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Burkemper NM. Dermatology. Clin Geriatr Med 2024; 40:xv-xvi. [PMID: 38000866 DOI: 10.1016/j.cger.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Affiliation(s)
- Nicole M Burkemper
- Department of Dermatology, SSM Health, Saint Louis University School of Medicine, 1008 S Spring Avenue, St. Louis, MO 63104, USA.
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2
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Tian Y, Hirsch G, Skayem C, Thomas E, Hua C, David JP, Chosidow O, Duong TA. Evolution and challenges of store-and-forward teledermatology for skin diseases of elderly in long-term care facilities: Results of a 5-year analysis. J Eur Acad Dermatol Venereol 2023; 37:e1242-e1244. [PMID: 37288518 DOI: 10.1111/jdv.19240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Yuan Tian
- Assistance Publique de Hôpitaux de Paris (APHP), Department of Dermatology, Hôpital Henri Mondor, Créteil, France
| | - Gaelle Hirsch
- Assistance Publique de Hôpitaux de Paris (APHP), Department of Dermatology, Hôpital Henri Mondor, Créteil, France
| | - Charbel Skayem
- Assistance Publique de Hôpitaux de Paris (APHP), Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Faculty of Medicine, Sorbonne University, Paris, France
- Faculty of Medicine, Paris Descartes University, Paris, France
| | - Emilie Thomas
- Faculty of Medicine, Paris Descartes University, Paris, France
- Department of Geriatric Medicine, Hôpital Emile Roux, APHP, Limeil Brévannes, France
| | - Camille Hua
- Assistance Publique de Hôpitaux de Paris (APHP), Department of Dermatology, Hôpital Henri Mondor, Créteil, France
| | - Jean-Philippe David
- Department of Geriatric medicine, Hôpital Henri Mondor, APHP, Créteil, France
- Facial Dermatosis Clinic, Department of ENT, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Chosidow
- Facial Dermatosis Clinic, Department of ENT, Hôpital Pitié-Salpêtrière, Paris, France
| | - Tu-Anh Duong
- Assistance Publique de Hôpitaux de Paris (APHP), Department of Dermatology, Hôpital Henri Mondor, Créteil, France
- Université Paris Est Creteil, INSERM, IMRB, CEpiA Team, Creteil, France
- Chaire Avenir Sante Numérique, Équipe 8 IMRB U955, INSERM, Créteil, France
- UPEC, Créteil, France
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3
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Perry WM, Vora P, Oh G, Park C, Chang ALS. Incorporating the "4Ms" framework to improve outpatient geriatric dermatology care. J Am Geriatr Soc 2023; 71:665-668. [PMID: 36205447 DOI: 10.1111/jgs.18060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/01/2022] [Accepted: 09/04/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Warren M Perry
- Department of Emergency Medicine, Geriatric Emergency Department Medical Director, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paayal Vora
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Gabriel Oh
- Stanford University School of Medicine, Stanford, California, USA
| | - Caroline Park
- Stanford University School of Medicine, Primary Care and Population Health, Section of Geriatric Medicine, Stanford, California, USA
| | - Anne Lynn S Chang
- Department of Dermatology, Stanford University School of Medicine, Redwood City, California, USA
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4
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Grinnell M, Price KN, Shah A, Butler DC. Antihistamine safety in older adult dermatologic patients. J Am Acad Dermatol 2021; 87:381-386. [PMID: 33465430 DOI: 10.1016/j.jaad.2021.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
Twenty percent of Americans will be older than 65 years by 2030, and without a dedicated geriatrics curriculum in many residency trainings programs, dermatologists may be less familiar with age-associated adverse effects of common dermatologic medications. Herein, we provide a practical guide and clinical safety pearls for the use of antihistamines in older adults. This Review aims to address the risks of antihistamines, anticholinergic burden and polypharmacy, pertinent preexisting medical conditions, and safe alternatives for aging adult patients.
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Affiliation(s)
| | - Kyla N Price
- University of Illinois Chicago College of Medicine, Chicago, Illinois
| | - Amit Shah
- Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Daniel C Butler
- Department of Dermatology, University of California-San Francisco, San Francisco, California.
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5
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Abstract
There are well-documented physiologic changes that occur in the human body during the aging process, such as decreased body fat, decreased muscle mass, cellular senescence, changes in skin pH, decreased metabolism, decreased immune function, vascular changes, altered tissue perfusion, nutritional status changes, and poor hydration. These changes affect skin integrity and wound healing, and raise the risk of pressure-related skin injury. This article discusses aging as a risk factor for pressure injury (PrI). Topics include evidence for advancing age as a significant PrI risk factor, identifying pathophysiologic changes/mechanisms of aging, and specific PrI preventive interventions to consider in older adults.
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6
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Liakos W, Siddiqui F, Toussi A, Le S, Kian S, Li Q, Leal AR, Maverakis E. Osteonecrosis of the calvarium: When clear margins are an impractical goal. Dermatol Ther 2020; 33:e14278. [DOI: 10.1111/dth.14278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/17/2020] [Accepted: 08/30/2020] [Indexed: 11/26/2022]
Affiliation(s)
- William Liakos
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Fariha Siddiqui
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Atrin Toussi
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Stephanie Le
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Sara Kian
- Department of Human Biology University of California, San Diego La Jolla California USA
| | - Qinyuan Li
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Annie Riera Leal
- Department of Dermatology University of California, Davis Sacramento California USA
| | - Emanual Maverakis
- Department of Dermatology University of California, Davis Sacramento California USA
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7
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Thompson LL, Chen ST, Lawton A, Charrow A. Palliative care in dermatology: A clinical primer, review of the literature, and needs assessment. J Am Acad Dermatol 2020; 85:708-717. [PMID: 32800870 DOI: 10.1016/j.jaad.2020.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 07/09/2020] [Accepted: 08/01/2020] [Indexed: 12/25/2022]
Abstract
Palliative care has been shown to improve quality of life, symptoms, and caregiver burden for a range of life-limiting diseases. Palliative care use among patients with severe dermatologic disease remains relatively unexplored, but the limited available data suggest significant unmet care needs and low rates of palliative care use. This review summarizes current palliative care patterns in dermatology, identifying areas for improvement and future investigation.
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Affiliation(s)
- Leah L Thompson
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Steven T Chen
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Andrew Lawton
- Harvard Medical School, Boston, Massachusetts; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Alexandra Charrow
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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8
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Zhong CS, Shi CR, Nambudiri VE. Dermatology education in geriatric fellowship programs: A nationwide survey of program directors. J Am Acad Dermatol 2020; 83:622-624. [DOI: 10.1016/j.jaad.2019.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022]
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9
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van Winden MEC, Garcovich S, Peris K, Colloca G, de Jong EMGJ, Hamaker ME, van de Kerkhof PCM, Lubeek SFK. Frailty screening in dermato-oncology practice: a modified Delphi study and a systematic review of the literature. J Eur Acad Dermatol Venereol 2020; 35:95-104. [PMID: 32403174 PMCID: PMC7818261 DOI: 10.1111/jdv.16607] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
Abstract
Background Appropriate management and prevention of both under‐ and overtreatment in older skin cancer patients can be challenging. It could be helpful to incorporate frailty screening in dermato‐oncology care, since frailty is associated with adverse health outcomes. Objectives This study aimed to identify and prioritize the requirements a frailty screening tool (FST) should fulfil in dermato‐oncology practice and to select the best existing FST(s) for this purpose. Methods A modified two‐round Delphi procedure was performed among 50 Italian and Dutch specialists and patients to review and prioritize a list of potential FST requirements, using a 5‐point Likert scale. Consensus was defined as a mean score of ≥4.0. A systematic literature search was performed to identify existing multidomain FSTs, which were then assessed on the requirements resulting from the modified Delphi procedure. Results Consensus was achieved on evaluation of comorbidities (4.3 ± 0.7), polypharmacy (4.0 ± 0.9) and cognition (4.1 ± 0.8). The FST should have appropriate measurement properties (4.0 ± 1.0), be quickly executed (4.2 ± 0.7), clinically relevant (4.3 ± 0.7), and both easily understandable (4.1 ± 1.2) and interpretable (4.3 ± 0.7). Of the 26 identified FSTs, four evaluated the content‐related domains: the Geriatric‐8 (G8), the modified Geriatric‐8 (mG8), the Groningen Frailty Indicator (GFI) and the Senior Adult Oncology Program 2 (SAOP2) screening tool. Of these, the G8 was the most extensively studied FST, with the best psychometric properties and execution within 5 min. Conclusions The G8 appears the most suitable FST for assessing frailty in older adults with skin cancer, although clinical studies assessing its use in a dermato‐oncology population are needed to further assess whether or not frailty in this particular patient group is associated with relevant outcomes (e.g. complications and mortality), as seen in previous studies in other medical fields.
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Affiliation(s)
- M E C van Winden
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Garcovich
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - K Peris
- Institute of Dermatology, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Colloca
- Department of Radiation Oncology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M E Hamaker
- Department of Geriatrics, Diakonessenhuis, Zeist, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S F K Lubeek
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Cenzer I, Nkansah-Mahaney N, Wehner M, Chren MM, Berger T, Covinsky K, Berger K, Abuabara K, Linos E. A multiyear cross-sectional study of U.S. national prescribing patterns of first-generation sedating antihistamines in older adults with skin disease. Br J Dermatol 2019; 182:763-769. [PMID: 31021412 DOI: 10.1111/bjd.18042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND First-generation antihistamines (FGAs) are classified as 'potentially inappropriate' for use in older patients (patients aged ≥ 65 years). However, the prevalence of and factors associated with FGA prescription have not been studied. OBJECTIVES To examine FGA prescription rates for older patients who visited dermatology offices, and compare them to those for younger patients (patients aged 18-65 years) who visited dermatology offices and those for older patients who visited primary-care physicians (PCPs). METHODS This was a multiyear cross-sectional observational study using data from the U.S. National Ambulatory Medical Care Survey (2006-2015). Visits by patients aged 18 years or older were included in the study; the data comprised 15 243 dermatology office visits and 66 036 PCP office visits. The main outcome was FGA prescription. Other variables included physician specialty (dermatologist or PCP), patient's age, diagnosis of dermatological conditions and reason for visit. RESULTS For dermatology visits, the overall FGA prescription rate for older patients was similar to that for younger patients (1·5% vs. 1·2%; P = 0·19), even when the diagnosis was dermatitis or pruritus (3·7% vs. 4·8%; P = 0·21) or when itch was a complaint (7·6% vs. 6·7%; P = 0·64). However, the rate of FGA prescription for dermatology visits was lower than that for PCP visits, in analyses matched for patient and visit characteristics (3·9% vs. 7·4%; P = 0·02). CONCLUSIONS Our findings suggest that FGAs are overprescribed to older patients but that dermatologists are less likely to prescribe FGAs than PCPs. What's already known about this topic? First-generation antihistamines (FGAs) have been shown to pose substantial risks to older adults, including cognitive impairment, falls, confusion, dry mouth and constipation. Therefore, FGAs have been classified as 'potentially inappropriate' for use in older patients by the American Geriatrics Society. It has also been shown that dermatologists do not always take patient characteristics (e.g. age or life expectancy) into account when deciding on a treatment, instead following a 'one-size-fits-all' approach. What does this study add? FGAs are often prescribed during dermatology visits, and prescription rates do not differ between older and younger patients. There were no significant differences in prescription rates when comparing younger and older adults with the same diagnosis or symptom (e.g. dermatitis, pruritus or itch). FGAs are prescribed at higher rates in primary-care offices than in dermatology offices.
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Affiliation(s)
- I Cenzer
- Division of Geriatrics, University of California, San Francisco, CA, U.S.A.,Department of Medicine III, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - N Nkansah-Mahaney
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, U.S.A
| | - M Wehner
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, U.S.A
| | - M M Chren
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | - T Berger
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, CA, U.S.A
| | - K Covinsky
- Division of Geriatrics, University of California, San Francisco, CA, U.S.A.,Veterans Affairs Medical Center, San Francisco, CA, U.S.A
| | - K Berger
- Division of Geriatrics, University of California, San Francisco, CA, U.S.A
| | - K Abuabara
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco, CA, U.S.A
| | - E Linos
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, U.S.A
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11
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Abstract
Aging skin is subject to morphological change due to both intrinsic (skin tone, genetics, endogenous hormones) and extrinsic (chronic sun exposure, medications, exogenous pigments) factors. The broad spectrum of transformation includes both hypo- and hyperpigmentation. Although cutaneous pigmentary disorders are common in younger individuals, certain disorders are more prevalent in the geriatric population. This article reviews the epidemiology, pathophysiology, clinical appearance, treatment, and prognosis of pigmentary lesions that are predominant in the elderly.
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12
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Linos E, Chren MM, Covinsky K. Creating a Partnership Between Dermatologists and Geriatricians-Reply. JAMA Dermatol 2019; 155:125-126. [PMID: 30484815 DOI: 10.1001/jamadermatol.2018.3660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Eleni Linos
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco
| | - Mary-Margaret Chren
- Program for Clinical Research, Department of Dermatology, University of California, San Francisco
| | - Ken Covinsky
- Department of Medicine, University of California, San Francisco
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13
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Mundluru SN, Lee DR. Creating a Partnership Between Dermatologists and Geriatricians. JAMA Dermatol 2019; 155:125. [DOI: 10.1001/jamadermatol.2018.3727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Shankar N. Mundluru
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - David R. Lee
- Department of Internal Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California
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14
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Zeitany A, Adamson A. Treatment of Non-melanoma Skin Cancer in the Elderly. CURRENT GERIATRICS REPORTS 2018. [DOI: 10.1007/s13670-018-0264-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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