Participation in Clinical Trials Among Academic Dermatologists Affiliated With Veterans Affairs Hospitals: Survey Study.

Background: Clinical trials have led to the development of new and effective therapies for many dermatologic conditions. To our knowledge, there is no published study that has quantified and described the degree of involvement in clinical trials among academic dermatologists and their university affiliates. Objective: The purpose of this study was to characterize the involvement of academic dermatology departments in clinical trials research. Methods: An online survey was sent to 211 Veterans Affairs (VA)-employed dermatologists. It comprised 20 questions related to the number of clinical trials, support staff dedicated to clinical research, skin diseases studied, and the effect of the COVID-19 pandemic on conducting clinical research. Three rounds of survey invitations were sent over a 3-month period (March to May 2021). Data from all survey responses were reviewed for quantitative and descriptive analyses of the key outcome measures. Results: A total of 48 dermatologists completed the survey and provided their university affiliations and details of involvement in clinical trials research. Over half of participants (n=25, 58.1%) with a university affiliate reported that their affiliated dermatology department had a dedicated clinical trials unit. Basal cell carcinoma was the most frequently studied skin condition (n=9, 18.8%), followed by atopic dermatitis and psoriasis (n=4, 8.3% each); 66.7% of participants reported no current clinical trials participation. Of those conducting clinical trials, 87% (n=18) noted that COVID-19 was a barrier to conducting trials, with 52.2% (n=11) citing disrupted or decreased trials due to the pandemic. Conclusions: Although many dermatologists with university affiliations reported having a dedicated clinical trials unit at their institution, a majority of those surveyed reported not taking part in any active trials. Overall, the diseases investigated in academic clinical trials appear to follow national trends, though some of the top dermatological diseases are underrepresented in clinical trials research. A key limitation of our study was the low response rate (~23%) and that the survey responses from the sample of VA-based dermatologists may not be generalizable to all academic dermatology departments in the United States. The effect of the COVID-19 pandemic appeared to play a significant role in disrupting active trials.

From the Cochrane Library: Hydrosurgical Debridement Versus Conventional Surgical Debridement for Acute Partial-Thickness Burns

The Cochrane systematic review “Hydrosurgical debridement versus conventional surgical debridement for acute partial-thickness burns” analyzed existing randomized controlled trials (RCTs) enrolling participants with acute partial-thickness burn injuries requiring debridement and grafting;this yielded one eligible study randomizing 61 pediatric patients to either conventional debridement (n=31) or hydrosurgery (n=30) [1]. Study conclusions were very low certainty on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment, showed a high risk of reporting bias, and were limited by the small sample size (not powered to detect differences in primary outcomes). RPD is a Joint Coordinating Editor for Cochrane Skin, a dermatology section editor for UpToDate, a Social Media Editor for the Journal of the American Academy of Dermatology, a Podcast Editor for the Journal of Investigative Dermatology (JID), Editor-in-Chief of JMIR Dermatology, a coordinating editor representative on Cochrane Council, and Cochrane Council cochair and director of the University of Colorado Anschutz Medical Campus United States Cochrane Affiliate.

Patient Perceptions of Dermatologic Photography: Scoping Review

Background: Medical photography is used extensively in dermatology to record disease progression, measure treatment response, and help teach patients about skin disease;such photos are also commonly utilized in teledermatology, medical education, research, and medical reference websites. Understanding patient perceptions of medical photographs obtained during dermatologic care in the clinic or hospital setting is critical to enable the delivery of high-quality, patient-centered medical care. Objective: The aims of this study were to elucidate patient perceptions of skin photos in dermatology and to explore possible next steps in improving the patient experience with medical photography in the hospital or clinic setting. Methods: A scoping review of the literature was performed using the PubMed database, with clinic- or hospital-based full-text publications in English spanning the last 10 years considered for inclusion. Results: The majority of included studies (10/11, 91%) found positive patient attitudes toward medical photographs. The majority of patients (1197/1511, 79.2%) felt that medical photographs could improve medical care in the clinic setting. Written consent detailing all photo uses, including secondary uses (such as research or teaching), was preferred, apart from in 1 study. Patients preferred or found it acceptable for the photographer of their medical photos to be a physician (1301/1444, 90.1%). Clinic-owned cameras with departmental record storage were the preferred modality. Latinx and African American patients expressed less trust in the utility of medical photographs to improve care, compared with Asian and White patients. The minimal number of available publications on this topic and the inclusion of articles older than 5 years are limitations, since patient perceptions of medical photography may have rapidly changed during this time span, particularly in light of the COVID-19 pandemic and the subsequent increase in teledermatology visits. Conclusions: Patients reported positive perceptions of dermatologic photography for improving their medical care. Ethnic disparities in patient perceptions require further exploration to better elucidate nuances and develop interventions to improve the experience of marginalized patients. Building patient trust in nonphysician photographers may enhance clinic efficiency. Although clinic-owned cameras are well-accepted by patients, improved patient education surrounding the safety of electronic medical record phone applications is needed.

From the Cochrane Library: Skin Care Interventions in Infants for Preventing Eczema and Food Allergy

Without a global standard for neonatal or infant skin care, and with few emollient studies performed in term infants, Kelleher et al’s Cochrane review [2] provides a much-needed assessment of the evidence for emollients and other interventions to prevent eczema, as well as their effects on the development of food allergy. Outcomes Comparison Relative risk (RR) or hazard ratio (HR) (CI) Number of studies and participants in the pooled analysis Quality of evidence Development of eczema by 1-2 years Skin care interventions vs standard carea RR=1.03 (CI 0.81-1.31) 7 trials, 3075 participants Moderate Time needed to develop eczema Skin care interventions vs standard care HR=0.86 (CI 0.65-1.14) 9 trials, 3349 participants Moderate Development of skin infections Skin care interventions vs standard care RR=1.34 (CI 1.02-1.77) 6 trialsb, 2728 participants Moderate IgEc-mediated food allergies at 1-2 years Skin care interventions vs standard care RR=2.53 (CI 0.99-6.47) 1 trial, 996 participants Very low Sensitization to food allergens at 1-2 years Skin care interventions vs standard care RR=0.86 (CI 0.28-2.69) 2 trials, 1055 participants Very low aStandard care is defined as no skin care or care as usual. bWhile 2 out of the 6 studies in the pooled analysis slightly favored skin care interventions (not statistically significant), the pooled data suggested an increased risk of skin infection with emollients. There are currently a number of ongoing clinical trials assessing skin care interventions for the prevention of atopic dermatitis and food allergy;one trial recently concluded there is no evidence that the use of daily emollients reduces the risk of eczema by the age of 2 years in high-risk patients (patients with first-degree relatives with a history of eczema, asthma, or allergic rhinitis) [3].

Interferon and Toll-Like Receptor 7 Response in COVID-19: Implications of Topical Imiquimod for Prophylaxis and Treatment.

BACKGROUND: The innate immune system is recognized as an essential aspect of COVID-19 pathogenesis. Toll-like receptors (TLRs) are important in inducing antiviral response, triggering downstream production of interferons (IFNs). Certain loss-of-function variants in TLR7 are associated with increased COVID-19 disease severity, and imiquimod (ImiQ) is known to have immunomodulating effects as an agonist of TLR7. Given that topical imiquimod (topImiQ) is indicated for various dermatologic conditions, it is necessary for dermatologists to understand the interplay between innate immunity mechanisms and the potential role of ImiQ in COVID-19, with a particular focus on TLR7. SUMMARY: Our objective was to survey recent peer-reviewed scientific literature in the PubMed database, examine relevant evidence, and elucidate the relationships between IFNs, TLR7, the innate immune system, and topImiQ in the context of COVID-19. Despite limited studies on this topic, current evidence supports the critical role of TLRs in mounting a strong immune response against COVID-19. Of particular interest to dermatologists, topImiQ can result in systemic upregulation of the immune system via activation of TLR7. Key Message: Given the role of TLR7 in the systemic activation of the immune system, ImiQ, as a ligand of the TLR7 receptor, may have potential therapeutic benefit as a topical immunomodulatory treatment for COVID-19.