Search

Women are entering medicine at increasing rates, particularly in dermatology. In this study, we compared women’s influence and status in academic dermatology with that of men by examining authorship roles in peer-reviewed dermatology literature. We examined the literature in 2009 and compared that to 10 years prior (1999). A total of 1399 articles were reviewed, 594 of which met study criteria and were included in statistical analysis. There was a marked increase in senior female authorship over a decade (22% vs. 38%, p < 0.001). Female first authorship increased as well (41% vs. 51%, p < 0.001). In contrast, changes in male senior and first authorship were not statistically significant. Federal funding for female senior authors increased over a decade (19% vs. 37%, p = 0.05), and female senior authors in the 2009 cohort were more likely to hold a dual MD/PhD degree (0% vs. 11%, p = 0.04) or pure PhD degree (11% vs. 27%, p = 0.04). Women are approaching parity with men in terms of authorship in the dermatology literature, and additional research training and attainment of federal funding have helped women publish as senior authors.

Chronic prurigo (CPG) is a highly burdensome pruritic disease characterized by chronic itch, a prolonged scratching behavior and the development of localized or generalized hyperkeratotic pruriginous lesions. Neuronal sensitization and the development of an itch-scratch cycle contribute to the augmentation of pruritus and the chronicity of the disease. We provide here the first international guideline for a rational diagnostic and therapeutic approach for CPG. Recommendations are based on available evidence and expert opinion. The diagnosis of CPG is made clinically. A detailed medical history together with laboratory and radiological examinations are advised in order to determine the severity of CPG, identify the underlying origin of the itch and assist in the elaboration of a treatment plan. Therapeutically, it is advised to adopt a multimodal approach, including general strategies to control itch, treatment of the underlying pruritic conditions, and of the pruriginous lesions. Topical (corticosteroids, calcineurin inhibitors, capsaicin) and systemic antipruritic agents (eg, gabapentinoids, immunosuppressants, and opioid modulators) as well as physical treatment modalities (phototherapy, cryotherapy) should be employed in a step-wise approach. Psychosomatic or psychological interventions may be recommended in CPG patients with signs of psychiatric/psychological comorbidities. (Less)

Objective To determine whether there is an association between duration of voriconazole therapy and number of nonmelanoma skin cancers (NMSC) after lung transplantation. Design A telephone-based survey and chart review were performed for all living patients who received a lung transplant at Emory University from 1993 to 2009. Setting Academic medical center. Participants Lung transplant recipients. Main Outcome Measured Number of NMSC after lung transplantation. Results Sixty of 91 (65.9%) subjects were exposed to voriconazole for at least 3 months (11.2 ± 8.7 months, range 3–58 months) after lung transplantation, of whom 16 developed NMSC, with a mean of 38 months to first NMSC. Of 31 patients not exposed to voriconazole, 12 developed NMSC, with a mean of 52 months to first NMSC . By univariate analysis, time since transplant (correlation coefficient (r) = 0.514), age (r = 0.101), and high lifetime sun exposure (r = 0.211) were correlated with number of skin cancers after transplantation. Skin types V and VI were protective (r = −0.353). In multivariate regression, time since transplantation (0.061 per month), age (0.151 per year), skin type I or II (4.939), and months of exposure to voriconazole (0.149) were found to be independent risk factors for number of skin cancers after lung transplantation. Conclusion Duration of voriconazole exposure correlates with number of NMSC after lung transplantation. All patients exposed to voriconazole should be educated about their increased risk of skin cancer and should have regular dermatologic follow-up for skin cancer screening. Physicians caring for lung-transplant recipients should consider alternatives to voriconazole in patients at risk for skin cancer.

BACKGROUND Dermatologists perform more cutaneous surgical procedures than any other medical specialists, including plastic surgeons, especially for treating skin cancers, but anecdotal evidence suggests that the public may not identify dermatologists as surgeons. OBJECTIVE Our study was designed to assess the public's perception of expertise in surgery of the skin of three medical specialties: dermatology, plastic surgery, and general surgery. We also investigated whether the physician's specialty biases people when they assess the cosmetic appearance of a surgical scar. MATERIALS AND METHODS We administered an institutional review board–approved survey to individuals at the Emory Student Center and the Emory Dermatology Clinic. Participants rated the perceived skills and training of the different medical specialties and scored the cosmetic appearance of 16 surgical scars created by a fellowship-trained Mohs surgeon labeled as the work of different specialists. RESULTS Results from 467 participants were overwhelmingly in favor of plastic surgeons (p

Patients with thick (Breslow4 mm) primary melanoma and/or regional nodal metastasis have a high risk of tumor recurrence. High-dose adjuvant interferon (IFN) alfa-2b offersor=10% improvement in relapse-free survival and overall survival with significant toxicity.The objective was to determine which prognostic factors and patient characteristics are significant in the decision to undergo IFN therapy.Of 781 patients who underwent sentinel lymph node (SLN) biopsy, 135 of 781 (17.3%) had positive SLN or thick melanomas and were informed of a/=50% risk of recurrence/disease-related mortality and offered IFN. Telephone surveys delineated reasons behind patients' decisions to accept IFN.Acceptors, 60 of 135 (45%), decided to take IFN alfa-2b whereas 75 of 135 (55%) declined. Being female (OR, 2.4; 95% CI, 1.17-5.03; p=.017) and positive SLN status (OR, 2.2; 95% CI, 1.01-4.97; p=.048) were strongly associated with patients who chose IFN. Acceptors of IFN were younger, more influenced by physicians, and less affected by depression and side effect profile (p.05 for all). Decliners were more concerned by strained relationships with family and social life (p.05).Gender and positive SLN were predictive of high-risk melanoma patients' acceptance of IFN treatment. Physician insight into melanoma patients' therapeutic decision-making process can guide patients through this difficult disease.

BACKGROUND Solid organ transplant recipients on high doses of immunosuppression are at increased risk for the development of nonmelanoma skin cancer (NMSC). OBJECTIVE The objective was to assess the possible factors impacting quality of life (QOL) in solid organ transplant recipients. METHODS Patients were seen in a dermatology clinic integrated within the transplant center at a university-based hospital. One anxiety questionnaire and three QOL questionnaires were administered to each patient. A regression model was used to determine possible predictors of anxiety and lower QOL. RESULTS The baseline scores on the QOL instruments and anxiety questionnaire indicate poor organ-specific and general QOL as well as high levels of anxiety. Time since transplant was predictive of lower QOL as measured by Skindex-16 (p

A 36-year-old primigravida at 36 weeks gestation presented to the dermatology clinic for her semi-annual check of multiple melanocytic nevi. Her medical history was significant for 2 in situ melanomas removed from her abdomen 2 years earlier. The remainder of her history was unremarkable. The patient thought that some of her nevi had gotten darker since her last visit, but she had not noticed any changes in size or shape. An examination of the patient's skin was performed, and her present nevi were compared with those in photographs taken 6 months before at an earlier visit (Fig. 1). Examination revealed no new nevi and no change in size of nevi, but a universal darkening (from light brown to dark brown) of all nevi was noted compared with those in photographs taken 6 months earlier. Should the patient and physicians worry? We sought dermatologic advice to sort this out.