7 research outputs found
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Does it match? Analyzing self-reported online dermatology match data to Charting Outcomes in the Match
Dermatology is arguably the most competitive residency (81.6% match rate for United States allopathic seniors) with significantly more applicants than available positions. To objectify this process, the National Residency Match Program (NRMP) has produced bi-annual Charting Outcomes in Match (COM) datasets, which aggregate data from the prior two application cycles and tabulate statistics to aid applicants. In parallel, online forums provide medical trainees with vast amounts of information, including residency application insights. Reddit medical school subforum compiles annual spreadsheets of anonymous, individualized applicant data to aid future applicants. We compared this data to NRMP data to show that although the data means are similar (e.g. Step 1), the Reddit dermatology spreadsheet collects more data and the individualized nature aids applicants in a personalized way unlike the mean aggregate data in NRMP. Under univariate analysis, Alpha Omega Alpha status, overall publications, and dermatology-specific publications are associated with interview invitation rates. Although limitations of the study include small data size and reporting bias, this is the first of its kind to our knowledge to compare these two often-used tools to aid dermatology applicants. Future endeavors should expand anonymous data reporting and use the data to carry out more extensive studies to investigate factors influencing the application process
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What are the ethical and legal considerations when your patient refuses the standard of care?
In medical practice, physicians are sometimes faced with patients who reject the gold-standard treatment for a condition. In this hypothetical clinical scenario, we present the case of a patient who refuses Mohs micrographic surgery for management of infiltrative basal cell carcinoma and instead requests off-label therapy with imiquimod. We discuss the treating dermatologist's options in response to this patient's request and the ethical considerations surrounding the case. We conclude that the physician has the right to refuse to provide treatment that deviates from standard clinical practice but that the physician should counsel the patient on all options, provide thorough informed consent, offer contact information for the patient to pursue a second opinion or a radiation oncology referral, and ensure safe transfer of care should the patient desire treatment with a different provider
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Brown-gray hyperpigmentation in a photosensitive distribution after levofloxacin exposure
Photosensitive drug reactions resulting in hyperpigmentation occur when there is an accumulation in the skin of melanin, heavy metals, or the drug itself. Herein we describe an immunocompromised orthotopic liver transplant patient with levofloxacin-induced hyperpigmentation with iron deposition. To identify the causal agent, consideration was given to medications the patient had taken long-term, as well as medications introduced more recently before the event. Levofloxacin and posaconzole emerged as the most likely culprit drugs, neither of which have a strong history in the literature of being associated with photosensitive hyperpigmentation. Levofloxacin was determined to be the culprit drug when the hyperpigmentation gradually resolved several weeks after discontinuation of levofloxacin, with continuation of posaconazole and all other long-term medications. This case highlights the challenges in identifying the causal agent in photosensitive drug reactions when patients are taking multiple medications. Key clinical data can be very helpful in making an assessment
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Brown-gray hyperpigmentation in a photosensitive distribution after levofloxacin exposure
Photosensitive drug reactions resulting in hyperpigmentation occur when there is an accumulation in the skin of melanin, heavy metals, or the drug itself. Herein we describe an immunocompromised orthotopic liver transplant patient with levofloxacin-induced hyperpigmentation with iron deposition. To identify the causal agent, consideration was given to medications the patient had taken long-term, as well as medications introduced more recently before the event. Levofloxacin and posaconzole emerged as the most likely culprit drugs, neither of which have a strong history in the literature of being associated with photosensitive hyperpigmentation. Levofloxacin was determined to be the culprit drug when the hyperpigmentation gradually resolved several weeks after discontinuation of levofloxacin, with continuation of posaconazole and all other long-term medications. This case highlights the challenges in identifying the causal agent in photosensitive drug reactions when patients are taking multiple medications. Key clinical data can be very helpful in making an assessment
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A toxic epidermal necrolysis-like presentation of linear IgA bullous dermatosis treated with dapsone
Linear IgA bullous dermatosis is a rare autoimmune vesiculobullous disease characterized by linear deposition of IgA along the basement membrane zone. It is classically idiopathic, but may also arise secondary to drug exposure. A heterogeneous spectrum of clinical features has been described, including a rare, morbid variant mimicking toxic epidermal necrolysis. Herein, we present a case of vancomycin-induced linear IgA bullous dermatosis that manifested clinically as toxic epidermal necrolysis and resolved with dapsone therapy