Aesthetic Considerations for Treating Lesbian, Gay, and Bisexual Patients: A Review and Our Experience.

Objectvie: The population of the United States continues to grow in diversity, particularly within sex and gender. In recent years, there has been a surge in aesthetic procedures in the Lesbian, Gay, Bisexual (LGB) community. Herein, we discuss a tailored approach to these patient populations and offer guidance to address their concerns both safely and effectively based on a comprehensive review of the literature as well as a roundtable series focusing on diversity in aesthetics. Methods: A literature search was conducted on PubMed using the following terms: "aesthetics," "cosmetics," "lesbian," "gay," and "bisexual." Additionally, an eight-part roundtable series focusing on diversity in aesthetics was conducted from August 2021 to August 2022. Results: The results of the literature search as well as the discussion from the roundtable series addressing the LGB community are reviewed within. Limitations: We are limited by the paucity of data available in the existing literature. We also acknowledge differences within LGB subgroups and a need for individualization. Conclusion: A tailored approach to the LGB patient with regards to fillers, neuromodulators, and energy-based devices may offer improved patient satisfaction and safety.

A photoaging smartphone application to promote sun safety behaviors among youth in late childhood and adolescence.

BACKGROUND: Ultraviolet (UV)-exposure behaviors can directly impact an individual's skin cancer risk, with many habits formed during childhood and adolescence. We explored the utility of a photoaging smartphone application to motivate youth to improve sun safety practices. METHODS: Participants completed a preintervention survey to gather baseline sun safety perceptions and behaviors. Participants then used a photoaging mobile application to view the projected effects of chronic UV exposure on participants' self-face image over time, followed by a postintervention survey to assess motivation to engage in future sun safety practices. RESULTS: The study sample included 87 participants (median [interquartile (IQR)] age, 14 [11-16] years). Most participants were White (50.6%) and reported skin type that burns a little and tans easily (42.5%). Preintervention sun exposure behaviors among participants revealed that 33 (37.9%) mostly or always used sunscreen on a sunny day, 48 (55.2%) experienced at least one sunburn over the past year, 26 (30.6%) engaged in outdoor sunbathing at least once during the past year, and zero (0%) used indoor tanning beds. Non-skin of color (18 [41.9%], p = .02) and older (24 [41.4%], p = .007) participants more often agreed they felt better with a tan. Most participants agreed the intervention increased their motivation to practice sun-protective behaviors (wear sunscreen, 74 [85.1%]; wear hats, 64 [74.4%]; avoid indoor tanning, 73 [83.9%]; avoid outdoor tanning, 68 [79%]). CONCLUSION: The findings of this cross-sectional study suggest that a photoaging smartphone application may serve as a useful tool to promote sun safety behaviors from a young age.

Revising ruling discourses: The griefwork evidence-to-practice gap and the mental health workforce.

Elisabeth Kübler-Ross' pioneering work focused on dying, yet some clinicians persist in prescribing it as a path through grief. We surveyed 964 mental health clinicians who completed a five-section mixed methods survey: two sections assessed knowledge with multiple choice questions and a case study to assess clinicians' knowledge-base and approach to grief/loss in practice. Analysis of four items related to Kübler-Ross' model and 66/962 case studies indicates ongoing use of "stages" and Kübler-Ross' model. Only 330 (34.2%) of the clinicians were deemed knowledgeable; 462 (47.9%) were questionable; and 172 (17.9%) were misinformed, continuing to use Kübler-Ross' stage theory for grief.

Efficacy and safety of topical treatments for seborrheic keratoses: a systematic review.

Seborrheic keratoses (SKs) are benign epidermal neoplasms presenting as waxy, brown to black papules and plaques. Patients often seek removal for cosmetic reasons or irritation. The objective of this systematic review is to assess the efficacy and safety of topical treatments for SKs. Studies involving any topical medication indicated for SK removal were retrieved from Embase, Scopus, PubMed, and Cochrane. The final search was conducted on November 9, 2021, and 26 reports met inclusion criteria. A quality rating scheme was utilized to assess evidence quality. Heterogeneity of treatments and outcome measures precluded meta-analysis. Topical treatments that yielded a good-to-excellent response include hydrogen peroxide, Maxacalcitol 25 µg/g, BID Tazarotene 0.1% cream, 5% potassium dobesilate cream, 1% diclofenac sodium solution, urea-based solution, and 65% and 80% trichloroacetic acid. Local skin reactions were often mild and transient. Topical hydrogen peroxide showed the greatest evidence for clinical clearance of SKs, although there are no studies to our knowledge that directly compared hydrogen peroxide to current first-line treatments (e.g. cryotherapy or shave excision). The results of this review suggest viable and safe treatment of SK with topical therapies; however, there remains demand for topical treatments that reliably equate or exceed the efficacy of current first-line therapies.Key PointsQuestion: Are safe and efficacious topical treatments for seborrheic keratoses available?Findings: Topical treatments for seborrheic keratoses yield different responses and may be associated with local skin reactions. Topical hydrogen peroxide shows the greatest evidence for clinical clearance of seborrheic keratoses and may be a viable option for patients requesting noninvasive removal. No studies to our knowledge directly compare hydrogen peroxide to current first-line treatments.Meaning: There remains demand for topical treatments that reliably equate or exceed the efficacy of current first-line therapies.

Sun Safety Policies among School Districts in the US: Findings from a National Survey.

Cumulative childhood sun damage increases skin cancer risk. Considerable childhood time is spent at school, posing an ideal site for sun safety intervention. Currently, national prevalence estimates of school district-level sun safety policies are limited. We evaluated the prevalence of sun safety policies in the US school districts and correlated with district-level factors using cross-sectional data from the 2012 and 2016 School Health Policies and Practices Study. The prevalence of sun safety policies among the US school districts was infrequent. In 2016, policies to schedule outdoor activities avoiding peak sun, allowing and encouraging use of sunscreen, and encouraging the use of protective attire were required by less than 5% of districts and remained unaddressed in 50%-75% of districts. Sun safety policies remain inadequately addressed in many US school districts and may contribute to preventable childhood sun damage. Implementing sun safety interventions in schools through more robust district-level regulations may more effectively reach students, allocate resources, and monitor implementation.

Treatment of early-stage mycosis fungoides with oral bexarotene and phototherapy: A systematic review and meta-analysis.

Mycosis fungoides (MF) is a rare subtype of non-Hodgkin lymphoma, for which no standard treatment exists. The objective of this study is to provide evidence-based recommendations for adult patients with early-stage MF treated with oral bexarotene and phototherapy. A systematic review and meta-analysis was conducted utilizing studies identified via Embase, Pubmed, Web of Science, and the Cochrane Library from inception to April 2020 to evaluate the clinical efficacy and adverse events of oral bexarotene and phototherapy. Of 645 abstracts retrieved, 17 full-text articles with 143 subjects were included for analysis. There were nine case reports, five retrospective cohort studies, two prospective cohort studies, and one randomized controlled trial. Most subjects were men (24.48%) with stage IB disease (54.4%), and the mean age at presentation was 63. One patient had folliculotropic disease. The retrospective studies' analysis included 67 subjects and indicated that the partial response was 40.36% (95% CI 18.24-64.92), complete response was 34.06% (95% CI 10.73-62.56), and overall response was 64.48% (95% CI 48.56-78.89). Side effects from bexarotene were hypertriglyceridemia (54%), hypothyroidism (50%), and hypercholesterolemia (46%). Similar results were noted in the prospective studies. The literature consists mostly of uncontrolled studies, which suggest that combination therapy with oral bexarotene and phototherapy is a therapeutic option. Future randomized control studies with longer follow-up and standardized definitions of treatment responses and dosages are needed to support the development of evidence-based approaches for the treatment of early-stage MF.

Balloon cell melanoma: a systematic review.

Balloon cell melanoma (BCM) is a rare presentation of malignant melanoma characterized by large, foamy melanocytes lacking pigmentation. This is a comprehensive review of the clinical, dermoscopic, and histological features among BCM cases reported in the literature. A systematic review of all case reports and series published since 1970 was conducted via MEDLINE, Embase, and Web of Science, using "balloon cell melanoma" and synonymous search terms. Our systematic search identified 76 cases (49% male, 51% female) of BCM in the literature. The mean age at presentation was 57.81 years. Prior skin cancer, particularly melanoma (47%), accounted for 58% of pertinent medical history. Prominent clinical exam findings included raised (46%), ulcerated (73%) lesions larger than 1 cm (68%) in the lower extremities (35%). Median Breslow thickness of primary BCM cases was 2.5 mm. Hairpin vessels (75%) and structureless architecture (75%) were predominant on dermoscopy. Notable histopathology included large (47%), vacuolated (58%) cells with foamy cytoplasm (62%) and conspicuous nucleoli (27%). Positive S-100 immunohistochemistry (73%) was most frequently employed to diagnose BCM. We observed 47% primary and 53% metastatic BCM cases. Of metastatic BCMs, balloon cells in the primary lesion were unknown in 48%, devoid in 33%, and present in 20% of cases. All metastases displayed predominant balloon cell morphology. BCM may represent an advanced phase in the progression of malignant melanoma. Improved awareness of BCM characteristics among clinicians may reduce the risk of misdiagnoses.

Preferences Towards Electronically Exchanging Digital Images With Healthcare Providers Among US Adults.

BACKGROUND: The rapid expansion of telemedicine, including teledermatology, during the COVID-19 pandemic has required both providers and patients alike to adapt to this digital transition. However, patient attitudes towards electronically shared images with their providers are poorly understood. To address this gap, we assessed digital image sharing preferences and associated determinants in a nationally representative sample. METHODS: We analyzed pooled data from the Health Information National Trends Survey 4, Cycle 3 and 4. Digital image sharing preferences were compared by patient characteristics and beliefs via chi-square at a significance level of p<0.05, using sampling and jackknife replicate weights to develop nationally representative sample estimates and account for the complex survey design. P-values were adjusted for multiple comparisons when appropriate. RESULTS: Among 6437 adults, 53.5% reported reluctance in electronically shared images and videos with providers. Greater aversion was observed among adults aged 75 or above (70.9%), retired (67.3%), and those with lower education (65.1%), lower annual income (60.9%), limited English proficiency (63.3%), distrust in health information from doctors (75.4%), and fair or poor health (60.4%). CONCLUSION: Patient hesitancy towards digital image sharing may present challenges for teledermatology adoption. Greater efforts may be needed to address the age and socioeconomic digital divide, multilingual telemedicine tools, and patient-physician dynamics to ensure vulnerable groups receive needed teledermatologic care.

Long-term Physical and Psychological Outcomes of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis.

IMPORTANCE: Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is known to cause multiple end-organ complications in its acute phase, but less is known about the long-term association with patients' mental health and quality of life. OBJECTIVE: To examine the chronic physical and psychological sequelae affecting patients with SJS/TEN. DESIGN, SETTING, AND PARTICIPANTS: A survey study conducted at 11 academic health centers in the US evaluated 121 adults diagnosed with SJS/TEN by inpatient consultive dermatologists between January 1, 2009, and September 30, 2019. INTERVENTIONS: Patients completed a survey that included the following validated questionnaires: Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Primary Care Post-Traumatic Stress Disorder Screen (PC-PTSD), and the 12-item Short Form Health Survey (SF-12). The survey also included questions created by the study team regarding fear, patient education, and long-term sequelae relevant to SJS/TEN. MAIN OUTCOMES AND MEASURES: Primary outcome measures were the percentage of patients reporting long-term physical sequelae; the percentage of patients with positive results on PHQ-9, GAD-7, and PC-PTSD screening; and the numeric score on the SF-12 (score of 50 defined as average physical and mental well-being). RESULTS: A total of 121 individuals (73 women [60.3%]; mean [SD] age, 52.5 [17.1] years) completed the survey (response rate, 29.2%). The most common long-term physical sequelae reported were cutaneous problems (102 of 121 [84.3%]), ocular problems (72 of 121 [59.5%]), and oral mucosal problems (61 of 120 [50.8%]). A total of 53.3% (64 of 120) of the respondents had results indicating depression on the PHQ-9, 43.3% (52 of 120) showed signs of anxiety on the GAD-7, and 19.5% had results indicating PTSD on the PC-PTSD. The mean (SD) SF-12 Physical Component Summary score was 42.4 (22.8), and the mean Mental Component Summary score was 46.1 (20.9). A total of 28.2% (33 of 117) of the respondents were unable to work, 68.1% (81 of 119) were fearful of taking new medications, and 30.0% (36 of 120) avoided taking prescribed medications for a diagnosed medical condition. CONCLUSIONS AND RELEVANCE: This survey study found that long-term physical sequelae, depression, and anxiety appear to be common in patients with SJS/TEN, with implications for health and well-being. Improved awareness of these complications may assist health professionals in offering medical care, counseling, and support to patients with SJS/TEN.

Treatment of pyoderma gangrenosum: A multicenter survey-based study assessing satisfaction and quality of life.

Pyoderma gangrenosum (PG) lacks consensus regarding treatment, and no prior studies assess treatment satisfaction in PG. The objective of this study was to determine patient-reported satisfaction in the treatment of PG, and associations with satisfaction. Methodology was a multicenter cross-sectional survey for patients who received systemic medication(s) to treat PG. Thirty-five patients completed the survey (mean age: 54.0 years, 65.7% female, response rate: 81.4%). Mean (± SD) SATMED-Q score was 75.0 (±16.2, range: 67.6-85.3). Older patients (72.6 ± 23.6 for 18-39 years, 74.4 ± 16.1 for 40-59, 77.1 ± 11.6 for 60+), plus those with higher incomes (72.9 ± 20.3 for $0-49 000; 74.0 ± 17.6 for $50 000-99 000; 79.0 ± 14.6 for $100 000+) and education status (69.4 ± 14.3 for high school equivalent, 72.9 ± 15.9 for undergraduate, 91.7 ± 10.6 for graduate), were more satisfied with treatment. Ulcerative PG had higher SATMED-Q scores (79.0 ± 13.2) than other subtypes (66.2 ± 19.3). For local therapy, wound care, or pain control, 63.2%, 100%, and 75% were satisfied, respectively. The mean DLQI was 8.6 (±7.6, range: 0-29), and higher DLQI was associated with decreased satisfaction. Satisfaction with providers was positively correlated with global satisfaction (Pearson's r = 0.638). The presence of pain and/or depression influenced both SATMED-Q (72.8 ± 18.8 with pain, 78.3 ± 11.2 without; 68.2 ± 18.8 with depression, 80.1 ± 12.2 without) and DLQI scores (12.1 ± 8.1 with pain, 3.9 ± 3.4 without; 10.3 ± 7.1 with depression, 7.4 ± 8.0 without). To optimize the patient experience, non-modifiable associations should be individually considered, and potentially modifiable associations such as satisfaction with specific providers, pain, and depression, may be targeted for management.

Rosacea and the Microbiome: A Systematic Review.

Rosacea, a chronic inflammatory skin disease characterized by recurrent episodes of facial flushing, erythema, pustules, and telangiectasia, largely affects fair-skinned women over 30 years of age. Although a long-recognized entity, the exact pathophysiology of this disease is still debated. Current theories highlight the role of the cutaneous microbiome and its associated inflammatory effects in rosacea's pathogenesis. However, microbiological reverberations are not limited to the skin, as recent studies have described the potential cutaneous effects of alterations in the gastrointestinal (GI) microbiome. Associations with additional GI pathologies, including small intestinal bacterial overgrowth (SIBO), irritable bowel syndrome (IBS), and inflammatory bowel disease (IBD), have been investigated, as well as Helicobacter pylori infection. In an attempt to better understand and characterize these relationships, as well as current treatment options, we conducted a systematic review of the literature in PubMed, Cochrane, and Embase from their inception to August 6, 2020. We have synthesized the literature findings within three sections of this manuscript: the cutaneous microbiome, the gut microbiome, and therapeutic strategies. Future studies should focus on specific mechanisms linking GI pathology with rosacea manifestations and the role of enteral drugs in mitigating cutaneous symptoms.

Randomized controlled trial of a brief Internet-based intervention for families of Veterans with posttraumatic stress disorder.

Veterans with posttraumatic stress disorder (PTSD) and their families require resources to cope with postdeployment readjustment. Responding to this need, the current study examined a brief Internet-based intervention that provided Veterans' families with psychoeducation on postdeployment readjustment. Participants were 103 dyads of Veterans with probable PTSD and a designated family member/partner. Dyads were randomized to an intervention group, in which the family member completed the intervention, or to a control group with no intervention. Each member of the dyad completed surveys at baseline and 2 mo follow-up. Family member surveys focused on perceived empowerment, efficacy to provide support, and communication (perceived criticism and reactivity to criticism). Veteran surveys assessed perceived family support and communication. Results showed that Veterans in the intervention group reported decreases in reactivity to criticism but also decreased perceived family support. No significant differences were observed in outcomes reported by family members. This preliminary study provides an early understanding of this novel outreach program, as well as the challenges inherent with a very brief intervention. Future research can build on the current study by more closely evaluating the communication changes that occur with this form of intervention and whether greater intervention intensity is needed. CLINICAL TRIAL REGISTRATION: Clinical Trials Identifier: NCT01554839.

Chronic opiate use in pregnancy and newborn head circumference.

OBJECTIVE: The aim of the study is to evaluate whether chronic opiate use in pregnancy affects newborn head circumference (HC). STUDY DESIGN: All newborns from January 1, 2010, to June 30, 2012, admitted to the neonatal intensive care unit for treatment of neonatal abstinence syndrome were prospectively collected. The demographic, obstetrical, neonatal, and perinatal ultrasound data were retrospectively obtained. A gestational age-matched control was used for comparison purposes. RESULTS: Of 332 neonates admitted for the treatment of neonatal abstinence syndrome, 98 (29.5%) had a HC ≤ 10th percentile for gestational age that was significantly increased when compared with controls (p < 0.001). Of these 98, 25 had a HC ≤ 3rd percentile. Of the case population, 141 had an ultrasound in the perinatal unit within 10 days of birth. A HC < 5th percentile was found in 38.3% of cases of which 74% were ≤ 10th percentile postdelivery. The ultrasound femur and humerus length measurements were also < 5th percentile in 36.2 and 28.9%, respectively. CONCLUSION: Chronic opiate use in pregnancy appears to increase the risk for a HC ≤ 10th percentile and ≤ 3rd percentile when compared with controls. From ultrasound findings, femur and humerus lengths also appear to be shortened suggesting a possible effect on bone growth.

Improving compliance with personal protective equipment use through the model for improvement and staff champions.

Although the known risks of exposure to hazardous drugs have been well documented and disseminated, certain barriers remain in the use of personal protective equipment (PPE) by nurses administering chemotherapy. At Dana-Farber Cancer Institute, a program was developed that incorporated not only monitoring and reporting compliance of the use of PPE, but also engaged the staff in audit and reporting activities. Compliance rates improved dramatically over time and have remained at high levels.