Mobile Teledermatology Shows Potential for HIV Patients

Welcome back to my general dermatology blog. My name is Sudhir Polisetty and I write this blog to help others stay abreast of interesting dermatology research and headlines. Today’s blog concerns a new study appearing in JAMA Dermatology about the potential to improve access to care for HIV-positive patients.

Face-to-face evaluations by a board certified dermatologist is the golden standard of dermatology, so little research is available on the effectiveness of mobile teledermatology. The study’s authors note that few have investigated this format’s reliability and validity while none, to the researchers’ knowledge, have used the technology in sub-Saharan Africa among HIV-positive patients. They hoped this study would provide a better understanding of whether mobile teledermatology would produce valid assessments when measured against face-to-face consultations.

The cross-sectional study in Gaborone, Botswana, evaluated 76 HIV-positive patients aged 18 years and older. Each of these patients had a skin or mucosal condition that had not been previously evaluated by a dermatologist.” To make accurate comparisons, researchers began by having patients evaluated in person by a board certified dermatologist. Next, their vitals and photos taken with a 5-megapixel camera were collected and transmitted via mobile phone to a password-protected website. A team of three dermatologists and one oral medicine specialist were then tasked with providing a diagnosis based only on the info collected remotely. Researchers also assessed test-retest reliability by asking the same specialists to make recommendations a few months later without looking at their previous comments.

Specialists agreed with their initial primary diagnoses between 52 and 80 percent of the time. Agreement between primary diagnoses from face-to-face evaluations and mobile teledermatology ranged from 47 to 57 percent while agreement on how to treat the primary diagnosis ranged from 32 and 51 percent. Researchers concluded that much work is still left to be done in order to optimize and validate the use of teledermatology on a large scale.

Learn more about the study in this write-up from Healio Dermatology: http://www.healio.com/infectious-disease/dermatology/news/online/%7B7a32becd-9f87-4ea0-b93c-54636a512e57%7D/mobile-teledermatology-shows-potential-for-hiv-patients

Thanks for reading,
Sudhir Polisetty

You can learn more about me on my Zerply profile, or on the US News & World Report: http://health.usnews.com/doctors/sudhir-polisetty-696608

Lure of Cosmetic Procedures Compounds Dermatologist Shortage

Welcome back to my general dermatology blog. My name is Sudhir Polisetty and I am a dermatologist with The Dermatology Center in New Albany, Indiana. This week’s blog focuses on a major story concerning the future of dermatology, a shortage of general dermatologists.

As the Star Tribune explains, the popularity of higher paying cosmetic procedures such as Botox, lip augmentation, and chemical peels is causing many medical students to shy away from general dermatology. Minnesota has 4.3 dermatologists for every 100,000 residents and the state’s medical school only graduates five dermatologists each year. Those who do graduate devote much of their time to practicing the cosmetic procedures mentioned above instead of lower-paying procedures for identifying and treating melanoma, psoriasis, and a host of other skin conditions. The shortage in dermatologists is already leading to delays in diagnosis and treatment of conditions such as skin cancer according to a few of the physicians interviewed in the article.

One reason for the disparity could be the rise in salaries for dermatologists since 1995, with cosmetic dermatologists seeing a much larger jump than general dermatologists. This has caused many dermatologists to devote their time to cosmetic procedures. In the Twin Cities alone, cosmetic dermatology accounts for between 20 and 40 percent of the average dermatologist’s schedule.

Unfortunately the need for general dermatologists will only increase in the years ahead. The threat of skin cancer continues to grow, with the latest estimates being that one in every 50 Americans will develop melanoma during their lifetimes. Skin cancer rates are also rising, with more and more Americans relying on tanning beds and long exposure to the sun to improve their appearance.

Fortunately there are many reasons to specialize in general dermatology. Dermatologists do not have advertising costs like cosmetic dermatologists do and as mentioned earlier, demand for their services will continue to go up in the years ahead.

Thanks for reading,

Sudhir Polisetty

Learn more about me on my about.me page, or view other interesting dermatology articles by following me on Pinterest: www.pinterest.com/sudhirpolisetty/‎

FDA Warns of Wart Removers Catching Fire

Some freeze-away wart treatments pose fire hazard.

Hello again and welcome back to my dermatology blog. A recent consumer report has shown some concern about the safety of in-home wart removal products, which are proving to be quite flammable.

Warts are the result of human papillomavirus (HPV) and are very common. They are usually small and blister-like, resemble a cauliflower, and are most commonly found on the hands or feet. While they may disappear on their own, some may linger and require treatment. There are many over the counter products available that can aid in wart removal including creams, tapes, injections, and more. If in-home treatments do not work, many turn to other procedures with guaranteed results. Cryosurgery is very common and involves freezing the wart with liquid nitrogen. Today, there is more HPV awareness than ever before. Vaccines such as Gardasil are available and are used to prevent many of the most common types of HPV.

Recently, the FDA put out a warning about wart freezing products catching fire during in-home use. Since 2009, there have been 14 reports about cryogenic wart removers catching fire and causing blisters or burns to the skin. The products available for in-home use are very similar to what you would receive at a dermatologist’s office, minus the controlled environment and skilled professional administering the treatment. While the label comes with a clear warning cautioning users to its flammability, FDA nurse consultant Karen Nast, RN, is worried that people may not be aware of how little it takes to ignite these products. She claims that while flames and cigarettes are the obvious threat, curling and straightening irons can be enough to send the product up in flames.

Since wart treatment is generally inexpensive, I encourage you to consider treatments performed in your doctor's office, or at least consulting with your dermatologist before taking action on your own.

Learn more about affected brands in the FDA’s official statement: http://www.fda.gov/forconsumers/consumerupdates/ucm381429.htm

Thanks for reading!
Sudhir Polisetty

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Tips for Dry Winter Skin

Welcome back to my blog. My name is Sudhir Polisetty and I am a dermatologist at The Dermatology Center in New Albany, Indiana. With record breaking cold temperatures and wind chills sweeping the country last week, I got a lot of questions about dry winter skin. It’s common for skin to dry out during the winter and this can lead to itching, cracking, flaking, and bleeding in certain cases. Fortunately the USNews and World Report recently shared a few tips for preventing and treating dry skin.

Avoid Long, Hot Showers

One tempting way to escape cold weather is to relax in a long, scalding hot shower. As Dr. Stephen Stone of the American Academy of Dermatology notes, “Being in the water for a long time and using hot water can be extremely drying to the skin.” Keep skin from drying by making efforts to take shorter showers using only warm water.

Consider Skin Cream

Applying a skin cleanser following a shower might help reduce itching while moisturizer, ointments, and creams are also shown to be more effective than skin lotion. Instead of rubbing skin cream, which can cause irritation, gently pat the cream onto your skin.

Know Your Skin Care Products

If you use soap, deodorant, or products that contain fragrances, these products will often cause irritation if your skin is already dry. Evaluate the ingredients of any skin care products you use to make sure that product is not exacerbating the problem.

Use Proper Hand Washing Techniques

Washing hands too frequently during winter can dry out the skin, so consider alternating between a washing hands and using hand sanitizer. Additionally, get into the habit of applying moisturizer or hand cream after washing hands.

If dry skin continues to be an issue, make an appointment with your dermatologist. He or she will be able to prescribe stronger ointment or diagnose underlying health conditions, such as eczema.

Thanks for reading,

Sudhir Polisetty

Learn more about me on my MD.com profile, or read more of my dermatology blog posts on Wordpress: http://sudhirpolisetty.wordpress.com/blog/

Most Dermatology Residency Programs Offered Cosmetic Training

Welcome back to my blog. My name is Sudhir Polisetty and I am a dermatologist practicing in New Albany, Indiana. Although I do not address cosmetic dermatological procedures, I recognize that it is a very important dermatology specialty. According to a new article in JAMA Dermatology, cosmetic dermatological surgical training is offered by most dermatology residency programs in the United States.

Researchers conducted the study by e-mailing a survey to 114 American dermatology residency program directors (PDs). The primary goal of the survey was to determine which resources are available for cosmetic dermatology training in the United States, though it also sought to gauge overall PD attitudes towards cosmetic dermatology training during residency. Other questions focused on strategies that training programs used to overcome all barriers seen in resident-performed cosmetic dermatology procedures, such as discounted prices.

46 percent of the contacted group responded to the survey (53 PDs). According to the results, all but three programs (94%) provided cosmetic dermatology training using botulinum toxin while 47 of the 53 (89%) offered training with hyaluronic acid fillers. 60 percent of the surveyed programs offered discount pricing for some cosmetic procedures, with the most frequently discounted procedures being:

• Botulinum toxin (94% discounted)
• Hyaluronic acid fillers (84%)
• Vascular lasers (53%)
• Hair removal lasers (38%)

When asked for their general attitudes on cosmetic dermatology training in residency programs, 38 percent of respondents believed it should be necessary. 17 percent of respondents believed it was appropriate for residents to gain hands-on training with cosmetic dermatology procedures while only 27 percent said residents should not be required to perform any cosmetic procedures.

The researchers concluded that while most programs offer hands-on cosmetic dermatology training, there are several barriers to training. They believed procedural competency is imperative to ensure patient safety. Ideally I would like to see a survey with a higher response rate, as 53 PDs is a small sample size.

You can learn more about the survey and its findings on Healio: http://www.healio.com/dermatology/aesthetic-cosmetic-surgery/news/online/%7B0325e9df-5b1b-4bce-a29e-e78df23dacde%7D/most-dermatology-residency-programs-offered-cosmetic-training

Thanks for reading,

Sudhir Polisetty

Learn more about me on my about.me page, or by viewing my MD.com profile: http://sudhirpolisetty.md.com/

Mobile Dermatology Apps Offer Benefits and Drawbacks

There are currently more than 200 dermatology apps, which offer
benefits and drawbacks for patients and dermatologists alike.

Welcome back to my blog. The purpose of this blog has been to shine a light on interesting development and trends in the world of general dermatology so that patients and healthcare providers alike are better informed. When treating patients at The Dermatology Center in New Albany, Indiana, I have recently noticed patients using dermatology related mobile apps. A new report in JAMA Dermatology uncovered more than 200 dermatology apps, with half of them created for non-doctors. These apps offer benefits and drawbacks when it comes to addressing dermatology issues.

Popular dermatology related mobile apps include sunscreen recommendation guides, mole photo storage apps, and other tools to aid in the prevention and diagnosis of melanoma. Researchers divided the 229 dermatology-related apps into the following categories:

• General dermatology reference (26.6%)
• Self-surveillance/diagnosis (17.9%)
• Disease guides (17%)
• Educational aids (8.7%)
• Sunscreen/UV recommendations (8.3%)
• Calculators (5.2%)
• Teledermatology (3.5%)

These categories represented less than 3% of the apps available in the marketplace: conference, journal, photograph storage/sharing, dermoscopy, pathology, and other. Researchers broke the 229 apps down into 209 unique apps and another 17 versions of existing apps on other operating systems. More than half of these apps are offered free of charge (51.1%) with the most expensive app costing $139.99. The identified target audiences were:

• Patients (51.1%)
• Health care providers (41%)
• Both (7.9%)

While these apps increase access to medical knowledge, the study’s senior author, Dr. Robert Dellavelle, is concerned that people are getting the wrong information. He added that very few of these apps are clearly made by medical professional and that patients and doctors should maintain a healthy sense of skepticism when using these apps; especially ones that claim to help spot conditions such as skin cancer. Misinformation on these apps could delay a real diagnosis and jeopardize patient health. Ideally, these apps should not be used in place of visiting a dermatologist but patients should instead consult with a doctor before using the app’s data to make treatment decisions.

You can learn more about this study here: http://www.reuters.com/article/2013/09/26/us-health-dermatology-app-risk-idUSBRE98P0KN20130926

Thank you for reading,

Sudhir Polisetty

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Sunscreen Recommendation Rates Low

Welcome back to my general dermatology blog. I have written in past blog posts about skin care and the benefits of regular sunscreen usage, so a recent article on new sunscreen research caught my eye. According to findings published in the September 4^th issue of JAMADermatology, physicians discussed sunscreen rates with patients during less than 1% of visits.

Researchers at the University of Wake Forest conducted their study on trends in sunscreen recommendations among physicians after recognizing that sunscreen might not be recommended as often as guidelines dictate. They worked with the National Ambulatory Medical Care Survey to identify patient visits to non-federal outpatient physician offices at American ambulatory care practices during which the physician recommended sunscreen. The data covered patient visits between January 1, 1989 and December 26, 2010.

The National Ambulatory Medical Care Survey reported an estimated 18.30 billion patient visits nationwide during the survey time frame. Physicians mentioned sunscreen during 12.83 million patient visits, which amounts to just 0.07% of all visits, although mention of sunscreen was reported for 0.9% of patients visits in which a patient was diagnosed with skin disease. Dermatologists fared a little better, mentioning sunscreen during 1.6% of dermatology visits while being responsible for 86.4% of all sunscreen mentions in the survey time frame. The researchers also found that sunscreen was recommended most frequently to patients aged 80 or older and to white patients, while children were the least likely to receive this recommendation.

Researchers concluded that sunscreen mentions during patient visits are still too low, even with patients who have a history of skin disease. They also suggested that high incidence and morbidity of skin cancer can be greatly reduced if patients exercise sun-protective behaviors, but it is up to physicians and dermatologists to make sure patients are properly educated on these behaviors.

Find out more about the study’s findings here: http://dermatologytimes.modernmedicine.com/dermatology-times/news/sunscreen-recommendation-rates-low?contextCategoryId=116

Thank you for reading,

Sudhir Polisetty 

Learn more about me on my Weebly page or learn about other dermatology news that interests me on Pinterest: http://pinterest.com/sudhirpolisetty/