Health literacy in pediatric dermatology: challenges and opportunities.

PURPOSE OF REVIEW: Health literacy influences how children and families participate in their medical care, use health services, and overall health outcomes. Health literacy is underexplored in pediatric dermatology. In this scoping review, we provide examples of how limited health literacy can be a barrier to patient care in pediatric dermatology and how to mitigate its effects. RECENT FINDINGS: Limited health literacy is associated with worse health outcomes, decreased medication adherence, and decreased use of the healthcare system versus those with adequate health literacy. Materials created to help patients understand their medical conditions and treatment options often are written at a reading level far above that of the average patient and caregiver. Given the reading level of patient-facing materials, those with limited health literacy are more susceptible to medication administration errors, with omissions or incorrect dosing being most frequent to occur. There is limited research about how skills related to health literacy, including numeracy and electronic health literacy, can be addressed in pediatric dermatology. SUMMARY: Health literacy impacts patient care, treatment, and adherence in pediatric dermatology. This article gives examples of how to address common challenges in the pediatric dermatology clinic and presents areas for further research and improvement.

A Case of Pasteurella Bacteremia in a Patient With Hepatocellular Carcinoma.

Pasteurella multocida is a Gram-negative coccobacillus commonly associated with soft tissue and skin infections. On rare occasions, it may result in systemic bacteremia and sepsis. Our case describes a 59-year-old male who presented to the emergency department with septic shock. Physical examination was remarkable for bilateral lower extremity wounds which were in recent contact with feline oral secretions. Blood cultures were obtained and resulted in the growth of P. multocida after 48 hours. His treatment involved intravenous antibiotics and supportive care. After finishing his two-week course of antibiotics, he was placed on inpatient hospice care due to his clinical course involving other comorbidities and expired shortly after. This case highlights the importance of early recognition and treatment of P. multocida infection in patients with comorbid conditions such as hepatocellular carcinoma.

Sepsis-Induced Cardiomyopathy Detected With Focused Cardiac Ultrasound in the Emergency Department.

BACKGROUND: Sepsis is a high mortality condition characterized by multi-organ dysfunction. Sepsis-induced cardiomyopathy (SIC) refers to cardiac dysfunction in sepsis. OBJECTIVES: Our goal was to determine whether SIC can be detected in the emergency department (ED) using focused cardiac ultrasound (FCU). METHODS: A retrospective analysis of adults presenting to a single ED with sepsis over a 21-month period was performed. Patients were included if they met clinical sepsis criteria, received an FCU by an emergency physician in the ED, and a baseline echocardiogram performed in the previous 12 months. SIC was defined as a significant decrease in estimated left ventricular ejection fraction (LVEF) by FCU relative to baseline. Demographic and outcome characteristics were compared between three cohorts: patients with normal baseline LVEF and no decrease on presentation, patients with decreased LVEF and no significant change, and those with a significant decrease in LVEF from their normal baseline (SIC). RESULTS: There were 110 patients that met inclusion criteria: 89 patients (81%) in the normal LVEF group, 12 (11%) in the prior decreased LVEF group, and 9 (8%) in the SIC group. Unadjusted mortality at 90 days for patients with SIC (67%) and prior decreased LVEF (58%) was significantly higher than those with normal EF (29%) (p = 0.019). When adjusted for age, gender, Charlson Index score, and lactate > 4.0 mmol/L, SIC was associated with mortality at 90 days (odds ratio 6.1, 95% confidence interval 1.37-32.92). CONCLUSION: SIC can be detected using FCU by emergency physicians in the ED and is associated with increased 90-day mortality.

Dermoscopic Features of Mycosis Fungoides and Its Variants in Patients with Skin of Color: A Retrospective Analysis.

BACKGROUND: Mycosis fungoides (MF) is a cutaneous T-cell lymphoma that disproportionately affects people with skin of color and is difficult to diagnose. OBJECTIVE: This study characterized the dermoscopic features of MF and its subtypes in patients with skin of color. METHODS: Dermoscopic images of patients with skin of color seen at the cutaneous T-cell lymphoma clinic at Michigan Medicine Dermatology between 2018 and 2019 were reviewed. Specific dermoscopic features were identified and summarized for each subtype of MF. RESULTS: A total of 33 dermoscopic images from 11 patients with skin of color were reviewed. Four patients had classic MF (18 dermoscopic images), 4 had hypopigmented MF (9 dermoscopic images), 1 had folliculotropic MF (4 dermoscopic images), and 2 had verrucous MF (2 dermoscopic images). Classic MF was characterized by striking pigmentary change, thick black lines, white rosettes, and geometric white lines. Hypopigmented MF was characterized by the loss of the patient's natural pigment network. In folliculotropic MF, follicular plugging and hyperpigmented to violaceous perifollicular halos were observed. In verrucous MF, large, yellow-gray amorphous structures with yellow-gray ridges and comedo-like openings were observed within hyperkeratotic areas. Overall, vessel morphology was difficult to discern on dermoscopy. CONCLUSIONS: Dermoscopic features of MF in patients with skin of color are predominantly characterized by striking pigmentary alteration. Vessel morphology is not a reliable diagnostic feature. As patients with MF and skin of color have a worse prognosis than light-skinned individuals, a better understanding of dermoscopic features may aid in early diagnosis and improve outcomes in this group.