Allergic Drug Reactions: How Do The Dermatologists Of Vadodara City Perceive And Contribute To Pharmacovigilance Program?

Background:The pharmacovigilanceisimperativein defining safety profile of the drug.As cutaneous Adverse Drug Reactions (ADRs) are very common, dermatologists’ contribution to pharmacovigilanceprogram of India (PvPI) is important. This study was conducted to know dermatologists’ perception about ADRs; their awareness and participation inPvPI. Material and Methods:A Prospective, cross-sectionalsurvey was conductedamongst dermatologists, approaching via Whatsappor during academic meetings. Pre-validated questionnaire including their demographic details, perception of risk of allergic reactions, awareness of PvPI and ADRs reporting was utilized. Data analysis was done with Microsoft Excel and Graph Pad prism software. Results:Out of 73 dermatologists, 44 responded the survey (Coverage rate 60%).Highest and lowest risk amongstantimicrobials for ADRswas perceived for sulphonamides and cephalosporins respectively. Amongstnon-antimicrobials, it was Non-steroidal anti-inflammatory drugs (NSAIDs) and local anaesthetics respectively. Awareness about PvPI was seen in 94% and 38% of dermatologists working in an institute and in a private set up respectively. Amongst them, 78% and 18% had ever reported ADRs to PvPI. Conclusions:Sulphonamides and NSAIDs were perceived to have higher risk ofADRs. Limited number of dermatologists have contributed to national ADR database amongst the ones who are aware of PvPI.

Clinical and Statistical Analysis of Patients with Anaphylaxis Visiting the Emergency Room of a Tertiary Hospital / 대한피부과학회지

BACKGROUND: Understanding the epidemiology of anaphylaxis is imperative for appropriate diagnosis and treatment, but the prevalence reportedly varies and only a few studies have compared the clinical features of anaphylaxis with the underlying causes in Korea. OBJECTIVE: This study aimed to investigate the etiology and clinical features of anaphylaxis. METHODS: We retrospectively reviewed the medical records of 319 anaphylaxis patients who visited our emergency room and extracted information on the causes, clinical characteristics, and subsequent outpatient visits. RESULTS: Food, drugs, and environmental factors were common causes of anaphylaxis. Statistically significant differences (p<0.001) were observed between children (<18 years of age) and adults (≥18 years of age), with food and drugs identified as the most common causes, respectively. Clinical characteristics of the patients were compared according to the common causes of anaphylaxis. Cutaneous symptoms were observed more frequently in food-induced cases (n=137, 95.1%) compared to drug-induced (n=73, 77.7%) and bee sting-induced (n=18, 78.3%) cases (p<0.001), whereas neurological symptoms were observed more frequently in drug-induced (n=37, 39.4%) and bee sting-induced (n=11, 47.8%) cases than in food-induced (n=18, 12.5%) cases (p<0.01). Drug-induced (n=44, 46.8%) and bee sting-induced (n=11, 47.8%) cases were more severe than food-induced cases (n=32, 22.2%). Out of the 319 assessed patients, only 25, 14, and 14 patients were referred to the pediatrics, allergy, and dermatology departments, respectively, after visiting the emergency room. CONCLUSION: Clinical characteristics of anaphylactic patients differed according to the underlying cause, but these findings are presumably influenced by factors determining the severity of anaphylaxis. We found that subsequent follow-up care in other departments to identify the cause of anaphylaxis was inadequate for most patients.

Trends and Opinion of Isotretinoin Use for Acne Treatment by Dermatologists in Western Area of Saudi Arabia: A Cross-Sectional Survey

Background: Acne is a common disease. Variety of treatment methods are available. Oral isotretinoin is an effective treatment but has some precautions.  Methods: In this study, the attitude of dermatologists in western area of Saudi Arabia toward isotretinoin and their practice are being studied through online questionnaire survey. Results: More than half of responding dermatologists used the dose of 0.5mg per kg per day. Variable dosing, length of therapy, and laboratory investigations were reported. All responding dermatologists did laboratory investigations before commencing therapy and most did it as well after one month. Most of responding dermatologists thought it was safe to perform laser hair removal during or shortly (1-2 months) post isotretinoin therapy, but laser resurfacing was not thought to be safe to do while on therapy. The most common side effects encountered with oral isotretinoin were skin and lip dryness and chelitis. All dermatologists counselled females for teratogenicity and pregnancy prevention. There were variable responses to depression, blood donation abstinence and irritable bowel syndrome. Conclusions: In conclusion, isotretinoin is an effective therapy for acne. There is a controversy among physicians on the dose, length of therapy and laboratory follow up. Controversies for depression, irritable bowel syndrome still exist.

Niveles de vitamina D en dermatólogos y residentes de dermatología de diferentes regiones de Colombia: un estudio piloto / Vitamin D Levels in Dermatologists and Residents of Dermatology in Different Areas of Colombia: a Pilot Study

Introducción: La deficiencia de vitamina D es considerada una pandemia. En la actualidad existen numerosas publicaciones que documentan esta deficiencia en pacientes con osteopenia y/o osteoporosis; sin embargo, no hay estudios en Colombia ni en Latinoamérica que evalúen la deficiencia e insuficiencia de vitamina D en población sana, ni en dermatólogos, quienes pueden ser susceptibles de adquirir esta deficiencia por las largas jornadas laborales y la falta de exposición solar. Objetivo: Determinar la prevalencia de deficiencia de vitamina D en dermatólogos y residentes de dermatología en Colombia, y establecer sí la región de origen estaba asociada a niveles de vitamina D. Metodología: estudio tipo piloto, observacional, analítico de corte transversal, en el cual se incluyeron dermatólogos y residentes de dermatología asistentes al congreso Colombiano de dermatología 2016. A todos los participantes se les aplicó un cuestionario, se practicó examen físico y se midió niveles de 25 hidroxi vitamina D3. Resultados: 100 participantes fueron incluidos en el estudio: la edad media fue 39 años, el 67 % eran mujeres, con prevalencia de insuficiencia o deficiencia de vitamina D del 96% y concentración media de vitamina D de 18.20 ng/ml. Conclusiones: La deficiencia de vitamina D es altamente prevalente en dermatólogos y residentes de dermatología en Colombia, se sugieren intervenciones preventivas en esta población, debido a la alta morbimortalidad relacionada con tal deficiencia...(AU)

Introduction: Vitamin D deficiency is considered as a pandemic. Now, there are lots of publications documenting this deficiency in patients with osteopenia and / or osteoporosis; however, there are no studies either in Colombia or Latin America that evaluate vitamin D deficiency and insufficiency in a healthy population, or in dermatologists, who can be susceptible to acquire this deficiency by the long working hours and the lack of sun exposure. Objective: To determine the prevalence of vitamin D deficiency in dermatologists and residents of dermatology in Colombia and to establish if the area of origin was associated with vitamin D levels. Methodology: This is a pilot, observational, cross-sectional and analytical study in which dermatologists and dermatology residents attending to the 2016 Colombian Congress of Dermatology were included. All participants were given a questionnaire; a physical exam was performed to them and their levels of 25-hydroxyvitamin D3 were measured as well. Results: 100 participants were included in this study: their average age was 39 years; 67% of them were women, with a prevalence of vitamin D deficiency or insufficiency of 96% and with a mean of vitamin D concentration of 18.20 ng/ml. Conclusions: Vitamin D deficiency is highly prevalent in dermatologists and residents of dermatology in Colombia. With this population, some preventive interventions are suggested due to the high morbimortality related to such deficiency...(AU)

Introdução: a deficiência de vitamina D é considerada uma pandemia. Existem agora inúmeras publicações documentando essa deficiência em pacientes com osteopenia e / ou osteoporose; no entanto, não há estudos na Colômbia ou na América Latina que avaliem a deficiência e insuficiência de vitamina D na população saudável, nem em dermatologistas, que podem ser suscetíveis de adquirir essa deficiência devido aos longos dias de trabalho e falta de exposição solar. Objetivo: Determinar a prevalência de deficiência de vitamina D em dermatologistas e residentes de dermatologia na Colômbia e determinar se a região de origem estava associada a níveis de vitamina D. Metodologia: estudo piloto, observacional, transversal, analítico em que dermatologistas e residentes de dermatologia presentes no Congresso Colombiano de Dermatologia 2016 foram incluídos. Todos os participantes receberam um questionário, exame físico e níveis de 25 hidroxi vitamina D3. Metodologia: estudo piloto, observacional, transversal, analítico em que dermatologistas e residentes de dermatologia presentes no Congresso Colombiano de Dermatologia 2016 foram incluídos. Todos os participantes receberam um questionário, exame físico e níveis de 25 hidroxi vitamina D3. Resultados: 100 participantes foram incluídos no estudo: idade média foi de 39 anos, 67% eram mulheres, com prevalência de deficiência de vitamina D ou insuficiência de 96% e concentração média de vitamina D de 18.20 ng/ml. Conclusões: A deficiência de vitamina D é altamente prevalente em dermatologistas e residentes de dermatologia na Colômbia. As intervenções preventivas nesta população, são sugeridas por causa da alta morbidade e mortalidade associada a esta deficiência...(AU)

Four Years Prospective Study of Natural History of Atopic Dermatitis Aged 7~8 Years at an Individual Level: A Community-Based Survey by Dermatologists' Skin Examination in Childhood

BACKGROUND: The age-dependent change in atopic dermatitis (AD) at an individual level has mostly performed in a hospital-setting. OBJECTIVE: We evaluated the age-dependent change of AD symptoms at an individual level in a community-setting. METHODS: For the diagnostic accuracy, all participants of schoolchildren were received skin examination by dermatologists (twice a year for the same group), instead of questionnaire-based surveys. For this study, sequential check-ups of 273 elementary school children, aged 7~8 years, were performed for 4 years up to the age of 10~11 years. RESULTS: Among the 47 AD children, who had been diagnosed as having AD at the first-year check-up, spontaneous remission was detected in nine children during the follow-up periods (remission rate of 19.1%). As a consequence, the one-year AD prevalence was decreased by 5.9% in the elementary schoolchildren over four years. Unexpectedly, late onset (after 8 years of age) AD was observed in 21.7% of AD children. There was no statistically significant relationship between spontaneous remission and host factors including sex and family history of atopic diseases. CONCLUSION: We observed that 19.1% of AD children in the age group of 7~11 years showed spontaneous remission based on skin examination by dermatologists. There might be an increase in the prevalence of late onset AD in Korea.

Age Changes in Human Skin from 3 Years to Years of Age.

Background: Natural aging process is reflected by gradual changes in the structure of the skin. These changes become very marked in old age. The changes in the epidermis and dermis as age advances is reflected externally as wrinkling, dryness, loss of elasticity , thinning and tendency towards purpurae on minor injury. So the aim of this study is to measure the thickness of the epidermis. Materials and Methods: The study was done in skin specimens by grouping the individuals in 4 age groups namely Group A (3-20yrs), Group B (21-50yrs), Group C (51-65yrs and Group D (>65yrs).The specimens were stained with Haematoxylin and Eosin stain and the changes in the thickness of the epidermis was observed. Results: The epidermis was found to be thin in children from 3years of age. The thickness of the epidermis starts increasing in young individuals and is thick till 50 years of age. Then the thickness of the epidermis starts reducing and becomes very thin in older persons. Conclusion: As the average life expectancy is increasing, the aging of skin presents a growing problem for the dermatologists. The computer system for image processing and analysis has made possible, measuring the thickness of the epidermis. Human aging is characterized by a number of disorders like epidermolysis bullosa and phemphigus vulgaris affecting the structure of the skin. So it is necessary to study the normal changes that occur in the skin as age advances which predisposes to various disorders. The study is done among Indian population.

Correlación clínico-patológica en entidades dermatológicas. Clínica Ces Medellín 1995-1997 / Clinic-patological correlation in dermatologicals diseases: Clinica Ces Medellin 1995-1997

A diario el dermatólogo se enfrenta con la tarea de hacer un buen diagnostico clínico, pero ¿cuántos de éstos se correlacionan en una forma adecuada con el estudio anatomopatológico? Para evaluar dicha concordancia se planteó este estudio, además se buscaba comparar el acierto de los dermatólogos con los de los médicos de otras especialidades. El presente es un estudio analítico buscando la correlación entre los diagnósticos clínicos y los de anatomía - patológica de todas las biopsias procesadas en la Clínica CES durante el período comprendido entre enero de 1995 y mayo de 1997. Para tal fin se revisaron todas las órdenes de solicitud de biopsias y los informes de patología respectivos. En total se tabularon 1198 muestras. La concordancia diagnóstica de los clínicos con los diagnósticos realizados mediante patología fue de 72,3% para los dermatólogos, 11% para los cirujanos plásticos y 16,7% para el grupo de otros médicos. En los tumores benignos no hubo diferencia significativa en la coincidencia diagnóstica entre las diferentes especialidades. La coincidencia entre dermatólogos y otros en los tumores benignos es muy semejante (55,9% y 53,2%); en las entidades infecciosas el grupo de otros médicos tuvo mejor correlación que los dermatólogos. Sería interesante realizar un trabajo por diagnósticos específicos y comparar con otros médicos, para evaluar la causa real de la poca correlación de los dermatólogos y el mejor desempeño de otros especialistas en entidades infecciosas y tumorales.

Everyday the dermatologist faces the responsibility of making a good clinical diagnosis, but how many of these are appropriately correlated with the anatomopathological studies? This study was made to evaluate such correlation, and to see how good are the diagnosis made by dermatologists compared to other specialists. This descriptive study is looking for the concordance between clinical diagnoses and the anatomy – pathology biopsies processed at the CES Clinic during the period between January 1995 and May 997. For such aim all the biopsy requests and the respective information of pathology were reviewed. 1198 samples were tabulated. The concordance viewed between clinical diagnoses and those made through pathology was of 72.3% for the dermatologists, 11% for plastic surgeons and 16.7% for the group of other physicians. In the benign tumors there was no significant difference in the diagnostic concordance among the different specialties. The coincidence between dermatologists and others in the benign tumors is very similar with 55.9% and 53.2%, respectively; in the infectious entities the group of other doctors had better correlation than the dermatologists. It would be interesting to conduct a specific diagnostic research and compare with other physicians, to assess the real cause of the low correlation of dermatologists and better perform of other specialistsin infectious and tumor entibies.

A Survey on the Topical Steroid Prescriptions of Dermatologists / 대한피부과학회지

BACKGROUND: A recent survey on dermatology outpatients, which assessed their knowledge and behavior for topical steroid use, showed that topical steroids were often used without sufficient information or guidelines. OBJECTIVE: Our study aimed to evaluate the general pattern of which dermatologists prescribe topical steroids, the prevalence of topical steroid phobia among the dermatology outpatients and the way dermatologists managed such patients. METHODS: 236 dermatologists, including those in private clinics and those in the secondary and tertiary hospitals, were asked via mail or e-mail to fill in a questionnaire on their topical steroid prescription. RESULTS: About sixty percent of the total respondents answered that they prescribed topical steroid to more than half of their outpatients, with excluding those patients who came to the office for cosmetic purposes. Most respondents informed their patients about their prescription of topical steroids (85.61%), they explained the mechanism of its action and the clinical effects (65%), the potency and duration of application (70%), and the side effects (82%). But most respondents forgot or did not tell their patients about their steroid formulation (46%), the optimal amount to apply (74%) and the means and duration of optimal storage (82%). 45% of the respondents assumed that more than half of the outpatients to have topical steroid phobia. Yet 80% of the respondents replied that less than 10% of their outpatients had experienced side effects of topical steroids. 73% of the respondents in private clinics and 62% in secondary and tertiary hospitals were influenced by the patients' negative attitude on topical steroid prescription. CONCLUSION: The results show that the information on topical steroids, in terms of formulation, the optimal amounts to apply and the means and duration of optimal storage, were not sufficiently provided by dermatologists. The topical steroid phobia of patients has been exaggerated despite the low incidence of side effects.