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Introduction: Despite proven benefits in other medical specialties, there is a paucity of patient decision aids (PDAs) in dermatology. The present study developed online PDAs for acne and psoriasis, incorporating iterative patient and physician feedback, in accordance with International Patient Decision Aid Standards (IPDAS). Design and Method: Content was adapted from clinical practice guidelines and primary research and formatted for an 8th grade reading level. Feedback on content and format was obtained through focus groups with 15 psoriasis patients and survey with 34 acne patients. Feedback on presentation and clinical utility of the PDAs was gathered by survey from 51 physicians in Canada and the United States. Each data collection stage informed further development. Results: Demand for decision support, and satisfaction with the PDAs was high among patients. Physicians were approving of content and expressed a strong interest in PDA use. Conclusion: Patients and physicians approve of the PDAs' content, format, and intended use. Online PDAs allow accessibility for patients and may reduce barriers to use for physicians.

Nirmatrelvir-ritonivir (Paxlovid) recently received emergency use authorization for the treatment of coronavirus disease 2019 (COVID-19). Literature has linked numerous cutaneous adverse effects to nirmatrelvir and ritonavir, the copackaged tablets within Paxlovid. A review and comparison of these adverse effects to the common cutaneous manifestations of COVID-19 is provided. Numerous drug-to-drug interactions exist between nirmatrelvir-ritonivir and commonly-used medications within dermatology.

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.

Owing to the COVID-19 outbreak, the use of telemedicine applications has increased throughout the United States. Using an algorithm to analyze mobile application rankings, we were able to examine how applications with telemedicine services have increased in prevalence and rank pre- and post- COVID-19. Telemedicine apps saw an increase of 210.92 ranked positions on average. Within US telehealth, skin conditions have become the fifth most common diagnosis. Widespread use of teledermatology has been well-accepted. Dermatologists and patients report high satisfaction using teledermatology during COVID-19 and intend to continue using these services in the future. COVID-19 has assisted in reducing physician concerns previously preventing some dermatologists from utilizing teledermatology in their services. Additionally, the geographical and socioeconomic barriers preventing some patients from receiving dermatologic care have been minimized through the use of teledermatology. Addressing these obstacles for dermatologic care improves healthcare equity.

Background: Patient decision aids (PDAs) are tools that facilitate informed shared decision-making between patients and health care providers. To address a previously identified need in treatment decision-making in hidradenitis suppurativa (HS), we developed an HS-PDA., Methods: Development of the HS-PDA was based on International Patient Decision Aids Standards. Evidence was derived from the North American Clinical Management Guidelines for HS., Results: Content from guidelines was transformed into patient-friendly language and reviewed by three physicians and two patient representatives. Feedback on HS-PDA content, presentation and practicality was obtained from 7 HS patients and 5 physicians. Revisions were made following thematic analysis. All patients felt the content on treatment options contained the right amount of information and 5 found it helpful to see these options contextualized to their values. Each stated they would use the HS-PDA during treatment decision-making. Three and four physicians respectively indicated the content was accurate and language was patient-friendly., Limitations: Small sample sizes may limit generalizability., Conclusion: This HS-PDA was developed in accordance with international standards based on current HS guidelines with input from patients and physicians. It is available online without cost.

Although tattoo artists provide tattoo aftercare instructions to their clients, recommendations are often not cost-effective or supported by evidence. A 22-year-old man developed a pruritic red rash over his healing tattoo one week after receiving the tattoo. Although multiple queries were negative, the patient did note use of a scented lotion before the eruption. We determined that allergic contact dermatitis from the scented lotion caused scarring and premature fading of the new tattoo. Tattoo artists should recommend avoidance of scented lotions and instruct clients to care for their new tattoo like a wound in their aftercare instructions.

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.

Virtual reality (VR) and augmented reality (AR) are making headlines, pushing the boundaries of educational experiences and applicability in a variety of fields. Medicine has seen a rapid growth of utilization of these devices for various educational and practical purposes. With respect to the field of dermatology, very few uses are discussed in the literature. We briefly present the current status of VR/AR with regard to this specialty.

Owing to the inherently visual nature of the field of dermatology, advances in imaging and communication technology have resulted in wide-spread application of teledermatology since its introduction in the mid-1990s. In the last 20 years, studies have repetitively shown that teledermatology provides effective and efficient quality care for patients. It also increases access to underserved patients and reduces traveling costs, wait times, and unnecessary referrals. In this letter the authors seek to analyze implementation of a direct patient to dermatologist model in a Veteran Health Administration (VHA) patient population, referred to as patient-assisted teledermatology. This population is largely over the age of 65 and a significant portion are either without internet or have the minimum technology necessary to participate in the studied model. Owing to these observations and personal experiences, the authors found the implementation process of a patient-assisted model to be challenging in this population.

WeChat is a closed social networking platform that allows users to connect privately, providing instant text, photo sharing, voice, and video calls. It is now the most popular mobile chat app in China. The widespread use and ease of establishing technology made WeChat an ideal platform for healthcare, in which it has many uses that include scheduling, follow up, and post-procedure monitoring. In addition, one may make payments and handle prescriptions via e-pharmacy. Dermatologists are often looking for a secure and easy way to use mobile applications to share clinical images and to obtain photographs from patients. We aim to provide an overview of WeChat and its current applications for healthcare and dermatology.

Despite the increasing popularity of social media, the activity of dermatology residency programs on top social media platforms has never been investigated to our knowledge. We investigated a total of 126 dermatology residency programs to assess their presence and popularity on social media. Searches were conducted to identify dermatology residency departments' accounts on Facebook, Twitter, and Instagram. The number of Facebook likes, Twitter followers, and Instagram followers were recorded. Of the 126 dermatology residency programs, 29 (23%) were active on Facebook, 14 (11%) on Twitter, and 9 (7%) on Instagram. There was a wide range in the number of Facebook likes, Twitter followers, and Instagram followers. The top ten dermatology residency programs with the highest Facebook likes, Twitter followers, and Instagram followers were charted. Our results demonstrate the sparse usage of social media by dermatology residency programs. Although social media continues to increase in prevalence, dermatology residency programs are underutilizing these valuable resources.

Because YouTube is one of the most popular search engines, it is an instrumental tool to stay up to date on the most relevant dermatology trends and content in order to better direct patients and improve health outcomes. Twelve select terms (i.e. Dermatology, Sun protection, Skin cancer awareness, Skin cancer, Skin condition, Sun safety, Tanning, Melanoma, Basal cell carcinoma, Squamous cell carcinoma, Skin cancer treatment, Skin cancer prevention) were searched on YouTube. Overall, the results included 240 videos with over 160 million views. Educational content was most prevalent at 35% of the total search results. Of the total videos, 42% were uploaded by or featured a medical health professional (MD, DO, PhD, RN, ND), with 28% involving a board-certified dermatologist. Trends in content type have changed: educational and personal videos have increased, while advocacy and advertising have decreased. Most search terms are moving in a positive, informative direction, specifically the term "tanning." Other search terms such as "skin condition" and "skin cancer treatment" should be more closely monitored for misleading and perhaps harmful information. Therefore, dermatologists and other medical personnel should keep pace with relevant and popular dermatology content on YouTube in order to understand, advise, market, educate, and address patients' questions and concerns.

Flickr, which was launched in 2004, is one of the oldest photo-sharing services online. The company, which was once at the forefront of the internet social media explosion, lost users and received criticism as its repeated acquisitions by other companies forced users to adapt to new owners. Now facing another acquisition by the online photo-sharing service SmugMug, the future is uncertain again for the once popular internet and mobile application service. Flickr, with its rapid rise in popularity, sudden halt in growth, and its gradual loss of users and popularity, has been repeatedly looked to as a lesson for other internet startups on the necessity of adapting quickly in the current internet age. Given the rise of social media use in the healthcare field, and the long-standing presence of Flickr on the internet, this study investigated the presence of dermatology-related content on Flickr and how the photo-sharing platform has applied to the visual field of dermatology, its dermatologists, and its professional associations.

Introduction: Atopic Dermatitis (AD) is a common dermatologic disorder that affects 17.8 million individuals in the United States. Online medical communities have become increasingly popular over the last several years, providing an additional avenue of therapy for patients., Purpose: This retrospective analysis looks to characterize the AD patient profile to better assess features of the AD community and appraise PatientsLikeMe data with current AD literature., Methods: PatientsLikeMe data recorded by April 2018 from persons who reported AD as their primary or secondary diagnosis were included in the analysis., Results: The PatientsLikeMe database had 410 individuals reporting AD as of April 2018. Of these, 61.46% (252/410) report AD as their primary disease. Of those reporting, 180/199 (90.45%) were diagnosed by a medical professional whereas 19/199 (9.55%) were self-diagnosed. The number of persons recording predefined PatientsLikeMe symptoms are as follows: stress (20), fatigue (132), pain (126), anxious mood (118), and depressed mood (103)., Significance: Patient-oriented medical communities are a valuable resource for those affected by various conditions. Although clinical applications are still uncertain, this data allows practitioners access to profiles self-defined by online users.

Background: Financial relationships between editorial board members of peer-reviewed journals and pharmaceutical and medical device manufacturing companies can potentially lead to biases and loss of objectivity of the medical literature. The purpose of this study was to evaluate the potential financial conflicts of interest that exist among editorial board members of dermatology journals., Methods: Editorial board members for 36 dermatology journals were identified and searched using the Open Payments database on the Center for Medicare and Medicaid Services website. The total amount of general payments made to these physician editors were collected and stratified using a tier system: 1) nothing reported, 2) >$0 and <$10,000, 3) >$10,000 and <$100,000, and 4) >$100,000., Results: We identified 551 editors from 36 dermatology journals for use in our analysis. Some form of general payment was made to 87% of these physicians (480 of 551). Four journals had >25% of their editorial staff receiving >$100,000., Conclusions: Financial relationships exist between editorial board members of dermatology journals and pharmaceutical/medical device manufacturing companies, which could lead to financial conflicts of interest. Publications coming from journals with highly paid physician editors have more potential to be biased.

The therapeutic applications of cannabis and cannabinoids are an increasingly conspicuous topic as de-criminalization and legalization of these products continues to expand. A limited number of cannabinoid compounds have been approved for a specific set of conditions. However, the current role of cannabinoids for the treatment of dermatologic conditions remains to be defined. We conducted a review of the current literature to determine the applications of cannabinoids for the therapy of various skin diseases. After conducting our analysis, we found that cannabinoid products have the potential to treat a variety of skin conditions, including acne vulgaris, allergic contact dermatitis, asteatotic dermatitis, atopic dermatitis, hidradenitis suppurativa, Kaposi sarcoma, pruritus, psoriasis, skin cancer, and the cutaneous manifestations of systemic sclerosis. However, the majority of available data on these compounds are pre-clinical and there is a corresponding lack of high-quality randomized, controlled trials that evaluate their effects. Cannabinoids have shown some initial promise as therapy for a variety of skin diseases. However, there is a requirement for thorough pre-clinical research and large-scale, randomized, controlled trials before cannabinoids can be considered safe and effective treatments for these conditions.

Payments made to dermatologists by pharmaceutical and medical device manufacturing companies have become better understood following the advent of the Open Payments program. The purpose of this study was to analyze payments made to dermatologists in 2016 and evaluate trends in the payments from the previously published 2014 data.

Cash prizes for academic publication were introduced by the Department of Physics at Nanjing University in the 1990s. Most Chinese universities and research institutions have established cash rewards for first authors of publications. Potential payments ranged from ~$14,000 for an original research article in JAAD to ~$2000 for a case report in JAMA Dermatology. We examined rewards for publication of academic dermatological articles in China by searching for the cash-reward policies of general and dermatology Chinese hospitals. Specific cash-rewards for publication in the top three highest impact dermatological journals were recorded and compared between two dermatological hospitals, four general hospitals, and Chinese national core journals. Rewards were based upon the Science Citation Index (SCI), impact factor (IF) and publication type. Payment policies were compared between dermatological hospital and general hospitals using the t-test. There was no statistically significant difference between the cash reward payments allotted by general versus dermatological hospitals in China (P=0.32). Chinese authors may receive monetary rewards for a publication in a top dermatology journal based upon journal impact factor and publication type. These policies motivate academic publications and provide an alternative means to reward researchers for their scientific achievements than currently practiced in the West.

Google+ sets itself apart from other social media platforms through a number of unique features, including search engine optimization services and high user satisfaction. The purpose of this study was to evaluate the presence of dermatological entities on Google+. Searches were conducted to locate any Google+ accounts associated with the most popular dermatology journals, dermatological patient-centered organizations, and professional dermatology-related organizations on social media. Additionally, "dermatology Google+" was searched via Google, and Google+ profiles retrieved in the first page of results were assessed. Four of the five active Google+ profiles identified in the first page of Google search results were run by private dermatology practices. Only one of the 13 searched journals was active on Google+. Twenty-six of the 34 patient-centered and professional organizations had Google+ accounts, but only seven of these accounts were active in the last year. Therefore, unlike some private practices, the majority of dermatology journals and organizations have yet to take advantage of the exclusive opportunities offered by Google+ to expand their audiences and bolster their overall online presence.

Background: Although previous studies identify gender differences in melanoma, limited research on the phenomenon exists., Methods: In this retrospective chart review, 1,156 adults diagnosed with melanoma, between 2006-2016, at the University of Colorado were included. Breslow depth, mitotic rate, ulceration status, and location were extracted from charts between March and August 2016. Cochran-Armitage trend tests and cumulative logistic regression were used to examine the association between gender and Breslow depth, univariately and after adjusting for potential confounders., Results: In univariate analysis, males were significantly more likely to present with lesions with higher Breslow depths (p for trend=0.005). In models adjusted for age, melanoma subtype, and location, males were marginally more likely to present with lesions with higher Breslow depths (cumulative OR: 1.261, 95% CI: 0.988-1.611, p=0.060). Males were also marginally more likely to present with lesions with higher mitotic rates, after further adjustments for all other prognostic factors (cumulative OR: 1.244, 95% CI: 0.979-1.580, p=0.074)., Limitations: This was a retrospective single-institution study., Conclusion: Differences in mitotic rates among melanomas in males versus females, even after adjustments for all other prognostic factors, suggests that biological differences may contribute to the female prognosis advantage.

Background: More than 80% of households in the US have a smartphone. Growth of mobile applications (apps) has grown in parallel with access to smartphones. Mobile health apps are used in medical fields, including dermatology. These apps allow patients to access information regarding dermatology conditions as well as access physicians via teledermatology., Purpose: To analyze changes in number of dermatology mobile apps since 2014 and discuss benefits and drawbacks of mobile application growth to dermatology., Methods: Apple, Android, and Windows were queried for dermatology-related apps. The apps were categorized by purpose and compared to previously published data to assess growth and change in dermatology apps., Results: A total of 526 dermatology mobile apps were found corresponding to an 80.8% growth in dermatology apps since 2014. The market share of teledermatology increased from 11.0% in 2014 to 20.1% in 2017., Conclusions: Dermatology apps continue to grow at a comparable pace to general app growth. Teledermatology apps experienced significant growth from 2014 to 2017. This growth has allowed time-efficient and cost-effective access to dermatologists, especially in rural areas. The growth of dermatology apps targeting patients allows for patient autonomy but also can result in access to inaccurate information regarding dermatology conditions.

Despite the increasing prevalence of social media usage, the activity of dermatology journals and professional and patient-centered organizations on top social media platforms has not been investigated since 2012. We investigated a total of 124 dermatology journals, 242 professional organizations, and 78 patient-centered organizations to assess their presence and popularity on social media. Searches were conducted to identify journals and organizations on Facebook and Twitter. Similar searches were done for organizations on LinkedIn. The number of Facebook likes, Twitter followers, and LinkedIn followers of the dermatological entities were quantified. There were 22 (17.7%) dermatology journals active on Facebook and 21 (16.9%) on Twitter. Amongst the professional organizations, 114 (47.1%) were on Facebook, 69 (28.5%) on Twitter, and 50 (20.7%) on LinkedIn. In comparison, 68 (87.2%) patient-centered organizations were on Facebook, 56 (71.8%) on Twitter, and 56 (71.8%) on LinkedIn. Our results demonstrate that the popularity of dermatology journals and professional and patient-centered organizations on top social networking sites has grown markedly since 2012. Although the number of dermatology journals on social media has increased since 2012, their presence continues to trail behind professional and patient-centered dermatological organizations, suggesting underutilization of a valuable resource.

Introduction: Numerous studies report a correlation between distance to diagnostic provider in an academic medical center and poorer prognosis ofdisease. Limited research on this topic exists with respect to melanoma., Methods: This was a retrospective chart review of 1,463 adults (≥18 years) initially diagnosed with melanoma between 2006-2016. Associations between distance traveled and Breslow depth and presence of metastatic disease were assessed via cumulative and binary logistic regression models, adjusting for patient and tumor characteristics., Results: Subjects traveling ≥50 miles had 58% greater odds of having an increased Breslow depth than those traveling less than that distance (OR: 1.58; 95% CI: 1.24-2.01; p&lt;0.0001), and had four times the odds of presenting with metastatic disease (OR: 4.04; 95% CI: 3.00-5.46; p&lt;0.0001)., Discussion: We highlight the correlation between increased distance to our academic medical center with greater Breslow depths and the presence ofmetastatic disease at presentation., Conclusion: Future studies assessing other factors and regional differences that limit access to diagnosis might help improve screening efforts to prevent poorer prognosis for patients in these areas.

Platforms of social media, including the website Reddit, have become increasingly popular sites for users to communicate medical information. A study investigating dermatology content on Reddit has not been performed in the current literature. The purpose of this study is to enumerate the dermatology subreddits, quantify subscribers, and characterize posts to estimate the presence of dermatology-related content on Reddit. A Reddit search of the fourteen most common skin diseases globally was performed. Additionally, the terms "dermatology", and "skin" were searched in order to identify more subreddits relevant to the field. Dermatology-related subreddits that had ≥1000 subscribers were evaluated for content and categorized for analysis. We identified 38 subreddits related to dermatology with subscriber numbers ranging from 52 to 209,973. For 17 of the 38 subreddits that were further analyzed, most posts fell under the category of "seeking health/cosmetic advice." Reddit serves as a communication stage for individuals to discuss, engage, and connect on dermatologic topics. Furthermore, the platform offers an opportunity for medical professionals to distribute evidence-based information concerning dermatologic conditions.

Launched in 2011, Snapchat is one of the newest social media platforms with over 158 million active daily users. This study investigated the presence of dermatology-related content on Snapchat. We searched for Snapchat accounts for the top ten most popular dermatology journals, professional dermatological organizations, and dermatology-related patient advocate groups on social media. None of the above-mentioned entities were found on Snapchat. Plastic surgeons were found to primarily utilize the application, although one prominent dermatologist was also found. It was theorized that the brevity of the "snaps" was a contributing factor for dermatological organizations to not use the application. However, Snapchat in the right practice setting may be useful for dermatologists, not only to educate followers, but also as a marketing tool to Millennials.

Recently named one of the most influential phone applications, Instagram continues to grow in popularity [1]. Instagram consists of images and video posts, making it ideal for education and communication within the visual field of dermatology. In this study, we seek to determine the presence of dermatology-related content with regard to the most common cutaneous diseases of the world. We searched the account types and hashtags associated with the eight most common skin diseases globally as identified by the Global Burden of Disease (GBD) study by Hollenstein et al.: eczema, psoriasis, acne,pruritus, alopecia, decubitus ulcer, urticaria, andscabies [9]. The majority of Instagram accounts included patient experiences (n=73), private accounts(n=52), and disease advocacy and awareness groups(n=20), (total n=221). We further investigated over 2 million skin disease hashtags. The greatest numbersof hashtags were the following: #acne (n = 1,622,626),#alopecia (n = 317,566), and #eczema (n = 196,115). Our results demonstrate that patients interact withone another through Instagram. As social networking platforms become more frequently used as a source of information for patients and patient support, medical professionals must gain awareness of content available through Instagram and consider it as a means to educate the public.

Many young adults have utilized indoor ultraviolet(UV) tanning, putting them at higher risk for development of skin cancers. Prior to the increased regulations on indoor tanning for minors, indoor tanning businesses marketed to teens through modalities such as advertisements in high school newspapers. The purpose of this study was to quantify tanning advertisements in high school newspapers published across the United States between August 2014 and July 2015. Online versions of the newspaper issues were available on issuu.com. Tanning advertisements appeared in 3 of 23 high school newspapers with advertisements of any kind(13%). Among all newspapers with advertisements, 10% were indoor tanning advertisements. One newspaper in Colorado contained advertisements of any kind and had 0 tanning advertisements. A prior study of Colorado high schools showed 11 of 23 schools (48%) to contain tanning advertisements. This suggests that there may be a decrease in indoor UV tanning advertisements owing to increased tanning regulation by state legislatures, national attention to UV tanning, or a general decrease in high school tanning advertisements.

Although social media ubiquitously supplementstraditional information sources such as newspapers,magazines, radio, and television, investigation of onlinehealth information related to sun protection and skincancer prevention has been scarce and largely limitedto English language sources. Using the search terms"sun protection," "sunscreen," "skin cancer prevention,""tanning bed" and "vitamin D," we investigated 281YouTube videos presented in 6 languages: English,German, French, Spanish, Swedish, and Danish. Foreach video, we used a four-sectioned checklist toassess general information, popularity, expert drivenmeasures, and heuristic driven measures. Differencesbetween languages were detected: English languagevideos were most frequently viewed (median numberof views: 5488 compared to 248 -1591 in otherlanguages). Approximately 60% of videos revealednegative effects of solar ultraviolet (UV)-exposure.The majority of videos (75%) targeted adults. Videoson tanning beds and sunscreen contained false ormisleading information 40% and 20% of the time,respectively. We confirm observations made withrespect to other medical disciplines that the generalquality of YouTube contributions is often inferiorand does not deliver sustainable information. Othersources of information should be included whensearching for health information online.

Background: Internet resources play an important role in how medical students access information related to residency programs.Evaluating program websites is necessary in order to provide accurate information for applicants and provide information regarding areas of website improvement for programs. To date, dermatology residency websites (D  WS) have not been evaluated.This paper evaluates dermatology residency websites based on availability of predefined measures., Methods: Using the FREIDA (Fellowship and Residency Electronic Interactive Database) Online database, authors searched forall accredited dermatology program websites. Eligible programs were identified through the FREIDA Online database and had a functioning website. Two authors independently extracted data with consensus or third researcher resolution of differences. This data was accessed and archived from July 15th to July 17th, 2015.Primary outcomes measured were presence of content on education, resident and faculty information, program environment, applicant recruitment, schedule, salary, and website quality evaluated using an online tool (WooRank.com)., Results: Out of 117 accredited dermatology residencies, 115 had functioning webpages. Of these, 76.5% (75) had direct links found on the FRIEDA Online database. Most programs contained information on education, faculty, program environment, and applicant recruitment. However, website quality and marketing effectiveness were highly variable; most programs were deemed to need improvements in the functioning of their webpages. Also, additional information on current residents and about potential away rotations were lacking from most websites with only 52.2% (60) and 41.7% (48) of programs providing this content, respectively., Conclusions: A majority of dermatology residency websites contained adequate information on many of the factors we evaluated. However, many were lacking in areas that matter to applicants. We hope this report will encourage dermatology residencyprograms to improve their websites and provide adequate content to attract the top residents for their respective programs.

Doximity, currently the largest online social networking service for United States (US) health care professionals and medical students, provides a wide variety of content to a large audience. In fact, its database includes 1,078,305 physicians in the US. It is therefore important to evaluate this content from time to time. Our objective is to analyze both the residency rankings and news content presented in Doximity, with respect to dermatology. The study compared the residency rankings created by Doximity to another dermatology residency ranking system that used a different algorithm. In terms of dermatology content, seven dermatology-related search terms were entered into the Doximity search query and data was collected on the first 20 "relevant" articles. Our study evaluated a total of 140 articles. The search term "skin cancer" yielded the most articles totaling 6,001. Informative articles were the most common type of article for each content item searched except for "dermatology", yielding research articles as the most common content type (70%). The search term "melanoma awareness" had the largest number of shares (19,032). In comparing dermatology residency rankings on Doximity with another ranking system that accounted for scholarly achievement, there was 50% overlap. In conclusion, it is vital to evaluate content on social media websites that are utilized by US medical students and health care professionals. We hope this information presented provides an up-to-date analysis on the quality of one particular social media platform.

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition characterized by eczematous lesions, i.e. ill-demarcated erythematous patches and plaques. AD is commonly associated with elevated immunoglobulin E (IgE) and atopic disorders, such as asthma, hay fever, and food allergies. Rackemann and Mallory were some of the first to distinguish between asthma based on the presence ("extrinsic") or absence ("intrinsic") of allergy. This distinction has subsequently been applied to AD based on the presence ("extrinsic") or absence ("intrinsic") of increased IgE and atopic disease. Although the distinction between intrinsic and extrinsic AD is widely used, it remains controversial.

Background: With a growing sphere of influence in the modern world, online social media serves as a readily accessible interface for communication of information. Aesthetic medicine is one of many industries increasingly influenced by social media, as evidenced by the popular website, "RealSelf," an online community founded in 2006 that compiles ratings, reviews, photographs, and expert physician commentary for nearly 300 cosmetic treatments., Objective: To investigate the current preferences of patients regarding cosmetic non-surgical, surgical, and dental treatments on RealSelf and in the documented medical literature., Methods: On a single day of data collection, all cosmetic treatments or procedures reviewed on the RealSelf website were tabulated, including name, percent "worth it" rating, total number of reviews, and average cost. Patient satisfaction rates documented in the current medical literature for each cosmetic treatment or procedure were also recorded. Statistical t-testingcomparing RealSelf ratings and satisfaction rates in the literature was performed for each category-non-surgical, surgical, and dental., Results: The top ten most-commonly reviewed non-surgical treatments, top ten most-commonly reviewed surgical procedures, and top 5 most-commonly reviewed dental treatments, along with documented satisfaction rates in the medical literature for each treatment or procedure were recorded in table format and ranked by RealSelf "worth it" rating. Paired t-testing revealed that satisfaction rates documented in the literature were significantly higher than RealSelf "worth it" ratings for both non-surgical cosmetic treatments (p=0.00076) and surgical cosmetic procedures (p=0.00056), with no statistically significant difference for dental treatments., Conclusions: For prospective patients interested in cosmetic treatments or procedures, social media sites such as RealSelf may offer information helpful to decision-making as well enable cosmetic treatment providers to build reputations and expand practices. "Worth it" ratings on RealSelf may, in fact, represent a more transparent view of cosmetic treatment or procedural outcomes relative to the high satisfaction rates documented in medical literature. Massive online communication of patient experiences made possible through social media will continue to influence the practice of medicine, both aesthetic and otherwise.

Background: Pinterest is a social media internet service utilized by individuals, organizations, and businesses to collect and share ideas related to projects or interests., Objective: The literature related to dermatology-related content on Pinterest is scarce. This study aims to investigate the presence of dermatology related content available on Pinterest., Methods: Investigators searched five terms related to dermatology in the "pins" and "boards" search categories of pinterest. The first 20 results were evaluated for content and assigned to a content group of "advocacy," "informative," or "home remedies." Boards were also categorized as being posted by an MD or professional society versus others. The top ten dermatology journals were also searched for under the boards category., Results: Informative pins were the most common (49%) followed by advocacy (37%) and home remedies (14%). Informative boards were the most common (53%) followed by home remedies (31%) and advocacy (16%).We identified that only 24% of boards were created by either M.D.s or advocacy organizations. The top ten dermatology journals identified by prior studies had little presence, with only one board posted by JAMA Dermatology., Conclusions: Our study contributes to a growing body of data that dermatology organizations are relatively absent from new social media sites, and Pinterest represents a potential outlet for targeted intervention in high-risk groups for skin disease.

Background: The Dermatology Education Wiki (dermwiki) website serves as a resource platform for medical students and residents. The readily accessible interface provides dermatology articles, survival guides, didactic lectures, and links to faculty talks as well as research opportunities., Objective: To assess medical student and resident satisfaction with the dermwiki website., Methods: Fourth-year medical students taking a dermatology elective were provided with a temporary password to access relevant dermwiki information. A satisfaction survey was created to assess whether medical students found the website helpful. Second- and third-year dermatology residents were also surveyed to compare satisfaction scores prior to and after the introduction of the dermwiki website. End-of-rotation medical student exam scores were tabulated and compared to the average scores from years prior to the development of the dermwiki website., Results: Medical students rated the dermatology elective with the dermwiki website higher than rotations without a wiki (8.12 vs 7.31). Students planning to go into dermatology were more satisfied with the dermwiki website, reported accessing the website more frequently (11 times vs 9.5 times), and reported more time spent studying (12.2 hours vs 6.7 hours) than students not going into dermatology. End-of-rotation medical student exam scores did not differ from those prior to the development of the demwiki website. Ten second- and third-year dermatology residents unanimously stated that they were more satisfied with the program after the institution of the dermwiki website., Conclusions: Overall, addition of the dermwiki website to the dermatology elective curriculum has improved medical student and resident satisfaction scores. The improvement is greater among students planning to enter the field of dermatology. This study serves as a model for the incorporation of internet-based interactive tools to transform and supplement the learning environment.

Google Trends is a publicly available resource for comparing Internet search query frequency and trends interest in queries over time. The tool provides country, region, and city-specific data for term search volume on Google Search. Our study sought to compare the relative search interest to the burden of disease for the fifteen skin conditions studied by the Global Burden of Disease (GBD) 2010 project. Searches on Google Trends were conducted by using the most inclusive terms and true ICD code definitions as possible for the skin conditions studied. We report that relative interest on Google Trends did largely correlate to burden of disease reported by the GBD 2010 study, though some conditions were either underrepresented or overrepresented. Acne and herpes were the most Googled skin disease terms. This study provides further insight into what may be the most burdensome skin diseases because those with more burdensome diseases likely sought out information on their condition.

Background: As the use of mobile devices surpasses that of personal computers, medical applications increasingly provide easy access to a diverse range of health care resources., Purpose: To analyze changes in the number of dermatologic mobile applications since 2012., Methods: We examined five mobile platforms (Apple, Android, Windows, Nokia, and Blackberry) for dermatology-related diagnoses applications. The apps were categorized by purpose, cost, and target audience., Results: A total of 365 dermatologic mobile applications were analyzed with 225 new mobile applications found since 2012. Since the last query, there was a decrease in market share of reference materials (26.6% in 2012 to 15.9% in 2014) and self-surveillance/diagnosis applications (17.9% in 2012 to 12.9% in 2014) while teledermatology apps increased from 3.5% of total apps in 2012 to 9% in 2014., Conclusions: Dermatology apps continue to proliferate with minimal regulation. As technology continues to advance and physicians have greater access to mobile- health information, novel advancements in diagnosis may lead to more time-and-location-flexible patient care.

The novel photo-sharing social networking platform, Instagram, has an impressive following of 75 million daily users, with a predominantly younger and female demographic. This study investigated the presence of dermatology-related content on Instagram. The most popular professional dermatological organizations, dermatology journals, and dermatology related patient advocate groups on Facebook and Twitter, determined from a prior study, were searched for established profiles on Instagram. In addition, dermatology-related terms (i.e. dermatology, dermatologist, alopecia, eczema, melanoma, psoriasis, and skin cancer) and dermatology-related hashtags (i.e. #dermatology, #dermatologist, #melanoma, #acne, #psoriasis, and #alopecia) were searched. None of the top ten dermatological journals or professional dermatological organizations were found on Instagram. Although only one of the top ten patient advocate groups related to dermatology conditions, Melanoma Research Foundation, had an Instagram presence, there were many private offices, cosmetic products, and some patient advocacy groups. This novel social networking platform could grant dermatology journals and other professional organizations a unique opportunity to reach younger demographic populations, particularly women, with the potential for true educational and life-changing impact.

YouTube, reaches upwards of six billion users on a monthly basis and is a unique source of information distribution and communication. Although the influence of YouTube on personal health decision-making is well established, this study assessed the type of content and viewership on a broad scope of dermatology related content on YouTube. Select terms (i.e. dermatology, sun protection, skin cancer, skin cancer awareness, and skin conditions) were searched on YouTube. Overall, the results included 100 videos with over 47 million viewers. Advocacy was the most prevalent content type at 24% of the total search results. These 100 videos were "shared" a total of 101,173 times and have driven 6,325 subscriptions to distinct YouTube user pages. Of the total videos, 35% were uploaded by or featured an MD/DO/PhD in dermatology or other specialty/field, 2% FNP/PA, 1% RN, and 62% other. As one of the most trafficked global sites on the Internet, YouTube is a valuable resource for dermatologists, physicians in other specialties, and the general public to share their dermatology-related content and gain subscribers. However, challenges of accessing and determining evidence-based data remain an issue.

Tumblr broke into the social media scene in 2007 as a micro-blogging platform that hosts 169 million blogs, 75 billion total posts, and 111 million posts daily to date. This study aimed to determine the presence of dermatology-focused journals, organizations, and groups on Tumblr. These were entered into the Tumblr search query to identify affiliated Tumblr blogs and 'dermatology Tumblr' was searched on Google to determine the first four distinct results that were active within the last six months. None of the dermatology-focused journals, organizations, or groups maintained a Tumblr blog and three of the first four blogs on Google were maintained by private practices. In conclusion, Tumblr remains a social media domain that lacks a strong presence from dermatology journals and organizations, remaining an untapped resource for information dissemination and interaction with the public.

Academic journals are mainly rated according to their impact factors. However, considering the enormous worldwide impact of social media, journals and potential authors may want to take social media impact into account.

The Physician Quality Reporting System (PQRS) was established in 2006 by the Centers for Medicare and Medicaid Services (CMS) as part of an incentive process to improve healthcare preventive practices. As of 2011, there were 235 PQRS measures but only three specific to skin diseases, specifically melanoma. To measure current usage of the PQRS among dermatologists in Colorado, a survey was distributed at the 2011 Colorado Dermatological Society Meeting. Of the 120 physician attendees, 60 responded, yielding a response rate of 50%. Compared with responses from a similar 2010 survey, a significantly higher number of physicians are using PQRS, as well as E-prescribing and EHR systems. This is likely owing to the fact that CMS will require mandatory reporting of these measures in 2015. Respondents from the current survey commented that a major hurdle to PQRS reporting is the inability to submit data through existing EHR or billing systems. Currently, CMS requires PQRS reporting through a designated registry such as that provided by the AAD. Some practices have opted to report metrics such as tobacco and alcohol screening, since these can be reported through their billing systems. The results suggest structural improvements in the PQRS reporting system could improve compliance.