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Article
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Trends in mortality from skin diseases in the United States: skin infectious diseases are claiming more lives

Fleischer, Jr, Alan B

Dermatology Online Journal, Volume 22, Issue 7 (2016)

BackgroundAlthough there has been some excellent work published on the mortality from non-neoplastic skin disease In the United States, further analysis of trends is limited.

MethodsData from the Centers for Disease Control and Prevention (CDC) for mortality abstracted from Death Certificates was obtained from the WONDER (wide-ranging online data for epidemiologic research) system from 1999 to 2014. Categorical variables were analyzed with Excel 2013 data analysis software using Chi-squared tests whereas regression was performed for trends.

ResultsCrude death rates were highest in the South, especially in Mississippi and Louisiana. This work also confirmed that Blacks or African Americans had higher risk of death from skin disease, whereas Hispanic or Latinos had lower risk. Overall mortality from non-neoplastic diseases is increasing over time and significant increases in mortality from infectious and papulosquamous diseases were observed, whereas there appears to be decreasing mortality from dermatitis and miscellaneous skin disorders (ICD-10-CM L80-90).

ConclusionsMortality is increasing from non-neoplastic diseases, especially infectious and papulosquamous diseases. Demographic factors such age race and Hispanic or Latino ethnicity also confer differential risk.

Cover page: Trends in mortality from skin diseases in the United States: skin infectious diseases are claiming more lives

Creative Commons 'BY-NC-ND' version 4.0 license

Article

Additional evidence that rosacea pathogenesis may involve demodex: new information from the topical efficacy of ivermectin and praziquantel

Dermatology Online Journal, Volume 21, Issue 9 (2015)

Additional evidence that Demodex folliculorum may contribute to the pathogenesis of papulopustular rosacea are new studies of two topical antiparasitic agents. Ivermectin and praziquantel have recently been shown to be effective in decreasing the severity of papulopustular rosacea. These two agents significantly differ in molecular structure, but yield similar antiparasitic mechanisms of action. Higher numbers of Demodex mites are found in the skin of patients with rosacea than in people with normal skin. If Demodex play a role in pathogenesis, then hypersensitivity to the mites, their flora, or their products could explain the observed efficacy of antidemodectic therapy.

Cover page: Additional evidence that rosacea pathogenesis may involve demodex: new information from the topical efficacy of ivermectin and praziquantel

Article

Is the duration of skin disease visits decreasing in the united states?

Dermatology Online Journal, Volume 21, Issue 2 (2015)

Background: Changes in the practice of medicine may be affecting how much time physicians spend with their patients. Economic pressures in some health systems may limit how much time patients spend with doctors. Inefficiencies associated with the use of EMR potentially could lengthen the duration of office visits.

Objective: To assess trends in the duration of skin disease visits over the last two decades.

Methods: Skin disease visits were selected from the 1993-2010 National Ambulatory Medical Care Survey. Changes in overall number of visits per dermatologist, variation in visit duration, and differences by specialty in visit duration were assessed.

Results: The mean duration of skin disease visits increased over time for both dermatologists (β=0.24 minutes) and nondermatologists (β=0.19, both P<0.0001). For visits with a sole diagnosis of skin disease, dermatologist visits were shorter (14.7 minutes) than nondermatologist visits (16.4 minutes, P<0.0001). Visits for unspecified warts, atopic dermatitis, unspecified dermatitis, and acne grew significantly longer over time. In a multivariate analysis, older age, later year, nondermatology specialty, new patient status, procedure performed, private insurance, no physician extender involvement, and electronic medical records were associated with longer visit duration.

Limitations: The data are not informative about the quality of the time physicians spend with patients.

Conclusions: Economic pressures have, so far, not reduced the average time physicians spend in direct contact with patients.

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Cover page: Is the duration of skin disease visits decreasing in the united states?

Article

Proposed classification for koebner, wolf isotopic, renbok, koebner nonreaction, isotopic nonreaction & other related phenomen.

Dermatology Online Journal, Volume 20, Issue 11 (2014)

Students of skin diseases have long noted a variety of disease responses and non-responses to trauma and the presence of structural abnormalities. This article will review the series of these responses including: Koebner phenomenon, Wolf isotopic response, Renbök response, Koebner nonreaction, isotopic nonreaction, and other related skin reactions. Because most of these reported phenomena have similar morphological features the diagnosis is often made on the basis of differences in the clinical presentation. Note that some of the cutaneous reactions of similar phenomena have been described using varied nomenclature, further adding to the confusion. In view of this, we believe that at present there is a robust need to define each cutaneous reaction accordingly and classify the various types of these phenomena under a broad universal term or terms. Respecting the idea of differences might facilitate a better understanding of the pathophysiology of these entities. We then will propose an alternative classification system.

Cover page: Proposed classification for koebner, wolf isotopic, renbok, koebner nonreaction, isotopic nonreaction & other related phenomen.