Graduates-of-foreign-dermatology residencies and military dermatology residencies and women in academic dermatology.

BACKGROUND: It is well known that there is a growing shortage of academic dermatologists in the U.S. The number of graduates of foreign dermatology residencies (GFDR) and graduates of military dermatology residencies (GMDR) who take full-time academic dermatology positions are currently unknown. It is likely that a higher proportion of GFDRs and GMDRs are more likely to enter academics and practice medical dermatology. The percentage of women in academic dermatology has not been reported since 1994. OBJECTIVE: To determine the total number of GFDRs, GMDRs, and women who are full-time faculty members at U.S. dermatology residency programs. METHODS: The educational background of all full-time faculty members of the 107 U.S. dermatology residency programs that were active as of December 2004 were determined through extensive Internet searches, telephone, and email correspondences with residency coordinators and faculty members. Pure PhDs, physicians who did not complete a dermatology residency program at an allopathic school, PharmDs, DDSs, and FNPs were excluded. The University of Puerto Rico was not considered a foreign residency program. RESULTS: As of December 2004, there were 988 full-time dermatology faculty members in the US, 813 of which met our inclusion criteria. There were 30 GFDRs, accounting for 3.7 percent of full-time academic dermatologists. There were 29 GMDRs, accounting for 3.6 percent of all full-time academic dermatologists. Women accounted for 44.42 percent of academic dermatologists and 15.9 percent (14/107) of dermatology chairs/chiefs. CONCLUSION: GFDRs, GMDRs, and women comprise important proportions of full-time faculty members at U.S. dermatology residency programs.

MD/PhDs are more likely than MDs to choose a career in academic dermatology.

There are fewer dermatologists entering and being retained in academics. We investigated the hypothesis that MD/PhDs are more likely than MDs to enter a career in academic dermatology. This retrospective study of university dermatology departments and divisions studied MDs, DOs, and MD/PhDs who completed a dermatology program in the U.S. and were serving as full-time dermatology faculty members at a US dermatology program as of December 2004. The main outcome measures were percentage of MD/PhDs who chose a career in academics compared to the percentage of MDs who chose a career in academics; MDs, DOs, MD/PhDs and serving as full-time faculty members and the number serving as chair or chief of dermatology. The total number of MD/PhDs and percentage of MD/PhDs as full-time faculty in 107 U.S. dermatology programs were determined. As of December 2004, there were 782 full-time faculty MDs who completed a residency in the US, with 72 (9.2%) MD/PhDs who completed a US dermatology residency program. MD/PhDs were 1.63 times (p < or =0.001) more likely to go into academics compared to MDs. The programs with the highest number of MD/PhDs as full-time faculty and the programs with the highest percentage of MD/PhDs as full-time faculty were tabulated. Seven out of an eligible 101 dermatology chiefs/chairs were MD/PhDs. The assumption that 5.8 percent of dermatology residents who were MD/PhD during 2004-2007 could be extrapolated to the 35 year period of 1970-2004. MD/PhDs are an important source of physician-scientists in academic dermatology and were 1.63 times more likely compared to MDs to choose a career in academics and remain in academics.

Ranking the dermatology programs based on measurements of academic achievement.

BACKGROUND: The only dermatology rankings in the past were based on National Institutes of Health (NIH) funding and journal citations. OBJECTIVE: To determine the highest ranking academic dermatology programs based on 5 outcome measures and on an overall ranking scale. To the best of our knowledge, this is the first report to rank the dermatology programs on 4 of the following outcome measures of academic achievement and with an overall ranking. METHODS: We collected extensive 2001 to 2004 data ranging from total publications to grant funding on 107 U.S. dermatology programs and their full-time faculty. Data from part-time and volunteer faculty were not used. MAIN OUTCOME MEASURES: Publications in 2001 to 2004; NIH funding in 2004; Dermatology Foundation grants in 2001 to 2004; faculty lectures in 2004 delivered at national conferences; number of full-time faculty members who were on the editorial boards of the top 3 U.S. dermatology journals and the top 4 subspecialty journals RESULTS: We used the 5 outcome measures to tabulate the highest ranking programs in each category. Using a weighted ranking system, we also tabulated the overall top 30 dermatology programs based on these 5 outcome measures. LIMITATIONS: We were not able to determine the total amount of NIH funding in dollars of the dermatology divisions. The impact factors of the journal in which these publications appeared was not factored into our calculations. Since faculty members may collaborate on the same publication, some publications may have been double-counted. CONCLUSION: In descending order, the 5 highest ranked academic programs are the University of Pennsylvania; University of California, San Francisco; Yale-New Haven Medical Center; New York University; and University of Michigan. This ranking system may allow residents and faculty to improve the academic achievements at their respective programs.

Dermatology residency program characteristics that correlate with graduates selecting an academic dermatology career.

OBJECTIVE: To examine the characteristics of 107 dermatology residency programs to determine which factors are correlated with producing academic dermatologists to help reverse the trend of a growing shortage of academic dermatologists. DESIGN: We collected data ranging from total publications to grant funding. Extensive Internet searches were completed to obtain most of the data. Individual programs were contacted as needed to obtain any missing data that were not found on the program's Web site. SETTING: Dermatology residency programs (departments and divisions) in the United States. MAIN OUTCOME MEASURES: Factors that correlated with producing full-time academic dermatologists. RESULTS: We tabulated and analyzed characteristics of 107 dermatology residency programs. Total full-time faculty members in 2004, total publications in 2004, and total publications from January 1, 2001, to December 31, 2004, were the 3 factors most strongly correlated with producing full-time faculty. National Institutes of Health and Dermatology Foundation grants and American Skin Association grant recipients were the 3 characteristics most strongly inversely correlated with producing full-time faculty. Those who entered academic dermatology tended to stay at the same program where they completed a dermatology residency, especially if this program was considered a "smaller" program. CONCLUSIONS: The programs' characteristics of total publications in 2004 and from 2001 to 2004 were 2 of the 3 factors most strongly positively correlated with dermatology residents entering academic dermatology. Encouraging residents to publish may be a window to motivate them toward a career in academic dermatology.

Mechanisms of action of new treatment modalities for actinic keratosis.

Actinic keratosis (AK) constitutes the initial lesion in a disease continuum that can progress to invasive squamous cell carcinoma (SCC). In this article, we describe the mechanisms of action, tolerability, and efficacy of the most frequently used chemopreventative, chemotherapeutic, destructive, and novel immunologic methods for the control and treatment of actinic keratoses.

Use of cyclooxygenase inhibitors and risk of melanoma in high-risk patients.

BACKGROUND: Results from in vitro and animal studies suggest that cyclooxygenase (COX) inhibitors may reduce the risk of melanoma, but among humans, the evidence remains limited. OBJECTIVE: In a pilot retrospective cohort, to determine the relationship between the use of COX inhibitors and the incidence, recurrence, and metastases of melanoma in high-risk patients. METHODS: Reviewing computerized records at the Miami Veterans Affairs Medical Center, we retrospectively examined the association between COX inhibitor use and melanoma incidence, recurrence, and metastases in high-risk subjects: white subjects previously diagnosed with melanoma (1996-2003). We evaluated three potential outcomes: new melanoma diagnosis, recurrence of a previous melanoma, and melanoma metastasis. RESULTS: Eighty-three subjects with melanoma were included. There was one metastasis among 28 subjects prescribed COX inhibitors, whereas four new melanomas (7.3%), two melanoma recurrences, and six metastases (10.9%) occurred among 55 patients not prescribed COX inhibitors. Although no individual outcomes measures reached statistical significance, combining the three measures, these were significantly lower in users of COX inhibitors compared with nonusers (1 vs 12; p = .05). After adjustment for age and tumor depth of invasion, COX inhibitor users had significantly lower rates of melanoma outcome measures (odds ratio 0.08; 95% confidence interval 0.01-0.77; p = .03). CONCLUSION: Potential exists for chemoprevention of melanoma among high-risk patients.

Cutaneous signs and syndromes associated with internal malignancies.

Cutaneous changes may indicate the presence of or herald the incipient development of internal malignancies. The authors review 24 cutaneous signs, symptoms, diseases, and syndromes associated with internal malignancies. Early recognition of these cutaneous changes may allow for vigilance for, and prompt detection and management of, the underlying neoplasm.

Self-warming lidocaine/tetracaine patch effectively and safely induces local anesthesia during minor dermatologic procedures.

BACKGROUND: Dermatologic procedures often cause some degree of pain. A self-warming patch containing lidocaine and tetracaine (L/T) was developed to provide topical local anesthesia prior to painful procedures. OBJECTIVES: To evaluate the safety and efficacy of a self-warming L/T patch to provide anesthesia in adult patients undergoing minor dermatologic procedures. METHODS: An active or placebo study drug was placed on adults 30 minutes prior to minor dermatologic surgical procedures in a prospectively randomized, double-blinded manner. Subcutaneous lidocaine injection was available during the procedure as a rescue medication if requested by the subject. Immediately following the procedure, the subjects, the investigator, and an independent observer rated pain intensity and adverse events were recorded. RESULTS: Patient-reported pain intensity was significantly lower in the L/T patch group (p<.001). Investigators and an independent observer rated the pain in the L/T patch group to be less than in the placebo patch group (p = .004 and p<.001, respectively). Forty-nine percent of patients in the placebo group required rescue subcutaneous lidocaine compared with 22% in the L/T patch study group (p = .008). One patient in the L/T patch group reported a transient moderate burning sensation. CONCLUSION: The self-warming L/T patch was effective in providing clinically useful local anesthesia for minor dermatologic procedures in adult patients.

Double-blind, randomized, placebo-controlled, prospective study evaluating the tolerability and effectiveness of imiquimod applied to postsurgical excisions on scar cosmesis.

BACKGROUND: It has been reported that topical application of imiquimod 5% cream induces interferon-alpha, an antifibrotic cytokine. OBJECTIVE: To determine the tolerability and effectiveness on the cosmetic outcome of the application of imiquimod to postsurgical excision sites. MATERIALS AND METHODS: A prospective, double-blinded, randomized, vehicle-controlled trial was conducted among 20 patients with two skin lesions clinically diagnosed as melanocytic nevi. Imiquimod 5% cream was applied to one of the sutured surgical wounds starting the night of the excision nightly for a period of 4 weeks. The second sutured excision site was treated with vehicle cream. Scar cosmesis, erythema, pigmentary alterations, induration, tenderness, and pain were assessed using a visual analogue scale 2, 4, and 8 weeks after surgery. RESULTS: Eighteen subjects completed the study, with a total of 36 excision sites; no wound site dehisced, and no signs of infection were noted. Surgical wounds treated with imiquimod had more erythema, pigmentary alterations, and lower cosmesis rated by the investigator compared with wounds treated with placebo, both becoming nonsignificant in further evaluations. For pigmentary alterations, induration, and cosmesis rated by the patients, no statistically significant difference between treatment groups was observed at week 8. CONCLUSION: Treatment of surgical excision-site wounds with imiquimod was well tolerated and without serious adverse events. Evaluations for cosmesis of placebo-treated surgical sites were better than imiquimod-treated sites at week 8, becoming nonsignificant later.

A refractory case of erythromelalgia involving the ears.

Erythromelalgia is a rare syndrome that is characterized by episodic attacks of burning pain, erythema, and increased temperature usually affecting the extremities, which is aggravated by warmth or exercise. We describe a patient with a 3-year history of refractory burning pain and red ears. A review of clinical features, disease classification, associated diseases, and treatment of this disease is presented.

Novel opportunities in the treatment and prevention of scarring.

Numerous treatments have been described for the treatment and prevention of scars, but the optimal management strategy is yet to be defined. In this article we present and evaluate new opportunities for the treatment and prevention of hypertrophic scars, keloids, and atrophic scars. Clinical, animal, and in vitro studies reporting novel techniques for the treatment and prevention of scarring were identified primarily from the MEDLINE/PubMed database. We found that a variety of new treatments exist with potential effectiveness for the treatment of hypertrophic scars and keloids, including interferon, imiquimod 5% cream, tacrolimus, botulinum toxin, 5-fluorouracil, bleomycin, and verapamil. For atrophic scars, different types of lasers represent modern treatment modalities with satisfactory results. Several agents have been reported to be effective in reducing scarring in vitro and in animal studies, representing potential opportunities for scarring management. We conclude that several novel modalities may be potential therapies for scarring.