BACKGROUND:Self-management is an important skill for patients with diabetes, and it involves frequent monitoring of glucose levels and behavior modification. Techniques to enhance the behavior changes of diabetic patients have been developed, such as diabetes self-management education and telehealthcare. Although the patients are engaged in self-management activities, barriers to behavior changes remain and additional work is necessary to address the impact of electronic media and telehealthcare on patient self-care behaviors.OBJECTIVE:The aims of this study were to (1) explore the behaviors of diabetic patients interacting with online applications, (2) determine the impact of a telehealthcare program among 7 self-care behaviors of the patients, and (3) determine the changes in glycosylated hemoglobin (HbA1c) levels.METHODS:A telehealthcare program was conducted to assist the patients with 7 self-care activities. The telehealthcare program lasted for 18 months and included the use of a third-generation mobile telecommunications glucometer, an online diabetes self-management system, and a teleconsultant service. We analyzed the data of 59 patients who participated in the telehealthcare program and 103 who did not. The behavioral assessments and the HbA1c data were collected and statistically analyzed to determine whether the telehealthcare services had an impact on the patients. We divided the 18-month period into 3 6-month intervals and analyzed the parameters of patients assisted by the telehealthcare service at different time points. We also compared the results of those who were assisted by the telehealthcare service with those who were not.RESULTS:There was a significant difference in monitoring blood glucose between the beginning and the end of the patient participation (P=.046) and between the overall period and the end of patient participation (P<.001). Five behaviors were significantly different between the intervention and control patients: being active (P<.001), healthy eating (P<.001), taking medication (P<.001), healthy coping (P=.02), and problem solving (P<.001). Monitoring of blood glucose was significantly different (P=.02) during the 6-12 month stage of patient participation between the intervention and control patients. A significant difference between the beginning and the 6-12 month stage of patient participation was observed for the mean value of HbA1c level (P=.02), and the differences between the overall HbA1c variability and the variability of each 6-month interval was also significant.CONCLUSIONS:Telehealthcare had a positive effect on diabetic patients. This study had enhanced blood glucose monitoring, and the patients in the program showed improvements in glycemic control. The self-care behaviors affect patient outcomes, and the changes of behavior require time to show the effects.

Disease management is a program which attempts to overcome the fragmentation of healthcare system and improve the quality of care. Many studies have proven the effectiveness of disease management. However, the case managers were spending the majority of time in documentation, coordinating the members of the care team. They need a tool to support them with daily practice and optimizing the inefficient workflow. Several discussions have indicated that information technology plays an important role in the era of disease management. Whereas applications have been developed, it is inefficient to develop information system for each disease management program individually. The aim of this research is to support the work of disease management, reform the inefficient workflow, and propose an architecture model that enhance on the reusability and time saving of information system development. The proposed architecture model had been successfully implemented into two disease management information system, and the result was evaluated through reusability analysis, time consumed analysis, pre- and post-implement workflow analysis, and user questionnaire survey. The reusability of the proposed model was high, less than half of the time was consumed, and the workflow had been improved. The overall user aspect is positive. The supportiveness during daily workflow is high. The system empowers the case managers with better information and leads to better decision making.

Background: Acral volar melanocytic lesions have a high potential for malignancy. Dermoscopy is a useful, noninvasive tool for the diagnosis of such malignancies. The use of immersion fluids can provide better visual effects and improve the diagnostic accuracy of dermoscopic examinations.Methods: Fifteen volar melanocytic lesions, including two palmar and 13 plantar lesions, were included in our study. We compared the visual effects of two different immersion fluids as an interface for dermoscopy. Four combinations of immersion fluid (ultrasound jelly or mineral oil) and observation mode (polarized or nonpolarized light) were compared for visual effects during the dermoscopic examination of lesions based on air bubble inclusion and microstructure visibility.Results: Both the mineral oil and the ultrasound jelly allowed at least one microstructure to be clearly visible in each image of the acral volar melanocytic lesions examined. All modes of observation achieved acceptable visual effects. The use of mineral oil and the polarized light mode resulted in the formation of fewer bubbles than the use of mineral oil and the nonpolarized light mode (p < 0.05). The use of ultrasound jelly and the polarized light mode resulted in significantly better visual effects (p < 0.05) than that of ultrasound jelly or mineral oil and the nonpolarized light mode.Conclusion: The use of either mineral oil or ultrasound jelly as interface provides acceptable visual effects for the dermoscopic examination of acral volar melanocytic lesions. The use of the polarized light mode reduced the reflection and scattering of light, resulting in better visual effect than that achieved using the nonpolarized light mode. In the early diagnosis of acral melanoma, choosing the appropriate application of immersion fluid and observation mode yields the optimal visual effect. Copyright (C) 2013, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC. All rights reserved.

Glycated hemoglobin A1c (HbA1c) is an important indicator of glycemic control. The current recommendation for glycemic control based on HbA1c values has been widely accepted. However, HbA1c values depend on the lifespan of erythrocytes and the assay methods used. Here, we report the case of a patient with type 2 diabetes with unusual falling of HbA1c due to interference from dapsone treatment for leukocytoclastic vasculitis. He was a 52-year-old man, who was diagnosed with type 2 diabetes mellitus 5 years previously and who had been treated in our hospital in the past 3 years. Glycemia was controlled by sulfonylurea and metformin. During the 3-years follow-up period, HbA1c dropped significantly during the addition of dapsone treatment, although plasma glucose levels remained stable. HbA1c levels were raised after discontinuation of dapsone. With rechallenge of dapsone usage, HbA1c decreased again. We conclude that dapsone may be the cause of artificially low HbA1c. Other measurements to monitor glycemic control should be considered when dapsone is used for the treatment of concurrent disorders, such as autoimmune disease and pneumocystis jiroveci pneumonia.

Transient neonatal pustular melanosis is mostly found in full-term black infants.It is a benign and self-limited disease, and the etiology is still unknown.We present a full-term female neonate with multiple vesiculopustular and pigmented macular lesions found immediately after her birth.A skin biopsy showed vesicles consisting of intracorneal and subcorneal aggregates of neutrophils, which is compatible with transient neonatal pustular melanosis.Although it is rare in Taiwan and Asian countries, transient neonatal pustular melanosis should always be considered when pustulosis is found in the neonatal period to prevent the use of unnecessary antibiotics.Dermatological consultation and histological confirmation are sometimes required for the final diagnosis.

Unilateral nevoid telangiectasia (UNT) is a rare disease characterized by punctuate and stellate telangiectasias that follow dermatomal distribution.1 Its etiology remains elusive; no standard treatment currently exists. We describe a 14-year-old Asian female (skin type IV) with UNT, who underwent treatment with long-pulsed 1064-nm Nd:YAG laser and 595-nm pulsed dye laser for her disease. The patient came to our clinic with linearly arranged, punctate telangiectasias over right side of back, shoulder, and arm (Figure 1). The lesions appeared at the age of 10. The diagnosis of UNT was made based on the clinical manifestations and telangiectasias in superficial dermis (as shown on a histologic exam done previously at another hospital). Angioma serpiginosum is an important differential diagnosis of UNT in this case. Three sessions of treatment with long-pulsed 1064-nm Nd:YAG laser (GentleYAG Laser; Candela Laser, Wayland, MA, USA) were given with parameters (fluence-spot sizepulse width) of 240 J/cm2-3 mm-10 ms (first week), 240 J/ cm2-3 mm-10 ms (second week), and 280 J/cm2-3 mm-10 ms (third week). The interval between each session was 4 weeks. However, there was only slight improvement. Histologic exam performed 2 weeks after the third session revealed marked telangiectasias in papillary dermis (Figure 2). Next, two sessions of pulsed dye laser with 595 nm wavelength (Vbeam Perfecta; Candela Laser) were given with parameters of 13 J/cm2-7 mm-40 ms (fluence-spot sizepulse width) for both sessions. Significant lightening of lesions (> 90%) was observed after the second session (Figure 3). The only adverse reaction was transient purpura that lasted for approximately 2 weeks. There was no hypoor hyper-pigmentation after treatment. There are two forms of UNT, the rarer congenital form and the more common acquired form.2 Telangiectasia develops during puberty in most of the acquired cases, as in our patient. Several reports point out the systemic association of acquired UNT, such as hyperestrogenemia and chronic liver disease.2 In out patient, there was no evidence of high serum level of estrogen or hepatic disease. Both long-pulsed 1064-nm Nd:YAG laser and pulsed dye laser have been shown to be effective in treating vascular lesions.3,4 Major et al3 reported good response with the former for facial and leg telangiectasias. However, it does not seem to be a good treatment modality for UNT for the current case. One possible explanation is that while the 1064-nm Nd:YAG laser beam tends to penetrate to deeper dermis, due to its long wavelength and lesser absorption Figure 1 Clinical picture before treatment.

The Journal of DermatologyVolume 37, Issue 4 p. 378-380 New-onset psoriasis associated with etanercept therapy Lu-An CHEN, Lu-An CHEN Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorLin-Hui SU, Lin-Hui SU Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorYing-Jui CHANG, Ying-Jui CHANG Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorYu-Ling HSU, Yu-Ling HSU Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorTsung-Hua TSAI, Tsung-Hua TSAI Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this author Lu-An CHEN, Lu-An CHEN Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorLin-Hui SU, Lin-Hui SU Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorYing-Jui CHANG, Ying-Jui CHANG Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorYu-Ling HSU, Yu-Ling HSU Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this authorTsung-Hua TSAI, Tsung-Hua TSAI Department of Dermatology, Far-Eastern Memorial Hospital, Pan-Chiao, Taipei, TaiwanSearch for more papers by this author First published: 25 March 2010 https://doi.org/10.1111/j.1346-8138.2010.00789.xCitations: 4 Lin-Hui Su, M.D., M.Sc., No. 21, Sec. 2, Nan-Ya S. Road., Pan-Chiao, Taipei, Taiwan. Email: sulh1129@ms1.hinet.net Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume37, Issue4April 2010Pages 378-380 RelatedInformation

An otherwise healthy 61-year-old female presented with a skin tumor on the left flank, which had been present since her early adulthood. The tumor gradually enlarged during the first 2–3 years and then stabilized in size. There were no symptoms from the tumor. On examination, a red to violaceous, shiny, polypoid, fusiform nodule with firm consis tency, measuring approximately 3.0 cm × 2.0 cm, was noted on her left flank (Figure 1). There were also many skin tumors on her face and scalp, most of which were dome-shaped, smooth surfaced, violaceous, firm nodules measuring several millimeters in diameter. These tumors were 1-cm dermal nodules that caused pain; others were rounded, skin-colored, firm papules with a size of approximately 5 mm in diameter around her nose. An excisional biopsy specimen was obtained from the tumor at the flank. Histopathologic examination revealed a tumor occupying the reticular dermis, which was composed of aggregations of neoplastic cells arranged in a jigsaw puzzle pattern. The aggregations consisted of neoplastic cells with two different appearances: (1) peripheral cells aligned in a palisade with small, dark staining columnar nuclei surrounded by a scant cytoplasm, and (2) cells with nuclei that were larger and paler, and that had a more abundant pale cytoplasm. Each aggregation was surrounded by a rim of homogenous eosinophilic basement membrane-like material. Globules of the same material were also present within the aggregations themselves (Figure 2). The patient then underwent several sessions of surgical removal for other tumors on the face and scalp, and pathology exams showed cylindroma, spiradenoma, trichoepithelioma, or combinations of them (Figure 3A: cylindroma + trichoepithelioma; Figure 3B: cylindroma + spiradenoma). She reported that two of her younger brothers and sisters also had similar skin tumors, but they were not as numerous as hers.

Intravascular large B-cell lyrnphoma is characterized by clusters of large neoplastic B cells within small blood vessels, most commonly in the dermis and subcutis. There is no nodal or parenchymal involvement until late in the disease, and its endothelial tropism is responsible for the variable clinical features. We report the case of a 51 year-old man who presented with fever, altered mental status, generalized edema, and profound telangiectasia. The diagnosis was made by a skin biopsy from the right thigh. Histology revealed ectatic vessels in the superficial dermis and large atypical lymphoid cells filling the small blood vessels in the deep dermis. Immunohistochemical staining showed strongly positive results for CD45 and CD79a. This was a rare case of intravascular large B-cell lymphoma with generalized edema and telangiectasia as the only cutaneous manifestation. (Dermatol Sinica 27: 248-253, 2009)

Background  Primary essential cutis verticis gyrata (CVG) is characterized by folds and furrows of the scalp, resembling the convoluted appearance of the brain, and is not associated with other abnormalities. Most patients with CVG are treated with surgical methods, such as scalp reduction; however, surgery may not be suitable for patients in whom the area involved is large.

A 52 year-old female presented with a 2-year history of progressive hairline recession over fronto tempro-parietal area (1 to 3.5 cm variably). Shiny affected area, mild pruritus, incomplete hair loss, and subtle loss of follicular openings were also noted. Follicular hyperkeratosis and focal minimal perifollicular erythema were found at the hairline. Nearly total absence of eyebrow hairs was observed, but all other parts of body hair appeared normal. Laboratory tests, including routine biochemistry tests, thyroid function, antinuclear antibodies, and hepatitis C test, showed no abnormalities. Sex hormones were also within normal range. Histologically, there were scanty lymphocytic infiltrate and marked fibrosis around hair follicles, especially the isthmus and infundibulum portion, without lichenoid inflammation in the papillary dermis. The direct immunofluorescence test did not show the deposition of immunoreactants in the follicular basement membrane zone. It is consistent with a case of frontal fibrosing alopecia (FFA) with characteristic clinical presentation and supporting histologic features. Furthermore, owing to the limited effectiveness of treatment, early diagnosis and communication with patients about the prognosis of FFA is important.

Carcinoid tumors are primarily regarded as tumors of the appendix and small intestine, but they have been shown to arise from almost any tissue derived from the primitive gut, including its respiratory diverticulum. Cutaneous metastasis from carcinoid tumors is distinctly rare, and only a few cases have been documented. In this report, we present one case of laryngeal atypical carcinoid tumor with skin metastasis. The diagnosis of metastastic carcinoid to the skin was established by clinical history, histopathology and immunocytochemical methods including positive stains of chromogranin, NSE, synaptophysin and cytokeratin AE1/AE3, etc.. To our knowledge, this is the first reported case of a laryngeal atypical carcinoid with skin metastasis in Taiwan. We disclose the aggravated behavior of the laryngeal atypical carcinoid tumor and remind dermatologists to be aware of the possibility of cutaneous metastasis, even if the primary tumor is a carcinoid.