Background:Student-run clinics (SRCs) for dermatology hold potential to significantly advance skin-related health equity, and a comprehensive analysis of these clinics may inform strategies for optimizing program effectiveness. Objective:We aimed to perform a scoping review of the literature about dermatology SRCs across the United States. Methods:We conducted systematic literature searches of Ovid MEDLINE, Ovid Embase, and Scopus on March 1, 2023, and June 19, 2024. No date, language, or paper-type restrictions were included in the search strategy. A total of 229 references were uploaded to Covidence for screening by 2 independent reviewers (SK and LL), and 23 full-text documents were assessed for eligibility. After an additional 8 documents were identified through a gray literature search, a total of 31 studies were included in the final analysis. Inclusion criteria were as follows: (1) studies set in an SRC, which was operationally led by medical students and could render condition-relevant treatments to patients, with dermatology care; (2) published in English; (3) within the United States; (4) included characterization of any of the following: logistics, care, patients, or design; and (5) included all study or document types, including gray literature that was not peer reviewed (eg, conference abstracts, preprints, and letters to the editor). Exclusion criteria were (1) papers not published in English and (2) those with duplicated data or that were limited in scope or not generalizable. Data were extracted qualitatively using Microsoft Excel to categorize the studies by several domains, including clinic location, demographics, services offered, and barriers to care. Results:There are at least 19 dermatology SRCs across the United States. The most common conditions encountered included atopic dermatitis; acne; fungal infections; benign nevi; psoriasis; and neoplasms, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. Key facilitators for the clinics included faculty oversight, attending physician participation for biopsy histopathology, and dedicated program coordinators. Major barriers included lack of follow-up, medication nonadherence, and patient no-shows. Conclusions:Dermatology SRCs serve a diverse patient population, many of whom are underrepresented in traditional dermatology settings. This scoping review provides insights to help build stronger program foundations that better address community dermatologic health needs.

Dermatologic care within the military faces unique ethical challenges. Service members are stationed across nationally and globally diverse settings, and therefore, dermatologic care rendered ranges from within resource-rich, advanced military medical treatment facilities to austere, resource-limited, deployed field environments. Additionally, military service members are often at unique risk for dermatologic disease, given occupational, environmental, and geographic exposures not commonly faced by their civilian counterparts. This review explores topics in dermatoethics via case analyses of ethical considerations within the scope of dermatologic care for military service members.

What is known about this subject in regard to women and their families? Melasma disproportionately affects women during and after pregnancy, and careful management of this condition with regard to hormones and sun sensitivity is important. There is little research evaluating the quality and accessibility of online resources for patients seeking information about melasma during pregnancy. What is new from this article as messages for women and their families? The median amount of educational attainment required to read and understand online articles about melasma in pregnancy is above 10th grade. Clinician involvement in reviewing online articles did not result in significantly higher readability ratings. Online resources about melasma in pregnancy should be written with their readers in mind, as many treatment options for melasma in nonpregnant patients would not be suitable for pregnant patients. To the editor: Melasma, a common pigmentary disorder characterized by brown-gray patches on the face, often occurs during pregnancy. While melasma, linea nigra, and postinflammatory hyperpigmentation do not pose any risk to the physical health of the pregnant patient, their negative impact on quality of life and psychological distress has been well characterized.1 Treatment options for melasma during pregnancy are constrained by the risk of further hyperpigmentation and teratogenicity.2 With limited access to dermatologists and gynecologists and the difficult nature of treating melasma, pregnant patients may face challenges in obtaining appointments,3 leading them to seek information online to understand their condition and manage their melasma. Online materials can help to assuage pregnant patients’ concerns and distress with melasma in an effective manner. This study aims to evaluate the readability and quality of online resources currently available for melasma in pregnancy. We searched for the term “melasma in pregnancy,” assessing the first 100 results in English on Google on March 1, 2023. Research articles and multimedia were excluded to mimic patient preferences. We used objective readability metrics to analyze the selected online resources: Flesch–Kincaid grade level, Gunning Fog index, Coleman–Liau index, SMOG index, and the Linsear Write formula; higher scores indicate a higher number of years of formal education required to understand an article. In addition, the modified DISCERN questionnaire was used to measure resources’ reliability with a maximum score of 5. Eighty-one online Web pages and articles were selected and evaluated. The median grade level required to understand these resources was 10th grade or higher for all readability metrics. The mean grade level ranged from 10.23 to 13.38, indicating a significant educational background needed (Fig. 1). The highest grade level required by an article was 19.3. Clinician-reviewed articles did not show a statistically significant difference in readability compared to non-clinician-reviewed articles, though the clinician-reviewed articles had the lower mean and median grade level in every category. Only 35/81 articles were clinician-reviewed. In addition, the mean modified DISCERN score was 3.12; clinician-reviewed articles had a significantly higher reliability rating (3.65) than non-clinician-reviewed articles (2.70), P < .01.Fig. 1.: Box and whisker plot of readability scores for online articles on melasma in pregnancy by different readability metrics.Our findings reveal that the readability of online resources for melasma in pregnancy does not align with the Agency for Healthcare Research and Quality’s recommendation for patient educational materials to be written at or below a 6th-grade reading level, indicating potential health literacy barriers.4 Pregnant patients are particularly vulnerable to online misinformation, given the potential teratogenic risk of mainstays of melasma treatment like Retin-A, hydroquinone, or chemical peels. In addition, research has shown that non-native English speakers are less likely to know their own dermatologic diagnosis.5 For individuals with low educational attainment or those who speak English as a second language, the lack of readability of online resources for melasma may hinder their ability to make informed decisions about treating melasma. Clinician-reviewed materials provide somewhat increased reliability and readability. Since melasma of pregnancy can cause significant distress and embarrassment to patients, it is imperative that online materials are readable and reliable for patients. Conflicts of interest None. Funding None. Study approval N/A Author contributions HV: Participated in research conception and design, data analysis and interpretation, and writing. S Kamat: Participated in research design and conception and data analysis. RO: Participated in data analysis and interpretation. S Khalil and JM: Participated in research conception and design, data interpretation, and writing.

This cross-sectional study characterizes the frequency and degree of innovation of new dermatologic drugs approved by the US Food and Drug Administration (FDA) from 2012 to 2022.

Background Acute kidney injury (AKI) is a known complication of COVID-19 and is associated with an increased risk of in-hospital mortality. Unbiased proteomics using biological specimens can lead to improved risk stratification and discover pathophysiological mechanisms. Methods Using measurements of ~4000 plasma proteins in two cohorts of patients hospitalized with COVID-19, we discovered and validated markers of COVID-associated AKI (stage 2 or 3) and long-term kidney dysfunction. In the discovery cohort (N= 437), we identified 413 higher plasma abundances of protein targets and 40 lower plasma abundances of protein targets associated with COVID-AKI (adjusted p <0.05). Of these, 62 proteins were validated in an external cohort (p <0.05, N =261). Results We demonstrate that COVID-AKI is associated with increased markers of tubular injury ( NGAL ) and myocardial injury. Using estimated glomerular filtration (eGFR) measurements taken after discharge, we also find that 25 of the 62 AKI-associated proteins are significantly associated with decreased post-discharge eGFR (adjusted p <0.05). Proteins most strongly associated with decreased post-discharge eGFR included desmocollin-2 , trefoil factor 3 , transmembrane emp24 domain-containing protein 10 , and cystatin-C indicating tubular dysfunction and injury. Conclusions Using clinical and proteomic data, our results suggest that while both acute and long-term COVID-associated kidney dysfunction are associated with markers of tubular dysfunction, AKI is driven by a largely multifactorial process involving hemodynamic instability and myocardial damage.

We aimed to understand clinician perspectives on mental healthcare delivery during COVID-19 and the utility of tele-mental health services in carceral settings. A survey was administered in November 2022 through the American College of Correctional Physicians listserv. A nationwide sample of 55 respondents included 78.2% male (n = 43) and 21.8% female (n = 12), 49.1% active clinicians (n = 27) and 50.9% medical directors (n = 28), with a median of 12 and mean of 14.5 years working in carceral settings. Most agreed that mental telehealth services could serve as a stopgap amid infection prevention measures and resource-limited settings with an increasing role moving forward (80.0%, n = 44) but may not be sufficient to replace in-person services completely. Access to mental healthcare is vital in helping achieve optimal health during incarceration. Most clinicians in a nationwide survey report an essential role of mental telehealth in the future, although they vary in beliefs on the present implementation. Future efforts should further identify facilitators and barriers and bolster delivery models, particularly via e-health.

Research in dermatology education highlights the lack of skin of color (SOC) instruction for medical students, leading to concerning healthcare outcomes. Because of the already limited opportunity for students to have dedicated teaching in pathophysiology, management, and treatment of dermatologic diseases in medical school, we developed an educational module that addresses these gaps. We created a one-hour virtual lecture for medical students focused on common skin diseases tested on the United States Medical Licensing Examination with visual images across all skin types. A questionnaire was administered before and after the educational module to assess outcomes comparing disease identification in lighter (Fitzpatrick scale I-III) versus darker (Fitzpatrick scale IV-VI) skin tones and to determine medical school student attitudes. An analysis of 43 examination scores before, and after attending the educational module determined rosacea, psoriasis, and basal cell carcinoma to be conditions in SOC patients that demonstrated the most significant improvement (47.3%, 54.9%, and 30.8%, respectively). Our results also highlighted worse performance outcomes for diseases in SOC in the pre-examination questionnaire. Thus, our study indicates that a concise education module focused on disease presentations inclusive of all skin types may efficiently increase students' ability to identify diseases commonly misdiagnosed in the clinical setting.

To the Editor: The burden of skin disease and the number of active dermatologists have grown in the United States.1,2 Yet, little is known about the advocacy efforts of the 2 primary organizations, the American Academy of Dermatology Association (AADA) and AADA Political Action Committee (SkinPAC), representing the profession, providers, and patients.

Background: The COVID-19 pandemic required a rapid expansion of teledermatology services. Objective: Analyze demographic shifts in a pediatric dermatology practice session with children of color. Methods: A retrospective chart review of pediatric dermatology patients seen in the 4 practice weeks preceding the New York COVID-19 lockdown and comparable teledermatology visits during the COVID-19 pandemic lockdown. Demographic differences (e.g., race, age, gender, and household income) were analyzed. Results: A greater proportion of patients seen were White during lockdown (59.7%), compared with pre-lockdown (43.6%), with a reduction in Asian patients seen in lockdown (6.0%) compared with pre-lockdown (24.5%). A lower proportion of no-show patients (4.3%, 3/70 scheduled) were noted in lockdown compared with pre-lockdown (16%, 18/112). Preferred provider organizations (PPO) and higher-income zip codes were more common for children seen during lockdown. Limitations: The sample addresses a limited New York pediatric dermatology practice during a short time period. Conclusions: White patients and patients with PPO were more likely to access telehealth, supporting disparity in teledermatology services. These results demonstrate reduced health care access for lower-income and Asian children during the COVID-19 pandemic lockdown.

The bipartisan Congressional Skin Cancer Caucus (CSCC) was founded in 2013 by 4 House members, with a mission to bring together US representatives to advance skin cancer policy and advocacy, with the potential to reduce mortality and costs.1Congressional Skin Cancer Caucus launchedMDedge Dermatology News.https://www.mdedge.com/dermatology/article/76099/health-policy/congressional-skin-cancer-caucus-launchedDate accessed: January 3, 2023Google Scholar Over the last decade, its membership has grown and the caucus is now co-led by a dermatologist in Congress. Caucus membership is voluntary and leadership often volitional or by recruitment; representatives join to support policy initiatives aligning with a common objective.2Eckman S.J. Congressional Member Organizations (CMOs) and informal member groups: Their purpose and activities, history, and formation. Congressional Research Service, 2019Google Scholar To understand the impacts of the CSCC over its inaugural decade, we conducted a retrospective analysis of activity covered by news from 2013 to 2022. We searched NexisUni, which is a public archive of news, business, and legal sources, for the skin cancer caucus. Duplicate items and those not discussing dermatology were excluded (Fig 1). Activities were analyzed using inductive, descriptive, and coding techniques.3Chandra Y. Shang L. Inductive coding.in: Chandra Y. Shang L. Qualitative Research Using R: A Systematic Approach. Springer, 2019: 91-106Crossref Google Scholar Two researchers independently analyzed results and created topic codes describing caucus activity. The researchers then compared their coding and finalized the codebook. Over the last decade, CSCC has brought attention to critical issues and promoted policies prioritizing the public, patients, and dermatological practice. Twenty-two activities, which involved some form of advocating or policymaking consistent with the CSCC mission, were identified. These fell into the following 4 categories: (1) skin cancer prevention (n = 8), (2) skin cancer awareness/education (n = 6), (3) tanning bed regulation (n = 6), (4) and other (n = 2) (Table I).4Library of Congress Congress.gov.https://www.congress.govDate accessed: March 26, 2023Google ScholarTable IRepresentative activities of Congressional Skin Cancer Caucus, 2013-2022TopicCountIllustrating activities and sponsored house resolutions∗Resolution details are accessible through the Library of Congress.4Skin Cancer Prevention8•Support following unanimous House approval of the Sunscreen Innovation Act (S. 2141), bipartisan legislation for more effective sunscreen products (2014)•Introduction of House Resolution #854 supporting federal, state, and local efforts to exempt sunscreen from medication bans in schools, and emphasize proper sun-safe behaviors (2016)•Submitted House Resolution #282, to reduce skin cancer through education underscoring the dangers of childhood sun exposure (2017)•Introduction of House Resolution #436 encouraging skin cancer prevention efforts for children (2021)Skin Cancer Awareness/Education6•Raise melanoma awareness in discussion with constituent public figure (2014)•Presence at National Cancer Prevention Day to make remarks at an event hosted by the LESS CANCER organization (2015)•Congressional Skin Cancer Caucus presence among advocates, scientists, doctors, legislators, and leaders in industry and academia at the Capitol, part of National Cancer Prevention Day (2016)Tanning Bed Regulation6•Call for nationwide tanning bed ban for minors following the reclassification of UV tanning lamps as class II medical devices (2014)•Letter to the Office of Management and Budget requesting release of the proposed rule, General and Plastic Surgery Devices: Restriction of Sunlamp Products (RIN 0910-AH14) to regulate tanning beds (2015)•Supporting the Food and Drug Administration’s announcement of a proposed rule to restrict tanning beds to those aged ≥18 (2015)Other2•Formation of Skin Cancer Caucus (2013)•Congressional award received by caucus member (2014)∗ Resolution details are accessible through the Library of Congress.4Library of Congress Congress.gov.https://www.congress.govDate accessed: March 26, 2023Google Scholar Open table in a new tab The CSCC was most active in the years immediately following its establishment; activities included their presence at National Cancer Prevention Day events, discussions with public figures, and participating at educational health fairs. In recent years, CSCC has shifted away from physical events and toward briefings and policy advocacy statements, including house resolutions largely directed at education/awareness, prevention, and indoor tanning restrictions (Table I). Although initial emphasis was largely on tanning, recent actions reflect potential future objectives involving broader prevention (sunscreen initiatives, reduced sun exposure). Throughout, the CSCC has collaborated with public and advocacy organizations, including the Food and Drug Administration and American Academy of Dermatology Association. Although there have been great strides in skin cancer regulations and prevention, CSCC is well-situated to address the remaining gaps. For example, there is no current national regulation banning youth aged <18 years from indoor tanning, even as the Food and Drug Administration proposed such a rule in 2015.5FDA Proposes New Safety Measures for Indoor Tanning Devices: The Facts U.S. Food and Drug Administration.https://www.fda.gov/consumers/consumer-updates/fda-proposes-new-safety-measures-indoor-tanning-devices-factsDate accessed: March 26, 2023Google Scholar This has resulted in varied state and local laws and regulations. The recent focus on resolutions and rules by the CSCC may help reach consensus on this important issue, and continued efforts in educating Congress members on skin cancer could prove helpful. Additionally, as public engagement is critical to these objectives, increased use of social media may present a valuable outlet. Dermatologists can also further partner with the CSCC by encouraging Congress members to join and participate in sponsored events. CSCC participation may also enhance relationships with constituencies, including patients and patient advocacy organizations,2Eckman S.J. Congressional Member Organizations (CMOs) and informal member groups: Their purpose and activities, history, and formation. Congressional Research Service, 2019Google Scholar such as SkinPAC, which considers membership for scoring purposes. Through sustained activity in prevention and awareness, as well as further recruitment among lawmakers to allow advocacy impacts to reach broader constituencies, CSCC can continue to have positive impacts on public health nationwide. Dr George Hruza served as Chair of the American Academy of Dermatology Association SkinPAC until 2022.

ABSTRACT:Radiotherapy (RT) is a modality for cancer management that frequently causes critical injury to tissues adjacent to the targeted cancer site. Acute radiation dermatitis (RD) is one of the most common adverse effects of RT and may lead to secondary infection, disfigurement, and discontinuation of therapy. The authors report the efficacy of a multidisciplinary collaboration between radiation oncology, dermatology, and wound care teams in the management of severe, acute RD. This case report describes the use of noncontact, low-frequency ultrasound (NCLFU)-assisted saline wash therapy leading to accelerated healing of severe RD in an older man treated with RT for scalp squamous cell carcinoma. Although NCLFU-assisted saline wash therapy provides gentle debridement of wound surfaces and has demonstrated efficacy in the management of chronic wounds, the potential role for NCLFU therapy in RD management has not yet been explored.

Purpose:To explore and report on how glaucoma care was impacted by the SARS-CoV-2 pandemic (COVID-19) in New York City (NYC) with a specific emphasis on the role of telemedicine.Patients and Methods:This was a qualitative, cross-sectional study that engaged glaucoma clinicians in semi-structured interviews to elicit perspectives on telemedicine and patient care experiences during the pandemic. Interview responses were coded and analyzed thematically.Results:Twenty clinicians participated. Mean participant age was 48.8 ± 12.3 years, and the mean number of years in practice post-glaucoma fellowship was 17.5 ± 12.4 years. Four main themes pertinent to the role of telemedicine triggered by the COVID-19 pandemic were identified: (1) The Need to Ensure Patient and Staff Safety Drove Telemedicine Uptake; (2) Telemedicine Allowed Providers to Address Subjective Complaints; (3) Telemedicine was Discontinued Due To Concerns of Compromised Patient Safety and Measurement Inaccuracy; (4) Technological Advances are Needed for Continued Telemedicine Usage and Uptake in Glaucoma Care. The interviews suggested that telemedicine usage dropped markedly within just a few months during the pandemic, and for most physicians interviewed, telemedicine is no longer part of their clinical practice. Several clinicians reported optimism towards future implementation of telemedicine as the technology develops.Conclusion:This study identified 4 themes outlining the uptake, application, discontinuation and overall perspectives on telemedicine by glaucoma clinicians. The role of telemedicine, as triggered by the COVID-19 pandemic, may have lasting implications for patient safety, continuity of care, and glaucoma care delivery beyond this public health crisis.

BACKGROUND:Acne keloidalis nuchae (AKN) is an inflammatory disorder primarily seen in individuals of color, characterized by acneiform and keloidal lesions on the occipital scalp/nuchal region. More than 50% of patients with keloids are known to search their condition on the internet. We sought to determine the level of readability of patient education materials (PEM) available to patients. The term 'acne keloidalis nuchae' was searched and screened for the top 100 search results on the Google&reg; search engine. For evaluation, 6 readability metrics (Flesch-Kincaid grade level, Gunning Fog index, Coleman-Liau index, SMOG index, automated readability, and Linsear Write Formula) were collected by entering text from each reference site into an automatic readability calculator for computation. Median readability scores of AKN PEMs ranged from 10.3th to 13.5th grade levels. Overall, readability median above the 8th-grade level were consistently seen across all 6 readability measures, with some median scores reaching university undergraduate levels. More readable educational tools are needed for acne keloidalis nuchae online. J Drugs Dermatol. 2023;21(2):195-196. doi:10.36849/JDD.7110.

Bortezomib is the first proteasome inhibitor to treat a variety of malignancies and is currently part of the standard of care regimen for the initial treatment of patients with newly diagnosed multiple myeloma. While bortezomib is generally well tolerated, it has been associated with various side effects, which have limited its use in some patients. Here, we describe a unique case with histological confirmation of a reticular eruption that appeared at the site of a subcutaneous administration of bortezomib in a 62-year-old male who was newly diagnosed with IgG kappa multiple myeloma. A skin biopsy was performed, which revealed superficial perivascular dermatitis predominantly composed of lymphocytes with rare eosinophils. The patient was successfully treated with betamethasone dipropionate 0.05% cream. When consulted, dermatologists should advise the oncology team of multiple myeloma patients treated with bortezomib to maintain a high threshold before discontinuing the drug when a patient experiences an atypical, reticular rash following subcutaneous administration. Additionally, potent topical corticosteroids, such as betamethasone dipropionate 0.05% cream, should be considered in managing the cutaneous reticular eruptions related to bortezomib administration, in order to maintain an optimal treatment regimen for patients with multiple myeloma.