Dermatopathology workforce in the United States: a survey.

BACKGROUND: Although several studies have documented an undersupply of dermatologic services in the United States, little is known about the dermatopathology workforce. OBJECTIVE: Objectives included the following: (1) describe the dermatopathology workforce in the United States; (2) identify characteristics associated with academic dermatopathologists; and (3) explore issues surrounding dermatopathology training. METHODS: We conducted a cross-sectional survey of all Fellows of the American Society of Dermatopathology (ASDP) practicing in the United States and its territories. RESULTS: Of 913 ASDP Fellows, 437 (48%) returned a completed questionnaire. Most were male (72%), Caucasian (85%), and had graduated from US/Canadian medical schools (88%). Approximately half (49%) had completed a dermatology residency and a quarter (24%) were in academia. As compared with those in private practice, academic dermatopathologists were more likely to be female (P = .0028), have a medical degree only (P = .0197), and earn $300,000 or less annually (P < .0001). No associations were identified for practice type with either location of medical school (United States/Canada vs other) or year of fellowship graduation (≤1996 vs ≥1997). Although most respondents were satisfied overall with their training, the most common areas identified as inadequate included: coding/billing (47%), biostatistics (38%), pediatric clinical dermatology (27%), and electron microscopy (27%). LIMITATIONS: Moderate response rate and potential recall bias are limitations. CONCLUSIONS: This study of the US dermatopathology workforce provides benchmarks for future studies and strategies for workforce planning.

Validity of self-reported nail counts in patients with onychomycosis: A retrospective pilot analysis.

BACKGROUND: Onychomycosis (fungal infection of the toenails or fingernails) is common, affecting up to 8% of the general population. Telephone and mailed surveys conducted to study this disease are usually completed via patient self-report. The validity of the counts of diseased nails reported by the patients participating in these surveys has not been established. OBJECTIVE: The aim of this study was to assess the interrater agreement between patient and health care professional (HCP) counts of affected nails in patients with onychomycosis. METHODS: Patient and HCP counts of infected toenails and fingernails corresponding to a total of 567 patients originating from 3 different clinical trials were retrospectively analyzed. All these patients were initially classified as mycologically positive for toenail onychomycosis, and all 3 trials used identical self-administered questions regarding counts of infected toenails and fingernails. The level of agreement between patient versus HCP counts of infected toenails and fingernails (based on collapsed and uncollapsed counts) was measured using the quadratically weighted kappa statistic. RESULTS: Thirty-eight percent (213/554, 95% confidence interval [CI] = 35% to 43%) of the 554 patients with self-reported and HCP counts of infected toenails had exact agreement; for these 554 patients, quadratically weighted kappa = 0.47 (95% CI: 0.40 to 0.54). The highest agreement rates-79, 62, and 50%-correspond to the patients with HCP counts of affected toenails equaling 1, 2, and 10, respectively; that is, HCP counts at the extremes. The agreement rates ranged from 3% to 31% for the remaining patients with HCP counts between 3 and 9. Patients tended to undercount affected toenails, irrespective of the number of affected toenails counted by HCPs. No statistically significant association was found between agreement rates and whether or not the patients had been previously treated for toenail onychomycosis (P = .91). A marginally nonsignificant association of increasing agreement rates with increasing disease duration was observed (P = .06). Among the patients who reported one or more affected fingernails (n = 122), percent agreement was similar to that of toenails (41%, 95% CI: 33.0 to 50.0%). LIMITATIONS: This pilot study is limited by its retrospective design, its homogeneous group of patients (predominantly white, male veterans), and the fact that information on intraobserver and interobserver reliability was not obtained from all of the 3 clinical trials, the sources for this analysis. CONCLUSIONS: Patients tend to undercount affected nails as compared to HCPs. Reliance on self-reported counts in epidemiological surveys may lead to an inaccurate, underestimate of disease severity.

Pancreatic panniculitis in a 4-year-old child with nephrotic syndrome.

Pancreatic panniculitis is an uncommon disorder with a distinctive histopathology. We report the youngest patient with pancreatic panniculitis caused by hypertriglyceridemia in association with nephrotic syndrome.

Patch testing for evaluating drug reactions due to systemic antibiotics.

Several studies have evaluated patch testing for the diagnosis of drug eruptions, but widespread acceptance of this procedure is lacking in North America. The objective of this review is to address patch testing for the evaluation of exanthematous drug eruptions due to systemic antibiotics, using a MEDLINE database search for articles in English on patch testing for systemic drug eruptions caused by antibiotics.

Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of duct tape occlusion therapy for the treatment of common warts in adults. DESIGN: Double-blind controlled clinical intervention trial. SETTING: Veterans Affairs medical center. PARTICIPANTS: A total of 90 immunocompetent adult volunteers with at least 1 wart measuring 2 to 15 mm were enrolled between October 1, 2004, and July 31, 2005. Eighty patients completed the study. INTERVENTION: Patients were randomized by a computer-generated code to receive pads consisting of either moleskin with transparent duct tape (treatment group) or moleskin alone (control group). Patients were instructed to wear the pads for 7 consecutive days and leave the pad off on the seventh evening. This process was repeated for 2 months or until the wart resolved, whichever occurred first. Follow-up visits occurred at 1 and 2 months. MAIN OUTCOME MEASURE: Complete resolution of the target wart. Secondary outcomes included change in size of the target wart and recurrence rates at 6 months for warts with complete resolution. RESULTS: There were no statistically significant differences in the proportions of patients with resolution of the target wart (8 [21%] of 39 patients in the treatment group vs 9 [22%] of 41 in the control group). Of patients with complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month. CONCLUSION: We found no statistically significant difference between duct tape and moleskin for the treatment of warts in an adult population.

NailQoL: a quality-of-life instrument for onychomycosis.

BACKGROUND: The disease burden onychomycosis is not trivial. The aim is to develop a quality of life instrument to measure the onychomycosis burden. METHODS: 402 patients with mycologically-confirmed onychomycosis completed a baseline questionnaire of 39 quality of life items (modified Skindex-29 questions and 10 additional nail-specific questions). Internal consistency, reproducibility and responsiveness of the final instrument, NailQoL were measured. RESULTS: 15 items consisting of symptom (3), emotion (10), and functional (2) domains were retained in NailQoL. Symptom and emotion subscales = 0.80-0.92. Administration alpha demonstrated good internal consistency (Cronbach's of the instrument to 46 patients at one month after baseline revealed good reproducibility (ICC 0.88-0.91). Responsiveness was measured in 292 patients at 18 months; statistically significant better NailQoL scores were found in individuals with complete cure (mycological and clinical) (P < 0.01). CONCLUSION: NailQoL represents a new concise, valid, reliable, and responsive instrument for measuring burden of skin disease for patients with onychomycosis.