With the emergence of a novel severe acute respiratory syndrome coronavirus, investigators worldwide are scrambling to identify appropriate treatment modalities, develop accurate testing, and produce a vaccine. To date, effective treatment remains elusive. Chloroquine phosphate and hydroxychloroquine sulfate (HCQ), well-known antimalarial drugs effective in the treatment of systemic lupus erythematosus, rheumatoid arthritis, porphyria cutanea tarda, and chronic Q fever, are currently under investigation. The United States Food and Drug Administration recently issued an Emergency Use Authorization for CQ and HCQ use in the treatment of coronavirus disease 2019 (COVID-19). With spikes in HCQ use and demand, ethical considerations encompassing appropriate use, patient autonomy, nonmaleficence, and distributive justice abound. As drug experts, pharmacists are uniquely positioned to advocate for patients with chronic conditions necessitating HCQ use, assist in the appropriate prescribing of HCQ for COVID-19, and ensure patients and health care professionals are continually educated during this public health crisis. This review highlights the worldwide pandemic, describes appropriate HCQ use for chronic conditions, highlights available alternatives, and deliberates evolving ethical questions. With assistance from colleagues, state boards of pharmacy, and national organizations, pharmacists ensure the just distribution of valuable pharmaceuticals to patients having COVID-19 while supporting the needs of patients requiring HCQ for chronic conditions.

Dermatologists serve a vast array of patients with unique backgrounds. The National Institutes of Health (NIH) designated members of sexual and gender minorities as underrepresented in scholarly literature. Our study examines the past 10 years of studies published in highly-cited dermatologic journals, surveying each study for common data collection of sexual orientation and gender identity (SOGI) in dermatological studies. We found representation of sexual and gender minorities to be increasing in dermatological studies but recommend that SOGI data be collected regularly just as any other common variable in dermatological patient studies.

To the Editor: We commend Fernandez et al1 for their recent work on the importance of mentorship in dermatology; they discussed virtual resources for medical students and trainees during the current pandemic and beyond. They highlighted the disadvantages that students without home dermatology residency programs encounter while pursuing dermatology mentorships. We aim to add to the findings of Fernandez et al1 by demonstrating additional barriers that medical students, especially osteopathic medical students and those who typically do not have a dermatology home residency program, face while finding a dermatology mentor.

To the Editor: We applaud Jones's1Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775https://doi.org/10.1016/j.jaad.2020.07.112Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar and Militello's2Militello M. Presley C.L. Meckley A.L. Szeto M.D. Dellavalle R.P. Reply to Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations: underrepresentation in additional popular resources.J Am Acad Dermatol. 2021; 85: e255-e256https://doi.org/10.1016/j.jaad.2021.01.108Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar examinations of skin of color (SoC) image underrepresentation in United States Medical Licensing Examination (USMLE) preparatory resources. Our analysis of popular question banks (AMBOSS Step 1, Kaplan Step 1, and USMLERx Step 1 Qmax) utilized by approximately one third of medical students in board preparation3Most Popular USMLE Step 1 Resources. Cram Fighter.https://cramfighter.com/usmle-step-1/most-popular-resources/Date accessed: May 4, 2021Google Scholar and our survey of the self-assessment exams provided by the National Board of Medical Examiners (NBME), which authors USMLE exams, are crucial additions to this work. Emulating previous methods, we identified 223 dermatology-related images from analyzed question banks.1Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775https://doi.org/10.1016/j.jaad.2020.07.112Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar,2Militello M. Presley C.L. Meckley A.L. Szeto M.D. Dellavalle R.P. Reply to Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations: underrepresentation in additional popular resources.J Am Acad Dermatol. 2021; 85: e255-e256https://doi.org/10.1016/j.jaad.2021.01.108Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar Duplicate or indeterminate (oral mucosa, acral surface, or poor image quality) images were excluded (n = 27), resulting in 196 images for review: Step 1 AMBOSS (n = 124), Kaplan (n = 17), USMLERx Qmax (n = 18), and NBME self-assessments (n = 37). Two authors independently categorized all images by the Fitzpatrick skin phototype scale, with discrepancies resolved by 2 additional authors. Fitzpatrick types I to III were considered “nonSoC,” while Fitzpatrick types IV to VI were considered “SoC.” Table I details SoC representation in images for the 5 common dermatologic diagnoses analyzed by Jones et al and the 23 dermatologic diagnoses identified with at least 1 SoC image in our question bank analysis.Table ICommon dermatologic diagnoses and diagnoses represented in skin of color (SoC) in additional question banks (adapted from Jones et al1Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775https://doi.org/10.1016/j.jaad.2020.07.112Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar)Dermatologic Diagnoses (26 Diagnoses with SoC Images)UWorld Step 1 Question BankUWorld Step 2 CK Question BankAMBOSS Step 1 Question BankKaplan Step 1 Question BankUSMLERx Step 1 Question BankNBME Self-AssessmentsTotal SoCTotal Question Bank Images (#)128299124171837623SoC Images (#)287216329130SoC Images (%)21.9%24.1%12.9%17.6%11.1%24.3%20.9% Acne Vulgaris0/32/50/10/00/00/22/11 = 18% Atopic Dermatitis2/40/60/30/10/20/12/17 = 12% ∗Common dermatologic diagnosis from Jones et al1 without skin of color representation.Contact Dermatitis0/30/110/20/00/00/10/17 = 0% Psoriasis4/122/120/40/00/00/06/28 = 21% ∗Common dermatologic diagnosis from Jones et al1 without skin of color representation.Seborrheic Dermatitis0/10/50/10/00/00/00/7 = 0% Acanthosis NigricansData not available from Jones et al0/32/20/00/02/5 = 40% Bacillary Angiomatosis1/20/00/00/01/2 = 50% Bullous Impetigo0/01/10/00/01/1 = 100% Congenital Dermal Melanocytosis0/00/01/10/01/1 = 100% Digital Clubbing1/10/00/00/11/2 = 50% Ganglion Cyst0/00/00/01/11/1 = 100% Genital Herpes0/00/00/01/21/2 = 50% Granuloma Inguinale1/10/00/00/01/1 = 100% Hereditary Angioedema1/20/00/00/01/2 = 50% Kaposi Sarcoma1/20/00/21/12/5 = 40% Keloids1/10/00/00/01/1 = 100% Lymphocutaneous Sporotrichosis1/10/00/00/01/1 = 100% Pellagra1/10/00/01/12/2 = 100% Pemphigus Vulgaris1/30/00/00/01/3 = 33% Pityriasis Versicolor Alba1/30/00/01/12/4 = 50% Pseudofolliculitis Barbae1/10/00/00/01/1 = 100% Scabies2/40/00/00/12/5 = 40% Shingles1/20/00/21/12/5 = 40% Stevens-Johnson Syndrome0/00/01/10/01/1 = 100% Strawberry Hemangiomas1/10/00/00/11/2 = 50% Tinea Capitis0/00/00/02/22/2 = 100% Tinea Corporis0/00/00/01/11/1 = 100% Vitiligo1/10/00/10/01/2 = 50%Values are reported as Fitzpatrick phototype IV-VI (skin of color)/total number of images for each respective diagnosis. Image totals are after exclusions.SoC, Skin of color; USMLE, United States Medical Licensing Examination; Uworld, USMLE World; CK, clinical knowledge; NBME, National Board of Medical Examiners.∗ Common dermatologic diagnosis from Jones et al1Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775https://doi.org/10.1016/j.jaad.2020.07.112Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar without skin of color representation. Open table in a new tab Values are reported as Fitzpatrick phototype IV-VI (skin of color)/total number of images for each respective diagnosis. Image totals are after exclusions. SoC, Skin of color; USMLE, United States Medical Licensing Examination; Uworld, USMLE World; CK, clinical knowledge; NBME, National Board of Medical Examiners. In our analysis, 30 images were rated SoC (30/196; 15%) (Fig 1). Comparing all 3 studies (ours, Jones's, and Militello's), question banks comprised the majority of general dermatologic (631/804; 78%) and SoC images (130/161; 81%) compared to other resources. NBME self-assessments and UWorld Step 2 CK contained the highest percent of SoC images—24% each. No SoC images were identified for the common dermatologic diagnoses analyzed by Jones et al1Jones V.A. Clark K.A. Shobajo M.T. Cordova A. Tsoukas M.M. Skin of color representation in medical education: an analysis of popular preparatory materials used for United States Medical Licensing Examinations.J Am Acad Dermatol. 2021; 85: 773-775https://doi.org/10.1016/j.jaad.2020.07.112Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar or for skin cancer diagnoses (ie, melanoma, basal cell carcinoma, and squamous cell carcinoma) in our material analysis (Table I). Additionally, there appears to be disproportionate SoC image representation among infectious conditions, totaling 11/26 (42%) diagnoses with SoC images, 3 of which are sexually transmitted (Table I). Question banks are valued board-preparation resources given their impact on long-term retention.4Smith A.M. Floerke V.A. Thomas A.K. Retrieval practice protects memory against acute stress.Science. 2016; 354: 1046-1048https://doi.org/10.1126/science.aah5067Crossref PubMed Scopus (46) Google Scholar SoC representation is essential for early recognition of dermatoses on various skin types. To ensure inclusive medical education, the NBME can establish SoC representation as a “core concept,” and question banks can bolster inclusivity by incorporating SoC images at a rate that mirrors the United States population, which, according to the 2020 Census, is >40% SoC (18.7% Hispanic/Latino, 14.2% Black, 7.2% Asian). Resources can increase dark-skin representation, specifically in diseases with higher SoC incidence—sarcoidosis, cutaneous lupus erythematosus, and cheilitis5Alvarado S.M. Feng H. Representation of dark skin images of common dermatologic conditions in educational resources: a cross-sectional analysis.J Am Acad Dermatol. 2021; 84: 1427-1431https://doi.org/10.1016/j.jaad.2020.06.041Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar—as well as melasma, acne keloidalis nuchae, dermatosis papulosa nigra, and pseudofolliculitis barbae. Lastly, conditions where erythema is a diagnostic clue (eg, atopic dermatitis, rosacea, and exanthems like Kawasaki disease) and common diagnoses, including seborrheic dermatitis, pityriasis versicolor, and pigmentary disorders, present significantly different in SoC and will likely be encountered in clinical practice, making them important for resources to include. This data reinforces previous studies' conclusions regarding SoC paucity throughout medical education resources. We encourage continued incorporation of SoC images in educational resources, including question banks, to prepare clinicians for accurate diagnosis in all patient populations. Dr. Dellavalle is a Joint Coordinating Editor for Cochrane Skin, a dermatology section editor for UpToDate, a Social Media Editor for the Journal of the American Academy of Dermatology (JAAD), editor of JMIR Dermatology, and a Podcast Editor for the Journal of Investigative Dermatology (JID). He is a coordinating editor representative on Cochrane Council. Reply to “Skin of color representation in medical education: An analysis of popular preparatory materials used for United States Medical Licensing Examinations”: Underrepresentation in additional popular resourcesJournal of the American Academy of DermatologyVol. 85Issue 4PreviewTo the Editor: We commend Jones et al1 for highlighting the lack of skin of color (SoC) representation in the United States Medical Licensing Examination's (USMLE) common preparatory materials. Several studies indicate that SoC representation is sparse within common textbooks used by the residents and physicians.2 Unsurprisingly, this lack of representation has also extended to medical student education, which has been eloquently demonstrated by Jones et al.1 Full-Text PDF Skin of color representation in medical education: An analysis of popular preparatory materials used for United States Medical Licensing ExaminationsJournal of the American Academy of DermatologyVol. 85Issue 3PreviewTo the Editor: Within the next 2 decades, individuals with Fitzpatrick skin phototypes IV to VI (skin of color [SOC]), will comprise nearly half of the United States population.1 Yet, medical education resources lack representation of SOC. In dermatologic education, dermatology textbooks depict a dearth of SOC vs non-SOC images.2 Given these data and the importance of SOC representation in medical education, we evaluated the use of SOC images in popular United States Medical Licensing Examination (USMLE) preparatory resources. Full-Text PDF Underrepresentation of skin of color in medical education: An updated analysis of popular question banksJournal of the American Academy of DermatologyVol. 86Issue 2PreviewTo the Editor: We laud Meckley et al1 for expanding upon our findings from our study “Skin of color representation in medical education: An analysis of popular preparatory materials used for United States Medical Licensing Examinations” (USMLE).2 Their analysis of skin of color (SoC) images in AMBOSS Step 1, Kaplan Step 1, USMLERx Step 1 Qmax, and self-assessment examinations provided by the National Board of Medical Examiners (NBME) is undoubtedly an enormous addition to our original findings and to the contributions by Mitello et al. Full-Text PDF

To the Editor: We applaud Schwartzman et al1Schwartzman G. Qureshi A. Friedman A.J. Utilization of Instagram by dermatology residency programs in the era of COVID-19.J Am Acad Dermatol. 2021; 85: 204-206https://doi.org/10.1016/j.jaad.2021.03.078Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar for studying Instagram as an effective avenue for dermatology residency program promotion during COVID-19. On May 11, 2020, the Coalition for Physician Accountability2Accreditation Council for Graduate Medical Education Coalition for physician accountability.https://acgme.org/COVID-19/Resources-from-Other-Organizations/-Coalition-for-Physician-Accountability/Date accessed: May 22, 2021Google Scholar discouraged away rotations, while recommending virtual interviews and transparent communication in the residency selection process.3The Coalition for Physician Accountability's Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate TrainingFinal report and recommendations for medical education institutions of LCME-accredited. U.S. osteopathic, and non-U.S. medical school applicants.https://www.aamc.org/media/44736/downloadDate: May 11, 2020Date accessed: April 21, 2021Google Scholar Social media can bolster transparency while enhancing organizational accountability and audience relationships.4DiStaso M.W. Bortree D.S. Multi-method analysis of transparency in social media practices: survey, interviews and content analysis.Public Relat Rev. 2012; 38: 511-514https://doi.org/10.1016/j.pubrev.2012.01.003Crossref Scopus (70) Google Scholar To extend prior analysis,1Schwartzman G. Qureshi A. Friedman A.J. Utilization of Instagram by dermatology residency programs in the era of COVID-19.J Am Acad Dermatol. 2021; 85: 204-206https://doi.org/10.1016/j.jaad.2021.03.078Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar we examined dermatology program engagement on Instagram, Facebook, and Twitter and highlight opportunities for interaction with prospective applicants. Social media accounts of accredited dermatology residency programs were searched in February 2021. Emulating Schwartzman,1Schwartzman G. Qureshi A. Friedman A.J. Utilization of Instagram by dermatology residency programs in the era of COVID-19.J Am Acad Dermatol. 2021; 85: 204-206https://doi.org/10.1016/j.jaad.2021.03.078Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar account creation dates were noted. To assess relative page popularity, account follower numbers (Instagram, Twitter) or profile likes (Facebook) were recorded and ranked. Total user engagement (likes, comments, and shares) for the latest 3 residency-focused posts of 2019 and 2020, excluding general patient- or department-oriented posts, were compared for each program by platform (Fig 1). Prior to the May 11, 2020 coalition recommendation, 63 official dermatology residency program social media accounts existed: 18 (29%) were Instagram accounts, 27 (43%) were Facebook accounts, and 18 (29%) were Twitter accounts. After that date, 64 new social media accounts were created, predominantly Instagram (55; 86%), followed by Twitter (6; 9%) and Facebook (3; 5%) (Fig 1). Instagram demonstrated the greatest popularity, reaching a maximum of 2223 followers (University of Miami). Average account followings were highest on Instagram (>1000 followers for the top 10 most-followed programs), compared to the published findings for 2019, where Facebook was most popular.5St Claire K.M. Rietcheck H.R. Patel R.R. Dellavalle R.P. An assessment of social media usage by dermatology residency programs.Dermatol Online J. 2019; 25 (13030/qt5v62b42z)Crossref Google Scholar The University of South Florida remained the most-liked (2294 likes) program on Facebook, but overall Facebook engagement largely fell (−2% to −100% for 7 of the top 10 programs) from 2019 to 2020. Program Facebook accounts were also much older than Instagram or Twitter accounts. Top Twitter account followings moderately grew (top account +66%; top 10 average, +230%) relative to 2019. Except for the University of Southern California (1075 likes plus comments and shares for 2020 Twitter posts), 2020 engagement was highest on Instagram, with the most consistent growth from 2019 (change, −14% to +186%). Due to Instagram's notable expansion, post engagement was also assessed by content category (Table I). Group photos, faculty spotlights, posts about residents socializing at work (gift exchanges, holiday parties), and program application cycle announcements showed the highest engagement. Posts with the least engagement were those on educational dermatology-related topics and posts highlighting the resident workday, including didactic sessions.Table IContent categories of dermatology residency program Instagram posts ranked by engagement: Likes and comments from December 2019 to December 2020Instagram post contentNo. of posts% of total postsTotal no. of likesTotal no. of commentsTotal no. of likes and commentsEngagement∗Engagement = 100 × (Likes + Comments)/(Number of Posts). (%)Resident group photo228.7111029113951.8Faculty spotlight135.26273466150.8Resident life: social at work4718.7228858234649.9Announcement: program2610.3117066123647.5Resident spotlight2911.5127271134346.3Resident life: social outside of work166.36702469443.4Announcement: social124.8354936330.3Location highlight124.8274828223.5Resident life: work6726.6136441140521.0Educational83.2901210212.8Total posts analyzed25292193529571∗ Engagement = 100 × (Likes + Comments)/(Number of Posts). Open table in a new tab COVID-19 complicated the residency selection process, which typically allows for applicants to familiarize themselves with programs. Allowances for away rotations in the near future remain unclear and dermatology residency programs should consider emphasizing social media, such as Instagram, Facebook, and Twitter, to interact with applicants. Instagram may currently be the most promising platform, as it accumulates the highest engagement metrics and reaches the largest audience. Because most existing residency social media accounts were created after the coalition recommendation, future investigation of a wider selection of posts and platforms is necessary to determine the true impact of this potential paradigm shift in communication. Further investigation of the level of engagement of different post types could also provide helpful information to augment the social media involvement of residency programs. Dr Dellavalle receives editorial stipends from the Journal of the American Academy of Dermatology and the Journal of Investigative Dermatology, royalties from UpToDate, and expense reimbursement from Cochrane Skin; and is Editor-in-Chief of the Journal of Medical Internet Research (JMIR) Dermatology. Authors Harp, Szeto, Meckley, and Geist and Drs Presley, Anderson, Laughter, Rundle, and Husayn have no conflicts of interest to disclose. Utilization of Instagram by dermatology residency programs in the era of COVID-19Journal of the American Academy of DermatologyVol. 85Issue 1PreviewTo the Editor: In response to the COVID-19 pandemic, the Association of American Medical Colleges has instituted protective measures, such as suspending away elective rotations that have limited student exposure to and interactions with residency training programs.1,2 To combat these limitations, programs have looked for alternative options such as social media. Although a 2019 assessment of social media usage by dermatology residency programs concluded that the usage is sparse,3 this has likely changed because of the aforementioned restrictions. Full-Text PDF Response to a letter to the editor regarding "Utilization of Instagram by Dermatology Residency Programs in the era of COVID-19"Journal of the American Academy of DermatologyVol. 85Issue 5PreviewTo the Editor: We thank Harp et al1 for the thoughtful response to our article2 highlighting the recent increase in Instagram usage by dermatology residency programs. In addition, we applaud their further work on social media usage by residency programs and evaluation of additional social media outlets. Full-Text PDF

The current Coronavirus Disease 2019 (COVID-19) pandemic has impacted individuals and groups all across the globe as countries and cities face widespread lockdown to limit transmission of the virus. Many have adapted quickly, utilizing virtual platforms for interviews, employment, and academic/social events. Academic conferences, such as the annual Cochrane Skin Conference, faced similar challenges as large gatherings have been banned. The in-person conference was cancelled several days prior to its hosting at the University of Colorado, leading conference organizers to employ a virtual platform to continue the conference as scheduled. In this letter, logistics, troubleshooting, and conversion of an NIH-funded conference from an in-person to a successful virtual conference are discussed. We hope this letter may serve as a guide for future hosting of academic conferences, and to those dedicated to collaboration and the sharing of information during such unprecedented times.

To the Editor: More than 30,000 scientific journals currently exist, with >100 primarily treating topics in dermatology.1,2 Each journal includes a specific set of guidelines for authors about which types of articles are accepted for publication. The variation in dermatology journals poses a challenge for authors as well as for editors determining submission categories to attract diverse dermatology content.

Parkinson’s disease (PD) is a neurodegenerative disorder associated with multiple comorbidities, including seborrheic dermatitis (SD), which develops in more than half of PD patients. SD in patients with PD can be severe and frequently intractable by traditional topical therapy. Cannabinoids possess anti-inflammatory and neuromodulatory properties working within the intrinsic endocannabinoid system, the activation of which may alleviate the motor symptoms of PD. The effect of cannabinoids on SD is unknown. Here we explore the pathophysiological mechanisms and possible therapeutic role of oral cannabinoids in PD patients with SD, and review speculative mechanisms underlying the association of PD and SD. Current data supporting the use of cannabinoids in both PD and SD, as well as oral cannabinoid safety and tolerability, are presented. Cannabinoids may provide the possibility of simultaneous treatment of both SD and PD. Specific SD studies and additional safety data on oral cannabinoids are needed.

Author(s): Presley, Colby L; Florek, Aleksandra G; Ricotti, Claudia M; Rundle, Chandler W; Husayn, Sameeha S; Szeto, Mindy D; Rietcheck, Hope R; Lada, Steven M; Militello, Michelle; Pulsipher, Kayd J; Olayinka, JT; Dellavalle, Robert P