Can a Correct Diagnosis Be Established Using the Teledermatology Method?

Teledermatology is a remote method of diagnosis, treatment, and follow-up of the patient with visual communication technologies. It has been a research subject for many years, but its reliabili-ty has not been fully explained. With the emergence of the coronavirus disease-19 (COVID-19) pandemic in 2019, the need for teledermatolo-gy increased. This study aimed to evaluate the reliability of telederma-tology. Material and Method: A total of 595 lesions of 546 patients who visited the dermatology outpatient clinic were included in the study. Two physicians evaluated the patients, one face-to-face and the other via multimedia messaging, and the diagnoses were compared with each other. Diagnoses were in total agreement if the first diagnoses were the same, in partial agreement if the second and third diagno-ses were the same, and in no agreement if all diagnoses differed. The first diagnoses of Physicians 1 and 2 matched in 468 (total agreement rate: 76.8%) patients, and the second and third diagnoses matched in 44 and 8 patients, respectively (partial agreement rate: 8.7%). There was no agreement in the diagnoses of 75 patients (12.7%). In total, an agreement was reached in 520 patients (87.3%). Common diseases in dermatology practice, such as papulopustular and urticarial lesions, nails and hair diseases, infectious diseases, erythematous squamous diseases, those with pruritus, and skin malignancies, were diagnosed teledermatologically at a high rate of accuracy. In contrast, eczematous diseases, premalignant lesions, and other groups of diseases were less accurately diagnosed. In the last year, the importance of teledermatology has greatly increased with the COVID-19 pandemic. Our study shows that the store and forward (asynchronous) method of teledermatology can diagnose dermatological diseases with a high rate of accuracy

Demographic characteristics, aetiology, and assessment of treatment options in leukocytoclastic vasculitis

A b s t r a c t Introduction: Vasculitides are a heterogeneous group of diseases characterized by inflammation of the blood vessel walls. Etiological factors include infections, drugs, connective tissue diseases, and malignancies. Aim: To examine the demographic characteristics, etiological factors, and treatment options in 75 patients with leukocytoclastic vasculitis. Material and methods: The study included 75 patients diagnosed with leukocytoclastic vasculitis at our clinic. The patients' medical records were reviewed to determine their age, sex, presence of systemic symptoms, possible etiological factors, laboratory results, types of cutaneous lesions, locations of the lesions, treatment options, and disease course. Results: There were 43 women and 32 men. Cutaneous lesions affected only the lower limbs in 60 of the 75 patients (80%) and usually presented as palpable purpura (64%, n = 48). Arthralgia (26.7%, n = 20) was the most frequent extracutaneous symptom. Of the patients with secondary vasculitis, the most common causes were infections and drugs. The mean age of the patients with Henoch-Schönlein purpura was 26.8 years. There was no significant association between age and renal, gastrointestinal, or joint involvement. Conclusions: The most common form of vasculitis in our study was cutaneous leukocytoclastic vasculitis. In most of the patients it appeared to be idiopathic. Among drugs, antibiotics were the most common etiological factor. In 4 patients, the cutaneous leukocytoclastic vasculitis behaved like the paraneoplastic syndrome

Can a Correct Diagnosis Be Established Using the Teledermatology Method?

Teledermatology is a remote method of diagnosis, treatment, and follow-up of the patient with visual communication technologies. It has been a research subject for many years, but its reliabili-ty has not been fully explained. With the emergence of the coronavirus disease-19 (COVID-19) pandemic in 2019, the need for teledermatolo-gy increased. This study aimed to evaluate the reliability of telederma-tology. Material and Method: A total of 595 lesions of 546 patients who visited the dermatology outpatient clinic were included in the study. Two physicians evaluated the patients, one face-to-face and the other via multimedia messaging, and the diagnoses were compared with each other. Diagnoses were in total agreement if the first diagnoses were the same, in partial agreement if the second and third diagno-ses were the same, and in no agreement if all diagnoses differed. The first diagnoses of Physicians 1 and 2 matched in 468 (total agreement rate: 76.8%) patients, and the second and third diagnoses matched in 44 and 8 patients, respectively (partial agreement rate: 8.7%). There was no agreement in the diagnoses of 75 patients (12.7%). In total, an agreement was reached in 520 patients (87.3%). Common diseases in dermatology practice, such as papulopustular and urticarial lesions, nails and hair diseases, infectious diseases, erythematous squamous diseases, those with pruritus, and skin malignancies, were diagnosed teledermatologically at a high rate of accuracy. In contrast, eczematous diseases, premalignant lesions, and other groups of diseases were less accurately diagnosed. In the last year, the importance of teledermatology has greatly increased with the COVID-19 pandemic. Our study shows that the store and forward (asynchronous) method of teledermatology can diagnose dermatological diseases with a high rate of accuracy

Pemphigus Vulgaris

Pemphigus vulgaris is a life-threatening bullous disease characterized by acantholysis resulting in the formation of intraepithelial blebs in the mucous membranes and skin. It is a chronic autoimmune bullous dermatosis caused by the production of autoantibodies against desmoglein 1 and 3. It often begins with blisters and erosions on the oral mucosa, followed by lesions on other mucous membranes and drooping blisters that may spread to the skin. If there is clinical suspicion, the diagnosis can be confirmed by cytological examination, histopathological examination, direct and indirect immunofluorescence tests. Before the introduction of corticosteroids, PV was fatal due to dehydration or secondary systemic infections. The mainstay of treatment is still systemic steroids. Immunosuppressants such as azathioprine, mycophenolate mofetil and methotrexate, high-dose intravenous immunoglobulins, CD20 monoclonal antibody Rituximab treatments are used as an adjuvant with steroids in suitable patients and successful results are obtained

Epidemiology of adult patients with atopic dermatitis in AWARE 1: A second international survey

Background: There are gaps in our understanding of the epidemiology of atopic dermatitis (AD) in adults. Objective: To evaluate the prevalence and severity of AD in adults from countries/regions within Asia, Eurasia, Latin America, Middle East, and Russia. Methods: This international, web-based survey was performed in Argentina, Brazil, China, Colombia, Egypt, Hong Kong, Israel, Malaysia, Mexico, Russia, Kingdom of Saudi Arabia (KSA), Singapore, Taiwan, Thailand, Turkey, and United Arab Emirates. Questionnaires were sent to adult members of online respondent panels for determination of AD and assessment of severity. A diagnosis of AD required respondents to meet the modified United Kingdom (UK) Working Party criteria and to self-report they had a physician diagnosis of AD. Severity of AD was determined using Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), and Patient Global Assessment (PGA). Results: Among respondents by country/region the prevalence of AD ranged from 3.4% in Israel to 33.7% in Thailand. The prevalence was generally higher in females versus males. Severity varied by scale, although regardless of scale the proportion of respondents with mild and moderate disease was higher than severe disease. PGA consistently resulted in the lowest proportion of severe AD (range 2.4% China – 10.8% Turkey) relative to PO-SCORAD (range 13.4% China – 41.6% KSA) and POEM (range 5.1% China – 16.6% Israel). Conclusions: This survey highlights the importance of AD in adults, with high prevalence and high morbidity among respondents and emphasizes that AD is not just a disease of childhood—there is disease persistence and chronicity in adults

Urticaria exacerbations and adverse reactions in patients with chronic urticaria receiving COVID-19 vaccination:Results of the UCARE COVAC-CU study

Background: Concern about disease exacerbations and fear of reactions after coronavirus disease 2019 (COVID-19) vaccinations are common in chronic urticaria (CU) patients and may lead to vaccine hesitancy.Objective: We assessed the frequency and risk factors of CU exacerbation and adverse reactions in CU patients after COVID-19 vaccination. Methods: COVAC-CU is an international multicenter study of Urticaria Centers of Reference and Excellence (UCAREs) that retrospectively evaluated the effects of COVID-19 vaccination in CU patients aged ≥18 years and vaccinated with ≥1 dose of any COVID-19 vaccine. We evaluated CU exacerbations and severe allergic reactions as well as other adverse events associated with COVID-19 vaccinations and their association with various CU parameters. Results: Across 2769 COVID-19–vaccinated CU patients, most (90%) received at least 2 COVID-19 vaccine doses, and most patients received CU treatment and had well-controlled disease. The rate of COVID-19 vaccination–induced CU exacerbation was 9%. Of 223 patients with CU exacerbation after the first dose, 53.4% experienced recurrence of CU exacerbation after the second dose. CU exacerbation most often started &lt;48 hours after vaccination (59.2%), lasted for a few weeks or less (70%), and was treated mainly with antihistamines (70.3%). Factors that increased the risk for COVID-19 vaccination–induced CU exacerbation included female sex, disease duration shorter than 24 months, having chronic spontaneous versus inducible urticaria, receipt of adenovirus viral vector vaccine, having nonsteroidal anti-inflammatory drug/aspirin intolerance, and having concerns about getting vaccinated; receiving omalizumab treatment and Latino/Hispanic ethnicity lowered the risk. First-dose vaccine–related adverse effects, most commonly local reactions, fever, fatigue, and muscle pain, were reported by 43.5% of CU patients. Seven patients reported severe allergic reactions. Conclusions: COVID-19 vaccination leads to disease exacerbation in only a small number of CU patients and is generally well tolerated.</p

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)