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Letter from the journal: Improving diagnostic acumen and patient outcomes [Editorial]

Elston, Dirk M; Grant-Kels, Jane M; Levin, Nikki A; Alam, Murad; Brodell, Robert T; Fernandez, Anthony P; Flamm, Alexandra; Hurley, M Yadira; Ratner, Desiree; Schaffer, Julie V; Peebles, Klint; Alexis, Andrew F; James, Alaina J
PMID: 37172734
ISSN: 1097-6787
CID: 5544622

Examining occupational characteristics of patients with allergic contact dermatitis: A retrospective claims-based analysis

Joshi, Isha; Maczuga, Steve; Flamm, Alexandra
PMID: 37269921
ISSN: 1097-6787
CID: 5543522

Are Dermatology Electives Meeting The Learning Objectives of Rotators?

Patel, Deep; Joshi, Isha; Flamm, Alexandra
ISSN: 2574-1624
CID: 5412492

A virtual dermatology elective for underrepresented in medicine medical students

Chopra, Shara; Simmers, Jocelyn; Kirby, Joslyn; Flamm, Alexandra
ISSN: 1087-2108
CID: 5412482

Internalized skin bias: validation study to explore the impact of the internalization of social stigma on those with hidradenitis suppurativa

Butt, M; Chinchilli, V M; Leslie, D L; Khesroh, E; Helm, M F; Flamm, A; Kirby, J S; Rigby, A
BACKGROUND:Hidradenitis suppurativa (HS) is a chronic auto-inflammatory disease that is highly associated with adverse psychopathology and impaired body image. Previous studies show that patients with HS are also impacted by social stigma associated with their skin disease. Over time, these experiences can influence the way in which patients feel about themselves, leading to internalized skin bias (ISB). OBJECTIVES/OBJECTIVE:To evaluate the validity and reliability of the Internalized Skin Bias Questionnaire (ISBQ) in an HS population and to determine the association of this instrument with markers of HS severity. METHODS:A cross-sectional survey with 72-h retest was sent to adult patients with HS from March to November 2021. Reliability for the ISBQ was evaluated using Cronbach's alpha and the Concordance Correlation Coefficient (CCC). Construct validity was evaluated using Pearson Correlation Coefficients with similar measures. RESULTS:Internal consistency for the ISBQ instrument was 0.89 with a CCC of 0.88. The ISBQ had moderate correlation (r = 0.63) with the experienced skin stigma questionnaire as well as the BDI-II (r = 0.66) and the psychosocial subscale of the HiSQOL (r = 0.65). ISBQ scores differed significantly across different stages of disease severity (P = 0.04). There was no significant difference between those with different durations of disease (P = 0.47). CONCLUSIONS:This study shows that the ISBQ is a valid and reliable instrument that can be used to assess the psychosocial construct of ISB especially in a population of HS patients. Further, ISB places a prevalent negative impact on the psychopathology of patients with HS.
PMID: 35170818
ISSN: 1468-3083
CID: 5412422

Poison Ivy Dermatitis Treatment Patterns and Utilization: A Retrospective Claims-based Analysis

Butt, Melissa; Flamm, Avram; Marks, James G; Flamm, Alexandra
INTRODUCTION/BACKGROUND:Poison ivy (toxicodendron) dermatitis (TD) resulting from contact with poison ivy, oak, or sumac is a common form of allergic contact dermatitis that impacts millions of people in the United State every year and results in an estimated 43,000 emergency department (ED) visits annually. Our objective in this study was to evaluate whether healthcare utilization outcomes are impacted by prescription practices of systemic corticosteroids. METHODS:We used a health claims database from 2017-2018 of those treated for TD. Descriptive statistics and logistics regression models were used to characterize trends. RESULTS:We included in this analysis 115,885 claims from 108,111 unique individuals (93.29%) with 7,774 (6.71%) return claims within 28 days. Of the return claims, 470 (6.05%) were to the ED. Emergency clinicians offered no oral corticosteroid prescription 5.27% (n = 3,194) of the time; 3276 (86.26%) prescriptions were for a duration of 1-13 days, 410 (10.80%) were for 14-20 days, and 112 (2.95%) were for >21 days. Further, we found that shorter duration oral corticosteroids (odds ratio [OR] 1.30; 95% confidence interval 1.17-1.44; P <0.001) and initial treatment for TD at the ED compared to primary care clinicians (OR 0.87 [0.80, 0.96]; P <0.001) and other non-dermatologists (OR 0.89 [0.80, 0.98]; P = 0.01) places patients at an increased risk for return visits with healthcare clinicians when controlling for drug group, duration of treatment, and initial treatment location. CONCLUSION/CONCLUSIONS:Despite recommendations to treat TD with oral steroids for at least 14 days, most emergency clinicians offered this treatment for shorter durations and was associated with return visits. Emergency clinicians should consider treatment of two to three weeks when providing systemic steroid coverage when there are no limiting contraindications, especially as patients who present to the ED may do so with more severe disease. Additional education may be needed on appropriate treatment pathways for TD to reduce healthcare utilization associated with undertreatment.
PMID: 35980412
ISSN: 1936-9018
CID: 5399312

Efficacy of pediatric dermatology Extension for Community Healthcare Outcomes (ECHO) sessions on augmenting primary care providers' confidence and abilities

Sun, Haorui; Green, Brian; Zaenglein, Andrea; Butt, Melissa; Kirby, Joslyn S; Flamm, Alexandra
Due to the shortage of pediatric dermatologists and the abundance of skin disorders presenting in childhood, general pediatricians shoulder the management of many pediatric dermatologic disorders and would benefit from additional dermatology-specific training. To address this educational gap, general pediatricians were enrolled in a pediatric dermatology-specific Project Extension for Community Healthcare Outcomes (ECHO) program and surveyed to assess the efficacy of the program in increasing providers' ability and confidence in managing pediatric dermatologic conditions. Providers unanimously reported increased confidence and abilities in assessment and management of pediatric dermatologic conditions. Pediatric dermatology Project ECHO demonstrated high efficacy in improving general practitioners' comfort and knowledge on dermatology-specific topics and may be used as an education model for enhancing primary care providers' knowledge and management of common disorders.
PMID: 34971007
ISSN: 1525-1470
CID: 5399262

Establishing Consensus on the Treatment of Toxicodendron Dermatitis

Butt, Melissa; Marks, James G; Flamm, Alexandra
BACKGROUND:Toxicodendron dermatitis (TD) is a common form of allergic contact dermatitis that affects millions of Americans every year. Studies have shown that although there are general recommendations for the treatment of TD, there are no treatment algorithms for clinicians to follow when patients present with TD. OBJECTIVE:The objective of this study was to achieve consensus on the treatment of TD to create practical guidelines for physicians who treat TD. METHODS:Data were collected from March 2020 to April 2021. This study included semistructured focus groups and a Delphi Study with dermatologists to achieve consensus. RESULTS:A total of 51 dermatologists were included in the Delphi. Final agreement with proposed severity criteria ranged from 90.9% to 100.0%. Primary indicators of disease severity were body surface area, presence and severity of pruritus, and anatomic locations of eruptions with 77.4% agreement. Final agreement for the treatment algorithm was over the threshold majority agreement at 67.6%. CONCLUSIONS:Literature guiding the treatment of TD is scarce. The use of the Delphi method and focus groups can help expand dermatological resources both within dermatology and to other specialties that may need to treat skin conditions.
PMID: 35481848
ISSN: 2162-5220
CID: 5399292

Associations of Internalized Skin Bias With Age, Adverse Psychopathology, and Health-Related Quality of Life Among Patients With Hidradenitis Suppurativa: A Cross-sectional Analysis

Butt, Melissa; Rigby, Andrea; Leslie, Douglas L; Foulke, Galen T; Flamm, Alexandra; Kirby, Joslyn S; Chinchilli, Vernon M
IMPORTANCE:Hidradenitis suppurativa (HS) is a chronic autoinflammatory disease that is highly associated with affective disorders such as depression and anxiety. Recent studies have shown that patients with HS may also endorse high levels of internalized skin bias (ISB). This redirection of skin disease-related social stigma toward oneself may also play an important role in the associations between adverse psychopathology (eg, depression, anxiety) and health-related quality of life (HRQOL). OBJECTIVES:To evaluate the associations of ISB with other core outcomes in HS and to determine if ISB may mediate the associations between adverse psychopathological outcomes and impaired HRQOL. DESIGN, SETTING, AND PARTICIPANTS:A cross-sectional study of adult patients with HS recruited from 1 academic medical center as well as through virtual social and recruitment networks. Eligible participants completed an online survey comprised of 4 survey instruments along with demographic and disease history information from April 1, 2021, to July 15, 2021. MAIN OUTCOMES AND MEASURES:Measures included the Internalized Skin Bias Questionnaire (ISBQ), Burns Anxiety Inventory, the Beck Depression Inventory-II, the Hidradenitis Suppurativa Quality of Life (HiSQOL) instrument, along with demographic and disease history information. The primary outcome was HRQOL as measured by the HiSQOL. Data were analyzed in July through August 2021. RESULTS:The survey was completed by 230 of 279 patients (82.4%; mean [SD] age, 39.2 [11.2] years; 209 [90.9%] identified as female, 203 [88.7%] as not Hispanic, 178 [77.7%] as White). Depression and anxiety were shown to be a substantial burden in this sample, with 56.5% of participants' scores qualifying for moderate or greater anxiety and 45.7% moderate or greater depression. The mean (SD) HRQOL scores were moderately high at 34.5 (16.7), indicating strong levels of impairment. There was a moderate correlation between ISBQ score and depression (r = 0.67); and fair correlations with HRQOL (r = 0.52) and anxiety (r = 0.56). Therefore, ISB appears to positively mediate the associations between depression and anxiety (estimated proportions of total effect that were mediated, 38.7% and 24.9%, respectively) and HRQOL. After controlling for age, disease severity, and disease duration, both ISB and anxiety were positive predictors of impaired HRQOL. CONCLUSIONS AND RELEVANCE:This cross-sectional study found that ISB was associated with adverse psychopathology and impaired HRQOL in patients with HS. Furthermore, ISB appears to mediate the associations of depression and anxiety with HRQOL. Future studies are needed to design interventions targeted at addressing adverse psychopathology associated with ISB and improving HRQOL and well-being for patients with HS.
PMID: 35293961
ISSN: 2168-6084
CID: 5399282

Characterizing demographics and cost of care for dyshidrotic eczema

Gladys, Taylor E; Maczuga, Steven; Flamm, Alexandra
BACKGROUND:Dyshidrotic eczema (DE) is a common form of eczema affecting the hands, feet, or both areas. To date, there has been little research examining demographics and cost burden associated with this disease. OBJECTIVE:This study seeks to characterize the demographics of patients affected and the direct costs of care associated with DE. METHODS:This is a retrospective analysis utilizing insurance claim information from IBM MarketScan. Pertinent data including demographic information, healthcare provider type, medications prescribed, and average cost of care were identified using the ICD 10 code L30.1 for DE for the year 2018. RESULTS:In 2018, 34 932 patients filed claims for DE, with 61% female and an average age of 37 years at first diagnosis. DE was mostly seen in employees from the service industry and the manufacturing of durable goods. The total annual direct cost was US $11 738 985. Average annual costs, however, did vary based on type of treating healthcare provider, level of care, and medications prescribed. CONCLUSIONS:Patients with DE can face an economic burden due to their disease and providers should aim to recognize this disease and its treatments to minimize healthcare costs for patients and improve quality of life.
PMID: 34773262
ISSN: 1600-0536
CID: 5399252