Teledermatología sincrónica en tiempos de Covid-19. Percepción del dermatólogo / Synchronous teledermatology in times of Covid-19. Dermatologist perception

Teledermatology (TD) is a remote medical care tool that experienced a great boom during the COVID19 pandemic, resulting in an increase in both, the number of remote consultations and the number of dermatologists who practice it. Several studies have reported a high degree of satisfaction among patients attended by this method. However, few studies have done so in dermatologists. We set out to investigate the experience of Chilean dermatologists with the tool by means of an online survey. Results. A total of 156 surveys were completed. The number of dermatologists using TD increased from 19.9% to 80.8% during the pandemic. They cited the absence of the physical examination-dermatoscopy as the main limitation to developing TD and reported feeling more comfortable with some pathologies. Dermatologists feel moderately comfortable and confident with the tool, however, they experienced varying degrees of stress and frustration. Only 40.8% plan to continue using TD in the future. Conclusion. Synchronous TD has clear limitations, however, these should emerge as an opportunity to consider in its development and its platforms, in order to generate a more comfortable tool for more dermatologists and thus extend its use, as an important tool for equal access to health care in Chile. (AU)

Psicodermatología: la necesidad de comprender la mente y el cuerpo como una unidad indivisible / Psychodermatology: the need to understand mind and body as an indivisible unit

La influencia entre la mente y el cuerpo es innegable, la psicodermatología es una subespecialidad de la dermatología, que trata el estudio de las condiciones que presentan un gran solapamiento entre la patología dermatológica y psiquiátrica, principalmente, en casos en los cuales hay eventos psicológicos predominantes al inicio de las dermatosis o en los casos en que estas producen daño o un efecto desequilibrante en la psiquis. OBJETIVO: Realizar una revisión de la literatura disponible acerca del desarrollo y avances en el campo de la psicodermatología. Existen diferentes y verosímiles explicaciones acerca de cómo surge la interrelación entre la piel y la mente, que comienzan en su origen embrionario común en el ectodermo, mostrando sincronía con algunos ritmos biológicos, pero por sobre todo, el impacto bidireccional que existe con el estrés. Estas dermatosis se han agrupado en tres categorías distintas: condiciones psiquiátricas primarias, condiciones psiquiátricas secundarias y trastornos psicofisiológicos de la piel. CONCLUSIONES: La psicodermatología busca dar atención a los estados mentales y emocionales que son parte de un contexto mayor, donde la piel es uno de los principales afectados. A la fecha, la investigación aún es incipiente, sin embargo, parece claro que se requiere una formación integral de los diferentes profesionales que se ven enfrentados a estas condiciones en sus pacientes, que les permitan, sino curar, proporcionar recursos para lidiar con los problemas de una manera balanceada y autónoma.

The connection between mind and body is undeniable, psychodermatology is a subspecialty of dermatology, which deals with the study of the conditions that present a great overlap between dermatological and psychiatric pathology, mainly in cases in which there are psychological factors predominant at the beginning of the dermatoses, or in cases where these produce damage or an unbalancing effect in the psyche.OBJECTIVE: To carryout a review of the available literature on development and advances in the field of psychodermatology. There are different and plausible explanations about how the interrelation between the skin and the mind arises, which begin in their common embryonic origin in the ectoderm, showing synchronicity with some biological rhythms, but, above all, the bidirectional impact of stress. These dermatoses have been grouped into three distinct categories: primary psychiatric conditions, secondary psychiatric conditions, and psychophysiological skin disorders.CONCLUSIONS: Psychodermatology seeks to give attention to the mental and emotional states that are part of a larger context, where the skin is one of the main affected organs. To date, the research is still incipient, however, it seems clear that it requires a comprehensive training of different professionals who are faced with these conditions in their patients, that allow them, if not to cure, to provide resources to deal with the problems in a balanced and autonomous way.

Polymeric nanoparticles in dermocosmetic / Nanopartículas poliméricas en dermocosmética

Recent advances in the fields of biomaterials and nanotechnology have allowed the development of advanced nanoparticles for biomedical applications. Despite a vast number of nanostructures such as liposomes, solid­lipid nanocapsules, polymeric and hybrid lipid­polymer nanoparticles have been studied as carriers for drug delivery for different pathologies with remarkable promising results; the use of polymeric nanoparticles in dermocosmetic still has not been widely explored. The evolution of cosmetic into the care skin and dermatology represents novel technological challenges. Also, the increasing knowledge about normal skin physiology and advances in nanotechnology provide an attractive environment for the creation of innovative dermocosmetic formulations. In this work, we discuss the state of the art of polymeric nanoparticles formulated for dermocosmetics, its mechanisms of action, and diffusion into the skin.

Los recientes avances en el campo de los biomateriales y la nanotecnología han permitido el desarrollo de nanopartículas avanzadas para aplicaciones biomédicas. A pesar de que un gran número de nanoestructuras tales como liposomas, nanocápsulas lípido-sólidas, nanopartículas poliméricas y lípido-polímero híbridas han sido estudiadas como vehículos para la administración de fármacos en diferentes patologías con notables resultados prometedores, el uso de nanopartículas poliméricas en dermocosmética todavía no ha sido ampliamente explorado. La evolución de la cosmética en el cuidado de la piel y la dermatología nos enfrentan a nuevos retos tecnológicos. Además, el aumento de los conocimientos sobre la fisiología de la piel normal y los avances en la nanotecnología proporcionan un entorno atractivo para la creación de formulaciones dermocosméticas innovadoras. En este trabajo se discute el estado del arte de las nanopartículas poliméricas desarrolladas para dermocosmética, sus mecanismos de acción y la difusión en la piel.

Stem cells in dermatology

Preclinical and clinical research have shown that stem cell therapy could be a promising therapeutic option for many diseases in which current medical treatments do not achieve satisfying results or cure. This article describes stem cells sources and their therapeutic applications in dermatology today.

Patient-assisted teledermatology practice: What is it: When, where, and how it is applied.

Recent teledermatology practice has been focused on different models made possible by robust advances in information technology leading to consistent interaction between the patient and health care professionals. Patient-assisted teledermatology practice also called patient-enabled teledermatology or home based teledermatology is one such novel model. There is a lack of scientifi c literature and substantive reviews on patient-assisted teledermatology practice. The present article reviews several studies and surveys on patientassisted teledermatology practice and outlines its advantages and barriers to clinical utility and analyses the potentiality of this concept. Incorporating patient-assisted teledermatology practice as a novel model in the revised classifi cation of teledermatology practice is proposed. In patient-assisted teledermatology, the patient can upload his/her clinical images as a fi rst contact with the dermatologist or an initial face-to-face examination can be followed by teledermatology consultations. The latter method is well suited to chronic diseases such as psoriasis, vitiligo, and leg ulcers, which may need frequent follow-up entailing signifi cant costs and time, particularly in the elderly. Teledermatology may also be used by the treating dermatologist to seek expert opinion for diffi cult cases. Studies have demonstrated the importance and usability of the concept of patient-assisted teledermatology practice. Various teledermatology care models are available and the appropriate model should be chosen depending on whether the clinical situation is that of easily diagnosed cases (“spotters”), chronic cases or doubtful cases and difficult-to-manage cases.

Nanotechnology in Dermatology

The scientific community and general public have been exposed to a series of achievements attributed to a new area of knowledge: Nanotechnology. Both abroad and in Brazil, funding agencies have launched programs aimed at encouraging this type of research. Indeed, for many who come into contact with this subject it will be clear the key role that chemical knowledge will play in the evolution of this subject. And even more, will see that it is a science in which the basic structure is formed by distilling different areas of inter-and multidisciplinary knowledge along the lines of new paradigms. In this article, we attempt to clarify the foundations of nanotechnology, and demonstrate their contribution to new advances in dermatology as well as medicine in general. Nanotechnology is clearly the future. .

Sinais dermatológicos clássicos na medicina veterinária / Classic dermatological signs in veterinary medicine

Arrolam-se os sinais dermatológicos evidenciados na rotina da clínica dermatológica, que permitem aventar um diagnóstico presuntivo ou até estabelecê-lo cabalmente. Os dezesseis sinais reunidos envolvem quadros dermatopáticos etiologicamente relacionados às enfermidades autoimunes, infecciosas, parasitárias, alérgicas, endócrinas, psicopáticas, disqueratinizantes, neoplásicas e genodermatóxicas.

Dermatological signals observed in routine dermatologic clinical practice, which allow producing any presumptive diagnosis or to establish it fully, are listed. The 16 signals gathered are related to autoimmune, infectious, parasitic, allergic, endocrine, psychopathic, neoplasic, genetic and of abnormal cornification diseases.

Acitretin in dermatology.

Acitretin, a synthetic retinoid has gradually replaced etretinate in today’s dermatologic practice because of its more favorable pharmacokinetics. Acitretin over the past 20 years has proven useful in a number of diffi cult-to-treat hyperkeratotic and infl ammatory dermatoses and nonmelanoma skin cancers. It is effective both as monotherapy and in combination with other drugs for hyperkeratotic disorders. It is considered to be an established second line treatment for psoriasis and exerts its effect mainly due to its antikeratinizing, antiinfl ammatory, and antiproliferative effect. Its antineoplastic properties make it a useful agent for cancer prophylaxis. Evidence-based effi cacy, side-effect profi le, and approach to the use of acitretin would be discussed in this review. In addition to its approved uses, the various off label uses will also be highlighted in this section. Since its use is limited by its teratogenic potential and other adverse effects, including mucocutaneous effects and hepatotoxicity, this review would summarize the contraindications and precautions to be exercised before prescribing acitretin.

A longitudinal study of consistency in diagnostic accuracy of teledermatology tools.

Background: Diagnostic accuracy (DA) is an outcome measure to assess the feasibility of teledermatology tools. Despite ample data with variable DA values, no study has examined the aggregate DA value obtained from the available studies and observed its consistency over a period of time. This kind of a longitudinal study about teledermatology will be necessary to check its usefulness and plan for further implementation. Aims: To observe the DA trend over a period of 15 years (1997-2011). Methods: Only those studies (n = 59) using a single tool for general, tertiary, and subspecialty teledermatology practice were included to obtain the DA values. Studies were graded based on the number of subjects and gold standard comparison between teledermatologist and clinical dermatologist (face-to-face examination). Results: This analysis sought to identify the DA trend was carried out by evaluating 17 store and forward teledermatology (SAFT) based and 8 Video conference (VC) tool-based studies with 2385 and 1305 patients respectively, in comparison with the gold-standard assessment. The average DA was 73.35% ± 14.87% for SAFT and 70.37% ± 7.01% for VC. One sample t-test analysis with 100% accuracy as standard value revealed 28% deficiency for SAFT (t = 7.925; P = 0.000) and 30% deficiency for VC (t = 11.955; P = 0.000). Kruskall-Wallis test confirmed the consistency of DA values in the SAFT (χ2 = 1.852, P = 0.763) tool. Conclusion: SAFT and VC were adequately validated on a large number of patients by various feasibility studies with the gold standard (face-to-face) comparison between teledermatologists and clinical dermatologists. The DA of SAFT was good, stable over the 15 years and comparable to VC. Health-care providers need to plan for appropriate utility of SAFT either alone or in combination with VC to implement and deliver teledermatology care in India.

Misnomers in dermatology: Time to change and update.

Most of the misnomers encountered in dermatology have arisen from lack of understanding of the underlying etiopathogenesis, histopathology and/or concepts. Some misnomers are due to imprecise translations from word of origin, etymological bungles and/or factual errors. It is very important for the residents and practitioners of dermatology to update and change the old misnomers with relevant names to avoid confusion and misunderstanding. In this article, we have listed all the misnomers in dermatology and suggested the appropriate names as indicated.

Teledermatología: ¿qué, cuándo y cómo?: [revisión] / Teledermatology: what, when and how?: [review]

La telemedicina es un campo con un alcance enorme, el que se ha expandido en los últimos años. Particularmente las especialidades gráficas, como por ejemplo la Dermatología, tienen un papel crucial en este terreno. La teledermatología tiene enormes beneficios como son: permitir el acceso a consultas especializadas de poblaciones remotas y con pocos recursos, realizar interconsultas entre expertos para casos complicados, brindar educación médica continua; no obstante se deben conocer sus limitaciones y obstáculos.

Telemedicine is an area with enormous potential that has expanded greatly in the last few years. Particularly specialties that rely on images, like Dermatology, have an important role in the field. Teledermatology brings on a lot of benefits, such as bringing specialty care to remote populations without resources, allowing experts to exchange ideas on difficult cases, continuing medical education; but it also has limitations and obstacles that need to be acknowledged.

Avances más destacados de la dermatología a nivel mundial en los últimos 30 años / The most important advances of the dermatologyin to world level in the last 30 years

En el presente artículo se hace una breve reseña de algunos de los más destacados avances de la dermatología en sus diferentes campos y su significado para la medicina general y la salud pública.

In the following article the most important advances in the different field of dermatology are discussed, with emphasis in their significance in regard to general medicine and public health.