Eczema apps conformance with clinical guidelines: a systematic assessment of functions, tools and content.

BACKGROUND: Eczema is a prevalent complex skin condition requiring active disease monitoring and personalized education. No studies have assessed the quality of apps that aim to support eczema self-management. OBJECTIVES: To evaluate the quality and comprehensiveness of English, Chinese and Spanish self-management eczema smartphone apps for patients and/or their caregivers. METHODS: A systematic assessment of eczema apps from July 2018 to November 2018. The assessment criteria were based on conformance with international eczema guidelines. The following domains were assessed: consistency and comprehensiveness of eczema-specific educational information; quality and comprehensiveness of eczema-specific tracking functions; compliance with health information best practice principles. RESULTS: In total, 98 apps were assessed: 82 (84%) provided educational information; 38 (39%) tracking functions; and 13 (13%) both. We found that 34% (28/82) of apps provided misleading information, particularly regarding aspects of treatment and disease progression of eczema. Only 15% (12/82) provided international guideline supported information on pharmacological therapies and 16% (13/82) on nonpharmacological therapies. Among 38 apps with a tracking function, 82% (31/38) measured specific symptoms, disease severity or current skin condition and 89% (34/38) helped users to record medication usage including application of topicals. Environmental or dietary allergens were recorded by 34% (13/38). None of the included apps complied with all criteria for educational information, tracking functions or health information principles. CONCLUSIONS: Eczema apps have not yet reached their potential. The large variance in quality of eczema apps highlights the need for quality assurance mechanisms for health apps and guidance for clinicians that would enable them to make personalized recommendations for patients and caregivers. What's already known about this topic? There is limited information about the quality of eczema self-management smartphone apps on the global market. What does this study add? This systematic assessment evaluated all English, Chinese and Spanish language apps that support eczema self-management. The majority did not conform with information in guidelines and insufficiently support evidence-based self-management. The large variance in the quality of eczema apps highlights the need for mechanisms to ensure app quality and to guide personalized app selection for patients, caregivers and doctors.

The cost of childhood atopic dermatitis in a multi-ethnic Asian population: a cost-of-illness study.

BACKGROUND: Childhood atopic dermatitis can often have a negative impact on quality of life for affected children and their caregivers. The condition contributes to increased healthcare costs and can pose heavy economic burdens on healthcare systems and societies. OBJECTIVES: The objective of this study is to provide a comprehensive estimate of the economic burden of childhood atopic dermatitis in a Singaporean sample and to investigate associated factors. METHODS: This cross-sectional cost-of-illness study applied a societal perspective. Data was collected between December 2016 and December 2017 in Singapore. Caregivers to children below 16 years of age with a physician-confirmed diagnosis of atopic dermatitis were recruited and sociodemographics, clinical characteristics, health service utilization data and time spent on caregiving were collected from all eligible participants. RESULTS: The average annual cost per child with atopic dermatitis was estimated at U.S. dollars (USD) 7943 (mild USD 6651, moderate USD 7935 and severe USD 14 335) in 2017 prices. The major cost was for informal caregiving (46% of the total cost) followed by out-of-pocket expenses (37%). Healthcare utilization contributed to 17% of the total cost of which 43% was for medications. CONCLUSIONS: Childhood atopic dermatitis imposes substantial costs with a large proportion arising from informal caregiving and out-of-pocket expenses. The costs related to atopic dermatitis are also strongly related to disease severity. This information is important for policy makers and other health planners when considering how to better support affected families. What's already known about the topic? Childhood atopic dermatitis is a costly disease for society. However, comprehensive cost estimations are lacking. Previous cost studies are old, based on small sample sizes or are healthcare-setting specific. What does this study add? This study comprises a health economic evaluation assessing different levels of care and includes various categories of costs. The result showed that informal caregiving was the most prominent cost for children with atopic dermatitis.

Danazol-induced Stevens-Johnson syndrome in a patient with systemic lupus erythematosus.

A patient with Stevens-Johnson syndrome related to danazol is presented.

Narrow-band ultraviolet B phototherapy for mycosis fungoides in children.

BACKGROUND: Mycosis fungoides (MF), the commonest form of cutaneous T-cell lymphoma, is uncommon in childhood. Phototherapy is a common treatment for MF. AIM: To retrospectively evaluate the efficacy and safety of narrow band ultraviolet B (NB-UVB) phototherapy for the treatment of MF n children. METHODS: We performed a retrospective analysis of children of East Asian descent with a clinical and histological diagnosis of MF, who were treated with NB-UVB phototherapy at the National Skin Centre, Singapore over the 5-year period 2004-2008. RESULTS: We identified nine suitable patients (eight boys, one girl; age range 5-12 years). Mean time from disease onset to diagnosis was 21 months (range 4 months to 3 years). There were two patients with stage 1A disease, six with stage 1B disease and one with stage 2A disease. Body surface area involvement ranged from 10% to 60%, and none of the patients had systemic involvement. Eight patients attained complete response after phototherapy, but only three had sustained remission after a follow-up of 1-3 years. Five patients had recurrence of lesions after an mean of 13.8 months (range 4-36). Treatment was well tolerated. CONCLUSION: Phototherapy using NB-UVB in the treatment of MF is efficacious and safe. We recommend it as first-line treatment in the management of early-stage MF in children.

Multiple epidermal cysts occurring in a tattoo.

In decorative tattooing, pigment is introduced into the skin with needles or a tattoo gun to create a picture, motif or symbol. Various skin reactions have been reported in association with tattoos. These include acute inflammatory reactions, eczematous hypersensitivity reactions, pseudolymphomatous reactions and skin infections. We present a 24-year-old Malay man who developed multiple epidermal cysts a month after tattooing. To the best of our knowledge, this is the first case in the literature of epidermal cysts occurring after skin tattooing.

Zosteriform herpes simplex.

Herpes simplex virus (HSV) infection, though most commonly seen in the oral, perioral and genital areas, can occur anywhere on the body. After primary infection, HSV then establishes latency in sensory nerve ganglia and reactivates intermittently, precipitated by various factors. These reactivations may be recurrent and appear in a dermatomal distribution, mimicking herpes zoster, often leading to misdiagnosis if no confirmatory laboratory tests are carried out. We report a 65-year-old man who presented with recurrent episodes of a "zosteriform eruption", who was initially clinically diagnosed and treated as for recurrent herpes zoster, but was subsequently found to have recurrent herpes simplex virus type 2 after laboratory investigations.