Mobile teledermatology helping patients control high-need acne: a randomized controlled trial.

BACKGROUND: Acne is an important health issue with a major psychological impact in addition to the physical problems it causes. OBJECTIVES: To investigate the superiority of mobile teledermatology in the care of patients with high-need facial acne in comparison to outpatient services with particular attention to treatment efficacy, safety, and patient compliance. Further, patient satisfaction with remote care was evaluated. METHODS: Sixty-nine consecutive patients (f: 25, m: 44, median age: 19 years, range: 13-37 years) were randomly allocated to either the teleconsultation (TCA) or the outpatient consultation (OCA) arm of the trial to receive isotretinoin treatment in weight and severity-dependent dosages over 24 weeks. Acne grading was performed by one examiner using the Global Acne Severity Scale (GEA) and the total lesion counting (TLC). RESULTS: Due to noncompliance issues, 17 of 69 (24.6%) patients were excluded from the study, of who 10 had been assigned to the TCA (10/34; 29.4%) and 7 to the OCA (7/35; 20%). Both, in the TCA (GEA-score: ∆ = 2.25; TLC: ∆ = 89.08) and in the OCA (GEA-score: ∆ = 2.0; TLC: ∆ = 91.21) excellent and almost equivalent therapeutic outcomes were achieved. In the TCA, however, less patients experienced adverse reactions (P = 0.55). Even though additional live supervision would have been appreciated in some teledermatology cases, patients were satisfied with the mobile service and no consultation request was created. CONCLUSION: Mobile teledermatology is an efficient, safe and well-accepted tool among patients with high-need acne constituting at least a valuable adjunct to outpatient care services. Further larger studies would be useful to confirm our findings.

Teledermatology for skin cancer prevention: an experience on 690 Austrian patients.

BACKGROUND: Recent studies investigated the value of teledermatology (TD) as a valid tool for a dermatologist-directed triage systems. OBJECTIVE: To investigate the feasibility of a store-and-forward TD triage system in a large number of patients. METHODS: Previously trained general practitioners selected suspicious skin tumours in the setting of a general preventive medicine screening programme and transmitted their dermoscopic images via virtual private network for decision-making. Within 48 h, two teleconsultants highly experienced in dermoscopy first assessed image quality, then made a diagnosis and answered if lesions were to follow-up, to excise or to be re-evaluated at face-to-face (FTF). RESULTS: A total of 955 lesions were telediagnosed [743 (78%) benign melanocytic, six (0.6%) malignant melanocytic, 186 (19%) benign non-melanocytic and 20 (2%) malignant non-melanocytic]. Excision was recommended for 111 (12%) lesions, 10 lesions (1%) were referred to FTF examination. Follow-up was recommended for 707 (74%) lesions. The vast majority of the lesions (82%) were screened as benign and an intervention was requested in only 18% of cases. Eighty-two patients (12% of the total) were lost at follow-up. The diagnostic accuracy was of 94% with sensitivity of 100% and specificity of 95.8%. CONCLUSIONS: We confirm that TD is suitable to triage skin cancers.

Patient acceptance and diagnostic utility of automated digital image analysis of pigmented skin lesions.

BACKGROUND: Computerized analysis of pigmented skin lesions may help to increase diagnostic accuracy for melanoma, help to avoid unnecessary procedures and reduce health care costs. OBJECTIVES: We evaluated both the patient acceptance and diagnostic utility of such an analysis tool in a real clinical setting. METHODS: Two hundred nine consecutive patients (median age: 34 years, range: 2-73 years), who were concerned about a pigmented skin lesion, answered a questionnaire about their attitude towards computerized analysis and their confidence in the resulting findings. Using a dermoscopy analyser, their skin lesions (n = 219) were then grouped into the categories, benign, suspicious and malignant, and results were compared with those obtained by in-person examination of dermato-oncologic experts. RESULTS: More than half of the patients (n = 114) would accept the use of computer analysis for melanoma screening; although 16 (14.0%) patients would accept this method solely, 98 (86.0%) patients would prefer an additional in-person examination by a dermatologist. Of the 219 pigmented skin lesions, the dermoscopic experts rated 171 (78.1%) as benign, 36 (16.4%) as suspicious and 12 (5.5%) as malignant, whereas computer analysis revealed 102 (46.6%) benign, 78 (35.6%) suspicious and 39 (17.8%) malignant lesions. At the expense of specificity (48.8%), the sensitivity of computerized analysis was excellent (100%) and equal to that of in-person examination. CONCLUSIONS: Most patients would accept computer analysis for melanoma screening, some of them even without reservations. However, due to a high rate of false positive computer assessments, it cannot be recommended as a screening tool at this time.

Vitamins E, A and B2 as Possible Risk Factors for Preeclampsia - under Consideration of the PROPER Study ("Prevention of Preeclampsia by High-Dose Riboflavin Supplementation").

In the course of the prospective, randomized, double-blind trial the influence of a high-dose riboflavin substitution on the risk for preeclampsia was studied in a high-risk collective 1. The present contribution evaluates supplementary data from the already published PROPER trial. The patients were from the two study centers Mérida, Venezuela, and Moshi, Tanzania, they were randomized from the 20th week of pregnancy and received either 15 mg riboflavin daily or placebo. Clinical and laboratory checks were carried out at four-week intervals up to childbirth. Concerning the question of whether there is a relationship between the serum levels of antioxidative vitamins and the risk of developing preeclampsia, it was found that no relationship could be detected between the measured laboratory values of vitamins E, A and B2 and the total risk of developing a hypertensive disease of pregnancy. On comparisons between patients with severe preeclampsia, those with a mild form, and the general healthy population, however, significant differences in the levels of antioxidative vitamins E and A as well as the FAD level were seen. The patients from Tanzania showed on the whole significantly lower vitamin levels than those from Venezuela, possibly due to the better nutritional situation in Venezuela. Considering the results altogether, the role of antioxidative parameters in the pathophysiology of preeclampsia remains unclear. However, the collected data provide valuable hints for future preventative strategies.

Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic image tele-evaluation using cellular phones.

BACKGROUND: The ability to diagnose malignant skin tumours accurately and to distinguish them from benign lesions is vital in ensuring appropriate patient management. Little is known about the effects of mobile teledermatology services on diagnostic accuracy and their appropriateness for skin tumour surveillance. OBJECTIVE: To evaluate the diagnostic accuracy of clinical and dermoscopic image tele-evaluation for mobile skin tumour screening. METHODS: Over a 3-month period up to three clinical and dermoscopic images were obtained of 113 skin tumours from 88 patients using a mobile phone camera. Dermoscopic images were taken with a dermatoscope applied to the camera lens. Clinical and dermoscopic images of each lesion together with clinical information were separately teletransmitted for decision-making. Results were compared with those obtained by face-to-face examination and histopathology as the gold standard. RESULTS: A total of 322 clinical and 278 dermoscopic images were acquired; two (1%) clinical and 18 (6%) dermoscopic pictures were inadequate for decision-making. After excluding inadequate images, the majority of which were dermoscopic pictures, only 104 of the 113 skin tumours from 80 of 88 patients could be tele-evaluated. Among these 104 lesions, 25 (24%) benign nonmelanocytic, 15 (14%) benign melanocytic, 58 (56%) malignant nonmelanocytic and six (6%) malignant melanocytic lesions were identified. Clinical and dermoscopic tele-evaluations demonstrated strong concordance with the gold standard (κ = 0·84 for each) and similar high sensitivity and specificity for all diagnostic categories. With regard to the detailed diagnoses, clinical image tele-evaluation was superior to teledermoscopy resulting in 16 vs. 22 discordant cases. CONCLUSIONS: Clinical image tele-evaluation might be the method of choice for mobile tumour screening.

Serum level of VEGF-D in patients with primary lymphedema.

Recent studies have indicated that vascular endothelial growth factor-D (VEGF-D) stimulates lymphangiogenesis in humans. Furthermore, mutations of vascular endothelial growth factor receptor 3 (VEGFR-3) have been observed in families with hereditary lymphedema. The lack of stimulation of lymphangiogenesis could lead to production of even more VEGF-D to obtain stimulation of lymphangiogenesis resulting in a high serum level of VEGF-D. The aim of the present study was to compare the serum level of VEGF-D in patients with primary lymphedema with healthy controls. In a prospective study, the serum level of VEGF-D was determined by a solid phase ELISA in patients with primary lymphedema and compared with healthy controls. In the group of patients with primary lymphedema the serum level of VEGF-D was significantly higher compared with controls (p=0.0047). The increased levels of VEGF-D observed in the present study suggest that primary lymphedema may be based on defective stimulation of VEGFR-3.

Riboflavin deficiency and preeclampsia.

OBJECTIVE: To examine in a prospective study riboflavin deficiency as a predisposing factor for preeclampsia in a high-risk collective of pregnant women in Zimbabwe. METHODS: At an antenatal clinic in Bulawayo, Zimbabwe, 154 women at increased risk for preeclampsia were observed prospectively until delivery. Riboflavin status was determined using the erythrocyte glutathione reductase activation coefficient test on the day of antenatal booking. Riboflavin deficiency was expressed by erythrocyte glutathione reductase activation coefficient of 1.4 or greater. RESULTS: Riboflavin deficiency was frequently found among the study population (33.8%). Incidence rose toward the end of pregnancy (27.3% at 29-36 weeks' gestation compared with 53.3% at over 36 weeks). In the riboflavin-deficient group, mothers were more likely to develop preeclampsia (28.8%) than in the riboflavin-adequate group (7.8%; P <.001, odds ratio [OR] 4.7, 95% confidence interval [CI] 1.8-12.2). The calculated concentrations of intracellular free flavin adenine dinucleotide were significantly lower in patients who developed preeclampsia than in normal pregnancies (P <.05). CONCLUSION: Riboflavin deficiency should be considered a possible risk factor for preeclampsia. Insufficient concentrations of the riboflavin-derived cofactors flavin adenine dinucleotide and flavin adenine mononucleotide could contribute to the established pathophysiologic changes including mitochondrial dysfunction, enhanced oxidative stress, and disturbances in nitric oxide release.

Seasonal change in the incidence of preeclampsia in Zimbabwe.

BACKGROUND: The aim of our study was to evaluate the number of women with hypertensive complications during pregnancy in a southern province in Zimbabwe and to examine the annual change in the incidence of preeclampsia. METHODS: In three different hospitals the preeclamptic women who were treated between January 1992 and August 1995 were counted. This data was compared with the amount of rainfall obtained from the local meteorological stations. RESULTS: A distinctive change in the incidence of preeclampsia during the year could be observed. These changes go along with the seasonal variation in precipitation: at the end of the dry season and in the first months of the rainy season there is an increase in the incidence. CONCLUSIONS: The relationship between climate and occurrence of preeclampsia raises new questions in the pathophysiology of preeclampsia. Possible explanations could be the impact of humidity and temperature on vessels or the production of vasoactive substances. Dry and rainy seasons influence the agricultural yields and therefore the nutritional status could also play a role in the pathophysiology.