ABSTRACT
Setting up an inpatient teledermatology service over 1 year at our National Health Service-based district general hospital made absolute sense on two grounds: The COVID pandemic and the ever-increasing role of teledermatology enabling dermatology departments, often with limited resources, to 'work smart'. Over a 43-week period, 124 referrals were dealt with on our teledermatology platform (around 12 referrals per month). Average response time to referral was 0.65 days: 56% same-day response, 32% next-day response;and 92% a response within 3 days. Following this, 32% of patients were seen face to face on the wards and 40% were dealt with via remote advice and guidance. Around 10% of referrals were deemed not to be appropriate for dermatology review/advice. Around 12% of referrals were given dermatology face-to-face outpatient appointments rather than review on the wards, and 7% were declined an appointment (pending further information being received) as insufficient information was given for triage/advice and guidance. Initially, just 10% of referrals were sent (first time) with clinical images, but this increased to 54% after 4 months, and although there has been some monthly variation, up to 64% has been achieved (noting that clinical images are not always required for the question being asked). Around 50 different diagnoses were made, illustrating the diversity and complexity of dermatological practice, and the scale of the diagnostic problems facing ward-based teams. Previously published data revealed that around one-third of inpatient dermatology referrals were for 'red legs', which was replicated in the current results, with diagnoses of venous or atopic eczema (14%), drug reactions (12%), skin neoplasia (6%), cellulitis/erysipelas (5%), intertrigo (4%), erythroderma (4%), Gianotti-Crosti syndrome (2.5%), bullous pemphigoid (2.5%), pyoderma gangrenosum (2.5%) and vasculitis (2%). Having an inpatient teledermatology service benefits dermatology departments, enabling efficient working, appropriate triage, training opportunities and ease of second opinions from colleagues. Benefits for referrers are acute ward-based teams including rapid responses to referrals, enabling skin concerns to be dealt with quickly and avoiding delays in investigation, treatment and discharge. Some hospitals where dermatology does not have a permanent base may be able to access dermatology advice and guidance via teledermatology. Overall, patients benefit from teledermatology and it is COVID secure.
ABSTRACT
The proceedings contain 388 papers. The topics discussed include: vitiligo diagnosis is associated with an increase in new-onset depression and anxiety: a population-based cohort study in the UK;effect modification of biologic survival by patient characteristics: a prospective cohort study from the British Association of Dermatologists Biologics And Immunomodulators Register;'a raised P3NP is a matter of time': replacing P3NP with FIB-4 for monitoring of methotrexate-related liver fibrosis;a randomized controlled trial assessing the effectiveness and safety of ciclosporin vs. methotrexate in the treatment of severe atopic eczema in children and young people: the treatment of severe atopic eczema trial (TREAT);carbonylated proteins as markers of oxidative stress and their association with filaggrin genotype in atopic eczema;skin tumors in England 2013-2019: in-depth reporting of a new consensus classification to improve prospective data extraction and clinical interpretation;a national review of porocarcinoma epidemiology in England 2013-2018;national Merkel cell carcinoma epidemiology and mortality-related risk factors in England 2004-2018;and hospitalization from COVID-19 is most frequently observed in patients with atopic dermatitis treated with systemic corticosteroids, and in particular when systemic corticosteroids are used in combination with another immunomodulatory treatment: lessons from the global SECURE-AD registry.
ABSTRACT
Background: The COVID-19 pandemic sparked increased utilization of telemedicine services, as telemedicine offers care at a safe distance. Dermatology is well-suited for telemedicine due to its visual nature;however, concerns regarding diagnostic accuracy limit its widespread use. Visits for certain types of concerns may be more conducive to virtual visits than others. Further study of teledermatology may reveal trends in visit types and influence future integration into practice. Methods: Thomas Jefferson University analyzed aggregated, de-identified data from FAIR Health’s FH NPIC repository of privately insured medical claims, for telehealth services performed by dermatologists between 2019 and 2020 at urban and rural levels. Calculations were performed to determine the percentage of teledermatology visits that used specific diagnosis codes relative to all teledermatology visits. Visits were also assessed for the following parameters: demographics, diagnosis codes, and procedure codes. Results: Diagnosis codes L70.0 and L71.0, which primarily pertain to acne and rosacea, comprised 61% and 75% of Disorders of Skin Appendages teledermatology claims in 2019 and 2020 respectively. In 2019, teledermatology visits most often used diagnosis codes L60-75 in both urban and rural locations (33.7% and 31.9%, respectively). Moreover, from 2019 to 2020, the percentage of teledermatology visits that used codes L60-75 was 1.35 times greater in urban locations and 1.48 times greater in rural locations. Conclusions: Teledermatology visits favored specific diagnoses, specifically pertaining to acne and rosacea. This suggests that these diagnoses may be more conducive to virtual visits relative to other diagnoses such as skin neoplasms or papulosquamous disorders, including psoriasis.
ABSTRACT
Objective: The number of older adults has increased throughout the world. Aging affects all the organs and creates psychological, physiologic and anatomic changes. One of the most important organs of the human body is the skin, which shows the effects of aging the most. This study aims to determine whether age, gender, and season of biopsy play a significant role in skin biopsy results. Additionally, the study investigates whether the frequency of skin diseases differs before and after the coronavirus disease-2019 (COVID-19) pandemic. Methods: We conducted a retrospective study on the histopathology results of patients over 65 years old between June 2016 and September 2021. The histopathology results were obtained from the Acibadem Pathology Department. Results: Of the 677 patients, 310 (45.8%) were male and 367 (54.2%) were female. The most common disease in all patients were benign cutaneous neoplasms (23%), followed by eczematous disease (18.5%) and epithelial cutaneous cancers (16.8%). We divided the results into 12 groups: group 1: Urticaria, erythema and purpuras, group 2: Papulosquamous and eczematous diseases, group 3: Infectious diseases, group 4: Rheumatologic diseases and alopecia, group 5: Benign cutaneous neoplasms, group 6: Precancerous lesions, group 7: Basal cell carcinoma, squamous cell carcinoma, group 8: Cutaneous metastasis and other skin cancers, group 9: Pigmentation disorders, group 10: Pschycology related dermatological disorders, group 11: Granulomatous dermatitis, group 12: Bullous dermatitis. Before the COVID-19 pandemic, the most prevalent results were group 2 (21.3%), followed by group 5 (20.4%) and group 7 (16.7%) whereas, after the COVID-19 pandemic, the most frequent results were group 5 (28.4%) followed by group 7 (17.1%), and group 6 (14.9%). In terms of seasons, the most common diseases were group 5 (24.1%) in winter, group 2 (21.6%) in spring, group 5 (30.0%) in summer, and group 2 (18.9%) in autumn. Before the COVID-19 pandemic, the most common result was group 2 (21.3%), followed by group 5 (20.4%) and group 7 (16.7%), and during the COVID-19 pandemic, the most common result was group 5 (28.4%), followed by group 7 (17.1%), group 6 (14.9%). Conclusion: Many skin diseases affect the geriatric population. Geriatric patients face challenges such as multiple drug use, comorbidities, mobility problems and cognitive disorders. In our study, the most common diseases in all patients were benign cutaneous neoplasms (23%), followed by eczematous diseases (18.5%), and epithelial cutaneous cancers (16.8%). Knowing about the frequency of skin diseases is critical for the early detection of precancerous and cancerous lesions.
ABSTRACT
Objective: The coronavirus disease-2019 (COVID-19) pandemic has caused delays in the diagnosis and treatment of some oncological diseases. This study aimed to reveal the effect of the COVID-19 pandemic on the frequency of diagnosis of non-melanoma skin cancers (NMSC) and the demographic characteristics of patients. Material and Methods: Patients aged over 18 years, who were histopathologically diagnosed with basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) between March 12, 2019 and March 11, 2021 were included in the study. The demographic characteristics of these patients, the number of total skin biopsies, and the number of BCC and SCC biopsies were compared between the pre-pandemic and pandemic periods, based on the date of March 12, 2020, when the pandemic measures began to be implemented in Turkey. Results: With the pandemic, there was a 26.7% decrease in the total skin biopsies and a 21% decrease in the total NMSC biopsies. Despite a 34% decrease in the number of biopsies for the diagnosis of BCC, a 15.8% increase was observed in the number of biopsies for the diagnosis of SCC. The frequency of excisional biopsies was observed to increase among the patients with BCC and SCC during the pandemic period (p=0.004 and p=0.001, respectively). Conclusion: The number of total skin biopsies and total NMSC biopsies significantly decreased during the pandemic period. The health system should be reorganized to effectively handle pandemics and similar crisis periods, and new strategies should be determined regarding patient education, early diagnosis, and treatment approaches for NMSC.