Where is teledermatology most useful? Patient web searches may provide clues.
An upcoming JAAD article-in-press explores how dermatologic needs of patients have evolved throughout the pandemic. Using Google Trends search volume index (SVI), the study authors examine patient interest in skin conditions and procedures during three time intervals: pre-pandemic (April 28, 2019 – March 8, 2020), onset of national stay-at-home orders (March 15-29, 2020), and the ongoing social distancing period (April 5 – present). Their findings suggest potential dermatologic areas of greatest demand for which telehealth offerings may provide significant benefit, the researchers wrote.
The authors categorized the search data into three categories: general dermatology conditions, premalignant and cancerous conditions, and cosmetic procedures.
Significant decreases in SVI were seen between the pre-pandemic period and the onset of the stay-at-home orders for general dermatologic conditions (82.6 vs. 71.9), premalignant and cancerous conditions (77.6 vs. 47.9), and cosmetic procedures (71.8 vs. 45.1). During the ongoing social distancing period, interest in general conditions has returned to baseline, while the other two categories remain persistently low.
The authors suggest it is likely that the pandemic caused many patients with general dermatologic conditions to have appointments postponed or missed, which may cause patients to turn to search engines, many of which suffer from bias and misinformation.
DW Insights and Inquiries: Lichenoid and granulomatous dermatitis — Points to ponder
Clinical-pathologic correlation is the foundation of dermatologic diagnosis; often this is straightforward, but on occasion, getting to the precise diagnosis requires great thought and sleuthing. If you receive a report from your dermatopathologist with a descriptive diagnosis of “lichenoid and granulomatous dermatitis” what do you do with that information?
In Lichenoid granulomatous dermatitis revisited: a retrospective series, Braswell et al. studied an unusual reaction pattern with confounding features. The authors observed that while TH1 cells are the primary subset involved in lichenoid interface dermatitis, TH2 cells can also activate cytotoxic CD8 T cells. Additionally, some antigens can trigger TH1 responses and simultaneously activate CD4 T cells. Concomitant TH1 and TH2 responses drive the vacuolar change and macrophage recruitment observed in lichenoid granulomatous dermatitis (LGD). Previously, dermatopathologists relied on descriptive reports to communicate these features, and dermatologists found clinical correlation of LGD challenging. In the largest series of LGD to date, Braswell et al. identified drug eruption (see image) and lichenoid keratosis as the most common clinical diagnoses associated with LGD, followed by tattoo reaction, postherpetic dermatitis, and scabies or postscabietic dermatitis. Pigmented purpuric dermatitis (PPD) and lichen striatus were also observed. Keep reading!
During the COVID-19 pandemic, ‘Leaders eat last.’
DW Weekly talked to Vinh Chung, MD, from Vanguard Skin Specialists in Colorado Springs, about his experiences helping his staff manage during the COVID-19 pandemic.
DW Weekly: How has the COVID-19 pandemic affected Vanguard Skin Specialists?
Dr. Chung: After executive orders suddenly limited medical services and procedures, the volume at our medical practice dipped by 90%. This unsustainable situation had no end in sight. The cash reserves in our practice were bleeding out and would be depleted if changes were not made immediately.
DW Weekly: What steps did you take to minimize the impact of the pandemic on your practice?
Dr. Chung: Even before any federal loans or financial assistance became available, our leadership team took action. We committed to follow our motto that “Leaders eat last.” Financial setbacks are scary for anyone, but we recognized that our hourly employees have it much worse. They need their paychecks to buy groceries and to pay rent, so we committed to protect them.
Starting from the top down, our executive team took an 80-100% cut in our salaries. The rest of the medical providers also voluntarily took significant pay cuts. After we announced our decision, other staff members began stepping up and following suit. Our managers asked to “work more and get paid less.” Some staff members even volunteered to work for free. Across our medical practice, team members who earned the most made disproportionately larger sacrifices in order to protect those who earned the least. Keep reading!
Two more days…there’s still time to register for AAD VMX
The Academy’s virtual meeting experience, AAD VMX, will be held June 12-14, 2020. AAD VMX offers more than 28 CME credits, 14 robust sessions on multiple clinical topics, live Q&As with presenters, 900 posters, a virtual exhibit hall, and more!
Nominations for Officers, Directors, and Nominating Committee Member Representatives (East Region) are now being accepted through Oct. 1. To view reference materials and submit a nomination and letter of support, visit staging.aad.org/aadnominations or email callfornominations@aad.org.
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