1
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Mashoudy KD, Perez SM, Nouri K. From diagnosis to intervention: a review of telemedicine's role in skin cancer care. Arch Dermatol Res 2024; 316:139. [PMID: 38696032 PMCID: PMC11065900 DOI: 10.1007/s00403-024-02884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/03/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024]
Abstract
Skin cancer treatment is a core aspect of dermatology that relies on accurate diagnosis and timely interventions. Teledermatology has emerged as a valuable asset across various stages of skin cancer care including triage, diagnosis, management, and surgical consultation. With the integration of traditional dermoscopy and store-and-forward technology, teledermatology facilitates the swift sharing of high-resolution images of suspicious skin lesions with consulting dermatologists all-over. Both live video conference and store-and-forward formats have played a pivotal role in bridging the care access gap between geographically isolated patients and dermatology providers. Notably, teledermatology demonstrates diagnostic accuracy rates that are often comparable to those achieved through traditional face-to-face consultations, underscoring its robust clinical utility. Technological advancements like artificial intelligence and reflectance confocal microscopy continue to enhance image quality and hold potential for increasing the diagnostic accuracy of virtual dermatologic care. While teledermatology serves as a valuable clinical tool for all patient populations including pediatric patients, it is not intended to fully replace in-person procedures like Mohs surgery and other necessary interventions. Nevertheless, its role in facilitating the evaluation of skin malignancies is gaining recognition within the dermatologic community and fostering high approval rates from patients due to its practicality and ability to provide timely access to specialized care.
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Affiliation(s)
- Kayla D Mashoudy
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA.
| | - Sofia M Perez
- University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 NW 14th Street, Miami, FL, 33136, USA
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2
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Aboye GT, Vande Walle M, Simegn GL, Aerts JM. mHealth in sub-Saharan Africa and Europe: A systematic review comparing the use and availability of mHealth approaches in sub-Saharan Africa and Europe. Digit Health 2023; 9:20552076231180972. [PMID: 37377558 PMCID: PMC10291558 DOI: 10.1177/20552076231180972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background mHealth can help with healthcare service delivery for various health issues, but there's a significant gap in the availability and use of mHealth systems between sub-Saharan Africa and Europe, despite the ongoing digitalization of the global healthcare system. Objective This work aims to compare and investigate the use and availability of mHealth systems in sub-Saharan Africa and Europe, and identify gaps in current mHealth development and implementation in both regions. Methods The study adhered to the PRISMA 2020 guidelines for article search and selection to ensure an unbiased comparison between sub-Saharan Africa and Europe. Four databases (Scopus, Web of Science, IEEE Xplore, and PubMed) were used, and articles were evaluated based on predetermined criteria. Details on the mHealth system type, goal, patient type, health concern, and development stage were collected and recorded in a Microsoft Excel worksheet. Results The search query produced 1020 articles for sub-Saharan Africa and 2477 articles for Europe. After screening for eligibility, 86 articles for sub-Saharan Africa and 297 articles for Europe were included. To minimize bias, two reviewers conducted the article screening and data retrieval. Sub-Saharan Africa used SMS and call-based mHealth methods for consultation and diagnosis, mainly for young patients such as children and mothers, and for issues such as HIV, pregnancy, childbirth, and child care. Europe relied more on apps, sensors, and wearables for monitoring, with the elderly as the most common patient group, and the most common health issues being cardiovascular disease and heart failure. Conclusion Wearable technology and external sensors are heavily used in Europe, whereas they are seldom used in sub-Saharan Africa. More efforts should be made to use the mHealth system to improve health outcomes in both regions, incorporating more cutting-edge technologies like wearables internal and external sensors. Undertaking context-based studies, identifying determinants of mHealth systems use, and considering these determinants during mHealth system design could enhance mHealth availability and utilization.
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Affiliation(s)
- Genet Tadese Aboye
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
- School of Biomedical Engineering, Jimma University, Jimma, Ethiopia
| | - Martijn Vande Walle
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| | | | - Jean-Marie Aerts
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
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3
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Sabourin KR, Borok M, Mawhinney S, Matimba M, Jaji F, Fiorillo S, Chifamba DD, Muserere C, Mashiri B, Bhodheni C, Gambiza P, Mandidewa R, Mutimuri M, Gudza I, Mulvahill M, Moore CM, Kutner JS, Simões EAF, Campbell TB. Evaluation of a training intervention to improve cancer care in Zimbabwe: Strategies to Improve Kaposi Sarcoma Outcomes (SIKO), a prospective community-based stepped-wedge cluster randomized trial. J Int AIDS Soc 2022; 25:e25998. [PMID: 36028920 PMCID: PMC9418419 DOI: 10.1002/jia2.25998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 07/27/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Most Zimbabweans access medical care through tiered health systems. In 2013, HIV care was decentralized to primary care clinics; while oncology care remained centralized. Most persons in Zimbabwe with Kaposi sarcoma (KS) are diagnosed late in their disease, and the prognosis is poor. Little is known about whether educational interventions could improve KS outcomes in these settings. Methods Interventions to improve KS detection and management were evaluated at eight Zimbabwe primary care sites (four rural/four urban) that provided HIV care. Interventions included a standardized KS clinical evaluation tool, palliative care integration, standardized treatment and improved consultative services. Interventions were implemented between February 2013 and January 2016 using a randomized stepped‐wedge cluster design. Sites were monitored for KS diagnosis rates and KS outcomes, including early diagnosis (T0 vs. T1 tumour stage), participant retention and mortality. Analyses controlled for within‐clinic correlations. Results A total of 1102 persons with suspected KS (96% HIV positive) were enrolled: 47% incident (new diagnosis), 20% prevalent (previous diagnosis) and 33% determined as not KS. Early (T0) diagnosis increased post‐intervention, though not significant statistically (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (95% CI): 0.66–3.79], p = 0.37). New KS diagnosis rates increased 103% (95% CI: 11–273%), p = 0.02) post‐intervention; although paired with an increased odds of incorrectly diagnosing KS (aOR = 2.08 [95% CI: 0.33–3.24], p = 0.001). Post‐intervention, non‐significant decreases in 90‐day return rates (adjusted hazard ratio [aHR] = 0.69 [95% CI: 0.38–1.45], p = 0.21) and survival (aHR = 1.36 [95% CI: 0.85–2.20], p = 0.20) were estimated. Conclusions KS training interventions at urban and rural Zimbabwe decentralized primary care clinics significantly increased overall and incorrect KS diagnosis rates, but not early KS diagnosis rates, 90‐day return rates or survival.
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Affiliation(s)
| | - Margaret Borok
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Maxwell Matimba
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Francis Jaji
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Suzanne Fiorillo
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | | | | | - Patricia Gambiza
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | | | - Mercia Mutimuri
- University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe
| | - Ivy Gudza
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Camille M Moore
- National Jewish Health, Denver, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA
| | - Jean S Kutner
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric A F Simões
- University of Colorado School of Medicine, Aurora, Colorado, USA.,Colorado School of Public Health, Aurora, Colorado, USA
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4
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Koh E, Maranga A, Yane T, Ndlovu K, Jereni B, Nwako-Mohamadi MK, Kovarik C, Forrestel A, Williams VL. Evaluation of WhatsApp as a Platform for Teledermatology in Botswana: Retrospective Review and Survey. JMIR DERMATOLOGY 2022. [DOI: 10.2196/35254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background
In emerging market countries in sub-Saharan Africa, access to specialty services such as dermatology is limited. Teledermatology is an innovative solution to address this issue; however, many initiatives have been tried without sustained success. Recently, WhatsApp has been used as a store-and-forward telemedicine communication platform for consultation and education in Botswana.
Objective
This study aims to describe the utilization of WhatsApp for teledermatology and the satisfaction levels of participating providers.
Methods
A 2-part pilot study was conducted. First, a retrospective review was performed of WhatsApp communications received by participating dermatologists in Gaborone, Botswana, from January 2016 to December 2019. Sender information, patient demographics and history, response time, diagnoses made, and follow-up recommendations were collected. Second, a 12-question cross-sectional survey was distributed to health care providers who utilized WhatsApp for teledermatology during this period. Descriptive statistics were then performed.
Results
There were 811 communication threads over the study period. The majority (503/811, 62%) of communications were consultations from providers inquiring about a specific patient, followed by multidisciplinary care coordination communications (90/811, 11%). Our in-depth analysis focused on the former. In 323 (64%) provider consultations, dermatologists responded within 1 hour. A diagnosis was made in 274 (55%) consultations. Dermatologists gave treatment recommendations remotely in 281 (56%) consultations and recommended an in-person dermatology visit in 163 (32%). Of the 150 health care providers surveyed, 23 (15%) responded. All respondents (100%) felt that there was a need for teledermatology and improved teledermatology education in Botswana. Moreover, 17 (74%) respondents strongly felt that the guidance received via WhatsApp was high quality, and 22 (96%) were satisfied with WhatsApp as a platform for teledermatology.
Conclusions
This retrospective review and survey demonstrated that WhatsApp is a quick, well-received, and sustainable method of communication between dermatologists and providers across Botswana. The app may offer a solution to the challenges providers face in accessing specialty referral systems, point-of-care education, and medical decision-making support for complex dermatologic cases in Botswana. The information gained from this pilot study can serve as the basis for future telemedicine studies to improve the implementation of teledermatology in Botswana and other resource-limited countries.
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5
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Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications. J Clin Med 2022; 11:jcm11061511. [PMID: 35329838 PMCID: PMC8950226 DOI: 10.3390/jcm11061511] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The most frequent inflammatory skin diseases are psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne. Their management is challenging for dermatologists since their relapsing chronic clinical course is associated with a great impact on quality of life. Nevertheless, the recent introduction of novel therapies, such as biological drugs and small molecules has been changing the history of these diseases. Methods: A systematic review of the scientific literature of case reports, case series, epidemiological studies, reviews, and systematic reviews regarding teledermatology and inflammatory skin disease. Studies were identified, screened, and extracted for relevant data following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Results: A total of 69 cases articles were included in the review. Conclusions: As we have shown in the review, several experiences of teledermatology for patients affected by inflammatory skin diseases have been demonstrated to increase due to clinical access to hospital and specialized health care services, allowing better access to specialized dermatology care for people living in remote areas, and saving costs and money with health care.
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6
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Joshi TP, Ren V. Teledermatology in the Control of Skin Neglected Tropical Diseases: A Systematic Review. Dermatol Pract Concept 2021; 11:e2021130. [PMID: 34631272 DOI: 10.5826/dpc.1104a130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 10/31/2022] Open
Abstract
Introduction Neglected tropical diseases (NTDs) include a group of about 20 illnesses that have garnered relatively little attention, despite their ability to inflict significant suffering and disability. Skin neglected tropical diseases (sNTDs) are a subset of NTDs that present with cutaneous manifestations and are well known for their ability to generate stigma and promote poverty. Teledermatology (TD) represents a potential method to control sNTDs. Objective We sought to analyze the potential for TD to ease the burden of sNTDs. Methods We performed a systematic literature search using the Texas Medical Center Library One Search, which scans 167 databases, including Embase, PubMed, and Scopus. We included all original investigations published after 2011 that assessed the impact of TD intervention in the control of one or more sNTDs. We excluded studies not written in English and studies that did not perform any outcome analyses. Results Twenty studies met our search criteria, and 18 expressed positive attitudes towards TD. Overall, we found that TD may be a sustainable, cost-effective strategy for expanding access to care for individuals afflicted with sNTDs. However, poor image quality, lack of access to further diagnostic tests, and ethical, legal, and cultural issues pose as barriers to TD utilization. Conclusion TD may be helpful in achieving control of sNTDs but has its limitations. An integrated approach, which employs TD in conjunction with other strategies, represents a realistic path for alleviating sNTDs.
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Affiliation(s)
| | - Vicky Ren
- Department of Dermatology, Baylor College of Medicine
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7
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Teledermatology Addressing Disparities in Health Care Access: a Review. CURRENT DERMATOLOGY REPORTS 2021; 10:40-47. [PMID: 33747638 PMCID: PMC7953516 DOI: 10.1007/s13671-021-00329-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2021] [Indexed: 11/09/2022]
Abstract
Purpose of Review Dermatologists have been at the forefront of researching telemedicine to expand access to care. The current COVID-19 pandemic has prompted even greater expansion and implementation of teledermatology. This review discusses the research examining the potential impact of teledermatology addressing disparities in care. Recent Findings Teledermatology appears to increase access to dermatology given expanded means to deliver care. Specifically, recent studies have found increased access among Medicaid-insured, resource-poor urban and rural, and elderly populations. Teledermatology implementation also facilitates education among providers at different levels of training. Still, as some patients have inconsistent access to the required technology, increased reliance on telemedicine may also potentially increase disparities for some populations. Summary Teledermatology may serve to reduce disparities in health care access in many underserved and marginalized communities. Future research should continue to study implementation, especially given the expansion during the COVID-19 pandemic. Ultimately, teledermatology may play an important role in ensuring equitable care access for all.
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8
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Greis C, Maul LV, Hsu C, Djamei V, Schmid-Grendelmeier P, Navarini AA. [Artificial intelligence to support telemedicine in Africa]. Hautarzt 2020; 71:686-690. [PMID: 32761386 PMCID: PMC7407433 DOI: 10.1007/s00105-020-04664-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Telemedizin findet seit Jahrzehnten Anwendung im Alltag von Dermatologen. Insbesondere in afrikanischen Ländern mit begrenzter medizinischer Versorgung, zu überbrückenden geografischen Distanzen und einem zwischenzeitlich relativ gut ausgebauten Telekommunikationssektor liegen die Vorteile auf der Hand. Nationale und internationale Arbeitsgruppen unterstützen den Aufbau von teledermatologischen Projekten und bedienen sich in den letzten Jahren zunehmend KI(künstliche Intelligenz)-gestützter Technologien, um Ärzte vor Ort zu unterstützen. Vor diesem Hintergrund stellen ethnische Variationen eine besondere Herausforderung in der Entwicklung automatisierter Algorithmen dar. Um die Genauigkeit der Systeme weiter zu verbessern und globalisieren zu können, ist es wichtig, die Zahl der verfügbaren klinischen Daten zu erhöhen. Dies kann nur mit der aktiven Beteiligung der lokalen Gesundheitsversorger sowie der dermatologischen Gemeinschaft gelingen und muss stets im Interesse des einzelnen Patienten erfolgen.
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Affiliation(s)
- C Greis
- Klinik für Dermatologie, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz.
| | - L V Maul
- Klinik für Dermatologie, Universitätsspital Basel, Basel, Schweiz
| | - C Hsu
- Klinik für Dermatologie, Universitätsspital Basel, Basel, Schweiz
| | - V Djamei
- Klinik für Dermatologie, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz
| | - P Schmid-Grendelmeier
- Klinik für Dermatologie, Universitätsspital Zürich, Gloriastr. 31, 8091, Zürich, Schweiz
| | - A A Navarini
- Klinik für Dermatologie, Universitätsspital Basel, Basel, Schweiz
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9
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Inena G, Chu B, Falay D, Limengo B, Matondo I, Bokanga A, Kovarik C, Williams VL. Patterns of skin cancer and treatment outcomes for patients with albinism at Kisangani Clinic, Democratic Republic of Congo. Int J Dermatol 2020; 59:1125-1131. [PMID: 32530079 DOI: 10.1111/ijd.14988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 03/22/2020] [Accepted: 05/08/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND People with albinism (PWA) are at increased risk of photodamage and skin cancer. In many parts of Africa, there is a significant lack of knowledge regarding albinism which can lead to societal stigma, discrimination, and persecution from an early age. In the Democratic Republic of Congo (DRC), there is limited clinical data on PWA and skin cancer. We aim to better understand sociodemographics, risk factors, clinical features, and outcomes of this population. METHODS Patients with a diagnosis of albinism and skin cancer presenting to Kisangani Albino Clinic were enrolled. RESULTS Of 205 PWA, 61 patients were diagnosed with skin cancer with a mean age of 26.5 years. Common occupations were student (45.6%) or unemployed (26.4%). Discrimination was experienced from close contacts (24.4%) and society (67.4%). A majority (88.5%) had never used sunscreen, only 4.9% used fully sun protective clothing, and 90.2% spent 4 or more hours in the sun daily. Skin cancers had a mean size of 3.8 cm and were most commonly located on the face (47.7%). Squamous cell carcinoma was the most common histopathological diagnosis. Most patients underwent excision, and 90.2% had clinical clearance of tumors at a mean follow-up of 5.7 months. CONCLUSION People living with albinism in the DRC experience a high rate of nonmelanoma skin cancers at a young age and additionally face a number of psychosocial challenges. This study represents the first attempt to analyze a cohort of patients with albinism from the DRC and serves to increase awareness of this vulnerable population.
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Affiliation(s)
- Gaylord Inena
- Cinquanteraire Hospital of Kisangani, Kisangani, Democratic Republic of Congo
| | - Brian Chu
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Dadi Falay
- Cinquanteraire Hospital of Kisangani, Kisangani, Democratic Republic of Congo.,Kisangani University Clinics, Kisangani, Democratic Republic of Congo
| | - Bambale Limengo
- Cinquanteraire Hospital of Kisangani, Kisangani, Democratic Republic of Congo.,Kisangani University Clinics, Kisangani, Democratic Republic of Congo
| | - Ibanda Matondo
- Cinquanteraire Hospital of Kisangani, Kisangani, Democratic Republic of Congo
| | - Abisa Bokanga
- Kisangani University Clinics, Kisangani, Democratic Republic of Congo
| | - Carrie Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria L Williams
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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10
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“Teledermatopathology: A Review”. CURRENT DERMATOLOGY REPORTS 2020. [DOI: 10.1007/s13671-020-00299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Coustasse A, Sarkar R, Abodunde B, Metzger BJ, Slater CM. Use of Teledermatology to Improve Dermatological Access in Rural Areas. Telemed J E Health 2019; 25:1022-1032. [PMID: 30741608 DOI: 10.1089/tmj.2018.0130] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Alberto Coustasse
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Raghav Sarkar
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Bukola Abodunde
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
| | - Brandon J. Metzger
- Health Informatics Program, Marshall University, Huntington, West Virginia
| | - Chelsea M. Slater
- Healthcare Administration Program, Lewis College of Business, Marshall University, South Charleston, West Virginia
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12
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Wlodek C, Va'a-Fuimaono H, Ekeroma A. Dermatological conditions encountered in The Independent State of Samoa and an exploration of possible strategies to manage dermatological health-care needs in this resource-poor setting. Australas J Dermatol 2019; 61:51-53. [PMID: 31319438 DOI: 10.1111/ajd.13118] [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: 05/21/2019] [Accepted: 06/22/2019] [Indexed: 11/28/2022]
Abstract
This report adds to the limited existing literature concerning dermatoses in Samoa. Conditions encountered during a 4-day private clinic are reported. Amongst the 75 patients reviewed, eczema was the most frequent condition diagnosed. This was followed by infective dermatoses particularly pityriasis versicolor and tinea infections. Reassuringly, in 97% of cases, suitable medications were available locally.
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Affiliation(s)
- Christina Wlodek
- Department of Dermatology, Waikato Hospital, Hamilton, New Zealand
| | | | - Alec Ekeroma
- School of Medicine, National University of Samoa, Apia, Samoa
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13
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Bervell B, Al-Samarraie H. A comparative review of mobile health and electronic health utilization in sub-Saharan African countries. Soc Sci Med 2019; 232:1-16. [PMID: 31035241 DOI: 10.1016/j.socscimed.2019.04.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/15/2019] [Accepted: 04/19/2019] [Indexed: 12/12/2022]
Abstract
This study distinguished between the application of e-health and m-health technologies in sub-Saharan African (SSA) countries based on the dimensions of use, targeted diseases or health conditions, locations of use, and beneficiaries (types of patients or health workers) in a country specific context. It further characterized the main opportunities and challenges associated with these dimensions across the sub-region. A systematic review of the literature was conducted on 66 published peer reviewed articles. The review followed the scientific process of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of identification, selection, assessment, synthesis and interpretation of findings. The results of the study showed that m-health was prevalent in usage for promoting information for treatment and prevention of diseases as well as serving as an effective technology for reminders towards adherence. For e-health, the uniqueness lay in data acquisition and patients' records management; diagnosis; training and recruitment. While m-health was never used for monitoring or training and recruitment, e-health on the other hand could not serve the purpose of reminders or for reporting cases from the field. Both technologies were however useful for adherence, diagnosis, disease control mechanisms, information provision, and decision-making/referrals. HIV/AIDS, malaria, and maternal (postnatal and antenatal) healthcare were important in both m-health and e-health interventions mostly concentrated in the rural settings of South Africa and Kenya. ICT infrastructure, trained personnel, illiteracy, lack of multilingual text and voice messages were major challenges hindering the effective usage of both m-health and e-health technologies.
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Affiliation(s)
- Brandford Bervell
- E-learning & Technology Unit, College of Distance Education, University of Cape Coast, Cape Coast, Ghana
| | - Hosam Al-Samarraie
- Centre for Instructional Technology & Multimedia, Universiti Sains Malaysia, Penang, Malaysia.
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14
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Kjærsgaard Andersen R, Jemec GBE. Teledermatology management of difficult-to-treat dermatoses in the Faroe Islands. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2019. [DOI: 10.15570/actaapa.2019.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Slaught C, Williams V, Grover S, Bigger E, Kayembe M, Chiyapo S, Jackson NJ, Dryden-Peterson S, Kovarik CL, Wanat KA. A retrospective review of patients with Kaposi's sarcoma in Botswana. Int J Dermatol 2018; 58:707-712. [PMID: 30460985 DOI: 10.1111/ijd.14305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/14/2018] [Accepted: 10/24/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Despite widespread antiretroviral coverage in Botswana, Kaposi's sarcoma (KS) remains among the most common malignancies. To date, adult KS in Botswana is not well characterized. The diagnosis relies on clinical suspicion that is often confirmed by histopathology given the implications of treatment; however, this poses a significant resource burden. METHODS We conducted a retrospective review of the cohort of patients biopsied for possible KS at Princess Marina Hospital, the main dermatology referral site in Botswana, from September 2008 through June 2015 to describe the demographics, human immunodeficiency virus (HIV) characteristics, and clinical presentations of these patients. Histopathologic diagnoses were reviewed, and positive predictive value (PPV) was used to characterize the accuracy of clinical suspicion of KS. RESULTS A total of 441 patients received 450 biopsies where KS was on the differential diagnosis, and 239 patients (54%) were ultimately diagnosed with KS. The KS cohort was more likely to be male (58% vs. 37%, P < 0.001), HIV positive (94% vs. 85%, P < 0.05), and have lower CD4 counts at the time of biopsy (274 cells/μl vs. 362 cells/μl, P < 0.05). The PPV of clinical suspicion of KS was 58%. When KS was not histopathologically diagnosed, clinically benign diseases were found in 17%, medically significant conditions requiring alternative therapies in 78%, and life-threatening diseases in 5%. DISCUSSION Our study reinforces the risk factors in development of KS. The poor PPV supports the important role of histology in KS diagnosis to both ensure appropriate treatment and prevent overtreatment. Improved accessibility to biopsy and augmentation of local dermatopathologic services would likely improve diagnostic accuracy and treatment.
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Affiliation(s)
- Christa Slaught
- Department of Dermatology, Oregon Health and Sciences University, Portland, OR, USA
| | - Victoria Williams
- Ministry of Health of Botswana, Gaborone, Botswana.,Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA.,Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Elizabeth Bigger
- Department of Medical Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Mukendi Kayembe
- Department of Anatomical Pathology, National Health Laboratory, Gaborone, Botswana.,Department of Pathology, University of Botswana School of Medicine, Gaborone, Botswana
| | - Sebathu Chiyapo
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Nicholas J Jackson
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott Dryden-Peterson
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA.,Botswana Harvard AIDS Institute, Gaborone, Botswana.,Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Karolyn A Wanat
- Department of Dermatology and Pathology, University of Iowa, Iowa City, IA, USA
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16
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Augustin M, Wimmer J, Biedermann T, Blaga R, Dierks C, Djamei V, Elmer A, Elsner P, Enk A, Gass S, Henningsen M, Hofman-Wellenhof R, von Kiedrowski R, Kunz HD, Liebram C, Navarini A, Otten M, Reusch M, Schüller C, Zink A, Strömer K. Praxis der Teledermatologie. J Dtsch Dermatol Ges 2018; 16 Suppl 5:6-57. [DOI: 10.1111/ddg.13512] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Johannes Wimmer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Tilo Biedermann
- Hautklinik Campus Biederstein; Technische Universität München, München
| | - Rolf Blaga
- Psoriasis Selbsthilfe Arbeitsgemeinschaft e. V.; Berlin
| | | | | | - Arno Elmer
- Hochschule für Ökonomie und Management Berlin, Berlin
| | - Peter Elsner
- Klinik für Hautkrankheiten; Universitätsklinikum Jena, Jena
| | - Alexander Enk
- Hautklinik; Universitätsklinikum Heidelberg, Heidelberg
| | | | - Maike Henningsen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | | | | | | | | | - Marina Otten
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP); Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | | | | | - Alexander Zink
- Dermatologischen Universitätsklinik; Technischen Universität München, München
| | - Klaus Strömer
- Gemeinschaftspraxis für Dermatologie und Allergologie; Mönchengladbach
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17
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Seth D, Cheldize K, Brown D, Freeman EF. Global Burden of Skin Disease: Inequities and Innovations. CURRENT DERMATOLOGY REPORTS 2017; 6:204-210. [PMID: 29226027 PMCID: PMC5718374 DOI: 10.1007/s13671-017-0192-7] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW We review the current understanding of the burden of dermatological disease through the lens of the Global Burden of Disease project, evaluate the impact of skin disease on quality of life in a global context, explore socioeconomic implications, and finally summarize interventions towards improving quality of dermatologic care in resource-poor settings. RECENT FINDINGS The Global Burden of Disease project has shown that skin diseases continue to be the 4th leading cause of nonfatal disease burden world-wide. However, research efforts and funding do not match with the relative disability of skin diseases. International and national efforts, such as the WHO List of Essential Medicines, are critical towards reducing the socioeconomic burden of skin diseases and increasing access to care. Recent innovations such as teledermatology, point-of-care diagnostic tools, and task-shifting help to provide dermatological care to underserved regions in a cost-effective manner. SUMMARY Skin diseases cause significant non-fatal disability worldwide, especially in resource-poor regions. Greater impetus to study the burden of skin disease in low resource settings and policy efforts towards delivering high quality care are essential in improving the burden of skin diseases.
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Affiliation(s)
- Divya Seth
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Khatiya Cheldize
- Weill Cornell Medical College, New York, New York
- Massachusetts General Hospital Department of Dermatology, Boston, MA
| | - Danielle Brown
- Massachusetts General Hospital Department of Pediatrics, Boston, MA
| | - Esther F Freeman
- Massachusetts General Hospital Department of Dermatology, Boston, MA
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18
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Trettel A, Eissing L, Augustin M. Telemedicine in dermatology: findings and experiences worldwide - a systematic literature review. J Eur Acad Dermatol Venereol 2017; 32:215-224. [PMID: 28516492 DOI: 10.1111/jdv.14341] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 03/29/2017] [Indexed: 01/28/2023]
Abstract
Telemedicine has become an important element of health care in many countries and profited from the technological progress of the last two decades. Due to the visual character of the dermatological specialty, teledermatology in particular participated in that development and is becoming a major tool in dermatological consultation. The objective of this article was to identify the use of teledermatology across the world based on published original articles. A systematic literature search of the MEDLINE and Embase databases for eligible publications (predefined inclusion and exclusion criteria) and a cross-validation search were conducted. Search results were reviewed systematically. The search resulted in 204 publications meeting the inclusion criteria for analysis. The highest number of published studies on teledermatology was performed in the United States, followed by the United Kingdom, Spain, the Netherlands, Italy and Austria. The majority of dermatological indications for telemedical consultations were not specified or included various kinds of skin diseases, followed by skin cancer and wounds. Research questions predominantly focused on concordance, effectiveness and cost-effectiveness to determine the value. Teledermatology proved to be a reliable consultation tool in the majority of studies. If specified, telemedicine was used in daily dermatological routine for patient management purposes, to consult patients in peripheral locations, or for medical support in nursing homes or home care settings. The application of teledermatology worldwide is highest in North American and European countries, while countries with poor geographical distribution of physicians seem to be under-represented in teledermatological use, as concluded from publication output. Regarding indications, comparison with classic consultation and area of application, most studies were of general nature. For precise determination of the value, systematic studies would be needed. However, teledermatology is already accepted as a valid tool.
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Affiliation(s)
- A Trettel
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - L Eissing
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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19
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Madu PN, Chang AY, Kayembe MK, Kovarik CL. Teledermatology as a Means to Provide Multispecialty Care: A Case of Global Specialty Collaboration. Pediatr Dermatol 2017; 34:e89-e92. [PMID: 28297155 DOI: 10.1111/pde.13079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Telemedicine can serve as a platform for specialty collaboration and potentially address the lack of specialized and subspecialized care globally. In this article we present a case in which the use of teledermatology facilitated global collaboration between multiple specialists and subspecialists, resulting in high-quality care of a child from a remote area of Botswana. We present the lessons learned and factors that should be considered when engaging in global specialty collaboration, especially between developed and developing countries. We also discuss the potential limitations of telemedicine when used within a global context. With these considerations in mind, global specialty collaboration facilitated by telemedicine can provide a potential solution to the lack of access to specialized and subspecialized care.
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Affiliation(s)
- Pamela N Madu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Aileen Y Chang
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mukendi K Kayembe
- Department of Pathology, National Health Laboratory, Gaborone, Botswana
| | - Carrie L Kovarik
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Streicher JL, Kini SP, Stoff BK. Innovative dermatopathology teaching in a resource-limited environment. J Am Acad Dermatol 2016; 74:1024-5. [PMID: 27085239 DOI: 10.1016/j.jaad.2015.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/02/2015] [Accepted: 11/11/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Jenna L Streicher
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Seema P Kini
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin K Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia.
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21
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Jahan-Tigh RR, Chinn GM, Rapini RP. A Comparative Study Between Smartphone-Based Microscopy and Conventional Light Microscopy in 1021 Dermatopathology Specimens. Arch Pathol Lab Med 2016; 140:86-90. [PMID: 26717060 DOI: 10.5858/arpa.2014-0593-oa.s1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The incorporation of high-resolution cameras into smartphones has allowed for a variety of medical applications including the use of lens attachments that provide telescopic, macroscopic, and dermatoscopic data, but the feasibility and performance characteristics of such a platform for use in dermatopathology have not been described. OBJECTIVE To determine the diagnostic performance of a smartphone microscope compared to traditional light microscopy in dermatopathology specimens. DESIGN A simple smartphone microscope constructed with a 3-mm ball lens was used to prospectively evaluate 1021 consecutive dermatopathology cases in a blinded fashion. Referred, consecutive specimens from the community were evaluated at a single university hospital. The performance characteristics of the smartphone platform were calculated by using conventional light microscopy as the gold standard. The sensitivity and specificity for the diagnosis of melanoma, nonmelanoma skin cancers, and other miscellaneous conditions by the phone microscopy platform, as compared with traditional light microscopy, were calculated. RESULTS For basal cell carcinoma (n = 136), the sensitivity and specificity of smartphone microscopy were 95.6% and 98.1%, respectively. The sensitivity and specificity for squamous cell carcinoma (n = 94) were 89.4% and 97.3%, respectively. The lowest sensitivity was found in melanoma (n = 15) at 60%, although the specificity was high at 99.1%. The accuracy of diagnosis of inflammatory conditions and other neoplasms was variable. CONCLUSIONS Mobile phone-based microscopy has excellent performance characteristics for the inexpensive diagnosis of nonmelanoma skin cancers in a setting where a traditional microscope is not available.
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Affiliation(s)
- Richard R Jahan-Tigh
- From the Departments of Dermatology and Pathology, University of Texas Houston Health Science Center, Houston (Drs Jahan-Tigh and Rapini);,and the Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (Dr Chinn)
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22
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A Comparison of Classification Methods for Telediagnosis of Parkinson’s Disease. ENTROPY 2016. [DOI: 10.3390/e18040115] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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23
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Amerson E, Woodruff CM, Forrestel A, Wenger M, McCalmont T, LeBoit P, Maurer T, Laker-Oketta M, Muyindike W, Bwana M, Buziba N, Busakhala N, Wools-Kaloustian K, Martin J. Accuracy of Clinical Suspicion and Pathologic Diagnosis of Kaposi Sarcoma in East Africa. J Acquir Immune Defic Syndr 2016; 71:295-301. [PMID: 26452066 PMCID: PMC4770348 DOI: 10.1097/qai.0000000000000862] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND HIV-associated Kaposi sarcoma (KS) is one of the most common malignancies in sub-Saharan Africa. The diagnosis is often based on clinical suspicion, without histopathologic confirmation. When biopsies are performed, the accuracy of interpretation by local pathologists is poorly understood. We assessed the accuracy of clinical suspicion and pathologic diagnosis of KS in 2 East African countries. METHODS At 2 large HIV care sites in Uganda and Kenya, we evaluated consecutive biopsies performed from October 2008 to January 2013 on HIV-infected adults with clinically suspected KS. Biopsies were interpreted by both local African pathologists and a group of US-based dermatopathologists from a high volume medical center. For the purpose of this analysis, the US-based dermatopathologist interpretation was used as the gold standard. Positive predictive value was used to characterize accuracy of local African clinical suspicion of KS, and concordance, sensitivity, and specificity were used to characterize accuracy of local pathologic diagnosis. RESULTS Among 1106 biopsies, the positive predictive value of clinical suspicion of KS was 77% (95% confidence interval: 74% to 79%). When KS was not histopathologically diagnosed, clinically banal conditions were found in 35%, medically significant disorders which required different therapy in 59% and life-threatening diseases in 6%. Concordance between African pathologists and US-based dermatopathologists was 69% (95% confidence interval: 66% to 72%). Sensitivity and specificity of African pathologic diagnoses were 68% and 89%, respectively. CONCLUSIONS Among East African HIV-infected patients, we found suboptimal positive predictive value of clinical suspicion of KS and specific, but not sensitive, histopathologic interpretation. The findings call for abandonment of isolated clinical diagnosis of KS in the region and augmentation of local dermatopathologic services.
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Affiliation(s)
- Erin Amerson
- Department of Dermatology, University of California-San Francisco, San Francisco, CA
| | | | - Amy Forrestel
- Department of Dermatology, University of Pennsylvania, Philadelphia, PA
| | - Megan Wenger
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Timothy McCalmont
- Department of Dermatology, University of California-San Francisco, San Francisco, CA
- Department of Pathology and Laboratory Medicine, University of California-San Francisco, San Francisco, CA
| | - Philip LeBoit
- Department of Dermatology, University of California-San Francisco, San Francisco, CA
- Department of Pathology and Laboratory Medicine, University of California-San Francisco, San Francisco, CA
| | - Toby Maurer
- Department of Dermatology, University of California-San Francisco, San Francisco, CA
| | - Miriam Laker-Oketta
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Winnie Muyindike
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mwebesa Bwana
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nathan Buziba
- Department of Pathology, Moi University School of Medicine, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Naftali Busakhala
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Hematology and Oncology, Moi Teaching and Referral Hospital, Eldoret, Kenya; and
| | - Kara Wools-Kaloustian
- Department of Hematology and Oncology, Moi Teaching and Referral Hospital, Eldoret, Kenya; and
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA
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24
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Jahan-Tigh RR, Chinn GM, Rapini RP. A Comparative Study Between Smartphone-Based Microscopy and Conventional Light Microscopy in 1021 Dermatopathology Specimens. Arch Pathol Lab Med 2016. [DOI: 10.5858/arpa.2014-0593-oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
The incorporation of high-resolution cameras into smartphones has allowed for a variety of medical applications including the use of lens attachments that provide telescopic, macroscopic, and dermatoscopic data, but the feasibility and performance characteristics of such a platform for use in dermatopathology have not been described.
Objective
To determine the diagnostic performance of a smartphone microscope compared to traditional light microscopy in dermatopathology specimens.
Design
A simple smartphone microscope constructed with a 3-mm ball lens was used to prospectively evaluate 1021 consecutive dermatopathology cases in a blinded fashion. Referred, consecutive specimens from the community were evaluated at a single university hospital. The performance characteristics of the smartphone platform were calculated by using conventional light microscopy as the gold standard. The sensitivity and specificity for the diagnosis of melanoma, nonmelanoma skin cancers, and other miscellaneous conditions by the phone microscopy platform, as compared with traditional light microscopy, were calculated.
Results
For basal cell carcinoma (n = 136), the sensitivity and specificity of smartphone microscopy were 95.6% and 98.1%, respectively. The sensitivity and specificity for squamous cell carcinoma (n = 94) were 89.4% and 97.3%, respectively. The lowest sensitivity was found in melanoma (n = 15) at 60%, although the specificity was high at 99.1%. The accuracy of diagnosis of inflammatory conditions and other neoplasms was variable.
Conclusions
Mobile phone–based microscopy has excellent performance characteristics for the inexpensive diagnosis of nonmelanoma skin cancers in a setting where a traditional microscope is not available.
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Affiliation(s)
- Richard R. Jahan-Tigh
- From the Departments of Dermatology and Pathology, University of Texas Houston Health Science Center, Houston (Drs Jahan-Tigh and Rapini)
- and the Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (Dr Chinn)
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25
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Byrom L, Lucas L, Sheedy V, Madison K, McIver L, Castrisos G, Alfonzo C, Chiu F, Muir J. Tele-Derm National: A decade of teledermatology in rural and remote Australia. Aust J Rural Health 2015; 24:193-9. [DOI: 10.1111/ajr.12248] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Lisa Byrom
- Dermatology Department; Mater Misericordiae Health Service; Brisbane Queensland Australia
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Lex Lucas
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Vicki Sheedy
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Kim Madison
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - Lachlan McIver
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
| | - George Castrisos
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Christina Alfonzo
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Frank Chiu
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Jim Muir
- Dermatology Department; Mater Misericordiae Health Service; Brisbane Queensland Australia
- University of Queensland School of Medicine; University of Queensland; Brisbane Queensland Australia
- Australian College of Rural and Remote Medicine; Brisbane Queensland Australia
- South East Dermatology; Brisbane Queensland Australia
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26
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Bashshur RL, Shannon GW, Tejasvi T, Kvedar JC, Gates M. The Empirical Foundations of Teledermatology: A Review of the Research Evidence. Telemed J E Health 2015; 21:953-79. [PMID: 26394022 PMCID: PMC4776540 DOI: 10.1089/tmj.2015.0146] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION This article presents the scientific evidence for the merit of telemedicine interventions in the diagnosis and management of skin disorders (teledermatology) in the published literature. The impetus for this work derives from the high prevalence of skin disorders, the high cost, the limited availability of dermatologists in certain areas, and the promise of teledermatology to address unmet needs in this area. MATERIALS AND METHODS The findings are based on a targeted review of scientific studies published from January 2005 through April 2015. The initial search yielded some 5,020 articles in Google Scholar and 428 in PubMed. A review of the abstracts yielded 71 publications that met the inclusion criteria for this analysis. Evidence is organized according to the following: feasibility and acceptance; intermediate outcomes (use of service, compliance, and diagnostic and treatment concordance and accuracy); outcomes (health improvement and problem resolution); and cost savings. A special section is devoted to studies conducted at the Veterans Health Administration. RESULTS Definitions of teledermatology varied across a wide spectrum of skin disorders, technologies, diagnostic tools, provider types, settings, and patient populations. Outcome measures included diagnostic concordance, treatment plans, and health. CONCLUSIONS Despite these complexities, sufficient evidence was observed consistently supporting the effectiveness of teledermatology in improving accessibility to specialty care, diagnostic and treatment concordance, and skin care provided by primary care physicians, while also reducing cost. One study reported suboptimal clinical results from teledermatology for patients with pigmented skin lesions. On the other hand, confocal microscopy and advanced dermoscopy improved diagnostic accuracy, especially when rendered by experienced teledermatologists.
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Affiliation(s)
- Rashid L. Bashshur
- eHealth Center, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary W. Shannon
- Department of Geography, University of Kentucky, Lexington, Kentucky
| | - Trilokraj Tejasvi
- Department of Dermatology, University of Michigan Health System, Ann Arbor, Michigan
| | - Joseph C. Kvedar
- Center for Connected Health, Partners HealthCare, Boston, Massachusetts
| | - Michael Gates
- eHealth Center, University of Michigan Health System, Ann Arbor, Michigan
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27
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Lipoff JB, Cobos G, Kaddu S, Kovarik CL. The Africa Teledermatology Project: A retrospective case review of 1229 consultations from sub-Saharan Africa. J Am Acad Dermatol 2015; 72:1084-5. [PMID: 25981007 DOI: 10.1016/j.jaad.2015.02.1119] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/05/2015] [Accepted: 02/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jules B Lipoff
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gabriela Cobos
- Department of Internal Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Steven Kaddu
- Department of Dermatology, Medical University of Graz, Austria
| | - Carrie L Kovarik
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania.
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28
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[Importance of dermatopathology in the diagnosis of tropical and travel-associated skin diseases]. Hautarzt 2015; 65:895-9. [PMID: 25209758 DOI: 10.1007/s00105-014-3500-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Skin diseases are frequent in tropical countries and cause a significant burden for their health systems. Tropical dermatoses are frequently of infectious nature. DIAGNOSTICS Dermatopathology plays an important role in the diagnosis of many tropical skin diseases. This refers specially to leishmaniasis, tropical helminthic diseases, tuberculosis, leprosy, and deep fungal infections. In addition, dermatopathology is important for the differential diagnosis of non-infectious inflammatory diseases in pigmented skin; their identification may be more challenging than when seen in Caucasian skin. CONCLUSION While it is usually not problematic to perform a dermatopathologic workup in travelers and expatriates returning from the tropics into Western industrialized countries, dermatopathologic services are frequently non-existent or severely limited in many tropical countries. Therefore, in improving health systems, not only should a dermatologic workforce be developed, but also training of dermatopathologists and the establishment of dermatopathology laboratories should be considered.
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29
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Teledermatology: From historical perspective to emerging techniques of the modern era. J Am Acad Dermatol 2015; 72:577-86; quiz 587-8. [DOI: 10.1016/j.jaad.2014.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 07/21/2014] [Accepted: 08/07/2014] [Indexed: 11/22/2022]
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30
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Greisman L, Nguyen TM, Mann RE, Baganizi M, Jacobson M, Paccione GA, Friedman AJ, Lipoff JB. Feasibility and cost of a medical student proxy-based mobile teledermatology consult service with Kisoro, Uganda, and Lake Atitlán, Guatemala. Int J Dermatol 2014; 54:685-92. [PMID: 25558031 DOI: 10.1111/ijd.12708] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 01/20/2014] [Accepted: 03/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The expansion of mobile technology and coverage has unveiled new means for delivering medical care to isolated and resource-poor communities. Teledermatology, or dermatology consultation from a distance using technology, is gaining greater acceptance among physicians and patients. OBJECTIVES To evaluate feasibility and cost of a smartphone-based teledermatology consult service utilizing a designated medical student proxy to facilitate all consults on site, and to evaluate the service's effect upon diagnosis and management. METHODS An IRB-approved smartphone-based teledermatology consult service was established to serve two rural communities in the developing world: Kisoro, Uganda, and Lake Atitlán, Guatemala. Fourth-year medical students were recruited as proxies for each site, responding to consults by local doctors and transmitting photographs and clinical information via a smartphone application to a dermatology resident and attending in the USA over an encrypted website. At the Ugandan site, when indicated, the medical student performed skin biopsies under supervision, and rotating Montefiore residents transported specimens back to the USA. RESULTS From October 2011 to August 2012, 93 cases were evaluated by the consult service (57 from Uganda and 36 from Guatemala). Initial diagnoses changed completely in 55.9% (52 of 93) of cases, and management changes were recommended in 89.2% (83 of 93) of cases. The estimated total cost of supplies and technology was 42.01 USD per consult and 64.24 USD per biopsy (including processing). Given fixed upfront costs, the cost per consult decreased with each additional case. CONCLUSION Smartphone-based systems for teledermatology consultation using a medical student proxy are feasible for delivery of care in the developing world at relatively little cost. Optimization and sustainability of this system requires and deserves further investigation in larger studies.
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Affiliation(s)
- Laura Greisman
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Tan M Nguyen
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ranon E Mann
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mark Jacobson
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Gerald A Paccione
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Adam J Friedman
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Physiology and Biophysics, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jules B Lipoff
- Division of Dermatology, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Dermatology, University of Pennsylvania, Philadelphia, PA, USA
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Lee P, Chen CF, Wan HT, Jian WS, Hsu MH, Syed-Abdul S, Huang CW, Huang YC, Lin YT, Chen TJ, Wu YH, Li YC. iSlide: a 'big picture' interactive teledermatopathology e-learning system. Br J Dermatol 2014; 172:692-9. [PMID: 25040884 DOI: 10.1111/bjd.13274] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermatopathology training is often limited by facilities and a dearth of specialists. Advancements in information and communication technologies have made possible the adoption of innovative learning techniques, especially in places where specialists are lacking. OBJECTIVES To implement and evaluate the performance of the iSlide system, which is an interactive dermatopathology training platform (http://scope.tmu.edu.tw/islide2/). METHODS Fifty-two cases representing a variety of dermatopathology conditions and complications were used to set up the iSlide system, and virtual slides of these cases were produced. Medical students from the Dermatology Department of Taipei Medical University were taught to use the system. Performance of the system was evaluated and validated using questionnaires, the first comprising 20 questions and the second a shorter, six-question telephone-based survey on 15 of the 96 interns. Twenty cases prepared by the iSlide system were also presented at an international dermatopathology conference and evaluated by conference participants. RESULTS Ninety-six students and 72 experts participated in the study. Ninety-two per cent of the students and 98% of the experts found the iSlide system to be a useful tool for learning dermatopathology. Of these, 82% of the students and 63% of the experts felt that iSlide was easy to use. CONCLUSIONS iSlide is useful for dermatopathology. As only 82% of the student evaluators and 63% of the expert evaluators found the system easy to use, further work has to be done to improve the iSlide interface to make the system more user friendly.
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Affiliation(s)
- P Lee
- Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan; College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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Beltraminelli H, Kiprono S, Zuriel D, Swai B, Giabbani E, Grossmann H, Masenga J. Dermatopathology in sub-Saharan Africa: a systematic 5-year analysis of all histopathological diagnoses from the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania. J Eur Acad Dermatol Venereol 2014; 29:1370-5. [DOI: 10.1111/jdv.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 10/22/2014] [Indexed: 12/31/2022]
Affiliation(s)
- H. Beltraminelli
- University Clinic for Dermatology; Inselspital - Bern University Hospital; Bern Switzerland
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
| | - S. Kiprono
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
- Department of Dermatology; Provincial General Hospital; Kakamega Kenya
| | - D. Zuriel
- Pathology Department; University of Nairobi; Nairobi Kenya
| | - B. Swai
- Pathology Department at the Kilimanjaro Christian Medical University College; Moshi Tanzania
| | - E. Giabbani
- University Clinic for Dermatology; Inselspital - Bern University Hospital; Bern Switzerland
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
| | - H. Grossmann
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
| | - J.E. Masenga
- Regional Dermatology Training Centre at Kilimanjaro Christian Medical University College; Moshi Tanzania
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Smith SE, Ludwig JT, Chinchilli VM, Mehta K, Stoute JA. Use of Telemedicine to Diagnose Tinea in Kenyan Schoolchildren. Telemed J E Health 2013; 19:166-8. [DOI: 10.1089/tmj.2012.0085] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sarah E. Smith
- The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - John T. Ludwig
- The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | | | - Khanjan Mehta
- The Pennsylvania State University College of Engineering, University Park, Pennsylvania
| | - José A. Stoute
- The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Chuh A, Zawar V, Law M, Sciallis G. Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, unilateral mediothoracic exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome: a brief review and arguments for diagnostic criteria. Infect Dis Rep 2012; 4:e12. [PMID: 24470919 PMCID: PMC3892651 DOI: 10.4081/idr.2012.e12] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 12/11/2022] Open
Abstract
Several exanthems including Gianotti-Crosti syndrome, pityriasis rosea, asymmetrical periflexural exanthem, eruptive pseudoangiomatosis, and papular-purpuric gloves and socks syndrome are suspected to be caused by viruses. These viruses are potentially dangerous. Gianotti-Crosti syndrome is related to hepatitis B virus infection which is the commonest cause of hepatocellular carcinoma, and Epstein-Barr virus infection which is related to nasopharyngeal carcinoma. Pityriasis rosea has been suspected to be related to human herpesvirus 7 and 8 infections, with the significance of the former still largely unknown, and the latter being a known cause of Kaposi's sarcoma. Papular-purpuric gloves and socks syndrome is significantly associated with human B19 erythrovirus infection which can lead to aplastic anemia in individuals with congenital hemoglobinopathies, and when transmitted to pregnant women, can cause spontaneous abortions and congenital anomalies. With viral DNA sequence detection technologies, false positive results are common. We can no longer apply Koch's postulates to establish cause-effect relationships. Biological properties of some viruses including lifelong latent infection, asymptomatic shedding, and endogenous reactivation render virological results on various body tissues difficult to interpret. We might not be able to confirm or refute viral causes for these rashes in the near future. Owing to the relatively small number of patients, virological and epidemiology studies, and treatment trials usually recruit few study and control subjects. This leads to low statistical powers and thus results have little clinical significance. Moreover, studies with few patients are less likely to be accepted by mainstream dermatology journals, leading to publication bias. Aggregation of data by meta-analyses on many studies each with a small number of patients can theoretically elevate the power of the results. Techniques are also in place to compensate for publication bias. However, these are not currently feasible owing to different inclusion and exclusion criteria in clinical studies and treatment trials. The diagnoses of these rashes are based on clinical assessment. Investigations only serve to exclude important differential diagnoses. A wide spectrum of clinical features is seen, and clinical features can vary across different populations. The terminologies used to define these rashes are confusing, and even more so are the atypical forms and variants. Previously reported virological and epidemiological results for these rashes are conflicting in many aspects. The cause of such incongruence is unknown, but low homogeneity during diagnosis and subject recruitment might be one of the factors leading to these incongruent results. The establishment and proper validation of diagnostic criteria will facilitate clinical diagnosis, hasten recruitment into clinical studies, and allow results of different studies to be directly compared with each another. Meta-analyses and systematic reviews would be more valid. Diagnostic criteria also streamline clinical audits and surveillance of these diseases from community perspectives. However, over-dependence on diagnostic criteria in the face of conflicting clinical features is a potential pitfall. Clinical acumen and the experience of the clinicians cannot be replaced by diagnostic criteria. Diagnostic criteria should be validated and re-validated in response to the ever-changing manifestations of these intriguing rashes. We advocate the establishment and validation of diagnostic criteria of these rashes. We also encourage the ongoing conduction of studies with a small number of patients. However, for a wider purpose, these studies should recruit homogenous patient groups with a view towards future data aggregation.
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Affiliation(s)
- Antonio Chuh
- School of Public Health, The Chinese University of Hong Kong and The Prince of Wales Hospital, Hong Kong
| | | | - Michelle Law
- School of Public Health, The Chinese University of Hong Kong and The Prince of Wales Hospital, Hong Kong
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