Deployed Airbag Causes Bullous Reaction Following a Motor Vehicle Accident.

Airbags can be lifesaving during a motor vehicle accident (MVA), but airbag deployment has been the cause of dermatologic injuries including irritant dermatitis, as well as thermal, friction, and chemical burns. A highly corrosive alkaline aerosol composed of sodium hydroxide, sodium bicarbonate, and metallic oxides is released during airbag deployment. We present the case of a 35-year-old man who developed a bullous reaction to released by-products from airbag deployment during an MVA.

Internet-based survey intervention improves adherence to methotrexate among psoriasis patients.

BACKGROUND: While it is known that psoriasis patients have poor adherence to both topical and systemic medications, adherence to methotrexate is not well-characterized, and ways to improve methotrexate adherence have not been addressed. OBJECTIVE: The aim of this study was to evaluate whether a digital intervention improved adherence to oral methotrexate as measured by electronic monitoring. METHODS: Twenty-nine patients were randomized to receive either weekly digital interventions assessing treatment adherence or no intervention for 24 weeks. Patients received medication bottles with electronic monitoring, and returned at weeks 4, 12, and 24 to evaluate disease severity. RESULTS: The intervention group took methotrexate correctly 77.1% of the weeks observed compared to the control group which averaged 64.5%. More intervention patients took methotrexate as directed compared to the control group (78.3% vs 64.2%, p < 0.0001). Patients were most adherent around follow-up visits, with 100% of digital intervention patients and 80% of control patients taking methotrexate correctly during the week of a follow-up visit (p = 0.02). The digital intervention did not significantly improve disease severity in the intervention group compared to the nonintervention group. CONCLUSIONS: Low cost, scalable digital interventions may have the potential to increase psoriasis patient adherence to methotrexate, although the mechanism for the improvement is not yet well defined.

Inpatient teledermatology: Current state and practice gaps.

BACKGROUND: Inpatient dermatology care can be challenging for dermatologists. Currently teledermatology is widely used in the outpatient setting but is not common in the inpatient setting, although it has the potential to reduce wait times and improve access to care. OBJECTIVE: To review the available literature on inpatient teledermatology, assess how teledermatology is currently being used in the inpatient setting, and recommend best practice use of inpatient teledermatology. METHODS: A literature review was performed and dermatology attending physicians were surveyed at the Society for Dermatology Hospitalists annual meeting about their current use of inpatient teledermatology. RESULTS: The majority of attending physicians (80.8%, n = 21/26) responded that their institution uses some form of teledermatology. Approximately half of those using teledermatology used it for both inpatient and outpatient consultations (55%, n = 11/20). For institutions with inpatient teledermatology, attending physicians used teledermatology to remotely staff inpatient consultations (81.8%, n = 9/11), triage consultations (63.6%, n = 7/11), and answer curbside questions from primary teams (18.2%, n = 2/11). LIMITATIONS: The limitations of this study include a limited sample size from a single meeting. CONCLUSION: Inpatient teledermatology is currently under-utilized has the potential to increase access to dermatology care and may be best used for triaging and remote staffing. Additionally, standardization of platforms and reimbursement would allow for increased use of inpatient teledermatology.

Assessing factors affecting sunscreen use and barriers to compliance: a cross-sectional survey-based study.

While sunscreen is effective prevention for skin cancer, public sunscreen use and compliance are low. Identifying factors affecting sunscreen use and barriers to compliance are important to understand in order to increase sunscreen use, especially among high-risk individuals. We conducted a single institution survey of 429 dermatology clinic patients to better understand patients' barriers to sunscreen use. Overall several personal barriers to sunscreen use included dislike of feel or appearance of sunscreen (33.7%) and time constraints (15.3%). The cost was a barrier to use in 16.4% of cases underscoring the importance for dermatologists to consider socioeconomic barriers to sunscreen use and provide cost-effective sun protection counseling to patients whenever possible. Dermatologists recommending sunscreen use was associated with a higher rate of use of sunscreen (p < .001) highlighting the important role of sun protective counseling by the dermatologist.

Uveoparotid fever as a presentation of sarcoidosis.

Uveoparotid fever, also known as Heerfordt-Waldenström syndrome, is an uncommon acute presentation of systemic sarcoidosis. Patients may have features of complete/classic or incomplete disease. Early diagnosis and multidisciplinary care should be initiated to prevent sequelae. Herein, the authors report a rare case of retrospectively diagnosed incomplete uveoparotid fever in a patient with anterior uveitis, parotid gland enlargement, and fever who presented to our dermatology clinic with cutaneous sarcoidosis.

Eosinophilic fasciitis: a case series with an emphasis on therapy and induction of remission.

Eosinophilic fasciitis is an uncommon connective tissue disorder that affects patients of all ages, resulting in significant morbidity. Systemic corticosteroids can induce remission of disease. However, there is no universally accepted treatment ladder for eosinophilic fasciitis. This case series evaluates treatment efficacy in patients with eosinophilic fasciitis seen at Wake Forest University Department of Dermatology outpatient clinics. Patient charts were screened using ICD-9 diagnosis code 710.9 (unspecified diffuse connective tissue disease) to identify patients with eosinophilic fasciitis (n=10) seen at our institution. Patients were treated for an average 24 months with a combination of methotrexate and prednisone therapy, unless one or both were contraindicated, with each medication tapered conservatively to prevent disease flares. Alternate treatments included mycophenolate mofetil with prednisone, azathioprine with prednisone, prednisone monotherapy, and methotrexate monotherapy. Disease remission off therapy and on low-dose therapy was 66 and 70%, respectively. Our first-line therapy of concomitant methotrexate and prednisone is well-tolerated and effective for managing patients with eosinophilic fasciitis. Our study was limited to cases seen at a single academic institution.

A Pilot Study Characterizing Factors in Adherence to Cutaneous Lupus Treatment.

Cutaneous lupus erythematosus (CLE) is an autoimmune skin disease that manifests as scarring, dyspigmentation, erythema, and pain. Topical corticosteroids are a mainstay of treatment. Irritation, messiness, and tediousness may deter use. Thus, nonadherence, rather than nonresponse, can result in treatment failure. Prior adherence studies were limited to systemic lupus erythematosus. We performed a single-center, open-label pilot study to assess adherence to topical medication in patients with CLE. CLE adherence to topical medications is suboptimal and declines over time. Shorter treatment duration and greater patient perception of disease severity may contribute to higher adherence. Improving adherence to existing treatments could be as or more valuable than new therapies for the disease.

Diversity in dermatology: a society devoted to skin of color.

The US Census Bureau predicts that more than half of the country's population will identify as a race other than non-Hispanic white by the year 2044. Racial disparities also exist in the physician population where black individuals and Latinos are underrepresented. The Skin of Color Society (SOCS) was established to address the need for parity among dermatology patients with skin of color. The society provides educational support on dermatologic health related to skin of color and functions through committees that represent the multifaceted aspects of the organization. This column highlights the ongoing efforts of SOCS and its impact since its inception. We also chronicle the society's approach to broadening the scope of the specialty of dermatology.

Teledermatology in the inpatient setting.

Teledermatology (TD) is a health care delivery modality that uses telecommunication technology to provide dermatologic care. It has grown to be a reliable and diagnostically accurate means of producing quality care while increasing access and reducing wait times in the outpatient setting. In the inpatient setting, TD may be an effective method to improve access to dermatologic care by remotely triaging, assisting, or providing dermatologic consultative services. For inpatient dermatology, there is the potential for TD to increase access to care in the community setting where dermatologists have full outpatient schedules. Using inpatient TD to triage conditions may be especially helpful in determining if a patient needs to be emergently/urgently seen, or if outpatient care could be appropriate. To best establish TD in the inpatient setting, certain practice guidelines should be considered to ensure the highest quality patient care. These features include Health Insurance Portability and Accountability Act (HIPAA)-consistent protocols to ensure high-quality video sessions and clinical photographs are acquired, stored, and transmitted using secure software and networks, establishing relationships with primary care teams to ensure trust in consulting advice and ensuring consistent communication regarding recommendations, and appropriate patient follow-up.

Retrospective Study of Rocky Mountain Spotted Fever in Children.

BACKGROUND/OBJECTIVES: Rocky Mountain spotted fever (RMSF), a lethal tick-borne illness, is prevalent in the south central United States. Children younger than 10 years old have the greatest risk of fatal outcome from RMSF. The objective of the current study was to review pediatric cases of RMSF seen in the dermatology consult service and to evaluate dermatology's role in the diagnosis and management of this disease. METHODS: A retrospective review was performed of inpatient dermatology consultations at a tertiary care center in North Carolina from 2001 to 2011. Data collected included patient demographic characteristics, symptoms, pre- and postconsultation diagnoses, diagnostic procedures, length of hospital stay, and outcome. RESULTS: A total of 3,912 consultations were conducted in the dermatology service over 10 years. Six patients with RMSF, ranging in age from 22 months to 10 years (mean 5.1 years), were evaluated during April, May, and June. All preconsultation diagnoses included RMSF in the differential diagnosis. All patients underwent skin biopsies, and a culture was obtained in one case. Fifty percent of patients died within 4 days of hospitalization. CONCLUSIONS: Variables associated with mortality from RMSF are delayed diagnosis and initiation of antirickettsial therapy. Physicians should consider RMSF in children presenting with fever and rash during the summer months. Dermatology consultation is useful in evaluating patients with suspicious clinical features of RMSF with skin findings.

Folliculocentric Lichen Sclerosus et Atrophicus in a 10-Year-Old Girl.

Lichen sclerosus et atrophicus (LSA) is a chronic inflammatory scarring disease with a predilection for the anogenital area; however, 15%-20% of LSA cases are extragenital. The folliculocentric variant is rarely reported and less well understood. The authors report a rare case of extragenital, folliculocentric LSA in a 10-year-old girl. The patient presented to the dermatology clinic for evaluation of an asymptomatic eruption of the arms and legs, with no vaginal or vulvar involvement. Physical examination revealed the presence of numerous 2-4 mm, mostly perifollicular, hypopigmented, slightly atrophic papules and plaques. Many of the lesions had a central keratotic plug. Cutaneous histopathological examination showed features of LSA. Based on clinical and histological findings, folliculocentric extragenital LSA was diagnosed.