏膜念珠菌病以外阴阴道念珠菌病为主, 致病菌主要为白念珠菌;念珠菌分离株对氟胞嘧啶、两性霉素B敏感性较好。     

Patients' attitudes toward resident participation in dermatology outpatient clinics

The attitudes of patients toward resident participation in a university-based dermatology outpatient clinic were evaluated. Of 206 patients asked to participate, 191 patients completed the self-administered questionnaire (92.7%). The overwhelming majority of patients (99.5%) were satisfied (81.8% "very satisfied" and 17.7% "satisfied") with the resident's participation in their care. Many more patients expressed a willingness to allow residents to take histories (93.6%), perform physical examinations (87.2%), and counsel on preventive measures (74.5%), than to allow surgical excisions of skin cancers (19.7%), perform skin biopsies (43.6%), or prescribe medications (44.7%). Of respondents to the questionnaire, 83.2% self-reported an understanding of the difference between "resident" and "attending" physicians. However, only 31.3% (95% confidence interval 24.5-38.1) were able to broadly categorize the amount of training completed by dermatology residents. Dermatology resident participation in outpatient clinics is essential to quality dermatologic education. Consistent with the results of prior studies in other medical disciplines, our study demonstrated an overwhelming patient satisfaction with the participation of dermatology residents in their care.