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Background Telemedicine was adopted to minimize exposure risks for patients and staff during the coronavirus disease 2019 pandemic. This study measured patient satisfaction and telemedicine usability in breast cancer care. Methods Adult breast cancer patients who had a telemedicine visit at a single academic institution (with surgical, radiation, or medical oncology) from 15 June 2020 to 4 September 2020 were surveyed anonymously. Patient and cancer characteristics were collected, and patient satisfaction and telemedicine usability were assessed using a modified Telehealth Usability Questionnaire with a 7-point Likert scale. Associations of satisfaction and usability with patient characteristics were analyzed using Wilcoxon rank-sum and Kruskal–Wallis tests. Results Of 203 patients who agreed to be contacted, 78 responded, yielding a response rate of 38%. The median age of the respondents was 63 years (range 25–83 years). The majority lived in an urban area (61%), were white (92%), and saw a medical oncologist (62%). The median patient satisfaction score was 5.5 (interquartile range [IQR] 4.25–6.25). The median telemedicine usability score was 5.6 (IQR 4.4–6.2). A strong positive correlation was seen between satisfaction and usability, with a Spearman correlation coefficient (ρ) of 0.80 (p

Background and Objectives: Gender-affirming hormone therapy (GAHT) is a key component in the primary care of transgender and gender-nonconforming (TGNC) people. However, physicians are hesitant to initiate GAHT, citing a lack of knowledge. We developed an educational program for medical students and sought to investigate whether medical students’ comfort and familiarity with GAHT could increase after a short interactive program. Methods: Second-year medical students (N=54) at the University of Minnesota were recruited to attend an hour long interactive lecture on GAHT. We calculated mean change in pre- and postintervention 5-point Likert scale scores from a survey assessing comfort and familiarity with key concepts of GAHT to assess the effectiveness of the intervention. Results: Mean response score change increased significantly after the intervention around the use of chosen names (0.4±0.13, P

Platelet α-granules release growth factors (GFs) that promote healing and tissue regeneration. Platelet-rich plasma (PRP) is shown to be beneficial in treating alopecia, and however, clinical response can be inconsistent. Due to several fold enrichment of platelets secreting large quantities of GFs following PRP injections, heterogeneity in amounts of GFs secreted by platelets may contribute to inconsistent clinical responses. Herein, we evaluated factors that could potentially contribute to heterogeneous secretion of GFs by platelets. We measured platelet secretion of transforming growth factor beta1 (TGFβ1), platelet-derived growth factor (PDGF-BB), epidermal growth factor (EGF), vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF2) in aliquots of de-identified PRP samples from female patients undergoing therapy in the hair disease clinic. Although secretion of GFs by platelets was comparable in PRP samples of patients with non-cicatricial and cicatricial alopecia, a Shapiro-Wilk test for normal distribution indicated significant variability across all patient samples. The amount of GF secreted by platelets was comparable when PRP prepared from two FDA-cleared devices with distinct techniques were compared. We provide evidence of platelets secreting heterogeneous amounts of GFs within each sample as high and low secretion of random factors could be simultaneously detected. These results suggest inherent heterogeneity in secretion of GFs by platelets in patient samples that are not influenced by the device used to prepare PRP. Since some GFs could have antagonistic effects on hair growth, a balance between amounts of growth promoting and inhibiting factors may be crucial in determining clinical response to PRP therapy.

BACKGROUND Skin cancer continues to be the most common cancer in the United States. The rise of social media platforms and internet use offers an opportunity to present health information through video-based education. The video "Dear 16-Year-OldMe," addresses the risks associated with tanning and sun exposure, the importance of practicing sun protection, and shares stories from melanoma survivors. OBJECTIVE To evaluate the video "Dear 16-Year-Old Me," as a patient education tool in dermatology clinics and to investigate whether viewing a short educational video can change knowledge about skin cancer risks and intention to improve skin cancer prevention behavior. PATIENTS AND METHODS/MATERIALS AND METHODS/METHODS English-speaking clinic patients between the ages of 14 to 45 years old were recruited. Exclusion criteria include both a personal or family history of skin cancer, dysplastic nevi, or other medical comorbidities. Forty-five participants agreed to participate; 38 were eligible for analysis. RESULTS Comparison of prevideo and postvideo responses demonstrated a statistically significant reduction in participants reporting they were likely to tan outdoors (p-value = .001). A significant increase was observed in the reported likelihood to have a professional skin examination (p-value < .001) or self-examination (p-value < .001) in the future. CONCLUSION and Relevance: Viewing "Dear 16-Year-Old Me," resulted in reported participant changes in intention to tan outdoors and participate in skin surveillance. Although these are encouraging results, future studies with a comparison group are needed to elucidate whether these results correspond to changes in behavior. In the age of viral videos and readily accessible health information via the internet, continued investigation of video media on patient health behaviors should be pursued.

Increased attention towards infection control measures during the COVID-19 pandemic have brought to light the dermatological consequences of intensified hand hygiene measures. Healthcare workers are inherently at an increased risk of developing both allergic and irritant contact dermatitis. Individuals with a history of atopy are especially vulnerable given their impaired native skin barriers and increased sensitivities at baseline. Examination gloves not only induce contact allergies from manufacturing chemicals, but also serve as an occlusive catalyst for facilitating contact sensitization and irritant dermatitis. Similarly, handwashing practices with soap and alcohol-based hand rubs (ABHRs) undermine the natural skin barriers with increasing frequency of use. We highlight clinical pearls for the frontline healthcare worker experiencing COVID-19 surges and offer practical measures to minimize the development of hand-based dermatitis.

Understanding rural and non-rural populations as recipients of dermatologic care and creating a diverse dermatology work force to serve them is no doubt a formidable challenge with high stakes. As you will see in the coming text, rural populations are aging at an alarming rate, less likely to be racially or ethnically diverse, have lower household median incomes, and are more likely to be uninsured. The dermatology workforce at this time is regrettably, mal positioned to care for all rural patients as dermatologists themselves age, migrate to more urban settings, and are more likely to be employed by larger hospital systems. Not only is the density of general dermatologists unfavorable for rural residents, it is less likely that patients will have access to subspecialists within dermatology, including pediatric dermatologists and dermatologic surgeons. Additionally, diversity within the field represents an area for improvement and the intended utilization of non-physician clinicians to fill gaps in care deserves thoughtful consideration.

BACKGROUND Most eyelid defects after Mohs micrographic surgery are referred to oculoplastic surgery or plastic surgery for reconstruction, but growing evidence suggests the safety of such repairs performed by dermatologic surgeons is equivalent if not better. Lateral canthotomy with inferior cantholysis may be used by the dermatologic surgeon to reconstruct larger lower eyelid defects. OBJECTIVE To demonstrate lateral canthotomy with inferior cantholysis performed by the dermatologic surgeon can result in safe, functionally and cosmetically acceptable surgical outcomes. MATERIALS AND METHODS An institutional review board-approved retrospective study of repairs performed by a single dermatologic surgeon between January 2013 and August 2019. Patient demographics, operative and follow-up notes were reviewed. Two cosmetic dermatologists assessed aesthetic results based on final follow-up photographs using a visual analogue scale. RESULTS Eight cases were included in the analysis. Seventy-five percent of patients were men, with a mean age of 74.1 years old. All tumors were basal cell carcinoma; the mean defect size was 2.4 cm2. No serious complications or postoperative interventions occurred. The median cosmetic score was 85.6 ± 11.5. CONCLUSION Dermatologic surgeons can safely perform repairs of lower eyelid defects with lateral canthotomy with inferior cantholysis, achieving satisfactory functional and cosmetic outcomes.

Background Side effects during hyaluronic acid (HA) injection are considered mild and reversible; however, an alarming trend of increased hypersensitivity reactions has recently been reported. Objective The goal of this article is to review the hypersensitivity reactions reported in the literature and, in combination with the authors' experience, to create a classification system to sort the timing and clinical manifestations of these reactions, as well as a treatment schema to manage their clinical course. Methods A literature search using PubMed, Ovid MEDLINE, and Embase databases was performed with no date restrictions. Search terms included "hyaluronic acid and hypersensitivity" and "hyaluronic acid and nodules." Data analyzed included study type, number of subjects, HA filler type, injection location, adverse reaction, timing, treatment, and outcomes. Results Thirty-six studies were identified, documenting hypersensitivity reactions to HA treatment. Twelve cases described events occurring within a week, 6 within a month, and 31 after a month of treatment. Combined with the authors' experience, a new classification system and management of hypersensitivity reactions to HA fillers is proposed of early (up to a week), intermediate (a week to a month), and late (over a month) hypersensitivity reactions. Conclusion The classification system proposed provides objective measurements and management options that can be helpful for physicians to navigate these hypersensitivity reactions and design treatment protocols that provide the best clinical outcomes for their patients.

Introduction: Fractional lasers and microneedling devices are increasingly used with topical drugs to treat various conditions, including alopecia, as they grant access to dermal structures such as hair follicles and cutaneous vasculature. Objective: To perform a comprehensive review on transcutaneous drug delivery for the management of alopecia. Methods: PubMed, Embase, and Ovid Medline databases were searched using terms including: alopecia, microneedling, lasers, androgenetic alopecia (AGA), alopecia areata (AA), drug delivery. Articles were examined for inclusion criteria: diagnosis of alopecia regardless of type, use of fractional laser or microneedling devices, and subsequent administration of topical medication. Results: 8 studies, 6 prospective clinical trials and 2 case series, examining either AA or AGA were identified. For AA, five studies examined microneedling together with topical triamcinolone in three of these, while two studies used photodynamic therapy. Regarding AGA, two studies used topical minoxidil plus microneedling, and one examined topical finasteride with fractional erbium glass laser. Improvement was seen in 6 of the 8 studies. Discussion: Transcutaneous drug delivery via fractional laser and microneedling is a promising modality with preliminary evidence for increased hair regrowth over topical therapy alone. Further studies are needed to elucidate treatment parameters and appropriate device selection for drug delivery.

The market for home-use photobiomodulation devices to treat androgenetic alopecia has rapidly expanded, and the Food and Drug Administration (FDA) has recently cleared many devices for this purpose. Patients increasingly seek the advice of dermatologists regarding the safety and efficacy of these hair loss treatments. The purpose of this guide was threefold: (1) to identify all home-use photobiomodulation therapy devices with FDA-clearance for treatment of androgenetic alopecia; (2) to review device design, features and existing clinical evidence; and (3) to discuss practical considerations of photobiomodulation therapy, including patient suitability, treatment goals, safety, and device selection. A search of the FDA 510(k) Premarket Notification database was conducted using product code "OAP" to identify all home-use devices that are FDA-cleared to treat androgenetic alopecia. Thirteen commercially available devices were identified and compared. Devices varied in shape, wavelength, light sources, technical features, price, and level of clinical evidence. To date, there are no head-to-head studies comparing the efficacy of these devices. Photobiomodulation therapy devices have an excellent safety profile and mounting evidence supporting their efficacy. However, long-term, high quality studies comparing these devices in diverse populations are lacking. As these devices become increasingly popular, dermatologists should be familiar with this treatment modality to add to their therapeutic armamentarium.AGA, androgenetic alopecia; FDA, Food and Drug Administration; IEC, International Electrotechnical Commission; LED, light-emitting diode; PBMT, photobiomodulation therapy.

Objective: The novel coronavirus 2019 (COVID-19) pandemic led to a shortage of personal protective equipment (PPE) early in the pandemic. Healthcare systems asked for public donations of PPE and established community drop-off sites. Herein, we aim to profile community PPE donors at one large academic medical center including evaluation of donor industry, public messaging, and psychosocial aspects of donation.Methods: A survey was created and distributed to donors at two urban PPE drop-off sites between March and April 2020. Targeted donors and drop-off sites were located in the Twin Cities metropolitan area (approximate population of 3.5 million people).Results: A total of 486 surveys were completed. Nearly half (47.3%) of PPE donated was initially intended for personal use. Donors primarily learned of PPE collection efforts through word of mouth (23.2%) and social media (22.7%). The most frequently reported barrier to donation included distance between donors and drop off sites or location (27.8%). Donors rated the severity of the PPE shortage in the state as a 7.8 ± 1.7 out of 10. There was a slight correlation between donors assessment of COVID-19 severity and feeling that their donation was a meaningful contribution against COVID-19 (r = 0.21, p = .00).Conclusions: Future community collection campaigns during widespread disasters should prioritize mobilizing privately held goods from individuals rather than small businesses. Public messaging around donation should utilize simple narratives that are easily shareable via social media and evoke donation as a means of building community.

The follicular presentation of psoriasis is a well-described but uncommon variant. In some cases, follicular psoriasis may clinically and histopathologically mimic pityriasis rubra pilaris. There are several reports discussing the resemblance of widespread follicular psoriasis in children to pityriasis rubra pilaris. We describe a case of follicular psoriasis in a 16-year-old black girl with acrally distributed follicular hyperkeratotic papules with associated keratoderma of her plantar surfaces resembling pityriasis rubra pilaris.

Acquired partial lipodystrophy (APL), also known as Barraquer-Simons syndrome, is a rare disorder characterized by progressive fat loss in the upper body. Use of poly-L-lactic acid and hyaluronic acid (HA) fillers for the treatment of APL is neither approved by the Food and Drug Administration nor described in the literature. Herein, we describe a case of APL that achieved significant improvement in facial volume following treatment with combination poly-L-lactic acid and HA fillers.

Pulsed dye laser (PDL) is an effective treatment option for erythematotelangiectatic rosacea. The use of a test spot allows patients to experience the procedure on a small area prior to further treatment. The purpose of this study was to elucidate whether the use of a no charge test spot influenced return rates for further PDL treatment. Data were obtained retrospectively using International Classification of Diseases (ICD)-10 codes for rosacea. Sixty charts were identified: 26 patients initially received a PDL test area free of charge, whereas 34 patients initially underwent full PDL treatment. Patients who experienced the test spot laser treatment had a lower return rate compared to those that directly underwent full PDL treatment. However, this difference was not statistically significant (Fisher's exact test p = 0.2883). Future studies evaluating and identifying factors that influence PDL return rates are needed. Abbreviations: ETR: Erythematotelangiectatic rosacea; PDL: pulsed dye laser; ICD: International classification of diseases.

Since the initial Food and Drug Administration clearance of the first photobiomodulation device for androgenetic alopecia in 2007, the market for these devices has rapidly expanded. Sixteen unique devices are currently available to consumers with varying designs, treatment durations and frequency. While the precise mechanism for hair growth stimulation remains to be elucidated, current evidence suggests the laser light alters hair cycle duration to promote the anagen growth phase. Photobiomodulation devices have an excellent safety profile with pruritus and skin dryness reported to be the most common side effects. Overall, research has demonstrated clinical efficacy of these devices, including randomized controlled studies. As photobiomodulation continues to emerge as a treatment modality for androgenetic alopecia, additional information on the most effective light sources, precise light wavelength, treatment schedule, and effectiveness on various hair diseases is still needed.

Highlights • Purulent drainage, woody induration and sinus tract formation suggest mycetoma. • Phaeohyphomycosis management may require debridement and prolonged antifungal therapy. • Microbiological identification is needed for optimal medical management., A 26-year old woman presented for evaluation of extensive edema, erythema, sinus tract formation and purulent drainage from the left lower extremity after trauma from a wooden object approximately three months prior. Skin biopsies and blood cultures revealed Phaeoacremonium parasiticum consistent with a diagnosis of phaeohyphomycosis. Despite hospitalization and initial treatment with several antifungals, including voriconazole, her infection progressed. Surgical debridement with split thickness skin grafting was performed. Subsequent clinical improvement allowed a transition from intravenous to oral voriconazole and discharge home. Seven months post presentation she remained on oral voriconazole with significant improvement and no clinical evidence of recurrence. This case illustrates an approach to management where aggressive debridement with split-thickness skin grafting and a prolonged course of intravenous and oral antifungals resulted in a good long-term outcome for the patient.

Many Healthcare institutions face continued challenges related to electronic medical record use (EMR). Within this viewpoint article, we seek to share with our dermatology colleagues our institutional experience on the creation of standardized dermatology records. In our experience, key elements are needed to implement a standardized record, including faculty buy-in, reconciliation with dictation, selection of a leader, and design of the standardized record template. Creation of a standardized record should not only account for the clinic but also patient handouts and support staff templates. We have obtained preliminary evidence that the use of an EMR template not only reduces the cost of dictation but also improves documentation. In addition, we have not seen evidence of over documentation. However, more studies are needed to understanding how a standardized EMR impacts billing, coding, teaching and overall, patient care.

Objectives. We studied the impact of clean indoor air law exemptions and preemption policies on the prevalence of a tobacco-specific lung carcinogen—4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)—among nonsmoking bar and restaurant workers. Methods.secondhand smoke were compared with results from participants who were exposed to it. Results. Participants exposed to workplace secondhand smoke were more likely to have any detectable level of NNAL (P=.005) and higher mean levels of NNAL (P < .001) compared with nonexposed participants. Increased levels of NNAL were also associated with hours of a single workplace exposure (P=.005). Conclusions. Nonsmoking employees left unprotected from workplace secondhand smoke exposure had elevated levels of a tobacco-specific carcinogen in their bodies. All workers—including bar and restaurant workers—should be protected from indoor workplace exposure to cancer-causing secondhand smoke.

Botulinum toxin has been used to treat plantar blistering and pain in 7 epidermolysis bullosa simplex patients, including one child, with excellent but transient success (Table I). Most of these patients were treated with abobotulinumtoxinA, including the indexed pediatric patient. We recently investigated the use of onabotulinumtoxinA to treat epidermolysis bullosa simplex (EBS) symptoms in a pediatric patient, making this successful treatment unusual. Dose equivalence ranging from 2:1 to 4:1 abobotulinumtoxinA to onabotulinumtoxinA, respectively, has been suggested for the treatment of glabellar wrinkles and axillary hyperhidrosis, but further evidence is needed to determine the appropriate dose for management of EBS symptoms in both pediatric and adult patients.3 Additionally, the relative importance of the toxin's role in hyperhidrosis reduction and on local neurotransmitter release in neuropathic pathways deserves exploration. Table I Reported cases of EBS symptoms treated with botulinum toxin Case report A 6-year-old African-American boy with a history of EBS presented with painful blisters on the plantar aspect of both feet. The hyperhidrosis was fairly well controlled during the winter months with glycopyrrolate, 1 mg daily. However, he noted continued exacerbations of plantar blistering, hyperhidrosis, tenderness, and malodor with warmer temperatures. Given the recalcitrance to other interventions and after informed consent, the patient was administered 50 U of onabotulinumtoxinA in 4 mL preserved normal saline under general anesthesia in the operating room in January 2013. Injections were intradermal and placed 1.5 to 2 cm apart, 1 U per site on the weight-bearing areas of the plantar surface: sole, ball, and heel of each foot, excluding the arch. A second onabotulinumtoxinA treatment of 100 U, 2 U per site, was given 4 months after the first administration. The patient tolerated both procedures well without complication He experienced decreased pain, bullae, malodor, and less hyperhidrosis, first noted approximately 2 weeks after each treatment. The patient continued to have baseline pain along the plantar surface of his feet, especially with increased physical activity. However, overall pain was decreased, which was attributed to fewer and smaller bullae. The patient's symptoms were noted to recur approximately 3 months after each onabotulinumtoxinA injection. He received 2 further treatments using the same dosing regimen and denied any additional side effects. Of note, he is able to stay involved with sports activities, including football, in the summer and fall because of his improvement.

Background and Purpose. Research has documented the feasibility and benefit of treadmill training in children with cerebral palsy and Down syndrome. The purposes of this case report are: (1) to determine the feasibility of treadmill training in an infant at high risk for neuromotor dysfunction and (2) to describe the child's treadmill stepping patterns following treadmill training. Case Description. The male infant, who had a grade III intraventricular hemorrhage following premature birth, began physical therapy and treadmill training at 5¼ months corrected age. Treadmill training was conducted 3 times weekly and videotaped weekly. Videotape analysis determined number of steps, step type, and foot position. Outcomes. Except for foot position, trends in treadmill stepping were similar to those of studies with infants not at high risk for neuromotor disabilities. Discussion. This case report shows that treadmill training is feasible for an infant at high risk for neuromotor disabilities and may be associated with more mature stepping characteristics. Future research should evaluate optimum treadmill training parameters and long-term developmental outcomes.