Semin Cutan Med Surg
· 2017 Jun · PMID 28538742
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Hidradenitis suppurativa (HS) is an inflammatory condition characterized by recurrent abscesses which may result in sinus tracts and dermal scarring. This article reviews current epidemiologic data on HS in diverse popul...Hidradenitis suppurativa (HS) is an inflammatory condition characterized by recurrent abscesses which may result in sinus tracts and dermal scarring. This article reviews current epidemiologic data on HS in diverse populations, including prevalence based on geography, age, gender, ethnicity, and details the spectrum of clinical features of hidradenitis suppurativa with discussion of disease severity and risk factors. Recently proposed HS diagnostic criteria are also presented.
Semin Cutan Med Surg
· 2017 Jun · PMID 28538741
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Hidradenitis suppurativa (HS) is a prevalent and devastating inflammatory skin disease predominating in women and minorities. HS is characterized by painful recurrent abscesses, foul-smelling purulent drainage, sinus tra...Hidradenitis suppurativa (HS) is a prevalent and devastating inflammatory skin disease predominating in women and minorities. HS is characterized by painful recurrent abscesses, foul-smelling purulent drainage, sinus tract and fistula formation, and disfiguring scarring involving intertriginous body sites including the axillae, breasts, groin, and buttocks. Disease onset typically occurs in the second to fourth decades of life and is associated with significant impacts on physical and psychological well-being due to pain, shame, and isolation, leading to profound suffering and despair. HS is both clinically and biologically understudied and therefore poorly understood. As a result, no uniformly effective therapies exist for management, and until recently, there was a paucity of high-level evidence to support current treatments.
Semin Cutan Med Surg
· 2017 Mar · PMID 28247875
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The question of what makes a successful dermatology hospitalist has risen to the forefront due to the rapidly increasing number of these providers. Inpatient dermatology fellowships have formed as a direct consequence. T...The question of what makes a successful dermatology hospitalist has risen to the forefront due to the rapidly increasing number of these providers. Inpatient dermatology fellowships have formed as a direct consequence. Though mostly in their infancy, these programs have primary or secondary goals to train providers in the dermatologic care of the hospitalized patient. This article presents a brief synopsis of the history of traditional hospitalist fellowships and extrapolates these findings to existing hospitalist dermatology fellowships. As more of these programs arise, these fellowships are poised to revolutionize dermatologic inpatient care from a systems perspective.
Semin Cutan Med Surg
· 2017 Mar · PMID 28247874
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Hospitalist dermatology is a subspecialty dedicated to high-quality care of medically complex hospitalized patients with dermatologic diseases. Significant unanswered questions affecting the diagnosis and management of t...Hospitalist dermatology is a subspecialty dedicated to high-quality care of medically complex hospitalized patients with dermatologic diseases. Significant unanswered questions affecting the diagnosis and management of these patients persist, and research is urgently needed to improve patient care and move the field forward. This article explores strategies for successful conduct of research in hospital dermatology, including the role of cross-collaboration, and draws parallels with strategies utilized in rare diseases research.
Semin Cutan Med Surg
· 2017 Mar · PMID 28247873
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A consultative dermatology service plays an important role in patient care and education in the hospital setting. Optimizing education in balance with high-quality dermatology consultative services is both a challenge an...A consultative dermatology service plays an important role in patient care and education in the hospital setting. Optimizing education in balance with high-quality dermatology consultative services is both a challenge and an opportunity for dermatology consultation teams. There is an emergence of new information about how dermatology can best be taught in the hospital, much of which relies on principles of workplace learning as well as the science of how learning and teaching best happen in work settings. These best practices are summarized in this narrative review with integrated discussion of concepts from outpatient dermatology education and lessons learned from other inpatient teaching models. In addition, consultative dermatology curricula should utilize a blended curriculum model comprised of patient care and active learning and self-study modalities. Specific educational methods will discuss 2 strategies: (1) direct patient-care activities (ie, bedside teaching rounds) and (2) nonpatient care activities (ie, case presentations, didactic sessions, online modules, and reading lists).
Semin Cutan Med Surg
· 2017 Mar · PMID 28247872
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Inpatient dermatology consultative services care for hospitalized patients with skin disease in collaboration with the primary inpatient team. Effective, efficient communication is important. A consultation service must...Inpatient dermatology consultative services care for hospitalized patients with skin disease in collaboration with the primary inpatient team. Effective, efficient communication is important. A consultation service must develop strong relationships with primary inpatient teams requesting consults in order to provide optimal patient care. Prior studies have identified effective communication practices for inpatient consultative services. This narrative review provides a summary of effective communication practices for an inpatient dermatology consultation service organized into 5 domains: (1) features of the initial consult request; (2) best practices in responding to the initial consult; (3) effective communication of recommendations; (4) interventions to improve consultations; and (5) handling curbside consultations. Recommendations include identifying the specific reason for consult; establishing urgency; secure sharing of sensitive clinical information such as photographs; ensuring timely responses; providing clear yet brief documentation of the differential diagnosis, problem list, final diagnosis and recommendations; and limiting curbside consultations. Future studies are needed to validate effective strategies to enhance communication practices within an inpatient dermatology consultative service.
Semin Cutan Med Surg
· 2017 Mar · PMID 28247871
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Skin biopsy remains one of the most important tools in the evaluation of dermatologic disease in hospitalized patients and is diagnostic for many common inpatient dermatoses, including various drug eruptions and cutaneou...Skin biopsy remains one of the most important tools in the evaluation of dermatologic disease in hospitalized patients and is diagnostic for many common inpatient dermatoses, including various drug eruptions and cutaneous infections. The dermatopathology team thus plays a crucial role in the care of many of these patients and can add significant value through timely and precise diagnoses. Here, we review the unique challenges of dermatopathology in hospital-based medicine, discuss approaches to timely care, and examine effective clinicopathologic correlation in this setting.
Semin Cutan Med Surg
· 2017 Mar · PMID 28247870
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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...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.
Semin Cutan Med Surg
· 2017 Mar · PMID 28247869
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Hospital dermatology is often thought to be too cumbersome for the private practicing dermatologist to handle, leaving patients in our communities without needed care and our medical colleagues in the dark when it comes...Hospital dermatology is often thought to be too cumbersome for the private practicing dermatologist to handle, leaving patients in our communities without needed care and our medical colleagues in the dark when it comes to diagnosing and/or managing skin disease in the hospitalized patient. This notion that "someone else will figure it out" undervalues our expertise as a specialty and threatens the appropriate health outcomes we knowingly understand patients deserve. In this manuscript, we intend to break down the hospital consult conceptually so as to make clear how simple it can be to help our physician colleagues and make an important impact upon patients at their most vulnerable time.
Semin Cutan Med Surg
· 2017 Mar · PMID 28247868
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Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology part...Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology participation are often attributed to a number of factors, including challenges navigating the administrative burdens of hospital credentialing, acclimating to different hospital systems involving potential alternate electronic medical records systems, medical-legal concerns, and reimbursement concerns. This article aims to provide basic guidelines to help dermatologists establish a presence as a consulting physician in the inpatient hospital-based setting. The emphasis is on identifying potential pitfalls, problematic areas, and laying out strategies for tackling some of the challenges of inpatient dermatology including balancing financial concerns and optimizing reimbursements, tracking data and developing a plan for academic productivity, optimizing workflow, and identifying metrics to document the impact of an inpatient dermatology consult service.
Semin Cutan Med Surg
· 2017 Mar · PMID 28247867
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Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the deliver...Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success.
Semin Cutan Med Surg
· 2016 Dec · PMID 27918008
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The United States is becoming increasingly diverse, and minorities are projected to represent the majority of our population in the near future. Unfortunately, health disparities still exist for these groups, and inequal...The United States is becoming increasingly diverse, and minorities are projected to represent the majority of our population in the near future. Unfortunately, health disparities still exist for these groups, and inequalities have also become evident in the field of dermatology. There is currently a lack of diversity within the dermatology workforce. Potential solutions to these health care disparities include increasing cultural competence for all physicians and improving diversity in the dermatology workforce.
Semin Cutan Med Surg
· 2016 Dec · PMID 27918007
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The types of cosmetic procedures favored by Asian individuals are unique and tailored to their anatomical differences. Thus, a customized approach is taken for different cosmetic procedures, ranging from neurotoxins and...The types of cosmetic procedures favored by Asian individuals are unique and tailored to their anatomical differences. Thus, a customized approach is taken for different cosmetic procedures, ranging from neurotoxins and fillers to nonablative fractional resurfacing. The purpose of this review article is to identify the different types of cosmetic procedures commonly sought by Asian individuals and to understand how these different procedures are customized toward their aesthetic preferences. This review integrates the findings from multiple clinical trials available on PubMed. The procedures listed are those that are mostly performed in dermatology offices.
Semin Cutan Med Surg
· 2016 Dec · PMID 27918006
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Patients with skin of color have similar skin care needs as lighter-skin patients. However, they are less likely to use sun protection on a daily basis, which leads to an increased risk of dyschromia, skin cancer, and ot...Patients with skin of color have similar skin care needs as lighter-skin patients. However, they are less likely to use sun protection on a daily basis, which leads to an increased risk of dyschromia, skin cancer, and other disorders. This article discusses the importance of a correct and consistent skin care regimen and the various cutaneous issues that should be considered when prescribing a skin care regimen for patients with darker skin types. Adopting a standardized methodology to identify affordable, efficacious products and to streamline the process of skin-type diagnosis, skin care regimen prescribing, patient communication, and staff education will result in improved patient outcomes and increased patient satisfaction.
Li JY, Geddes ER, Robinson DM
… +1 more, Friedman PM
Semin Cutan Med Surg
· 2016 Dec · PMID 27918005
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Melasma is a pigmentary disorder of unclear etiology with numerous treatment options and high recurrence rates. Laser and light therapies may be utilized cautiously as second- or third-line options for recalcitrant melas...Melasma is a pigmentary disorder of unclear etiology with numerous treatment options and high recurrence rates. Laser and light therapies may be utilized cautiously as second- or third-line options for recalcitrant melasma, but low-energy settings are preferred due to the risk of postinflammatory hyperpigmentation and melasma stimulation. Commonly used lasers include the low-fluence 1064-nm Q-switched neodymium-doped yttrium aluminum garnet laser, nonablative fractionated lasers, and intense pulsed light. Strict sun protection, concomitant use of bleaching agents, and maintenance treatments are necessary. A variety of other treatments that may also help to improve results are now being more widely adopted, including oral tranexamic acid, pulsed dye laser, antioxidants, and laser-assisted drug delivery.
Semin Cutan Med Surg
· 2016 Dec · PMID 27918004
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Lasers and light sources, as well as other energy devices, including radiofrequency, ultrasound, and cold-based therapies, can be used for treatment of aging, dyschromic, or texturally uneven skin. In patients with ethni...Lasers and light sources, as well as other energy devices, including radiofrequency, ultrasound, and cold-based therapies, can be used for treatment of aging, dyschromic, or texturally uneven skin. In patients with ethnic skin (ie, skin of color), energy devices are used more cautiously to avoid adverse events. The most common and concerning adverse event is postinflammatory hyperpigmentation. Lower fluence, longer pulse durations, and careful device selection can mitigate the risk of scarring and pigmentary abnormality. Modified treatment approaches can allow physicians to safely treat patients with skin of color with energy devices.
Semin Cutan Med Surg
· 2016 Dec · PMID 27918003
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With the rapid increase in patients seeking cosmetic treatments, the variation in responses of lightly pigmented skin versus darkly pigmented skin has become increasingly apparent. Despite extensive treatment options in...With the rapid increase in patients seeking cosmetic treatments, the variation in responses of lightly pigmented skin versus darkly pigmented skin has become increasingly apparent. Despite extensive treatment options in patients with skin of color, there is a paucity of well-designed studies performed on this patient population. The lack of research is concerning, as it is well documented that patients with darker skin types are at an increased risk of adverse events when treated with many of the available modalities used in cosmetic procedures. Fortunately, by combining a variety of treatments, these risks may be abrogated, and combination treatments may be a promising regimen for a wide variety of cosmetic complaints. An overview and evaluation of the research of combination therapy in skin of color is presented.