The Impact of COVID-19 on Teledermatology

The accelerated implementation and use of teledermatology during COVID-19 has been met with successes and challenges. This review explores first, how telemedicine was utilized in dermatology prior to the pandemic, the regulatory adaptions made in response to the pandemic and the effectiveness of the rapid implementation of teledermatology during COVID-19, and finally, how teledermatology has expanded in response to the pandemic. In sum, this review examines lessons learned, how teledermatology’s reliance on digital technologies might paradoxically exacerbate healthcare disparities, and considers the future outlook. Prior to COVID-19, teledermatology was limited due to decreased insurance reimbursement for telemedicine visits, concern about liabilities, and licensing restrictions. COVID-19 prompted regulatory and policy changes, with corresponding new telemedicine growth and innovation; health systems created and adapted protocols to continue care, save personal protective equipment, and decrease unnecessary exposures. Teledermatology has been conducive to COVID-19 constraints, but limitations focus on access; dependence on telemedicine may actually worsen access to care for many patients who lack digital access. Expansion of telemedicine reimbursements favored synchronous video visits rather than store-and-forward teledermatology, which may be a missed opportunity for more efficient delivery of care. Policy changes established during COVID-19, though possibly temporary, have nevertheless set new precedents that will surely have long-term impacts on teledermatology use post-pandemic

The spectrum of COVID-19-associated dermatologic manifestations: an international registry of 716 patients from 31 countries

BACKGROUND: Coronavirus disease 2019 (COVID-19) has associated cutaneous manifestations. OBJECTIVE: To characterize the diversity of cutaneous manifestations of COVID-19, and facilitate understanding of underlying pathophysiology. METHODS: Case series from an international registry from the American Academy of Dermatology and International League of Dermatological Societies. RESULTS: The registry collected 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19. Of the 171 patients in the registry with laboratory-confirmed COVID-19, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were common in patients with mild disease, while retiform purpura presented exclusively in ill, hospitalized patients. LIMITATIONS: We cannot estimate incidence or prevalence. Confirmation bias is possible. CONCLUSION: This study highlights the array of cutaneous manifestations associated with COVID-19. Many morphologies were non-specific, while others may provide insight into potential immune or inflammatory pathways in COVID-19 pathophysiology

Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases

BACKGROUND: Cutaneous reactions after messenger RNA (mRNA)-based COVID-19 vaccines have been reported but are not well characterized. OBJECTIVE: To evaluate the morphology and timing of cutaneous reactions after mRNA COVID-19 vaccines. METHODS: A provider-facing registry-based study collected cases of cutaneous manifestations after COVID-19 vaccination. RESULTS: From December 2020 to February 2021, we recorded 414 cutaneous reactions to mRNA COVID-19 vaccines from Moderna (83%) and Pfizer (17%). Delayed large local reactions were most common, followed by local injection site reactions, urticarial eruptions, and morbilliform eruptions. Forty-three percent of patients with first-dose reactions experienced second-dose recurrence. Additional less common reactions included pernio/chilblains, cosmetic filler reactions, zoster, herpes simplex flares, and pityriasis rosea-like reactions. LIMITATIONS: Registry analysis does not measure incidence. Morphologic misclassification is possible. CONCLUSIONS: We report a spectrum of cutaneous reactions after mRNA COVID-19 vaccines. We observed some dermatologic reactions to Moderna and Pfizer vaccines that mimicked SARS-CoV-2 infection itself, such as pernio/chilblains. Most patients with first-dose reactions did not have a second-dose reaction and serious adverse events did not develop in any of the patients in the registry after the first or second dose. Our data support that cutaneous reactions to COVID-19 vaccination are generally minor and self-limited, and should not discourage vaccination

Practice Guidelines for Teledermatology

Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140294/1/tmj.2016.0137.pd

Variable potential for social media platforms in raising skin cancer awareness

Social media plays an important role in public health outreach, given its ability to connect virtual communities. Examples include campaigns for smoking cessation, breast cancer awareness, and emergency relief [1]. Few studies have investigated the utility of social media in skin cancer awareness, though the potential has been demonstrated [2]. We sought to evaluate current differential social media platform use in skin cancer awareness

Impact factor of major dermatology journals and the increasing influence of dermatology in the house of medicine.

Background: Journal impact factor (JIF) is a bibliometric proxy of relative journal importance. Mean dermatology JIF has nearly doubled since 1997. The reasons behind the increase have not been previously explored. Objective: To assess factors contributing to rising dermatology JIF. Methods: This bibliometric study utilized publicly-available citation and JIF data from the Thomson-Reuters InCites Journal Citation Reports "Dermatology and Venereology" category, from 1997-2017. Results: From 1997-2017, aggregate dermatology JIF increased by 70%, associated with a 64% increase in JIF numerator (total journal citations) and a 3% decrease in JIF denominator (total journal articles and reviews). In the four highest-JIF journals (JAAD, JAMA Dermatology/Archives of Dermatology, JID, and BJD), there was an increase in citations coming from non-dermatology specialty journals, including oncology, rheumatology, and multidisciplinary sciences. Journal impact factor was positively correlated with five JIF alternatives. Immediacy Index, a reflection of how fast dermatology journals are cited, increased four-fold (P<0.001). Limitations: Impact factor numerator/denominator data were not available before 1999. Conclusions: The nearly two-fold rise in dermatology JIF from 1997-2017 was associated with increased citations, an increasing proportion of which came from non-dermatology journals. This may reflect growing influence of dermatology research within both dermatology and other fields of medicine

Impact of, Factors for the Success of, and Concerns Regarding Transplant Patients’ Skin Cancer Campaigns: Observational Study

BackgroundDue to rising health care costs, patients have sought alternative ways of addressing medical expenses. In particular, transplant patients have complex and expensive medical needs—including skin cancer surveillance—that may not be fully covered by insurance. One such method of financing medical costs is by crowdsourcing through web-based platforms, most notably GoFundMe. ObjectivePrevious work identified factors associated with GoFundMe campaigns’ fundraising success for dermatologic diseases. We sought to characterize these factors in transplant recipients’ campaigns for funds raised for covering skin cancer–related costs. These factors include demographics, campaign traits, and subjective themes. MethodsFrom January to April 2022, we analyzed GoFundMe campaigns using the following search terms chosen on the basis of author consensus: “transplant skin cancer,” “transplant basal cell,” “transplant squamous,” “transplant melanoma,” and “dermatologist transplant.” Demographic data were coded from campaign text or subjectively coded based on author consensus. Campaigns were read completely by 2 independent coders and associated with up to 3 different themes. Linear regression was performed to examine the qualities associated with success, which was defined as funds raised when controlling for campaign goals. Logistic regression was used to examine qualities associated with extremely successful campaigns, defined as those raising funds over 1.5 times the IQR. ResultsAcross 82 campaigns, we identified several factors that were associated with fundraiser success. Patients who experienced complications during infectious disease treatment, those who received a pancreas transplant, or those who died from their disease raised significantly more money. Patients older than 61 years raised significantly less money. Extremely successful campaigns (>US $20,177) were associated with campaigners who emphasized a disability from their disease, those who were reluctant to ask for help, or those who died due to their disease. ConclusionsDemographic and thematic factors are associated with transplant patients’ skin cancer–related fundraising success, favoring those who are younger, in more extreme situations, and appear reluctant to ask for help; these findings are consistent with those of previous studies. Additionally, transplant patients have complex and expensive dermatologic needs that may not be fully covered by insurance, as reflected in their GoFundMe campaigns. The most commonly mentioned reasons for fundraising included living expenses or loss of income, inadequate or no insurance, and end-of-life costs. Our findings may inform transplant patients how to maximize the success of their campaigns and highlight gaps in health care coverage for skin cancer–related costs. Limitations include the possibility for misclassification due to the data abstraction process and limiting data collection to fundraisers available on GoFundMe while excluding those on other websites. Further research should investigate the ethical implications of crowdfunding, financial needs of this patient population, and potential ways to improve access to routine skin cancer surveillance among patients receiving transplants