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Background: Teledermatology programs in the United States have evolved over the past several decades. No systematic survey of teledermatology programs in the United States is available in peer-reviewed literature. Objective: To provide up-to-date information regarding the state of teledermatology programs in the United States. Methods: Active U.S. teledermatology programs were surveyed in 2011 with regards to practice models, clinical volume, and payment methods. These findings were compared with those from 2003. Results: By January 2012, 37 teledermatology programs were active in the United States. Store-and-forward teledermatology was the most frequent delivery modality offered by 30 (81%) of the programs. The majority of the programs were based at academic institutions (49%), followed by Veterans Administration hospitals (27%), private practice (16%), and health maintenance organizations (HMOs) (8%). The majority of programs (67%) provided services to their home state only, whereas the rest also served additional U.S. states or abroad. The median number of consultations per program was 309 (range, 5-6500) in 2011. The most frequent payer sources were private payers, followed by self-pay, Medicaid, Medicare, and HMOs. Since 2003, with the confirmed discontinuation of 24 previously active programs, the total number of active teledermatology programs in 2011 was 60% of that in 2003. However, the annual consult volume per program nearly doubled for the sustainable programs in 2011. Limitations: Itemized billing information was not uniformly available from all programs. Conclusion: The turnover in teledermatology programs is relatively constant, with an increase in consult volume for sustainable programs. Store-and-forward is the dominant modality of delivery, while hybrid technology model is emerging. [ABSTRACT FROM AUTHOR]

Background: Store-and-forward teledermatology is an emerging means of access for patients with skin disease lacking direct access to dermatologists. Objectives: We sought to examine the patient demographics, diagnostic concordance, and treatment patterns in teledermatology for patients younger than 13 years. Methods: We conducted a descriptive retrospective cohort study involving 429 patients. Results: Diagnoses were concordant in 48% of cases, partially concordant in 10%, and discordant in 42%. Management recommendations were concordant in 28% of cases, partially concordant in 36%, and discordant in 36%. Primary care providers tended to underuse topical steroids and overuse topical antifungals and systemic antibiotics. Only 1.4% and 6.0% of patients required repeated teledermatology consultation and in-person dermatology consultation, respectively. Limitations: Limitations were the inability to generalize the data from the population studied and the chances of error and bias in teledermatology diagnoses. Conclusions: Store-and-forward teledermatology can improve diagnostic and therapeutic care for skin disease in children who lack direct access to dermatologists. [Copyright &y& Elsevier]

Sufficient data exist to implicate the monocyte-macrophage as the major source of prostaglandins in monocyte-macrophage-T lymphocyte interactions. Prostaglandin (PG) E2, a major prostaglandin synthesized by human monocyte-macrophages is able to modulate a variety of T lymphocyte reactivities including blastogenesis, lymphokine secretion, and cytotoxicity. The effect of PGE2 on T lymphocyte function varies according to the primary activating stimulus, the specific response under investigation, as well as the population of T lymphocytes involved. Some immunologic abnormalities found in clinical disease may in part derive from alterations occurring in the synthesis of PGE2 by monocyte-macrophages or in the response of T lymphocytes to PGE2. [ABSTRACT FROM AUTHOR]

Prostaglandins E1, E2,. F1α,, and F2α,, did not demonstrate direct in vitro chemotactic properties either to rabbit peritoneal polymorphonuclear leukocytes or to rabbit or human polymorphonuclear leukocytes isolated from blood. Prostaglandin F2α, however, enhanced the chemotactic responsiveness of human polymorphonuclear leukocytes to the chemotactic agent casein. [ABSTRACT FROM AUTHOR]

The article presents information on the role of prostaglandins in cutaneous inflammation. The prostaglandins constitute a series of cyclic, oxygenated, 20-carbon fatty acids synthesized from the essential fatty acids and having a broad spectrum of biologic activity. The molecular skeleton common to all prostaglandins consists of a cyclopentane ring with two carbon side chains. Both physically and chemically induced cutaneous inflammation can be associated with prostaglandin activity. Prostaglandins also have been identified in inflammatory cutaneous lesions induced by immunologic stimuli.

Arterioles (200 to 400 μ in outer diameter) from dog and human skin were studied in vitro to measure changes in tension induced by prostaglandin E2 (PGE2) alone and in combination with catecholamines. The effects of sympathetic blocking drugs and of calcium on vessel response to PGE2 were also studied. PGE2 caused contraction of both the dog and human vessels, with evident differences in frequency of response. PGE2 also increased the magnitude of vessel response to a given dose of epinephrine or norepinephrine, in addition to lowering the threshold level for response to the catecholamines. Alpha blockade and beta blockade did not prevent PGE2-induced contraction. The contractile response to PGE2 was observed to increase as the calcium concentration of the vessel bath was increased. These studies show that, in vitro, the cutaneous arteriolar vascular smooth muscle of the dog and the human responds to PGE2 via a pathway other than that of the alpha receptor. However, alpha-receptor response can be modified by PGE2. Thus, prostaglandins may mediate cutaneous vascular activity not only through their own effect but also by modifying responses to catecholamines. [ABSTRACT FROM AUTHOR]

By the use of a sensitive and specific double antibody radioimmunoassay, immunoglobulin E was demonstrated in sweat from 6 of 11 healthy volunteers; the concentrations of IgE ranged from 1 to 3.9 ng/ml of sweat. Six of seven patients with dermatitis and elevated levels of serum IgE also had high IgE levels in sweat; the highest IgE value in sweat was 75.5 ng/ml and was noted in a patient with atopic dermatitis. Thus, all the main immunoglobulin classes can he demonstrated in eccrine sweat. [ABSTRACT FROM AUTHOR]

Murine 3T3 fibroblasts, treated with mitomycin C in order to inhibit their proliferation, have been extensively used as feeder layers to enhance the cultivation of human keratinocytes in vitro. In order to identify possible factors responsible for this enhancing effect, studies were undertaken to determine whether eicosanoid generation by 3T3 cells was preserved following mitomycin C treatment. Accordingly, both untreated and mitomycin C-treated 3T3 cells were incubated with [1 - 14C]arachidonic acid and their qualitative generation of [1 - 14C]labeled eicosanoids assessed by thin layer chromatography. Levels of endogenously generated eicosanoids were quantitatively determined by specific radioimmunoassays performed on culture supernatants obtained from incubations of both treated and untreated cells. Results of these studies demonstrate that mitomycin C treatment, although preventing the proliferation of 3T3 cells, failed to alter their generation of prostaglandin E2 or 6-keto-prostaglandin F1α. Furthermore, in parallel cultures, the untreated 3T3 cells stopped generating eicosanoids upon reaching confluence, whereas the mitomycin C-treated 3T3 cells that did not proliferate continued to generate eicosanoids. [ABSTRACT FROM AUTHOR]