Inequalities in the patterns of dermoscopy use and training across Europe: conclusions of the Eurodermoscopy pan-European survey.

BACKGROUND: Dermoscopy is a widely used technique, recommended in clinical practice guidelines worldwide for the early diagnosis of skin cancers. Intra-European disparities are reported for early detection and prognosis of skin cancers, however, no information exists about regional variation in patterns of dermoscopy use across Europe. OBJECTIVE: To evaluate the regional differences in patterns of dermoscopy use and training among European dermatologists. MATERIALS & METHODS: An online survey of European-registered dermatologists regarding dermoscopy training, practice and attitudes was established. Answers from Eastern (EE) versus Western European (WE) countries were compared and their correlation with their respective countries' gross domestic product/capita (GDPc) and total and government health expenditure/capita (THEc and GHEc) was analysed. RESULTS: We received 4,049 responses from 14 WE countries and 3,431 from 18 EE countries. A higher proportion of WE respondents reported dermoscopy use (98% vs. 77%, p<0.001) and training during residency (43% vs. 32%) or anytime (96.5% vs. 87.6%) (p<0.001) compared to EE respondents. The main obstacles in dermoscopy use were poor access to dermoscopy equipment in EE and a lack of confidence in one's skills in WE. GDPc, THEc and GHEc correlated with rate of dermoscopy use and dermoscopy training during residency (Spearman rho: 0.5-0.7, p<0.05), and inversely with availability of dermoscopy equipment. CONCLUSION: The rates and patterns of dermoscopy use vary significantly between Western and Eastern Europe, on a background of economic inequality. Regionally adapted interventions to increase access to dermoscopy equipment and training might enhance the use of this technique towards improving the early detection of skin cancers.

Ciclopirox nail lacquer for the treatment of onychomycosis: an open non-comparative study.

Onychomycosis is a relatively common disease accounting for up to 50% of all nail disorders. Topical treatment, although less effective than systemic, is usually preferred by patients. Topical antifungal nail lacquers have been formulated to provide better delivery of the antifungal agent to the nail unit. The purpose of this research is to evaluate the efficacy and safety of ciclopirox nail lacquer in the treatment of onychomycosis. Patients suffering from distal and lateral subungual toenail onychomycosis (DLSO) and lateral subungual onychomycosis (LSO) were treated by ciclopirox nail lacquer once daily for 9 months. Every week the nail lacquer was removed using acetone. Clinical nail status, KOH examination and mycological culture were recorded by the same investigator at 0, 3, 6 and 9 months. Thirty-six patients completed the 9-month regimen. Trichophyton rubrum was the most common pathogen. At the end of the study, good improvement to complete cure was observed in 13 patients (36%), 12 patients showed only mild to moderate improvement and 11 patients (31%) had no clinical improvement. No adverse effects were noted throughout the treatment period. Ciclopirox nail lacquer seems to be slightly more effective than other topical modalities and could be used in patients who cannot or do not want systemic treatment.

Treatment of moderate to severe facial seborrheic dermatitis with itraconazole: an open non-comparative study.

BACKGROUND: Seborrheic dermatitis is a common chronic disease. Malassezia yeasts have been implicated in the pathogenesis of this disease. Antifungal agents are known to be effective in the treatment of Malassezia yeast infections. OBJECTIVES: To evaluate the efficacy of itraconazole in the treatment of mild to severe facial seborrheic dermatitis. METHODS: Sixty patients with moderate to severe seborrheic dermatitis were evaluated in an open non-comparative study. Patients were treated with oral itraconazole, initially 200 mg/day for a week, followed by a maintenance therapy of a single dose of 200 mg every 2 weeks. Four clinical parameters (erythema, scaling, burning, itching) were assessed using a 0-3 score. Mycological evaluation determined the presence of Malassezia spores in the scales using a direct smear. RESULTS: At the end of the initial treatment significant improvement was reported in three clinical parameters: erythema, scaling, itching. Maintenance therapy led to only slight further improvement. Burning sensation was only mildly improved during the treatment. The quantity of Malassezia spores present in the direct smear decreased throughout the treatment period. No blood test abnormalities were found during the treatment. CONCLUSIONS: In this study initial treatment with itraconazole was beneficial in patients with moderate to severe seborrheic dermatitis.

Ultraviolet-B treatment for cutaneous lichen planus: our experience with 50 patients.

BACKGROUND: Previous small reports suggested the role of ultraviolet (UV)-B in the management of cutaneous lichen planus. OBJECTIVE: To summarize our experience with UVB in a relatively large study group looking specifically into predictive factors for complete response and the long-term relapse rates. METHODS: A retrospective analysis of 50 patients with generalized cutaneous lichen planus, treated by broad or narrow band UVB. RESULTS: Seven and 43 patients were treated by broad and narrow band UVB, respectively. Complete response was achieved in 70% and 85% of those were still in remission after a median of 34.7 months. The complete response rate and the need for higher cumulative exposure doses were not influenced by sex, age, skin type, presence of additional diseases, failure of previous treatment or disease duration. LIMITATIONS: This is a retrospective non-randomized analysis of a usually self-limiting disease. CONCLUSION: UVB is a safe and efficient treatment option for generalized cutaneous lichen planus.

Efficacy of a mucoadhesive patch compared with an oral solution for treatment of aphthous stomatitis.

OBJECTIVE: The purpose of this study was to evaluate the efficacy and tolerability of a mucoadhesive patch compared with a pain-relieving oral solution for the treatment of aphthous stomatitis. METHODS: Patients with active aphthous stomatitis were randomly treated either once a day with a mucoadhesive patch containing citrus oil and magnesium salts (n = 26) or three times a day with an oral solution containing benzocaine and compound benzoin tincture (n = 22). All patients were instructed to apply the medication until pain had resolved, and completed a questionnaire detailing multiple clinical parameters followed by an evaluation of the treatment. RESULTS: The mucoadhesive patch was found to be more effective than the oral solution in terms of healing time (mean +/- SD: 36.0 +/- 22.8 hours vs 134.7 +/- 57.7, p < 0.001) and pain intensity after 12 and 24 hours (3.7 +/- 2.8 vs 6.3 +/- 2.6, p = 0.003, and 2.3 +/- 2.7 vs 5.7 +/- 2.5, p < 0.001, respectively). Local adverse effects 1 hour after treatment were significantly (p < 0.01) less frequent among the mucoadhesive patch patients compared with the oral solution patients. CONCLUSIONS: The mucoadhesive patch was found to be significantly more effective and better tolerated than the oral solution in the treatment of aphthous stomatitis.

Pigmented lesions clinic for early detection of melanoma: preliminary results.

BACKGROUND: Early detection of malignant melanoma of the skin is the most important factor in patient survival. Naked-eye diagnostic sensitivity and specificity are low. Patients with multiple nevi are at high risk to develop melanomas and the clinical follow-up of such patients is difficult, resulting in missed melanomas on the one hand and unnecessary biopsies on the other. OBJECTIVES: To describe the set-up of a special clinic aimed at early detection of melanoma and follow-up of high risk patients and preliminary results from 20 months of operation. METHODS: We established a pigmented lesions clinic based on a digital photography studio enabling documentation and comparison over time of full body photography and dermoscopy. RESULTS: In the first 20 months of work, 895 patients were seen, 206 of them for follow-up visits. A total of 29,254 photos were taken. Altogether, 236 lesions were suspicious (either clinically or dermoscopically) and the patients were advised to excise them. Seven melanomas were found in this initial examination (which did not include long-term follow-up). CONCLUSIONS: With multimode photographic cutaneous surveillance, early detection of melanoma in high risk patients has been reported. Our clinic utilizes the same techniques and diagnostic algorithm as other leading clinics throughout the world, thus enabling us to deliver better follow-up for those patients.

Patterns of recurrence in patients with melanoma after radical lymph node dissection.

HYPOTHESIS: Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field. DESIGN: Retrospective analysis. SETTING: Tertiary care referral center. PATIENTS: One hundred forty-one consecutive patients who underwent radical lymph node dissection (RLND) either in the groin or the axilla owing to malignant melanoma were followed up for a median period of 41 months. INTERVENTIONS: All of the 141 patients received either elective or therapeutic RLND. Their medical records were analyzed for demographic data, disease history, previous treatments, recurrence patterns, and survival. MAIN OUTCOME MEASURES: Patterns of first recurrence after RLND and survival. RESULTS: Radical lymph node dissection was performed on 148 lymph node basins (141 patients; 86 axillae and 62 groins). Nineteen patients (13%) received previous open interventions in the lymph node basin (tampering) other than radical dissection. Radical lymph node dissection was performed prophylactically in 38 basins (26%), for palpable disease in 75 (51%), and for a positive sentinel node in 35 (24%). There were 74 failures (52%) of RLND: 51 patients (70%) with systemic disease, 12 (16%) with recurrence in the surgical field, 9 (11%) with in-transit metastases, and 2 (3%) with local recurrence. On multivariate analysis, the only significant predictors of recurrence after RLND were Breslow thickness of greater than 4 mm (P = .02), tampering (P = .01), and lymph node capsular invasion (P = .001). Tampering was the only independent prognosticator of failure in the surgical field, as tampering was noted in 10 (83%) of 12 patients with failure in the surgical field as compared with 6 (10%) of 62 patients with other types of first failures (P<.001). This effect did not translate into a survival difference (P = .54). Failure in the surgical field was not detected in any of the patients who underwent sentinel lymph node biopsy. CONCLUSIONS: Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field, and they should be avoided. Fine-needle aspiration and sentinel node biopsy, performed with strict surgical oncologic techniques, are safe with regard to failure in the surgical field.

Teledermatology: quality assessment by user satisfaction and clinical efficiency.

BACKGROUND: The Israel Defense Forces implemented a pilot teledermatology service in primary clinics. OBJECTIVES: To assess user satisfaction and clinical short-term effectiveness of a computerized store and forward teledermatology service in urban and rural units. METHODS: A multi-center prospective uncontrolled cohort pilot trial was conducted for a period of 6 months. Primary care physicians referred patients to a board-certified dermatologist using text email accompanied by digital photographs. Diagnosis, therapy and management were sent back to the referring PCP. Patients were asked to evaluate the level of the CSAFTD service, effect of the service on accessibility to dermatologists, respect for privacy, availability of drugs, health improvement and overall satisfaction. PCPs assessed the quality of the teledermatology consultations they received, the contribution to their knowledge, and their overall satisfaction. RESULTS: Tele-diagnosis alone was possible for 95% (n=413) of 435 CSAFTD referrals; 22% (n=95) of referrals also required face-to-face consultation, Satisfaction with CSAFTD was high among patients in both rural and urban clinics, with significantly higher scores in rural units. Rural patients rated the level of service, accessibility and overall satisfaction higher than did urban patients. PCPs were satisfied with the quality of the service and its contribution to their knowledge. Rural physicians rated level of service and overall satisfaction higher than did urban physicians. Tele-referrals were completed more efficiently than referral for face-to-face appointments. CONCLUSIONS: CSAFTD provided efficient, high quality medical service to rural and urban military clinics in the IDF.

[Eye cosmetics--the beauty and the beast].

The use of eye cosmetics is a popular practice in modern times that dates back to ancient civilizations. This practice, however, is not without hazards. The most common adverse effect of eye cosmetics is eyelid dermatitis, although an array of other adverse effects has been reported. This article reviews the different types of eye cosmetics in current use, their composition and the adverse effects of both commercial and traditional products.