Solutions for Addressing the Dermatologist Shortage in Rural Canada: A Review of the Literature.

In Canada, there is a maldistribution of dermatologists, with as many as 5.6 dermatologists per 100,000 population in urban areas and as low as 0.6 per 100,000 in rural areas. Considering trends of dermatologists to work in group practices in urban areas, and the low number of rural dermatologists, one solution may be to incentivize dermatologists to practice rurally. Several solutions using the following themes are discussed: dermatology program-specific incentives, dermatology practice-specific incentives, and other indirect incentives. The low number of dermatologists in rural areas in Canada is concerning and has negative consequences for access to care for patients in rural areas, ultimately resulting in worse patient outcomes. Future research is needed to evaluate the impact of these initiatives and assess future access to dermatological care.

Teledermatology Utilization and Integration in Residency Training Over the COVID-19 Pandemic.

BACKGROUND: During the 2019 Coronavirus (COVID-19) pandemic, the Division of Dermatology, University of Ottawa, adapted pre-existing local healthcare infrastructures to provide increased provider-to-provider teledermatology services as well as integrated teledermatology into the dermatology residency training program. OBJECTIVES: (1) To assess the differences in utilization of provider-to-provider teledermatology services before and during the COVID-19 pandemic; and (2) to assess dermatology resident and faculty experiences with the integration of teledermatology into dermatology residency training at the University of Ottawa. METHODS: We conducted a cross-sectional analysis comparing provider-to-provider teledermatology consults submitted to dermatologists from April 2019 to October 2019 pre-pandemic with the same period during the pandemic in 2020. Two different questionnaires were also disseminated to the dermatology residents and faculty at our institution inquiring about their perspectives on teledermatology, education, and practice. RESULTS: The number of dermatologists completing consults, the number of providers submitting a case to Dermatology, and the number of consults initiated all increased during the pandemic period. Ninety-one percent of residents agreed that eConsults and teledermatology enhanced their residency education, enabled continuation of training during the pandemic, and that eConsult-based training should be incorporated into the curriculum. Ninety-six percent of staff incorporated a virtual dermatology practice model, and one-third used teledermatology with residents during the pandemic. Most staff felt there was value in providing virtual visits in some capacity during the pandemic. CONCLUSIONS: Our study confirms that the use of teledermatology services continues to increase accessibility during the pandemic. Teledermatology enhances the education and training of residents and will be incorporated into dermatology residency programs.

Topical treatment for postinflammatory hyperpigmentation: a systematic review.

BACKGROUND: Topical measures are the mainstay treatment for postinflammatory hyperpigmentation (PIH). Numerous studies have assessed the efficacy of topical medications for the treatment of PIH, but few have evaluated the quality of evidence supporting these topical therapies. We performed a systematic review to evaluate the evidence of topical treatments for PIH. METHODS: We included English-language studies that evaluated topical medications for PIH. We searched PubMed, MEDLINE, and EMBASE from conception to March 29 2021. We used the modified Grading of Recommendations, Assessment, Development and Evaluation scale (GRADE) scale to assess quality of evidence. RESULTS: Forty-seven of 1,224 studies with 1,853 subjects were included. Topical agents with high-quality studies included retinoids, hydroxy acids, corticosteroids, thiamidol, niacinamide and plant-derived products. Sunscreens with SPF30 or greater was recommended in almost every study. Common side effects included desquamation, burning, stinging, dryness, and pruritus. CONCLUSIONS: Retinoids, hydroxy acids and broad-spectrum sunscreen were supported by the greatest number of high-quality studies. Ongoing inflammation may be subtle, especially in darker skin phenotypes. Herein, we proposed an evidence-based algorithm for PIH based on the high-quality studies. There is a need to adopt a validated outcome measure for PIH to better compare efficacy between various treatments in future studies.

Medical Student and Resident Dermatology Education in Canada During the COVID-19 Pandemic [Formula: see text].

The coronavirus disease 2019 (COVID-19) pandemic and subsequent physical distancing recommendations created major gaps in traditional dermatologic undergraduate and postgraduate medical education delivery. Nevertheless, the educational consequences of various public health restrictions have indirectly set aside the inertia, resistance, and risk averse approach to pedagogical change in medicine. In Canada, rapid collaboration and innovation in dermatologic education has led to novel programs including the implementation of a range of internet-facilitated group learning activities and a dramatic expansion of digital telehealth and virtual care. Going forward, three key issues arising from these developments will need to be addressed: the ongoing assessment of these innovations for efficacy; sustaining the momentum and creativity that has been achieved; and, determining which of these activities are worth maintaining when traditional "tried and true" learning activities can be resumed.

Cutaneous granulomas as the presenting manifestation of Griscelli syndrome type 2.

Griscelli syndrome type 2 is a rare autosomal recessive disorder characterized by hypopigmentation, silvery hair, and immunological dysfunction with no primary neurological impairment. We report an 18-month-old girl with Griscelli syndrome type 2 who presented to the dermatology department for cutaneous granulomas that developed following live-attenuated vaccination. Two compound heterozygous variants in the RAB27A gene were subsequently identified. She developed hemophagocytic lymphohistiocytosis, the key immunological concern, at age 5 years.

Non-Healing Perianal Ulcers in a Healthy Elderly Male: An Unusual Case of Perforating Dermatosis.

BACKGROUND: Perforating dermatoses are a rare group of dermatologic conditions characterized by transepidermal elimination of dermal material that can be primary or acquired secondary to systemic disease. OBJECTIVE: We present an atypical case of perforating dermatosis resembling elastosis perforans serpiginosa (EPS) presenting with perianal ulcers in an elderly male with no systemic disease or medications and outline his successful treatment course. CONCLUSIONS: Perianal ulcers in an otherwise healthy individual is an unusual presentation for perforating disorders but should be considered in cases not responding to traditional treatment options.

Noninfectious genital ulcers.

Noninfectious genital ulcers are much more common than ulcers arising from infections. Still, it is important to take a thorough history of sexual activity and a sexual abuse screen. A physical exam should include skin, oral mucosa, nails, hair, vulva, and vaginal mucosa if needed. The differential diagnosis of noninfectious genital ulcers includes: lipschütz ulcers, complex aphthosis, Behçet's syndrome, vulvar metastatic Crohn's disease, hidradenitis suppurativa, pyoderma gangrenosum, pressure ulcers, and malignancies. It is important to come to the correct diagnosis to avoid undue testing, stress, and anxiety in patients experiencing genital ulcerations.

Dental allergic contact dermatitis: an interesting case series and review of the literature.

When patients have persistent oral complaints, it is important to consider allergic contact dermatitis to dental components. We present 3 cases seen at the Ottawa Hospital Patch Test Clinic between 2007 and 2009 with persistent oral lesions. Mercury, methacrylate, and beryllium were found to be the responsible allergens after patch testing. Of note, our case is the fourth reported dental contact dermatitis case to beryllium. Subsequently, a literature review and an examination of reported cases and management strategies were done. There is debate over the necessity of changing dental work after a positive patch-test result. We conclude that it is necessary to do your best to uncover all of the materials used in dental work. Often, material safety sheets do not include all allergens present in products. We advocate that if a positive reaction is found and deemed relevant, then appropriate replacement of the offending agent should be recommended.

Teaching dermatology to Canadian undergraduate medical students.

BACKGROUND: The Canadian dermatology undergraduate curriculum was reviewed in 1983, 1987, and 1996. All surveys revealed the limited amount of time dedicated to dermatology in the undergraduate curriculum. OBJECTIVE: This survey was designed to obtain current information regarding undergraduate dermatology teaching in Canadian medical schools. METHODS: A survey was sent electronically to all undergraduate dermatology curriculum coordinators at each of the 17 Canadian medical schools. RESULTS: Between 1996 and 2008, the average number of hours of dermatology teaching has increased by 7 hours to 20.5 ± 17.2 hours. Again, most of the teaching is performed in the preclinical years. The majority of schools would like to have more time dedicated to dermatology teaching; however, many schools cited a restriction in the number of dermatology faculty members, with an average of 7.8 ± 7 dermatologists, as a barrier to education delivery. CONCLUSION: It is important to have dermatology included throughout the undergraduate medical curriculum because most dermatologic problems are seen by nondermatologists. Respondents at each school believed that there may be value in moving toward a national strategy for dermatology curriculum changes, and this can ensure both uniformity and consistency within Canada.

Alopecia areata following adalimumab.

BACKGROUND: Alopecia areata is a nonscarring hair loss characterized by well-circumscribed patchy areas, most often on the scalp. The inflammatory cytokine tumor necrosis factor alpha (TNF-alpha), has been connected with the development of alopecia areata in vivo; thus, the TNF-alpha inhibitors have been cited as possible treatments for this autoimmune condition. OBJECTIVE: We report a case of alopecia areata that developed in a 52-year-old woman who was recently started on adalimumab for treatment of her psoriatic arthritis. RESULTS: We discuss the previously published cases in the literature linking alopecia areata to TNF-alpha inhibitor administration. Our case is the first report of a new-onset alopecia areata following adalimumab. CONCLUSIONS: Even though TNF-alpha is implicated in causing alopecia areata, TNF-alpha inhibitors have paradoxically been associated with new cases of alopecia areata. It is possible that TNF-alpha may not be involved in the pathogenesis of alopecia areata, as in vitro studies have suggested.

Debridement: a vital component of wound bed preparation.

PURPOSE: To provide practitioners with an overview of debridement and its role in wound healing. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses who assess and treat wounds. OBJECTIVES: After reading the article and taking the test, the reader should be able to: 1. Discuss the physiologic process of wound healing and the rationale for debridement. 2. Describe evidence-based indications for and methods of debridement.