%0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e67356 %T Fine-Grained Classification of Pressure Ulcers and Incontinence-Associated Dermatitis Using Multimodal Deep Learning: Algorithm Development and Validation Study %A Brehmer,Alexander %A Seibold,Constantin %A Egger,Jan %A Majjouti,Khalid %A Tapp-Herrenbrück,Michaela %A Pinnekamp,Hannah %A Priester,Vanessa %A Aleithe,Michael %A Fischer,Uli %A Hosters,Bernadette %A Kleesiek,Jens %K computer vision %K image classification %K wound classification %K deep learning %K pressure ulcer %K incontinence-associated dermatitis %K multi modal data %K synthetic image generation %D 2025 %7 1.5.2025 %9 %J JMIR AI %G English %X Background: Pressure ulcers (PUs) and incontinence-associated dermatitis (IAD) are prevalent conditions in clinical settings, posing significant challenges due to their similar presentations but differing treatment needs. Accurate differentiation between PUs and IAD is essential for appropriate patient care, yet it remains a burden for nursing staff and wound care experts. Objective: This study aims to develop and introduce a robust multimodal deep learning framework for the classification of PUs and IAD, along with the fine-grained categorization of their respective wound severities, to enhance diagnostic accuracy and support clinical decision-making. Methods: We collected and annotated a dataset of 1555 wound images, achieving consensus among 4 wound experts. Our framework integrates wound images with categorical patient data to improve classification performance. We evaluated 4 models—2 convolutional neural networks and 2 transformer-based architectures—each with approximately 25 million parameters. Various data preprocessing strategies, augmentation techniques, training methods (including multimodal data integration, synthetic data generation, and sampling), and postprocessing approaches (including ensembling and test-time augmentation) were systematically tested to optimize model performance. Results: The transformer-based TinyViT model achieved the highest performance in binary classification of PU and IAD, with an F1-score (harmonic mean of precision and recall) of 93.23%, outperforming wound care experts and nursing staff on the test dataset. In fine-grained classification of wound categories, the TinyViT model also performed best for PU categories with an F1-score of 75.43%, while ConvNeXtV2 showed superior performance in IAD category classification with an F1-score of 53.20%. Incorporating multimodal data improved performance in binary classification but had less impact on fine-grained categorization. Augmentation strategies and training techniques significantly influenced model performance, with ensembling enhancing accuracy across all tasks. Conclusions: Our multimodal deep learning framework effectively differentiates between PUs and IAD, achieving high accuracy and outperforming human wound care experts. By integrating wound images with categorical patient data, the model enhances diagnostic precision, offering a valuable decision-support tool for health care professionals. This advancement has the potential to reduce diagnostic uncertainty, optimize treatment pathways, and alleviate the burden on medical staff, leading to faster interventions and improved patient outcomes. The framework’s strong performance suggests practical applications in clinical settings, such as integration into hospital electronic health record systems or mobile applications for bedside diagnostics. Future work should focus on validating real-world implementation, expanding dataset diversity, and refining fine-grained classification capabilities to further enhance clinical utility. %R 10.2196/67356 %U https://ai.jmir.org/2025/1/e67356 %U https://doi.org/10.2196/67356 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e70282 %T Use of Clinical Public Databases in Hidradenitis Suppurativa Research %A Liu,Xu %A Guo,Linghong %A Jiang,Xian %+ Department of Dermatology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, China, 86 028 85423315, jiangxian@scu.edu.cn %K hidradenitis suppurativa %K clinical public databases %K disease progression %K patient data %K HS %D 2025 %7 18.2.2025 %9 Viewpoint %J Interact J Med Res %G English %X In this viewpoint, we argue that recent studies using clinical public databases have revolutionized our understanding of hidradenitis suppurativa (HS), a chronic inflammatory skin condition with significant impacts on patients’ quality of life. Our key messages are as follows: (1) these databases enable large-scale studies integrating genetic, epidemiological, and clinical data, providing crucial insights into HS’s genetic predispositions, comorbidities, and treatment outcomes; (2) findings highlight a strong genetic component, with mutations in the γ-secretase complex playing a key role in HS pathogenesis and shaping targeted therapies; (3) studies also reveal elevated risks for comorbidities like obesity, diabetes, cardiovascular disease, and systemic inflammation in patients with HS, with diet-driven inflammatory pathways potentially exacerbating disease severity; (4) while these databases offer unprecedented research opportunities, limitations such as data representativeness and quality must be considered; (5) nonetheless, their benefits outweigh potential drawbacks, allowing the identification of rare comorbidities, disease progression patterns, and personalized treatment strategies; and (6) increased funding for HS research is crucial to harness these databases’ full potential, develop targeted therapies, and ultimately improve patient outcomes. As HS’s impact is disproportionate to current research investments, we believe advocating for more resources and addressing database limitations will be key to advancing HS understanding and care. %M 39965202 %R 10.2196/70282 %U https://www.i-jmr.org/2025/1/e70282 %U https://doi.org/10.2196/70282 %U http://www.ncbi.nlm.nih.gov/pubmed/39965202 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e59452 %T The Social Construction of Categorical Data: Mixed Methods Approach to Assessing Data Features in Publicly Available Datasets %A Willem,Theresa %A Wollek,Alessandro %A Cheslerean-Boghiu,Theodor %A Kenney,Martha %A Buyx,Alena %+ Institute of History and Ethics in Medicine, School of Medicine and Health, Technical University of Munich, Ismaningerstraße 22, Munich, 81675, Germany, 49 89 4140 4041, theresa.willem@tum.de %K machine learning %K categorical data %K social context dependency %K mixed methods %K dermatology %K dataset analysis %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: In data-sparse areas such as health care, computer scientists aim to leverage as much available information as possible to increase the accuracy of their machine learning models’ outputs. As a standard, categorical data, such as patients’ gender, socioeconomic status, or skin color, are used to train models in fusion with other data types, such as medical images and text-based medical information. However, the effects of including categorical data features for model training in such data-scarce areas are underexamined, particularly regarding models intended to serve individuals equitably in a diverse population. Objective: This study aimed to explore categorical data’s effects on machine learning model outputs, rooted the effects in the data collection and dataset publication processes, and proposed a mixed methods approach to examining datasets’ data categories before using them for machine learning training. Methods: Against the theoretical background of the social construction of categories, we suggest a mixed methods approach to assess categorical data’s utility for machine learning model training. As an example, we applied our approach to a Brazilian dermatological dataset (Dermatological and Surgical Assistance Program at the Federal University of Espírito Santo [PAD-UFES] 20). We first present an exploratory, quantitative study that assesses the effects when including or excluding each of the unique categorical data features of the PAD-UFES 20 dataset for training a transformer-based model using a data fusion algorithm. We then pair our quantitative analysis with a qualitative examination of the data categories based on interviews with the dataset authors. Results: Our quantitative study suggests scattered effects of including categorical data for machine learning model training across predictive classes. Our qualitative analysis gives insights into how the categorical data were collected and why they were published, explaining some of the quantitative effects that we observed. Our findings highlight the social constructedness of categorical data in publicly available datasets, meaning that the data in a category heavily depend on both how these categories are defined by the dataset creators and the sociomedico context in which the data are collected. This reveals relevant limitations of using publicly available datasets in contexts different from those of the collection of their data. Conclusions: We caution against using data features of publicly available datasets without reflection on the social construction and context dependency of their categorical data features, particularly in data-sparse areas. We conclude that social scientific, context-dependent analysis of available data features using both quantitative and qualitative methods is helpful in judging the utility of categorical data for the population for which a model is intended. %M 39874567 %R 10.2196/59452 %U https://medinform.jmir.org/2025/1/e59452 %U https://doi.org/10.2196/59452 %U http://www.ncbi.nlm.nih.gov/pubmed/39874567 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 8 %N %P e60479 %T Mobile Health App as an Auxiliary Tool in Management of Atopic Dermatitis in Children: Randomized Controlled Trial %A Zvulunov,Alex %A Lenevich,Stepan %A Migacheva,Natalia %K atopic dermatitis %K skin %K disease management %K children %K pediatric %K feasibility %K mHealth %K mobile health %K app %K eczema %K Atopic App %K dermatology %D 2025 %7 22.1.2025 %9 %J JMIR Dermatol %G English %X Background: Mobile health apps can boost treatment adherence and support disease management at home. The Atopic App and web-based Atopic School patient education program offer a chance to enhance adherence to atopic dermatitis (AD) management. Objective: We aim to evaluate the feasibility, acceptability, and preliminary efficacy of the Atopic App mobile health intervention in the managing of AD in children. Methods: A randomized controlled study in children with AD divided participants into 3 groups: a control group (no app), an observational group with the app, and an interventional group with investigator supervision. Patients were examined at screening and follow-up visits 1 and 2 at 3-month intervals. Outcome measures included SCORAD (Scoring Atopic Dermatitis) for objective severity and Patient-Oriented Eczema Measure (POEM) for subjective effectiveness. Statistical analysis used paired t tests (2-tailed), the Mann-Whitney U test, and multiple regression. Results: Fifty-eight participants entered this study (38 boys and 20 girls): group 1 (control) comprised 17 patients, while experimental groups 2 and 3 consisted of 20 and 21 patients, respectively. The rates of missed appointments were similar and statistically insignificant across the groups. All groups showed a significant decrease in SCORAD and POEM scores (P<.05). Usage of the app for ≥8 days showed a more significant decrease in severity scores compared to those who used it for ≤7 days, or did not use it at all. Participants who used the app for ≥8 days had a median SCORAD of 6.25 (95% CI 4.6‐14.1; IQR 4-16.3) at visit 1, significantly lower than nonusers (17.9, 95% CI 13.9‐24.0; IQR 13.9-24; P=.03) and those using it ≤7 days (13, 95% CI 9.35‐27; IQR 7.2-27; P=.04). Their median POEM of 2 (95% CI 1.0‐4.5; IQR 1-5.3) was also significantly lower than those using the app ≤7 days (9, 95% CI 2‐12; IQR 2-12; P=.04) and lower, though not significantly, than nonusers (7, 95% CI 1‐9; IQR 1-9; P=.14). Additionally, using the Atopic App for ≥8 days after the screening visit strongly predicted a decrease in both SCORAD and POEM scores (P=.01 and P=.04, respectively). The time since the screening visit significantly predicted increased outcome scores, while prescriptions of topical calcineurin inhibitors, oral antihistamines, and oral antibiotics were weak and insignificant predictors of score changes. Conclusions: Our findings indicate that the Atopic App is helpful tool in managing AD in children, and they underscore the potential of mobile health interventions in the disease management. Trial Registration: ClinicalTrials.gov NCT06412094; https://clinicaltrials.gov/study/NCT06412094 %R 10.2196/60479 %U https://derma.jmir.org/2025/1/e60479 %U https://doi.org/10.2196/60479 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52159 %T Improving Outcomes and Quality of Life for Patients With Hand and Foot Eczema: Randomized Study of a Patient-Centered Monitoring App %A Bruch,Aimee %A Weigandt,Wanja %A Schardt,Yannic %A Herr,Raphael %A Benecke,Johannes %A Schmieder,Astrid %+ Department of Dermatology, Venereology and Allergology, University Hospital Würzburg, Josef-Schneider-Strasse 2, Würzburg, 97080, Germany, 49 +4993120126234, schmieder_a@ukw.de %K hand and foot eczema %K eHealth %K mHealth %K teledermatology %K telemedicine %K disease management %K smartphone application %K mental health %K eczema %K clinical outcome %K quality of life %K dermatology %K pain %K motor skills %K educational %K support %K mobile phone %D 2025 %7 21.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Hand and foot eczema is a frequent chronic dermatological condition. The persistent itching, pain, and blistering can impair hand and foot function, leading to difficulties in performing tasks requiring fine motor skills. In addition, the impact on the quality of life for affected patients is significant, as the symptoms can be extremely uncomfortable and disruptive to daily activities. By incorporating digital health apps and educational programs into the management of hand and foot eczema, patients may receive ongoing support, optimize their clinical outcomes, and ultimately enhance their overall quality of life. Objective: The purpose of this study was to evaluate the effect of a smartphone app combined with educational training on the clinical outcomes and mental health of patients with chronic hand and foot eczema during a 60-week study period. Methods: Patients in the intervention group participated in an educational program focused on chronic hand and foot eczema at baseline and had in-person visits at weeks 0, 12, 24, 36, and 60, as well as access to our study smartphone app. The app allowed patients to upload pictures of their hands and feet and answer questions about pain severity, itching, mood, and quality of life. A chat function was also available for patients to contact their dermatologist. The control group received only the in-person study visits described above. Results: A total of 87 patients were included in the study and randomized to the intervention (n=43) or control (n=44) groups. In total, 23 patients from the intervention group and 34 patients from the control group completed the study. Throughout the 60-week study period, a significant reduction in Hand Eczema Severity Index (HECSI) was consistently observed in all patients (week 60: linear regression coefficient [Coef]=–1.108; P≤.001). A trend toward a greater improvement of the HECSI in the intervention group compared to the control group was noticed (week 60: Coef=0.597; P=.05). Subgroup analysis revealed that patients who used the app with a usage frequency of less than 20% demonstrated a significant reduction in the HECSI from week 0 to week 60 (week 60: Coef=–1.275; P=.04) and a significant reduction in the Dermatology Life Quality Index (week 60: Coef=–1.246; P=.04) compared to the control group. We were able to demonstrate a significant correlation between the HECSI calculated based on pictures uploaded by patients through the app and the HECSI assessed during personal visits (ρ=0.885; P<.001), despite the potentially lower image quality of the pictures uploaded through the app. Conclusions: This study provides further evidence that digital health apps can provide valuable support in improving patient clinical outcomes and management, especially as the app-based assessment of hand and feed images appears to be reliable. Trial Registration: Deutsches Register Klinischer Studien DRKS00020963; https://drks.de/search/de/trial/DRKS00020963 %M 39836950 %R 10.2196/52159 %U https://www.jmir.org/2025/1/e52159 %U https://doi.org/10.2196/52159 %U http://www.ncbi.nlm.nih.gov/pubmed/39836950 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 8 %N %P e60210 %T Modern Digital Query Analytics of Patient Education Materials on Acanthosis Nigricans: Systematic Search and Content Analysis %A Varghese,Kevin Johny %A Singh,Som %A Kamali,Emily %A Qureshi,Fahad %A Jamal,Aleena %A Qureshi,Fawad %K acanthosis nigricans %K dermatology %K patient education %K public health %K skin %K readability %K information resource %K DISCERN %K general public %K reading level %K information seeking %K information behavior %D 2025 %7 6.1.2025 %9 %J JMIR Dermatol %G English %X Background: Online digital materials are integral to patient education and health care outcomes in dermatology. Acanthosis nigricans (AN) is a common condition, often associated with underlying diseases such as insulin resistance. Patients frequently search the internet for information related to this cutaneous finding. To our knowledge, the quality of online educational materials for AN has not been systematically examined. Objective: The primary objective of this study was to profile the readability and quality of the content of publicly available digital educational materials on AN and identify questions frequently asked by patients. Methods: This study analyzed publicly available internet sources to identify the most frequent questions searched by patients regarding AN using the Google Rankbrain algorithm. Furthermore, available articles on AN were evaluated for quality and reading level using metrics such as the Brief DISCERN score, and readability was determined using three specific scales including the Flesch-Kincaid score, Gunning Fog index, and the Coleman-Liau index, based on literature. Results: Patients most frequently accessed facts on AN from government sources, which comprised 30% (n=15) of the analyzed sources. The available articles did not meet quality standards and were at a reading level not appropriate for the general public. The majority of articles (n=29/50, 58%) had substandard Brief DISCERN scores, failing to meet the criteria for good quality. Conclusions: Clinicians should be aware of the paucity of valuable online educational material on AN and educate their patients accordingly. %R 10.2196/60210 %U https://derma.jmir.org/2025/1/e60210 %U https://doi.org/10.2196/60210 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52914 %T Artificial Intelligence–Aided Diagnosis System for the Detection and Classification of Private-Part Skin Diseases: Decision Analytical Modeling Study %A Wang,Wei %A Chen,Xiang %A Xu,Licong %A Huang,Kai %A Zhao,Shuang %A Wang,Yong %+ School of Automation, Central South University, 932 South Lushan Road, Changsha, 410083, China, 86 18507313729, ywang@csu.edu.cn %K artificial intelligence-aided diagnosis %K private parts %K skin disease %K knowledge graph %K dermatology %K classification %K artificial intelligence %K AI %K diagnosis %D 2024 %7 27.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Private-part skin diseases (PPSDs) can cause a patient’s stigma, which may hinder the early diagnosis of these diseases. Artificial intelligence (AI) is an effective tool to improve the early diagnosis of PPSDs, especially in preventing the deterioration of skin tumors in private parts such as Paget disease. However, to our knowledge, there is currently no research on using AI to identify PPSDs due to the complex backgrounds of the lesion areas and the challenges in data collection. Objective: This study aimed to develop and evaluate an AI-aided diagnosis system for the detection and classification of PPSDs: aiding patients in self-screening and supporting dermatologists’ diagnostic enhancement. Methods: In this decision analytical modeling study, a 2-stage AI-aided diagnosis system was developed to classify PPSDs. In the first stage, a multitask detection network was trained to automatically detect and classify skin lesions (type, color, and shape). In the second stage, we proposed a knowledge graph based on dermatology expertise and constructed a decision network to classify seven PPSDs (condyloma acuminatum, Paget disease, eczema, pearly penile papules, genital herpes, syphilis, and Bowen disease). A reader study with 13 dermatologists of different experience levels was conducted. Dermatologists were asked to classify the testing cohort under reading room conditions, first without and then with system support. This AI-aided diagnostic study used the data of 635 patients from two institutes between July 2019 and April 2022. The data of Institute 1 contained 2701 skin lesion samples from 520 patients, which were used for the training of the multitask detection network in the first stage. In addition, the data of Institute 2 consisted of 115 clinical images and the corresponding medical records, which were used for the test of the whole 2-stage AI-aided diagnosis system. Results: On the test data of Institute 2, the proposed system achieved the average precision, recall, and F1-score of 0.81, 0.86, and 0.83, respectively, better than existing advanced algorithms. For the reader performance test, our system improved the average F1-score of the junior, intermediate, and senior dermatologists by 16%, 7%, and 4%, respectively. Conclusions: In this study, we constructed the first skin-lesion–based dataset and developed the first AI-aided diagnosis system for PPSDs. This system provides the final diagnosis result by simulating the diagnostic process of dermatologists. Compared with existing advanced algorithms, this system is more accurate in identifying PPSDs. Overall, our system can not only help patients achieve self-screening and alleviate their stigma but also assist dermatologists in diagnosing PPSDs. %M 39729353 %R 10.2196/52914 %U https://www.jmir.org/2024/1/e52914 %U https://doi.org/10.2196/52914 %U http://www.ncbi.nlm.nih.gov/pubmed/39729353 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e59368 %T Dermatology in Student-Run Clinics in the United States: Scoping Review %A Kamat,Samir %A Agarwal,Aneesh %A Lavin,Leore %A Verma,Hannah %A Martin,Lily %A Lipoff,Jules B %K dermatology %K dermatologist %K dermatological %K volunteerism %K underserved population %K medical education %K student-run clinic %K scoping review %K review %K PRISMA %D 2024 %7 13.12.2024 %9 %J JMIR Dermatol %G English %X Background: Student-run clinics (SRCs) for dermatology hold potential to significantly advance skin-related health equity, and a comprehensive analysis of these clinics may inform strategies for optimizing program effectiveness. Objective: We aimed to perform a scoping review of the literature about dermatology SRCs across the United States. Methods: We conducted systematic literature searches of Ovid MEDLINE, Ovid Embase, and Scopus on March 1, 2023, and June 19, 2024. No date, language, or paper-type restrictions were included in the search strategy. A total of 229 references were uploaded to Covidence for screening by 2 independent reviewers (SK and LL), and 23 full-text documents were assessed for eligibility. After an additional 8 documents were identified through a gray literature search, a total of 31 studies were included in the final analysis. Inclusion criteria were as follows: (1) studies set in an SRC, which was operationally led by medical students and could render condition-relevant treatments to patients, with dermatology care; (2) published in English; (3) within the United States; (4) included characterization of any of the following: logistics, care, patients, or design; and (5) included all study or document types, including gray literature that was not peer reviewed (eg, conference abstracts, preprints, and letters to the editor). Exclusion criteria were (1) papers not published in English and (2) those with duplicated data or that were limited in scope or not generalizable. Data were extracted qualitatively using Microsoft Excel to categorize the studies by several domains, including clinic location, demographics, services offered, and barriers to care. Results: There are at least 19 dermatology SRCs across the United States. The most common conditions encountered included atopic dermatitis; acne; fungal infections; benign nevi; psoriasis; and neoplasms, such as basal cell carcinoma, squamous cell carcinoma, and melanoma. Key facilitators for the clinics included faculty oversight, attending physician participation for biopsy histopathology, and dedicated program coordinators. Major barriers included lack of follow-up, medication nonadherence, and patient no-shows. Conclusions: Dermatology SRCs serve a diverse patient population, many of whom are underrepresented in traditional dermatology settings. This scoping review provides insights to help build stronger program foundations that better address community dermatologic health needs. %R 10.2196/59368 %U https://derma.jmir.org/2024/1/e59368 %U https://doi.org/10.2196/59368 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e50401 %T Lichen Planus Pigmentosus and Vitiligo in a 61-Year-Old Filipino Man: Case Report %A Belizario,Maria Isabel %A Gatmaitan,Julius Garcia %A Dayrit,Johannes %K lichen planus pigmentosus %K vitiligo %K autoimmune %K isotretinoin %K tacrolimus %K skin %K melanin %K hyperpigmentation %K LPP %D 2024 %7 29.11.2024 %9 %J JMIR Dermatol %G English %X Pigmentary disorders have been implicated in causing psychosocial turmoil in patients as they can cause some degree of cosmetic disfigurement. Lichen planus pigmentosus (LPP) presents as ashy, dermatosis-like eruptions on sun-exposed areas, particularly on the head, neck, and earlobes. On the other hand, vitiligo is a chronic disorder that appears as depigmented patches on the skin. A 61-year-old man with Fitzpatrick skin phototype IV presented to us initially with LPP but eventually also developed vitiligo. The patient was treated with low-dose oral isotretinoin for LPP and topical tacrolimus 0.1% ointment for both LPP and vitiligo with a good clinical outcome. One case of segmental vitiligo and zosteriform LPP, affecting a 22-year-old Indian woman, has been previously reported in the English-language literature. An autoimmune etiology that causes melanocytorrhagy may be a plausible hypothesis for the coexistence of these 2 conditions. %R 10.2196/50401 %U https://derma.jmir.org/2024/1/e50401 %U https://doi.org/10.2196/50401 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e60500 %T How Dermatologists Can Aid Nondermatologic Professionals Using the Figure 1 App: Case Analysis %A Coican,Alexis %A Marroquin,Nathaniel A %A Carboni,Alexa %A Holt,Sara %A Zueger,Morgan %K dermatology %K app %K nondermatologic professional %K dermatologist %K nondermatologist %K mHealth %K health professional %K medical education %K social media %K treatment %K diagnostic %D 2024 %7 13.11.2024 %9 %J JMIR Dermatol %G English %X We found that third-party apps such as Figure 1 were used predominantly by nondermatologist medical personnel for collaboration in medical decision-making related to dermatologic conditions conducted with other health care providers. This finding calls attention to the need for more readily available resources for nondermatologist health care providers encountering patients with skin-related conditions, with the added benefits of trained dermatologists being allies on such medical app platforms, and the platform allowing for recognition of instances when additional consultation or referral to trained dermatologists for more complex cases is appropriate. %R 10.2196/60500 %U https://derma.jmir.org/2024/1/e60500 %U https://doi.org/10.2196/60500 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e60282 %T US Public Interest in Merkel Cell Carcinoma Following Jimmy Buffett’s Death and Implications for Continued Health Advocacy: Infodemiology Study of Google Trends %A Haight,Macy %A Jacobs,Hayden R %A Boltey,Sarah K %A Murray,Kelly A %A Hartwell,Micah %K skin cancer %K merkel cell carcinoma %K infodemiology %K cancer %K carcinoma %K cell carcinoma %K sunlight %K infodemiology study %K Google Trends %K temporal analysis %K United States %K USA %K sun %D 2024 %7 31.10.2024 %9 %J JMIR Dermatol %G English %X Through Jimmy Buffett’s unfortunate battle with lymphoma originating from Merkel cell carcinoma and subsequent media coverage of his death, public interest in skin cancer, Merkel cell carcinoma, and the health effects of sunlight exposure increased, as evidenced by our results. %R 10.2196/60282 %U https://derma.jmir.org/2024/1/e60282 %U https://doi.org/10.2196/60282 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e50451 %T AI in Psoriatic Disease: Scoping Review %A Barlow,Richard %A Bewley,Anthony %A Gkini,Maria Angeliki %+ Department of Dermatology, The Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1FR, United Kingdom, 44 020 7377 700, gkinimargo@gmail.com %K artificial intelligence %K machine learning %K psoriasis %K psoriatic arthritis %K psoriatic disease %K biologics %K prognostic models %K mobile phone %D 2024 %7 16.10.2024 %9 Review %J JMIR Dermatol %G English %X Background: Artificial intelligence (AI) has many applications in numerous medical fields, including dermatology. Although the majority of AI studies in dermatology focus on skin cancer, there is growing interest in the applicability of AI models in inflammatory diseases, such as psoriasis. Psoriatic disease is a chronic, inflammatory, immune-mediated systemic condition with multiple comorbidities and a significant impact on patients’ quality of life. Advanced treatments, including biologics and small molecules, have transformed the management of psoriatic disease. Nevertheless, there are still considerable unmet needs. Globally, delays in the diagnosis of the disease and its severity are common due to poor access to health care systems. Moreover, despite the abundance of treatments, we are unable to predict which is the right medication for the right patient, especially in resource-limited settings. AI could be an additional tool to address those needs. In this way, we can improve rates of diagnosis, accurately assess severity, and predict outcomes of treatment. Objective: This study aims to provide an up-to-date literature review on the use of AI in psoriatic disease, including diagnostics and clinical management as well as addressing the limitations in applicability. Methods: We searched the databases MEDLINE, PubMed, and Embase using the keywords “AI AND psoriasis OR psoriatic arthritis OR psoriatic disease,” “machine learning AND psoriasis OR psoriatic arthritis OR psoriatic disease,” and “prognostic model AND psoriasis OR psoriatic arthritis OR psoriatic disease” until June 1, 2023. Reference lists of relevant papers were also cross-examined for other papers not detected in the initial search. Results: Our literature search yielded 38 relevant papers. AI has been identified as a key component in digital health technologies. Within this field, there is the potential to apply specific techniques such as machine learning and deep learning to address several aspects of managing psoriatic disease. This includes diagnosis, particularly useful for remote teledermatology via photographs taken by patients as well as monitoring and estimating severity. Similarly, AI can be used to synthesize the vast data sets already in place through patient registries which can help identify appropriate biologic treatments for future cohorts and those individuals most likely to develop complications. Conclusions: There are multiple advantageous uses for AI and digital health technologies in psoriatic disease. With wider implementation of AI, we need to be mindful of potential limitations, such as validation and standardization or generalizability of results in specific populations, such as patients with darker skin phototypes. %M 39413371 %R 10.2196/50451 %U https://derma.jmir.org/2024/1/e50451 %U https://doi.org/10.2196/50451 %U http://www.ncbi.nlm.nih.gov/pubmed/39413371 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e62948 %T Google Search Trends About Systemic Psoriasis Treatment: What Do People Want to Know About Biologics and Janus Kinase Inhibitors? %A Lim,Subin %A Kooper-Johnson,Sarah %A Chau,Courtney A %A Chen,Claire %A Yang,Fei-Shiuann Clarissa %A Cobos,Gabriela %+ Department of Dermatology, Tufts Medical Center, 260 Tremont Street, Boston, MA, 02116, United States, 1 6176360156, subin.lim@tuftsmedicalcenter.org %K Google %K psoriasis vulgaris %K psoriasis %K systemic treatment %K biologics %K small molecule inhibitors %K adalimumab %K apremilast %K methotrexate %K health care delivery %K skin %K dermatologist %K medication %D 2024 %7 1.10.2024 %9 Research Letter %J JMIR Dermatol %G English %X %M 39243516 %R 10.2196/62948 %U https://derma.jmir.org/2024/1/e62948 %U https://doi.org/10.2196/62948 %U http://www.ncbi.nlm.nih.gov/pubmed/39243516 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e52493 %T Epithelioid Hemangioendothelioma as a Dangerous, Easy to Miss, and Nearly Impossible to Clinically Diagnose Condition: Case Report %A Pulsipher,Kayd %A Mills,Samantha %A Harris,Blair %A Bermudez,Rene %A Arida,Muammar %A Crane,Jonathan %+ Department of Dermatology, Campbell University, Sampson Regional Center, 607 Beaman Street, Clinton, NC, 28328, United States, 1 (910) 592 8511, kpulsipher@sampsonrmc.org %K epithelioid hemangioendothelioma %K EHE %K vascular tumor %K tumor %K vascular %K blood vessel %K cutaneous %K skin %K lesion %K histopathology %K case report %K metastatic %K dermatology %K dermatological %K diagnose %K diagnosis %K rare cancer %K oncology %D 2024 %7 28.8.2024 %9 Case Report %J JMIR Dermatol %G English %X Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor with metastatic potential. EHE can have single- or multiorgan involvement, with presentations ranging from asymptomatic disease to pain and systemic symptoms. The extremely heterogeneous clinical presentation and disease progression complicates EHE diagnosis and management. We present the case of a 24-year-old woman with two periauricular erythematous papules, leading to the discovery of metastatic EHE through routine biopsy, despite a noncontributory medical history. Histology revealed the dermal proliferation of epithelioid cells and vacuoles containing red blood cells. Immunohistochemistry markers consistent with EHE solidified the diagnosis. Although extremely rare, prompt diagnosis of EHE is essential for informed decision-making and favorable outcomes. Key clinical and histopathological findings are highlighted to aid dermatologists in diagnosing and managing this uncommon condition. %M 39196615 %R 10.2196/52493 %U https://derma.jmir.org/2024/1/e52493 %U https://doi.org/10.2196/52493 %U http://www.ncbi.nlm.nih.gov/pubmed/39196615 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e53271 %T From the Cochrane Library: Interventions for Chronic Pruritus of Unknown Origin %A Parmar,Pritika %A Singal,Amit %A Szeto,Mindy D %A Pathak,Gaurav N %A Taranto,Viktoria %A Truong,Thu M %A Rao,Babar %A Miranda,Andrea Andrade %A Franco,Juan VA %A Dellavalle,Robert P %+ Department of Dermatology, University of Minnesota Medical School, Phillips-Wangensteen Building, 516 Delaware St SE Suite 1-400, Minneapolis, MN, 55455, United States, 1 612 625 8625, della056@umn.edu %K Cochrane %K systematic review %K randomized controlled trial %K RCT %K pruritus %K chronic pruritus %K chronic pruritus of unknown origin %K CPUO %K serlopitant %K dupilumab %K pregabalin %D 2024 %7 21.8.2024 %9 Research Letter %J JMIR Dermatol %G English %X %M 39167781 %R 10.2196/53271 %U https://derma.jmir.org/2024/1/e53271 %U https://doi.org/10.2196/53271 %U http://www.ncbi.nlm.nih.gov/pubmed/39167781 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e50143 %T Nutrition, Obesity, and Seborrheic Dermatitis: Systematic Review %A Woolhiser,Emily %A Keime,Noah %A Patel,Arya %A Weber,Isaac %A Adelman,Madeline %A Dellavalle,Robert P %+ Department of Dermatology, University of Minnesota, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 7208480500, robert.dellavalle@cuanschutz.edu %K seborrheic dermatitis %K systematic review %K diet %K nutritional supplements %K alcohol %K BMI %K body mass index %K skin %K review methods %K review methodology %K nutrition %K nutritional %K supplement %K supplements %K dermatology %K dermatitis %K skin %K nutrient %K nutrients %K micronutrient %K micronutrients %K vitamin %K vitamins %K mineral %K minerals %K obesity %K obese %K weight %D 2024 %7 5.8.2024 %9 Review %J JMIR Dermatol %G English %X Background: Pathogenesis of seborrheic dermatitis involves lipid secretion by sebaceous glands, Malassezia colonization, and an inflammatory response with skin barrier disruption. Each of these pathways could be modulated by diet, obesity, and nutritional supplements. Current treatment options provide only temporary control of the condition; thus, it is essential to recognize modifiable lifestyle factors that may play a role in determining disease severity. Objective: This study aimed to summarize published evidence on diet, nutritional supplements, alcohol, obesity, and micronutrients in patients with seborrheic dermatitis and to provide useful insights into areas of further research. Methods: A literature search of Scopus, PubMed, and MEDLINE (Ovid interface) for English language papers published between 1993 and 2023 was conducted on April 16, 2023. Case-control studies, cohort studies, and randomized controlled trials with 5 or more subjects conducted on adult participants (>14 years) were included, case reports, case series, and review papers were excluded due to insufficient level of evidence. Results: A total of 13 studies, 8 case-control, 3 cross-sectional, and 2 randomized controlled trials, involving 13,906 patients were included. Seborrheic dermatitis was correlated with significantly increased copper, manganese, iron, calcium, and magnesium concentrations and significantly lower serum zinc and vitamin D and E concentrations. Adherence to the Western diet was associated with a higher risk for seborrheic dermatitis in female patients and an increased consumption of fruit was associated with a lower risk of seborrheic dermatitis in all patients. The prebiotic Triphala improved patient satisfaction and decreased scalp sebum levels over 8 weeks. Most studies find associations between regular alcohol use and seborrheic dermatitis, but the association between BMI and obesity on seborrheic dermatitis severity and prevalence is mixed. Conclusions: This review sheds light on specific promising areas of research that require further study, including the need for interventional studies evaluating serum zinc, vitamin D, and vitamin E supplementation for seborrheic dermatitis. The negative consequences of a Western diet, alcohol use, obesity, and the benefits of fruit consumption are well known; however, to fully understand their specific relationships to seborrheic dermatitis, further cohort or interventional studies are needed. Trial Registration: PROSPERO CRD42023417768; https://tinyurl.com/bdcta893 %M 39102684 %R 10.2196/50143 %U https://derma.jmir.org/2024/1/e50143 %U https://doi.org/10.2196/50143 %U http://www.ncbi.nlm.nih.gov/pubmed/39102684 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54376 %T Efficacy and Mechanism of Acupoint Catgut Embedding in the Treatment of Chronic Spontaneous Urticaria: Protocol for a Randomized Double-Blind Placebo-Controlled Trial %A Bi,Jianing %A Liu,Li %A Fan,Zhu %A Qu,Shengyuan %A Yang,Jiao %A Xu,Chenchen %A Cui,Bingnan %+ Guang'anmen Hospital, China Academy of Chinese Medical Sciences, No. 5, Beixiange, Xicheng District, Beijing, 100053, China, 86 10 88001009, cbn1998@163.com %K chronic spontaneous urticaria %K acupoint catgut embedding %K functional magnetic resonance imaging %K randomized controlled trial %K mechanism of action %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic spontaneous urticaria (CSU) is a common chronic inflammatory skin disease that manifests as itching and wheals, seriously affecting quality of life. Clinical observations and previous research trials have shown that acupuncture is safe and effective for the treatment of CSU. However, there are problems, such as a short duration of action and frequent treatment. Compared with traditional acupuncture, acupoint catgut embedding (ACE) has the advantages of a longer effect and higher compliance. Clinical trials are needed to prove its efficacy and mechanism of action. Objective: This trial aims to provide definitive evidence for the treatment of CSU with ACE and explore the mechanism of ACE. Methods: This is a randomized, double-blind, placebo-controlled trial. In this trial, 108 participants aged 18-60 years with a diagnosis of CSU and no history of ACE will be randomly assigned to 2 groups (1:1 ratio) using the Statistical Analysis System: treatment (ACE) and control (sham ACE). The participants and efficacy evaluators will be blinded to the grouping. Both the ACE and sham ACE groups will undergo acupuncture, but the sham ACE group will not receive catgut sutures. Treatment will be performed twice weekly for 8 weeks, with a 1-week run-in period and a 16-week follow-up period. Twenty patients will be randomly selected to undergo functional magnetic resonance imaging before and after the treatment period. The primary outcome will be the urticaria activity score over 7 days (UAS7). We will use R (version 4.0.1; R Project for Statistical Computing) to perform ANOVA and independent samples t tests to compare the differences within and between groups before and after treatment by judging the rejection range based on a significance level of .05. Results: The study protocol has been approved by the Ethics Committee of Guang’anmen Hospital on September 7, 2022, and has been registered on November 30, 2022. Recruitment began on March 1, 2023. A total of 4-6 participants are expected to be recruited each month. The recruitment is planned to be completed on March 1, 2025, and we expect to publish our results by the winter of 2025. As of November 1, 2023, we have enrolled 25 participants with CSU. Conclusions: This randomized, double-blind, placebo-controlled trial aims to provide definitive evidence for the treatment of CSU with ACE and explore the mechanism of ACE. We hypothesize that wheals and itching will show greater improvement in participants receiving active therapy than in those receiving sham treatment. The limitations of this study include its single-center trial design, small sample size, and short treatment duration, which may have certain impacts on the research results. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200066274; https://www.chictr.org.cn/showprojEN.html?proj=179056 International Registered Report Identifier (IRRID): DERR1-10.2196/54376 %M 39083341 %R 10.2196/54376 %U https://www.researchprotocols.org/2024/1/e54376 %U https://doi.org/10.2196/54376 %U http://www.ncbi.nlm.nih.gov/pubmed/39083341 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e60686 %T Assessing the Relationship Between Vitiligo and Major Depressive Disorder Severity: Cross-Sectional Study %A Molla,Amr %A Jannadi,Raed %A Alayoubi,Hamza %A Altouri,Haya %A Balkhair,Maryam %A Hafez,Dareen %+ Department of Medicine, College of Medicine, Taibah University, Universities Road, P.O. Box: 344, Taibah, Madinah, 42353, Saudi Arabia, 966 504342992, molladerm@outlook.com %K vitiligo %K major depressive disorder (MDD) %K PHQ-9 %K Patient Health Questionnaire-9 %K depression severity %K Saudi Arabia %K cross-sectional study %D 2024 %7 12.7.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Vitiligo, a common dermatological disorder in Saudi Arabia, is associated with significant psychological impacts. This study explores the relationship between vitiligo and the severity of major depressive disorder (MDD), highlighting the broader implications on mental health among affected individuals. Objective: We aim to assess the prevalence and predictors of depression among adult patients with vitiligo, and to examine the relationship between MDD severity and vitiligo. Methods: Using a cross-sectional design, the research used the vitiligo area severity index and the Patient Health Questionnaire-9 to measure the extent of vitiligo and depression severity, respectively. This study involved 340 diagnosed patients with vitiligo from various health care settings. Logistic and ordinal regression analysis were applied to evaluate the impact of sociodemographic variables and vitiligo types on MDD severity. Results: The prevalence of MDD was 58.8% (200/340) of participants. Depression severity varied notably: 18.2% (62/340) of patients experienced mild depression, 17.9% (61/340) moderate, 11.8% (40/340) moderately severe, and 10.9% (37/340) severe depression. Female patients had higher odds of severe depression than male patients (adjusted odds ratio [aOR] 3.14, 95% CI 1.93-5.1; P<.001). Age was inversely related to depression severity, with patients aged older than 60 years showing significantly lower odds (aOR 0.1, 95% CI 0.03-0.39; P<.001). Lower income was associated with higher depression severity (aOR 10.2, 95% CI 3.25-31.8; P<.001). Vitiligo types also influenced depression severity; vulgaris (aOR 5.3, 95% CI 2.6-10.9; P<.001) and acrofacial vitiligo (aOR 2.8, 95% CI 1.5-5.1; P<.001) were significantly associated with higher depression levels compared to focal vitiligo. Conclusions: The findings suggest that vitiligo contributes to an increased risk of severe depression, highlighting the need for integrated dermatological and psychological treatment approaches to address both the physical and mental health aspects of the disease. %M 38888950 %R 10.2196/60686 %U https://derma.jmir.org/2024/1/e60686 %U https://doi.org/10.2196/60686 %U http://www.ncbi.nlm.nih.gov/pubmed/38888950 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e55898 %T Assessing the Application of Large Language Models in Generating Dermatologic Patient Education Materials According to Reading Level: Qualitative Study %A Lambert,Raphaella %A Choo,Zi-Yi %A Gradwohl,Kelsey %A Schroedl,Liesl %A Ruiz De Luzuriaga,Arlene %+ Pritzker School of Medicine, University of Chicago, 924 East 57th Street #104, Chicago, IL, 60637, United States, 1 7737021937, aleksalambert@uchicagomedicine.org %K artificial intelligence %K large language models %K large language model %K LLM %K LLMs %K machine learning %K natural language processing %K deep learning %K ChatGPT %K health literacy %K health knowledge %K health information %K patient education %K dermatology %K dermatologist %K dermatologists %K derm %K dermatology resident %K dermatology residents %K dermatologic patient education material %K dermatologic patient education materials %K patient education material %K patient education materials %K education material %K education materials %D 2024 %7 16.5.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Dermatologic patient education materials (PEMs) are often written above the national average seventh- to eighth-grade reading level. ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT are large language models (LLMs) that are responsive to user prompts. Our project assesses their use in generating dermatologic PEMs at specified reading levels. Objective: This study aims to assess the ability of select LLMs to generate PEMs for common and rare dermatologic conditions at unspecified and specified reading levels. Further, the study aims to assess the preservation of meaning across such LLM-generated PEMs, as assessed by dermatology resident trainees. Methods: The Flesch-Kincaid reading level (FKRL) of current American Academy of Dermatology PEMs was evaluated for 4 common (atopic dermatitis, acne vulgaris, psoriasis, and herpes zoster) and 4 rare (epidermolysis bullosa, bullous pemphigoid, lamellar ichthyosis, and lichen planus) dermatologic conditions. We prompted ChatGPT-3.5, GPT-4, DermGPT, and DocsGPT to “Create a patient education handout about [condition] at a [FKRL]” to iteratively generate 10 PEMs per condition at unspecified fifth- and seventh-grade FKRLs, evaluated with Microsoft Word readability statistics. The preservation of meaning across LLMs was assessed by 2 dermatology resident trainees. Results: The current American Academy of Dermatology PEMs had an average (SD) FKRL of 9.35 (1.26) and 9.50 (2.3) for common and rare diseases, respectively. For common diseases, the FKRLs of LLM-produced PEMs ranged between 9.8 and 11.21 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). For rare diseases, the FKRLs of LLM-produced PEMs ranged between 9.85 and 11.45 (unspecified prompt), between 4.22 and 7.43 (fifth-grade prompt), and between 5.98 and 7.28 (seventh-grade prompt). At the fifth-grade reading level, GPT-4 was better at producing PEMs for both common and rare conditions than ChatGPT-3.5 (P=.001 and P=.01, respectively), DermGPT (P<.001 and P=.03, respectively), and DocsGPT (P<.001 and P=.02, respectively). At the seventh-grade reading level, no significant difference was found between ChatGPT-3.5, GPT-4, DocsGPT, or DermGPT in producing PEMs for common conditions (all P>.05); however, for rare conditions, ChatGPT-3.5 and DocsGPT outperformed GPT-4 (P=.003 and P<.001, respectively). The preservation of meaning analysis revealed that for common conditions, DermGPT ranked the highest for overall ease of reading, patient understandability, and accuracy (14.75/15, 98%); for rare conditions, handouts generated by GPT-4 ranked the highest (14.5/15, 97%). Conclusions: GPT-4 appeared to outperform ChatGPT-3.5, DocsGPT, and DermGPT at the fifth-grade FKRL for both common and rare conditions, although both ChatGPT-3.5 and DocsGPT performed better than GPT-4 at the seventh-grade FKRL for rare conditions. LLM-produced PEMs may reliably meet seventh-grade FKRLs for select common and rare dermatologic conditions and are easy to read, understandable for patients, and mostly accurate. LLMs may play a role in enhancing health literacy and disseminating accessible, understandable PEMs in dermatology. %M 38754096 %R 10.2196/55898 %U https://derma.jmir.org/2024/1/e55898 %U https://doi.org/10.2196/55898 %U http://www.ncbi.nlm.nih.gov/pubmed/38754096 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51628 %T Evaluating the World Health Organization’s SkinNTDs App as a Training Tool for Skin Neglected Tropical Diseases in Ghana and Kenya: Cross-Sectional Study %A Cano,Mireia %A Ruiz-Postigo,José A %A Macharia,Paul %A Ampem Amoako,Yaw %A Odame Phillips,Richard %A Kinyeru,Esther %A Carrion,Carme %+ eHealth Lab Research Group, eHealth Center, School of Health Sciences, Universitat de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 630983328, mcarrionr@uoc.edu %K SkinNTDs app %K mHealth %K mobile health %K neglected tropical diseases %K NTDs %K skin neglected tropical diseases %K low- and middle-income countries %K tropical disease %K app %K training tool %K digital health %K intervention %K decision support tool %K mobile phone %D 2024 %7 30.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, primarily impoverished populations in low- and middle-income countries. Skin NTDs, a significant subgroup, manifest primarily as skin lesions and require extensive diagnosis and treatment resources, including trained personnel and financial backing. The World Health Organization has introduced the SkinNTDs app, a mobile health tool designed to train and be used as a decision support tool for frontline health care workers. As most digital health guidelines prioritize the thorough evaluation of mobile health interventions, it is essential to conduct a rigorous and validated assessment of this app. Objective: This study aims to assess the usability and user experience of World Health Organization SkinNTDs app (version 3) as a capacity-building tool and decision-support tool for frontline health care workers. Methods: A cross-sectional study was conducted in Ghana and Kenya. Frontline health care workers dealing with skin NTDs were recruited through snowball sampling. They used the SkinNTDs app for at least 5 days before completing a web-based survey containing demographic variables and the user version of the Mobile Application Rating Scale (uMARS), a validated scale for assessing health apps. A smaller group of participants took part in semistructured interviews and one focus group. Quantitative data were analyzed using SPSS with a 95% CI and P≤.05 for statistical significance and qualitative data using ATLAS.ti to identify attributes, cluster themes, and code various dimensions that were explored. Results: Overall, 60 participants participated in the quantitative phase and 17 in the qualitative phase. The SkinNTDs app scored highly on the uMARS questionnaire, with an app quality mean score of 4.02 (SD 0.47) of 5, a subjective quality score of 3.82 (SD 0.61) of 5, and a perceived impact of 4.47 (SD 0.56) of 5. There was no significant association between the app quality mean score and any of the categorical variables examined, according to Pearson correlation analysis; app quality mean score vs age (P=.37), sex (P=.70), type of health worker (P=.35), country (P=.94), work context (P=.17), frequency of dealing with skin NTDs (P=.09), and dermatology experience (P=.63). Qualitative results echoed the quantitative outcomes, highlighting the ease of use, the offline functionality, and the potential utility for frontline health care workers in remote and resource-constrained settings. Areas for improvement were identified, such as enhancing the signs and symptoms section. Conclusions: The SkinNTDs app demonstrates notable usability and user-friendliness. The results indicate that the app could play a crucial role in improving capacity building of frontline health care workers dealing with skin NTDs. It could be improved in the future by including new features such as epidemiological context and direct contact with experts. The possibility of using the app as a diagnostic tool should be considered. International Registered Report Identifier (IRRID): RR2-10.2196/39393 %M 38687587 %R 10.2196/51628 %U https://www.jmir.org/2024/1/e51628 %U https://doi.org/10.2196/51628 %U http://www.ncbi.nlm.nih.gov/pubmed/38687587 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e49965 %T Oral Cannabidiol for Seborrheic Dermatitis in Patients With Parkinson Disease: Randomized Clinical Trial %A Weber,Isaac %A Zagona-Prizio,Caterina %A Sivesind,Torunn E %A Adelman,Madeline %A Szeto,Mindy D %A Liu,Ying %A Sillau,Stefan H %A Bainbridge,Jacquelyn %A Klawitter,Jost %A Sempio,Cristina %A Dunnick,Cory A %A Leehey,Maureen A %A Dellavalle,Robert P %+ Dermatology Service, Rocky Mountain Regional Veterans Affairs Medical Center, 1700 N Wheeling St, Rm E1-342, Aurora, CO, 80045, United States, 1 720 857 5562, Robert.dellavalle@ucdenver.edu %K cannabidiol %K cannabis %K CBD treatment %K CBD %K image %K photograph %K photographs %K imaging %K sebum %K clinical trials %K seborrheic dermatitis %K Parkinson disease %K clinical trial %K RCT %K randomized %K controlled trial %K drug response %K SEDASI %K drug %K Parkinson %K dermatitis %K skin %K dermatology %K seborrheic dermatitis %K treatment %K outcome %K cannabis %K chi-square %D 2024 %7 11.3.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Seborrheic dermatitis (SD) affects 18.6%-59% of persons with Parkinson disease (PD), and recent studies provide evidence that oral cannabidiol (CBD) therapy could reduce sebum production in addition to improving motor and psychiatric symptoms in PD. Therefore, oral CBD could be useful for improving symptoms of both commonly co-occurring conditions. Objective: This study investigates whether oral CBD therapy is associated with a decrease in SD severity in PD. Methods: Facial photographs were collected as a component of a randomized (1:1 CBD vs placebo), parallel, double-blind, placebo-controlled trial assessing the efficacy of a short-term 2.5 mg per kg per day oral sesame solution CBD-rich cannabis extract (formulated to 100 mg/mL CBD and 3.3 mg/mL THC) for reducing motor symptoms in PD. Participants took 1.25 mg per kg per day each morning for 4 ±1 days and then twice daily for 10 ±4 days. Reviewers analyzed the photographs independently and provided a severity ranking based on the Seborrheic Dermatitis Area and Severity Index (SEDASI) scale. Baseline demographic and disease characteristics, as well as posttreatment SEDASI averages and the presence of SD, were analyzed with 2-tailed t tests and Pearson χ2 tests. SEDASI was analyzed with longitudinal regression, and SD was analyzed with generalized estimating equations. Results: A total of 27 participants received a placebo and 26 received CBD for 16 days. SD severity was low in both groups at baseline, and there was no treatment effect. The risk ratio for patients receiving CBD, post versus pre, was 0.69 (95% CI 0.41-1.18; P=.15), compared to 1.20 (95% CI 0.88-1.65; P=.26) for the patients receiving the placebo. The within-group pre-post change was not statistically significant for either group, but they differed from each other (P=.07) because there was an estimated improvement for the CBD group and an estimated worsening for the placebo group. Conclusions: This study does not provide solid evidence that oral CBD therapy reduces the presence of SD among patients with PD. While this study was sufficiently powered to detect the primary outcome (efficacy of CBD on PD motor symptoms), it was underpowered for the secondary outcomes of detecting changes in the presence and severity of SD. Multiple mechanisms exist through which CBD can exert beneficial effects on SD pathogenesis. Larger studies, including participants with increased disease severity and longer treatment periods, may better elucidate treatment effects and are needed to determine CBD’s true efficacy for affecting SD severity. Trial Registration: ClinicalTrials.gov NCT03582137; https://clinicaltrials.gov/ct2/show/NCT03582137 %M 38466972 %R 10.2196/49965 %U https://derma.jmir.org/2024/1/e49965 %U https://doi.org/10.2196/49965 %U http://www.ncbi.nlm.nih.gov/pubmed/38466972 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52200 %T Patient Phenotyping for Atopic Dermatitis With Transformers and Machine Learning: Algorithm Development and Validation Study %A Wang,Andrew %A Fulton,Rachel %A Hwang,Sy %A Margolis,David J %A Mowery,Danielle %+ University of Pennsylvania, A206 Richards Building, 3700 Hamilton Walk, Philadelphia, PA, 19104, United States, 1 2157466677, dlmowery@pennmedicine.upenn.edu %K atopic dermatitis %K classification %K classifier %K dermatitis %K dermatology %K EHR %K electronic health record %K health records %K health %K informatics %K machine learning %K natural language processing %K NLP %K patient phenotyping %K phenotype %K skin %K transformer %K transformers %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Atopic dermatitis (AD) is a chronic skin condition that millions of people around the world live with each day. Performing research into identifying the causes and treatment for this disease has great potential to provide benefits for these individuals. However, AD clinical trial recruitment is not a trivial task due to the variance in diagnostic precision and phenotypic definitions leveraged by different clinicians, as well as the time spent finding, recruiting, and enrolling patients by clinicians to become study participants. Thus, there is a need for automatic and effective patient phenotyping for cohort recruitment. Objective: This study aims to present an approach for identifying patients whose electronic health records suggest that they may have AD. Methods: We created a vectorized representation of each patient and trained various supervised machine learning methods to classify when a patient has AD. Each patient is represented by a vector of either probabilities or binary values, where each value indicates whether they meet a different criteria for AD diagnosis. Results: The most accurate AD classifier performed with a class-balanced accuracy of 0.8036, a precision of 0.8400, and a recall of 0.7500 when using XGBoost (Extreme Gradient Boosting). Conclusions: Creating an automated approach for identifying patient cohorts has the potential to accelerate, standardize, and automate the process of patient recruitment for AD studies; therefore, reducing clinician burden and informing the discovery of better treatment options for AD. %M 38277207 %R 10.2196/52200 %U https://formative.jmir.org/2024/1/e52200 %U https://doi.org/10.2196/52200 %U http://www.ncbi.nlm.nih.gov/pubmed/38277207 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e52507 %T Periorbital Necrotizing Fasciitis: Case Presentation %A Huang,Ryan S %A Patil,Nikhil S %A Khan,Yasser %+ Temerty Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada, 1 4038911818, ry.huang@mail.utoronto.ca %K periorbital necrotizing fasciitis %K Streptococcus pyogenes A %K skin infection %K soft tissue infection %K dermatology infection %K skin reaction %K periorbital %K necrotizing fasciitis %K necrotizing %K necrosis %K case report %K case reports %K fasciitis %K fatal %K life-threatening %K fascia %K soft tissue %K infection %K pathology %K pathophysiology %K periorbital %K eye %K orbital %K orbit %K muscle %K bacteria %K bacterial %K Streptococcus %K inflammation %K tissue %K tissues %D 2023 %7 28.11.2023 %9 Case Report %J Interact J Med Res %G English %X Necrotizing fasciitis (NF) is an aggressive and potentially life-threatening infection of the superficial fascia and surrounding skin, fat, fascia, muscle, and other soft tissue structures. Here, we outline the rare case of a 26-year-old man with a periorbital Streptococcus pyogenes A NF infection. Our case report underscores a unique instance of periorbital NF, distinctively presenting without any predisposing risk factors, shedding light on its presentation, treatment, and pathophysiology. %M 37971729 %R 10.2196/52507 %U https://www.i-jmr.org/2023/1/e52507 %U https://doi.org/10.2196/52507 %U http://www.ncbi.nlm.nih.gov/pubmed/37971729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44614 %T A Web-Based Instrument for Infantile Atopic Dermatitis Identification (Electronic Version of the Modified Child Eczema Questionnaire): Development and Implementation %A Fang,Heping %A Chen,Lin %A Li,Juan %A Ren,Luo %A Yin,Yu %A Chen,Danleng %A Yin,Huaying %A Liu,Enmei %A Hu,Yan %A Luo,Xiaoyan %+ Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Health and Nutrition, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China, 86 02363622764, hy420@126.com %K atopic dermatitis %K identification %K infant %K web-based questionnaire %K public health %D 2023 %7 19.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Atopic dermatitis (AD) is a chronic inflammatory cutaneous disease that affects 30.48% of young children; thus, there is a need for epidemiological studies in community settings. Web-based questionnaires (WBQs) are more convenient, time-saving, and efficient than traditional surveys, but the reliability of identifying AD through WBQs and whether AD can be identified without the attendance of doctors, especially in community or similar settings, remains unknown. Objective: This study aimed to develop and validate a web-based instrument for infantile AD identification (electronic version of the modified Child Eczema Questionnaire [eCEQ]) and to clarify the possibility of conducting WBQs to identify infantile AD without the attendance of doctors in a community-representative population. Methods: This study was divided into 2 phases. Phase 1 investigated 205 children younger than 2 years to develop and validate the eCEQ by comparison with the diagnoses of dermatologists. Phase 2 recruited 1375 children younger than 2 years to implement the eCEQ and verify the obtained prevalence by comparison with the previously published prevalence. Results: In phase 1, a total of 195 questionnaires were analyzed from children with a median age of 8.8 (IQR 4.5-15.0) months. The identification values of the eCEQ according to the appropriate rules were acceptable (logic rule: sensitivity 89.2%, specificity 91.5%, positive predictive value 97.1%, and negative predictive value 72.9%; statistic rule: sensitivity 90.5%, specificity 89.4%, positive predictive value 96.4%, and negative predictive value 75%). In phase 2, a total of 837 questionnaires were analyzed from children with a median age of 8.4 (IQR 5.2-14.6) months. The prevalence of infantile AD obtained by the eCEQ (logic rule) was 31.9% (267/837), which was close to the published prevalence (30.48%). Based on the results of phase 2, only 20.2% (54/267) of the participants identified by the eCEQ had previously received a diagnosis from doctors. Additionally, among the participants who were not diagnosed by doctors but were identified by the eCEQ, only 6.1% (13/213) were actually aware of the possible presence of AD. Conclusions: Infantile AD can be identified without the attendance of doctors by using the eCEQ, which can be easily applied to community-based epidemiological studies and provide acceptable identification reliability. In addition, the eCEQ can also be applied to the field of public health to improve the health awareness of the general population. %M 37467020 %R 10.2196/44614 %U https://www.jmir.org/2023/1/e44614 %U https://doi.org/10.2196/44614 %U http://www.ncbi.nlm.nih.gov/pubmed/37467020 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e44913 %T Experiences Regarding Use and Implementation of Artificial Intelligence–Supported Follow-Up of Atypical Moles at a Dermatological Outpatient Clinic: Qualitative Study %A Haugsten,Elisabeth Rygvold %A Vestergaard,Tine %A Trettin,Bettina %+ Department of Dermatology and Allergy Centre, Odense University Hospital, Kløvervænget 15, Odense, 5000, Denmark, 45 91856560, elisabeth_rh@hotmail.com %K artificial intelligence %K AI %K computer-assisted diagnosis %K CAD %K dermatology %K diagnostic tool %K FotoFinder %K implementation %K interview %K melanoma %K Moleanalyzer Pro %K total body dermoscopy %K TBD %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Dermatol %G English %X Background: Artificial intelligence (AI) is increasingly used in numerous medical fields. In dermatology, AI can be used in the form of computer-assisted diagnosis (CAD) systems when assessing and diagnosing skin lesions suspicious of melanoma, a potentially lethal skin cancer with rising incidence all over the world. In particular, CAD may be a valuable tool in the follow-up of patients with high risk of developing melanoma, such as patients with multiple atypical moles. One such CAD system, ATBM Master (FotoFinder), can execute total body dermoscopy (TBD). This process comprises automatically photographing a patient´s entire body and then neatly displaying moles on a computer screen, grouped according to their clinical relevance. Proprietary FotoFinder algorithms underlie this organized presentation of moles. In addition, ATBM Master’s optional convoluted neural network (CNN)-based Moleanalyzer Pro software can be used to further assess moles and estimate their probability of malignancy. Objective: Few qualitative studies have been conducted on the implementation of AI-supported procedures in dermatology. Therefore, the purpose of this study was to investigate how health care providers experience the use and implementation of a CAD system like ATBM Master, in particular its TBD module. In this way, the study aimed to elucidate potential barriers to the application of such new technology. Methods: We conducted a thematic analysis based on 2 focus group interviews with 14 doctors and nurses regularly working in an outpatient pigmented lesions clinic. Results: Surprisingly, the study revealed that only 3 participants had actual experience using the TBD module. Even so, all participants were able to provide many notions and anticipations about its use, resulting in 3 major themes emerging from the interviews. First, several organizational matters were revealed to be a barrier to consistent use of the ATBM Master’s TBD module, namely lack of guidance, time pressure, and insufficient training. Second, the study found that the perceived benefits of TBD were the ability to objectively detect and monitor subtle lesion changes and unbiasedness of the procedure. Imprecise identification of moles, inability to photograph certain areas, and substandard technical aspects were the perceived weaknesses. Lastly, the study found that clinicians were open to use AI-powered technology and that the TBD module was considered a supplementary tool to aid the medical staff, rather than a replacement of the clinician. Conclusions: Demonstrated by how few of the participants had actual experience with the TBD module, this study showed that implementation of new technology does not occur automatically. It highlights the importance of having a strategy for implementation to ensure the optimized application of CAD tools. The study identified areas that could be improved when implementing AI-powered technology, as well as providing insight on how medical staff anticipated and experienced the use of a CAD device in dermatology. %M 37632937 %R 10.2196/44913 %U https://derma.jmir.org/2023/1/e44913 %U https://doi.org/10.2196/44913 %U http://www.ncbi.nlm.nih.gov/pubmed/37632937 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43295 %T Acute Spontaneous Colonic Perforation in a Case of Newly Confirmed Scleroderma: Case Report %A Goodwin,Glenn %A Ryckeley,Christian %A Fox,Davide %A Ashley,Michael %A Dubensky,Laurence %A Danckers,Mauricio %A Slesinger,Todd %+ Emergency Department, Aventura Hospital and Medical Center, 20900 Biscayne Blvd, Aventura, FL, 33180, United States, 1 3056923392, ggoodwin954@gmail.com %K scleroderma %K systemic sclerosis %K spontaneous bowel perforation %K CREST syndrome %K calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasis %K multisystem connective tissue disorder %K sclerosis %K skin %K dermatology %K internal medicine %K autoimmune %K perforation %K gastroenterology %K esophagus %K esophageal %K connective tissue %K emergency %K gastrointestinal %K case report %D 2023 %7 8.3.2023 %9 Case Report %J Interact J Med Res %G English %X Scleroderma is a group of autoimmune diseases that principally affects the skin, blood vessels, muscles, and viscera. One of the more well-known subgroups of scleroderma is the limited cutaneous form of the multisystem connective tissue disorder known as CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasis) syndrome. In this report, we present a case of a spontaneous colonic bowel perforation in a patient with incomplete features of CREST. Our patient underwent a complicated hospital course involving broad-spectrum antibiotic coverage, surgical hemicolectomy, and immunosuppressives. She was eventually discharged home with a return to functional baseline status after esophageal dysmotility confirmation via manometry. Physicians managing patients with scleroderma ensuing to an emergency department encounter must anticipate the multitude of complications that can occur, as was seen in our patient. The threshold for pursuing imaging and additional tests, in addition to admission, should be relatively low, given the extremely high rates of complications and mortality. Early multidisciplinary involvement with infectious disease, rheumatology, surgery, and other respective specialties is crucial for patient outcome optimization. %M 36862558 %R 10.2196/43295 %U https://www.i-jmr.org/2023/1/e43295 %U https://doi.org/10.2196/43295 %U http://www.ncbi.nlm.nih.gov/pubmed/36862558 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e34228 %T A Glance at the Practice of Pediatric Teledermatology Pre- and Post–COVID-19: Narrative Review %A Long,Valencia %A Chandran,Nisha Suyien %+ Division of Dermatology, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore, 65 88292608, valencialong@gmail.com %K teledermatology %K telehealth %K telemedicine %K pediatric teledermatology %K COVID-19 %K pandemic %K dermatology %K pediatric %K children %D 2022 %7 17.5.2022 %9 Review %J JMIR Dermatol %G English %X Background: The COVID-19 pandemic has accelerated the use of pediatric teledermatology, with centers showing increased uptake of teledermatology. Pediatric patients possess unique characteristics that pose different challenges with teledermatology compared to adults, in turn affecting the feasibility and uptake of pediatric teledermatology in the community. Objective: This narrative review summarizes the evolution of pediatric teledermatology from pre–COVID-19 pandemic times to the post–COVID-19 period. Methods: A search of MEDLINE, PubMed, and Embase was performed for original articles written in English and published from December 1, 2019, to April 1, 2022. Results: A total of 22 publications were included. Conclusions: Teledermatology will continue to play an increasing role in the management of skin diseases. A mindset shift in the types of conditions deemed suitable for pediatric teledermatology is needed. %M 35610984 %R 10.2196/34228 %U https://derma.jmir.org/2022/2/e34228 %U https://doi.org/10.2196/34228 %U http://www.ncbi.nlm.nih.gov/pubmed/35610984 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e37030 %T From the Cochrane Library: Hydrosurgical Debridement Versus Conventional Surgical Debridement for Acute Partial-Thickness Burns %A Kokoska,Ryan E %A Szeto,Mindy D %A Sivesind,Torunn E %A Dellavalle,Robert P %A Wormald,Justin C R %+ Department of Dermatology, University of Colorado Anschutz Medical Campus, 1665 Aurora Court, 3rd Floor, Mailstop F703, Aurora, CO, 80045, United States, 1 7208480500, mindy.d.szeto@gmail.com %K Cochrane %K systematic review %K randomized controlled trial %K hydrosurgery %K hydrosurgical debridement %K debridement %K burns %K wound healing %D 2022 %7 4.5.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632860 %R 10.2196/37030 %U https://derma.jmir.org/2022/2/e37030 %U https://doi.org/10.2196/37030 %U http://www.ncbi.nlm.nih.gov/pubmed/37632860 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e30737 %T Novel Kappa-Opioid Receptor Agonist for the Treatment of Cholestatic Pruritus: Systematic Review %A Bailey,Adrian Joseph Michel %A Li,Heidi Oi-Yee %A Kirchhof,Mark G %+ Faculty of Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8M2, Canada, 1 613 858 5029, adbailey@ohri.ca %K opioid %K pruritus %K cholestasis %K dermatology %K chronic pruritis %K kappa-opioid receptor %K opioid receptor %D 2022 %7 2.5.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632854 %R 10.2196/30737 %U https://derma.jmir.org/2022/2/e30737 %U https://doi.org/10.2196/30737 %U http://www.ncbi.nlm.nih.gov/pubmed/37632854 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e37271 %T Correlation Between Interest in COVID-19 Hair Loss and COVID-19 Surges: Analysis of Google Trends %A Han,Joseph %A Kamat,Samir %A Agarwal,Aneesh %A O'Hagan,Ross %A Tukel,Connor %A Owji,Shayan %A Ghalili,Sabrina %A Luu,Yen %A Dautriche Svidzinski,Cula %A Abittan,Brian J %A Ungar,Jonathan %A Gulati,Nicholas %+ Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, 5th Floor, New York, NY, 10029, United States, 1 212 241 3288, nicholas.gulati@mssm.edu %K COVID-19 %K SARS-CoV-2 virus %K pandemic %K hair loss %K telogen effluvium %K Google Trends %K omicron %K omicron variant %K delta variant %K public interest %K stress %K dermatology %K public perception %K social media %K online health %K digital dermatology %D 2022 %7 27.4.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 35505684 %R 10.2196/37271 %U https://derma.jmir.org/2022/2/e37271 %U https://doi.org/10.2196/37271 %U http://www.ncbi.nlm.nih.gov/pubmed/35505684 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 2 %P e34111 %T Crowdsourcing Medical Costs in Dermatology: Cross-sectional Study Analyzing Dermatologic GoFundMe Campaigns %A Mark,Erica %A Sridharan,Mira %A Florenzo,Brian %A Schenck,Olivia L %A Noland,Mary-Margaret B %A Barbieri,John S %A Lipoff,Jules B %+ Department of Dermatology, University of Virginia, 775 Walker Square, Charlottesville, VA, 22903, United States, 1 19258189733, ejm5we@virginia.edu %K crowdfunding %K crowdsourcing %K fundraising %K GoFundMe %K social media %K medical expenses %K financial burden %K health equity %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Dermatol %G English %X Background: Crowdfunding for medical costs is becoming increasingly popular. Few previous studies have described the fundraising characteristics and qualities associated with success. Objective: This study aimed to characterize and investigate the qualities associated with successful dermatological fundraisers. Methods: This cross-sectional study of dermatological GoFundMe campaigns collected data, including demographic variables, thematic variables using an inductive qualitative method, and quantitative information. Linear regression examined the qualities associated with success, which are defined based on funds raised when controlling for campaign goals. Logistic regression was used to examine qualities associated with extremely successful campaigns, defined as those raising >1.5 times the IQR. Statistical significance was set at P<.05. Results: A total of 2008 publicly available campaigns at the time of data collection were evaluated. Nonmodifiable factors associated with greater success included male gender, age 20-40 years, and White race. Modifiable factors associated with success included more updates posted to the campaign page, non–self-identity of the campaign creator, mention of a chronic condition, and smiling in campaign profile photographs. Conclusions: Understanding the modifiable factors of medical crowdfunding may inform future campaigns, and nonmodifiable factors may have policy implications for improving health care equity and financing. Crowdfunding for medical disease treatment may have potential implications for medical privacy and exacerbation of existing health care disparities. This study was limited to publicly available GoFundMe campaigns. Potential limitations for this study include intercoder variability, misclassification bias because of the data abstraction process, and prioritization of campaigns based on the proprietary GoFundMe algorithm. %M 37632862 %R 10.2196/34111 %U https://derma.jmir.org/2022/2/e34111 %U https://doi.org/10.2196/34111 %U http://www.ncbi.nlm.nih.gov/pubmed/37632862 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e34935 %T Patterns of Promotional Content by Dermatology Influencers on TikTok %A Ranpariya,Varun K %A Fathy,Ramie %A Chu,Brian %A Wang,Sonia %A Lipoff,Jules B %+ Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3737 Market Street, Suite 1100, Philadelphia, PA, 19104, United States, 1 215 662 8060, Jules.Lipoff@pennmedicine.upenn.edu %K social media %K TikTok %K Instagram %K promotion %K conflicts of interest %K influencer %K dermatology %K dermatologist %D 2022 %7 30.3.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632857 %R 10.2196/34935 %U https://derma.jmir.org/2022/1/e34935 %U https://doi.org/10.2196/34935 %U http://www.ncbi.nlm.nih.gov/pubmed/37632857 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e34323 %T Treatments for Primary Delusional Infestation: Systematic Review %A Lu,Justin Di %A Gotesman,Ryan D %A Varghese,Shawn %A Fleming,Patrick %A Lynde,Charles W %+ Michael G DeGroote School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada, 1 6474709858, justin.lu@medportal.ca %K delusional infestation %K Morgellons disease %K treatment %K delusional parasitosis %K atypical %K typical %K antipsychotic %K SSRI %K delusion %K rare disorder %K systematic review %K pharmacology %K pharmacological %K psychiatric %K dermatology %K dermatologist %K drug %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Dermatol %G English %X Background: Delusional infestation, also known as Ekbom syndrome, is a rare delusional disorder characterized by the fixed belief that one is infested with parasites, worms, insects, or other organisms. Although delusional infestation is a psychiatric condition, patients often consult dermatologists with skin findings, and it is currently unclear what treatments are recommended for this disorder. Objective: We aimed to systematically review and describe the treatment and management of patients presenting with primary delusional infestation. Methods: A systematic search was conducted using Ovid on MEDLINE, Embase, PsycINFO, and the Cochrane Register of Clinical Trials. Relevant data, including treatment, dosage, response, adherence, and side effects, were extracted and analyzed. Results: A total of 15 case series were included, comprising 280 patients (mean age 53.3 years, 65.4% female) with delusional infestation. Overall, aripiprazole had the highest complete remission rate at 79% (11/14), although this was limited to 14 patients. Among drug classes, selective serotonin reuptake inhibitors were the most effective with a 79% (11/14) complete remission rate and 43% (9/21) partial remission rate in patients with comorbid depression, anxiety, or trichotillomania. First-generation antipsychotics and second-generation antipsychotics had similar complete remission rates (56/103, 54.4% vs 56/117, 47.9%, respectively) and partial remission rates (36/103, 35% vs 41/117, 35%, respectively). Conclusions: Due to the rarity of delusional infestation, we only found 15 case series. However, we found that first-generation antipsychotics appear to be similar in effectiveness to second-generation antipsychotics for the treatment of primary delusional infestation. Larger studies and randomized controlled trials are needed to evaluate the efficacy of pharmacological therapy for delusional infestation. Trial Registration: PROSPERO CRD42020198161; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=198161 %M 37632851 %R 10.2196/34323 %U https://derma.jmir.org/2022/1/e34323 %U https://doi.org/10.2196/34323 %U http://www.ncbi.nlm.nih.gov/pubmed/37632851 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e35137 %T The Effects of Using the Sun Safe App on Sun Health Knowledge and Behaviors of Young Teenagers: Results of Pilot Intervention Studies %A Clare,Isabelle M %A Gamage,Nisali %A Alvares,Gail A %A Black,Lucinda J %A Francis,Jacinta %A Jaimangal,Mohinder %A Lucas,Robyn M %A Strickland,Mark %A White,James %A Nguyen,Rebecca %A Gorman,Shelley %+ Telethon Kids Institute, University of Western Australia, PO Box 855, Perth, 6872, Australia, 61 8 6319 1747, Shelley.Gorman@telethonkids.org.au %K app development %K co-design %K knowledge gain %K sun exposure %K sun protection %K sun behaviors %K teenagers %K UV Index %K vitamin D %K young adolescents %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Dermatol %G English %X Background: A balanced approach toward sun exposure and protection is needed by young people. Excessive sun exposure increases their risk for skin cancers such as melanoma, whereas some exposure is necessary for vitamin D and healthy bones. We have developed a new iOS smartphone app—Sun Safe—through a co-design process, which aims to support healthy and balanced decision-making by young teenagers (aged 12-13 years). Objective: The aim of this study was to test the capacity of Sun Safe to improve sun health knowledge and behaviors of young teenagers in 3 pilot intervention studies completed in 2020. Methods: Young teenagers (aged 12-13 years; N=57) were recruited through the web or through a local school via an open-access website and given access to Sun Safe (29/57, 51%) or a placebo (SunDial) app (28/57, 49%). Participants completed sun health questionnaires and knowledge quizzes before and after the 6-week intervention (either on the web or in class) and rated the quality of the app they used via a survey. Results: Of the 57 participants, 51 (89%) participants (26, 51% for placebo arm and 25, 49% for the Sun Safe arm) completed these studies, with most (>50%) reporting that they used a smartphone to access their designated app either “once a fortnight” or “once/twice in total.” Improved sun health knowledge—particularly about the UV Index—was observed in participants who were given access to Sun Safe compared with those who used the placebo (−6.2 [percentage correct] difference in predicted means, 95% CI –12.4 to –0.03; P=.049; 2-way ANOVA). Unexpectedly, there were significantly more sunburn events in the Sun Safe group (relative risk 1.7, 95% CI 1.1-1.8; P=.02; Fisher exact test), although no differences in time spent outdoors or sun-protective behaviors were reported. COVID-19 pandemic–related community-wide shutdowns during April 2020 (when schools were closed) reduced the time spent outdoors by >100 minutes per day (–105 minutes per day difference in predicted means, 95% CI –150 to –59 minutes per day; P=.002; paired 2-tailed Student t test). Sun Safe was well-rated by participants, particularly for information (mean 4.2, SD 0.6 out of 5). Conclusions: Access to the Sun Safe app increased sun health knowledge among young teenagers in these pilot intervention studies. Further investigations with larger sample sizes are required to confirm these observations and further test the effects of Sun Safe on sun-protective behaviors. %M 37632872 %R 10.2196/35137 %U https://derma.jmir.org/2022/1/e35137 %U https://doi.org/10.2196/35137 %U http://www.ncbi.nlm.nih.gov/pubmed/37632872 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e34772 %T Vitiligo and Metabolic Syndrome: Systematic Review and Meta-Analysis %A Xia,Joyce %A Melian,Christina %A Guo,William %A Usmani,Hunya %A Clark,Richard %A Lozeau,Daniel %+ Renaissance School of Medicine, Stony Brook University, 101 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 7185010945, joyce.xia@stonybrookmedicine.edu %K vitiligo %K leukoderma %K metabolic syndrome X %K dysmetabolic syndrome X %K insulin resistance syndrome X %K syndrome X %D 2022 %7 16.3.2022 %9 Review %J JMIR Dermatol %G English %X Background: Metabolic syndrome (MetS) has been associated with various skin conditions including vitiligo. However, the association between these 2 conditions has yet to be determined by quantitative meta-analysis. Objective: The aim of this paper was to determine the association between vitiligo and metabolic syndrome via systematic review and meta-analysis. Methods: A systematic literature search of Pubmed, Embase, Cochrane, and Web of Science was performed for all published literature prior to August 16, 2020. Case control and prospective cross-sectional studies analyzing the association between vitiligo and MetS were included in this review. The primary outcome measures include the type of vitiligo, diagnostic criteria for MetS, components of MetS (waist circumference, blood pressure, triglycerides, fasting glycemic index, and high-density lipoprotein cholesterol), low-density lipoprotein cholesterol levels, and BMI. A meta-analysis was performed to evaluate the prevalence and association of MetS in patients with vitiligo. Results: A total of 6 studies (n=734 participants) meeting eligibility criteria were included for systematic review and meta-analysis. The pooled prevalence of MetS in patients with vitiligo was (0.296, 95% CI 0.206, 0.386; P<.001). Patients with vitiligo were no more likely to develop MetS compared to control patients (odds ratio 1.66, 95% CI 0.83, 3.33; P=.01). A leave-one-out sensitivity analysis showed a significant association between MetS and vitiligo (P<.001). Significant elevations in fasting glycemic index (mean difference 5.35, 95% CI 2.77, 7.93; P<.001) and diastolic blood pressure (mean difference 1.97, 95% CI 0.02, 3.92; P=.05) were observed in patients with vitiligo compared to control patients. Conclusions: The association between vitiligo and metabolic syndrome carries important clinical implications. Dermatologists and other multidisciplinary team members should remain vigilant when treating this patient population in order to prevent serious cardiovascular complications that may arise as a result of metabolic disease. %M 37632859 %R 10.2196/34772 %U https://derma.jmir.org/2022/1/e34772 %U https://doi.org/10.2196/34772 %U http://www.ncbi.nlm.nih.gov/pubmed/37632859 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e33920 %T The Importance of Exploring the Role of Anger in People With Psoriasis %A Hughes,Olivia %A Hunter,Rachael %+ School of Psychology, Cardiff University, Tower Building, 70 Park Place, Cardiff, CF10 3AT, United Kingdom, 44 0 29 2087 4000, hughesoa@cardiff.ac.uk %K psoriasis %K skin conditions %K psychodermatology %K stigma %K chronic illness %K dermatology %K mental health %K quality of life %D 2022 %7 15.3.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632869 %R 10.2196/33920 %U https://derma.jmir.org/2022/1/e33920 %U https://doi.org/10.2196/33920 %U http://www.ncbi.nlm.nih.gov/pubmed/37632869 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e29966 %T From the Cochrane Library: Interventions for Hidradenitis Suppurativa %A Maghfour,Jalal %A Sivesind,Torunn %A Piguet,Vincent %A Dellavalle,Robert %A Ingram,John R %+ Dermatology Department, Glamorgan House, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, United Kingdom, ingramjr@cardiff.ac.uk %K hidradenitis suppurativa %K quality of life %K outcome measures %K heterogenetity in HS research %K dermatology %K comorbidities %K treatment interventions %K review %D 2022 %7 11.3.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632870 %R 10.2196/29966 %U https://derma.jmir.org/2022/1/e29966 %U https://doi.org/10.2196/29966 %U http://www.ncbi.nlm.nih.gov/pubmed/37632870 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e26405 %T The Effects of Modified Intermittent Fasting in Psoriasis (MANGO): Protocol for a Two-Arm Pilot Randomized Controlled Open Cross-over Study %A Grine,Lynda %A Hilhorst,Niels %A Michels,Nathalie %A Abbeddou,Souheila %A De Henauw,Stefaan %A Lambert,Jo %+ Dermatology Research Unit, Department of Head and Skin, Ghent University, Medical Research Building 2, Entrance 38, Corneel Heymanslaan 10, Ghent, 9000, Belgium, 32 9 332 5117, lynda.grine@ugent.be %K psoriasis %K leaky gut %K gut-skin axis %K dietary intervention %K intermittent fasting %D 2022 %7 23.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psoriasis is a complex disease associated with multiple comorbidities, including metabolic syndrome and leaky gut syndrome. Dietary lifestyle interventions have been reported to affect the disease in terms of lesional severity. It remains unclear how diets affect these comorbidities and the general health in psoriasis patients. Modified intermittent fasting (MIF) on 2 nonconsecutive days has shown beneficial effects on metabolic parameters. A significant advantage of MIF over the currently investigated dietary changes is its feasibility. Objective: Here, we aim to study the effects of MIF on skin, gut, and metabolic health in psoriasis patients. Methods: A 2-arm pilot randomized controlled open cross-over study will be performed in 24 patients with psoriasis. Patients will be randomized 1:1 to either start with 12 weeks of MIF and go on a subsequent regular diet for another 12 weeks or start with 12 weeks of regular diet and do subsequent MIF for 12 weeks. The following parameters will be assessed: demographics, disease phenotype, medical and familial history, psoriasis severity, dermatology-specific and general quality of life, nutritional and physical habits, mental and intestinal health, intestinal and cutaneous integrity, inflammatory and metabolic markers, and satisfaction. Results: A total of 24 participants have been enrolled in the study. The final visit is foreseen for June 2021. Conclusions: The aim is to uncover the effects of MIF on psoriasis severity and gut health integrity through clinical and molecular investigation. More precisely, we want to map the evolution of the different markers, such as psoriasis severity, permeability, and inflammation, in response to MIF as compared to a regular diet,. Understanding how dietary lifestyles can affect epithelial lineages, such as the skin and gut, will greatly improve our understanding of the development of psoriasis and may offer a nonpharmacological venue for treatments. Trial Registration: ClinicalTrials.gov NCT04418791; https://clinicaltrials.gov/ct2/show/NCT04418791 International Registered Report Identifier (IRRID): DERR1-10.2196/26405 %M 35195533 %R 10.2196/26405 %U https://www.researchprotocols.org/2022/2/e26405 %U https://doi.org/10.2196/26405 %U http://www.ncbi.nlm.nih.gov/pubmed/35195533 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e33391 %T Common Dermatologic Disorders in Down Syndrome: Systematic Review %A Lam,Megan %A Lu,Justin Di %A Elhadad,Levi %A Sibbald,Cathryn %A Alhusayen,Raed %+ Michael G. DeGroote School of Medicine, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada, 1 6479188459, Megan.lam@medportal.ca %K autoimmune %K comorbidities %K trisomy 21 %K inflammatory %K Down syndrome %K dermatology %K hidradenitis suppurativa %K systematic review %D 2022 %7 8.2.2022 %9 Review %J JMIR Dermatol %G English %X Background: Down syndrome (DS) has been associated with cardiovascular, gastrointestinal, and immune-related abnormalities. Several dermatologic conditions, including hidradenitis suppurativa, have also been found to be associated with DS. Objective: The objective of this study was to characterize the prevalence, presentation, and unique features of dermatologic disorders associated with DS. Methods: Electronic searches of EMBASE (via Ovid), MEDLINE (via Ovid), and Web of Science databases were conducted on December 14, 2020. Observational studies including case reports of patients with DS presenting with concomitant primary dermatologic disorder were included. Results: This systematic review captured 40 observational studies and 99 case reports, including 10 observational studies that examined the prevalence of common skin disorders in patients with DS. The most common dermatologic conditions reported includes atopic dermatitis (8 studies, n=180; 19.7% mean prevalence), hidradenitis suppurativa (15, n=478; 3.2%), ichthyosis (4, n=16; 4.7%), lichen nitidus (6, n=6; 1.1%), psoriasis (21, n=65; 4.8%), alopecia areata (27, n=253; 7.4%), vitiligo (8, n=40; 4.4%), onychomycosis (3, n=198; 24.7%), calcinosis cutis (14, n=15), connective tissue nevi (6, n=6), dermatofibroma (3, n=3), melanoma (3, n=3), syringomas (14, n=182; 21.2%), and elastosis perforans serpiginosa (19, n=24; 0.5%). Conclusions: Our results indicate an increased prevalence of common cutaneous disorders in patients with DS, particularly infectious, inflammatory, autoimmune, and connective tissue conditions. Current guidelines for the screening, general management, and use of systemic immunomodulatory agents in this patient population are lacking. Patients with DS would benefit from screening for dermatologic disorders not otherwise regularly performed for earlier diagnosis and treatment. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021226295; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=226295 %M 39475820 %R 10.2196/33391 %U https://derma.jmir.org/2022/1/e33391 %U https://doi.org/10.2196/33391 %U http://www.ncbi.nlm.nih.gov/pubmed/39475820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31140 %T Social Media Platforms Listening Study on Atopic Dermatitis: Quantitative and Qualitative Findings %A Voillot,Paméla %A Riche,Brigitte %A Portafax,Michel %A Foulquié,Pierre %A Gedik,Anaïs %A Barbarot,Sébastien %A Misery,Laurent %A Héas,Stéphane %A Mebarki,Adel %A Texier,Nathalie %A Schück,Stéphane %+ Kap Code, 28 rue d'Enghien, Paris, 75010, France, 33 972605764, pamela.voillot@kapcode.fr %K atopic dermatitis %K Atopic Dermatitis Control Tool %K health-related quality of life %K social media use %K real world %K dermatology %K skin disease %K social media %K online health information %K online health %K health care %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Atopic dermatitis (AD) is a chronic, pruritic, inflammatory disease that occurs most frequently in children but also affects many adults. Social media have become key tools for finding and disseminating medical information. Objective: The aims of this study were to identify the main themes of discussion, the difficulties encountered by patients with respect to AD, the impact of the pathology on quality of life (QoL; physical, psychological, social, or financial), and to study the perception of patients regarding their treatment. Methods: A retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experience with AD, their QoL, and their treatments. Messages related to AD discomfort posted between July 1, 2010, and October 23, 2020, were extracted from French-speaking publicly available online forums. Automatic and manual extractions were implemented to create a general corpus and 2 subcorpuses depending on the level of control of the disease. Results: A total of 33,115 messages associated with AD were included in the analysis corpus after extraction and cleaning. These messages were posted by 15,857 separate web users, most of them being women younger than 40 years. Tips to manage AD and everyday hygiene/treatments were among the most discussed topics for controlled AD subcorpus, while baby-related topics and therapeutic failure were among the most discussed topics for insufficiently controlled AD subcorpus. QoL was discussed in both subcorpuses with a higher proportion in the controlled AD subcorpus. Treatments and their perception were also discussed by web users. Conclusions: More than just emotional or peer support, patients with AD turn to online forums to discuss their health. Our findings show the need for an intersection between social media and health care and the importance of developing new approaches such as the Atopic Dermatitis Control Tool, which is a patient-related disease severity assessment tool focused on patients with AD. %M 35089160 %R 10.2196/31140 %U https://www.jmir.org/2022/1/e31140 %U https://doi.org/10.2196/31140 %U http://www.ncbi.nlm.nih.gov/pubmed/35089160 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e34578 %T From the Cochrane Library: Interventions for Necrotizing Soft Tissue Infections in Adults %A Shakshouk,Hadir %A Hua,Camille %A Adler,Brandon L %A Ortega-Loayza,Alex G %+ Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave, CH16D, Portland, OR, 97239, United States, 1 9196194096, ortegalo@ohsu.edu %K necrotizing soft tissue infections %K therapy %K intervention %K systematic review %K infections %K management %K evidence-based medicine %K dermatology %K skin infection %D 2022 %7 21.1.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632849 %R 10.2196/34578 %U https://derma.jmir.org/2022/1/e34578 %U https://doi.org/10.2196/34578 %U http://www.ncbi.nlm.nih.gov/pubmed/37632849 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e30620 %T The Contact Dermatitis Quality of Life Index (CDQL): Survey Development and Content Validity Assessment %A Hill,Mary K %A Laughter,Melissa R %A Harmange,Cecile I %A Dellavalle,Robert P %A Rundle,Chandler W %A Dunnick,Cory A %+ School of Medicine, University of Colorado, 1665 Aurora Court, MS 703, Aurora, CO, 80045, United States, 1 7208480500, cecile.harmange@cuanschutz.edu %K contact dermatitis %K allergic contact dermatitis %K irritant contact dermatitis %K quality of life %K outcomes instruments %K health outcomes %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: There is limited measurement and reporting of quality of life (QoL) outcomes for patients with contact dermatitis (CD). Objective: The purpose of this study is to develop a standardized Contact Dermatitis Quality of Life index (CDQL) for adult patients. Methods: A list of 81 topics was compiled from a review of QoL measures used previously in CD research. A total of 2 rounds of web-based Delphi surveys were sent to physicians who registered to attend the 2018 American Contact Dermatitis Society meeting, asking that they rank the relevance of topics for measuring QoL in CD using a 4-point scale. Items met consensus for inclusion if at least 78% of respondents ranked them as relevant or very relevant, and their median score was ≥3.25. Results: Of the 210 physicians contacted, 34 physicians completed the initial survey and 17 completed the follow-up survey. A total of 22 topics met consensus for inclusion in the CDQL, addressing symptoms, emotions, functions of daily living, social and physical functions, work/school functions, and treatment. Conclusions: This study was limited by the following factors: few open-ended questions in the initial survey, a lack of direct patient feedback, and long survey length, which likely contributed to lower survey participation. The CDQL is a comprehensive, CD-specific QoL measure developed on the basis of expert consensus via a modified Delphi process to be used by physicians and other health care professionals who care for adult patients with contact dermatitis. %M 37632827 %R 10.2196/30620 %U https://derma.jmir.org/2021/2/e30620 %U https://doi.org/10.2196/30620 %U http://www.ncbi.nlm.nih.gov/pubmed/37632827 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e29912 %T First-line Advanced Cutaneous Melanoma Treatments: Where Do We Stand? %A Abdulkarim,Louay S %A Motley,Richard J %+ Department of Dermatology, Cardiff University, Glamorgan House, University Hospital Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom, 44 7852509164, louaysaak@gmail.com %K advanced cutaneous melanoma %K first-line treatments %K immunotherapy %K targeted therapy %K combinational therapy %K dermatologic adverse events %K cutaneous side effects %D 2021 %7 15.12.2021 %9 Viewpoint %J JMIR Cancer %G English %X Cutaneous melanoma has always been a dreaded diagnosis because of its high mortality rate and its proclivity for invasiveness and metastasis. Historically, advanced melanoma treatment has been limited to chemotherapy and nonspecific immunotherapy agents that display poor curative potential and high toxicity. However, during the last decade, the evolving understanding of the mutational burden of melanoma and immune system evasion mechanisms has led to the development of targeted therapy and specific immunotherapy agents that have transformed the landscape of advanced melanoma treatment. Despite the considerable strides in understanding the clinical implications of these agents, there is a scarcity of randomized clinical trials that directly compare the efficacy of the aforementioned agents; hence, there are no clear preferences among the available first-line options. In addition, the introduction of these agents was associated with a variety of dermatologic adverse events, some of which have shown a detrimental effect on the continuity of treatment. This holds especially true in light of the current fragmentation of care provided by the managing health care professionals. In this study, we attempt to summarize the current understanding of first-line treatments. In addition, the paper describes the indirect comparative evidence that aids in bridging the gap in the literature. Furthermore, this paper sheds light on the impact of the scarcity of dermatology specialist input in the management of dermatologic adverse events associated with advanced melanoma treatment. It also looks into the potential avenues where dermatologic input can bridge the gap in the care provided by oncologists, thus standardizing the care provided to patients with melanoma presenting with dermatologic adverse events. %M 34914610 %R 10.2196/29912 %U https://cancer.jmir.org/2021/4/e29912 %U https://doi.org/10.2196/29912 %U http://www.ncbi.nlm.nih.gov/pubmed/34914610 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e33900 %T From the Cochrane Library: Topical Treatments for Cutaneous Warts %A Oganesyan,Ani %A Sivesind,Torunn %A Dellavalle,Robert %+ Department of Dermatology, University of Colorado School of Medicine, 13001 E 17th Place, Aurora, CO, 80045, United States, 1 818 441 6860, ani.oganesyan@cuanschutz.edu %K cutaneous wart %K plantar wart %K topical treatment %K papillomavirus infections %K evidence-based medicine %K wart %K treatment %K disease management %K dermatology %D 2021 %7 14.12.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632858 %R 10.2196/33900 %U https://derma.jmir.org/2021/2/e33900 %U https://doi.org/10.2196/33900 %U http://www.ncbi.nlm.nih.gov/pubmed/37632858 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e33433 %T From the Cochrane Library: Interventions for Impetigo %A Oganesyan,Ani %A Sivesind,Torunn %A Dellavalle,Robert %+ Department of Dermatology, University of Colorado Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, United States, 1 818 441 6860, ani.oganesyan@cuanschutz.edu %K impetigo %K pustular lesions %K Staphylococcus aureus %K Streptococcus pyogenes %K dermatology %K skin infection %D 2021 %7 3.12.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 39478281 %R 10.2196/33433 %U https://derma.jmir.org/2021/2/e33433 %U https://doi.org/10.2196/33433 %U http://www.ncbi.nlm.nih.gov/pubmed/39478281 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e33241 %T Surgical Surprise: Cutaneous Metastasis Presenting for Mohs Micrographic Surgery Without a Prior Diagnostic Biopsy %A Dunaway,Spencer %A Aggarwal,Pushkar %A Shaughnessy,Cristin %A Neltner,Scott %+ University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH, 45267, United States, 1 240 200 0896, aggarwpr@mail.uc.edu %K cutaneous metastasis %K Mohs surgery %K biopsy %K micrographic surgery %K dermatology %K dermatologist %K skin cancer %K melanoma %D 2021 %7 1.11.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632877 %R 10.2196/33241 %U https://derma.jmir.org/2021/2/e33241 %U https://doi.org/10.2196/33241 %U http://www.ncbi.nlm.nih.gov/pubmed/37632877 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e31838 %T From the Cochrane Library: Topical Tacrolimus for Atopic Dermatitis %A Hamp,Austin %A Anderson,Jarett D %A Sivesind,Torunn E %A Szeto,Mindy D %A Cury-Martins,Jade %+ Arizona College of Osteopathic Medicine, Midwestern University, 19555 N 59th Ave, Glendale, AZ, 85308, United States, 1 8016470632, ahamp79@midwestern.edu %K atopic dermatitis %K eczema %K calcineurin inhibitor %K tacrolimus %K lymphoma %K dermatology %K dermatitis %D 2021 %7 28.10.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632863 %R 10.2196/31838 %U https://derma.jmir.org/2021/2/e31838 %U https://doi.org/10.2196/31838 %U http://www.ncbi.nlm.nih.gov/pubmed/37632863 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26025 %T The Classification of Six Common Skin Diseases Based on Xiangya-Derm: Development of a Chinese Database for Artificial Intelligence %A Huang,Kai %A Jiang,Zixi %A Li,Yixin %A Wu,Zhe %A Wu,Xian %A Zhu,Wu %A Chen,Mingliang %A Zhang,Yu %A Zuo,Ke %A Li,Yi %A Yu,Nianzhou %A Liu,Siliang %A Huang,Xing %A Su,Juan %A Yin,Mingzhu %A Qian,Buyue %A Wang,Xianggui %A Chen,Xiang %A Zhao,Shuang %+ Department of Dermatology, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha, China, 86 13808485224, shuangxy@csu.edu.cn %K artificial intelligence %K skin disease %K convolutional neural network %K medical image processing %K automatic auxiliary diagnoses %K dermatology %K skin %K classification %K China %D 2021 %7 21.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Skin and subcutaneous disease is the fourth-leading cause of the nonfatal disease burden worldwide and constitutes one of the most common burdens in primary care. However, there is a severe lack of dermatologists, particularly in rural Chinese areas. Furthermore, although artificial intelligence (AI) tools can assist in diagnosing skin disorders from images, the database for the Chinese population is limited. Objective: This study aims to establish a database for AI based on the Chinese population and presents an initial study on six common skin diseases. Methods: Each image was captured with either a digital camera or a smartphone, verified by at least three experienced dermatologists and corresponding pathology information, and finally added to the Xiangya-Derm database. Based on this database, we conducted AI-assisted classification research on six common skin diseases and then proposed a network called Xy-SkinNet. Xy-SkinNet applies a two-step strategy to identify skin diseases. First, given an input image, we segmented the regions of the skin lesion. Second, we introduced an information fusion block to combine the output of all segmented regions. We compared the performance with 31 dermatologists of varied experiences. Results: Xiangya-Derm, as a new database that consists of over 150,000 clinical images of 571 different skin diseases in the Chinese population, is the largest and most diverse dermatological data set of the Chinese population. The AI-based six-category classification achieved a top 3 accuracy of 84.77%, which exceeded the average accuracy of dermatologists (78.15%). Conclusions: Xiangya-Derm, the largest database for the Chinese population, was created. The classification of six common skin conditions was conducted based on Xiangya-Derm to lay a foundation for product research. %M 34546174 %R 10.2196/26025 %U https://www.jmir.org/2021/9/e26025 %U https://doi.org/10.2196/26025 %U http://www.ncbi.nlm.nih.gov/pubmed/34546174 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e30530 %T Teledermatology Consults in a County Hospital Setting: Retrospective Analysis %A Funkhouser,Colton H %A Funkhouser,Martha E %A Wolverton,Jay E %A Maurer,Toby %+ Georgetown University School of Medicine, 3900 Reservoir Road NW, Washington, DC, 20007, United States, 1 (202) 687 0100, chf36@georgetown.edu %K dermatology %K teledermatology %K telemedicine %K referrals %K primary care %K keratosis %K digital health %K skin cancer %K dermatitis %D 2021 %7 8.9.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632816 %R 10.2196/30530 %U https://derma.jmir.org/2021/2/e30530 %U https://doi.org/10.2196/30530 %U http://www.ncbi.nlm.nih.gov/pubmed/37632816 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e30197 %T From the Cochrane Library: Skin Care Interventions in Infants for Preventing Eczema and Food Allergy %A Anderson,Jarett %A Sivesind,Torunn %+ Midwestern University, 19555 N 59th Ave, Glendale, AZ, 85308, United States, 1 8016567069, janderson99@midwestern.edu %K eczema %K atopic dermatitis %K skin care %K emollients %K pediatrics %K food allergy %K allergy %K dermatology %D 2021 %7 2.9.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632815 %R 10.2196/30197 %U https://derma.jmir.org/2021/2/e30197 %U https://doi.org/10.2196/30197 %U http://www.ncbi.nlm.nih.gov/pubmed/37632815 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e21709 %T Psoriasis Google Trends %A Garcia-Souto,Fernando %A Pereyra-Rodriguez,Jose Juan %+ Department of Dermatology, Valme University Hospital, Avda Bellavista s/n, Sevilla, 41014, Spain, 34 666608249, fernandogarciasouto@gmail.com %K Google Trends %K psoriasis %K treatment %D 2021 %7 8.6.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 37625163 %R 10.2196/21709 %U https://derma.jmir.org/2021/1/e21709 %U https://doi.org/10.2196/21709 %U http://www.ncbi.nlm.nih.gov/pubmed/37625163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24766 %T Remote Rating of Atopic Dermatitis Severity Using Photo-Based Assessments: Proof-of-Concept and Reliability Evaluation %A Ali,Zarqa %A Joergensen,Kristina Melbardis %A Andersen,Anders Daniel %A Chiriac,Andrei %A Bjerre-Christensen,Theis %A Manole,Ionela %A Dutei,Ana-Maria %A Deaconescu,Irina %A Suru,Alina %A Serban,Adina %A Isberg,Ari Pall %A Dahiya,Priyanka %A Thomsen,Simon Francis %A Zibert,John Robert %+ Department of Dermato-Venereology and Wound Healing Centre, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen, 2400, Denmark, 45 60122596, zarqa_ali@hotmail.com %K atopic dermatitis %K eczema %K remote assessment %K photo %K photographs %K EASI %K SCORAD %K severity %K assessment %K agreement %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital imaging of dermatological patients is a novel approach to remote assessment and has recently become more relevant since telehealth and remote decentralized clinical trials are gaining ground. Objective: We aimed to investigate whether photographs taken by a smartphone are of adequate quality to allow severity assessments to be made and to explore the usefulness of an established atopic dermatitis severity assessment instrument on photograph evaluation. Methods: During scheduled visits in a previously published study, the investigating doctor evaluated the severity of atopic dermatitis using the Scoring AD (SCORAD) index and took photographs of the most representative lesions (target lesions) with both a smartphone and a digital single-lens reflex camera (DSLR). The photographs were then assessed by 5 dermatologists using the intensity items of the SCORAD (iSCORAD), which consists of erythema, oedema/papulation, excoriations, lichenification, oozing/crusts, and dryness (scale 0-3, maximum score 18). The mean iSCORAD of the photographs was calculated and compared with in-person assessments using Pearson correlation and Bland-Altman plots. Intraclass correlation coefficients were used for interrater reliability. Results: A total of 942 photographs from 95 patients were assessed. The iSCORAD based on smartphone photographs correlated strongly with the evaluations performed in person (iSCORAD: r=0.78, P<.001; objective SCORAD: r=0.81, P<.001; and total SCORAD: r=0.78, P<.001). For iSCORAD specifically, a Bland-Altman plot showed a difference in mean score of 1.31 for in-person and remote iSCORAD. In addition, the interrater agreement between the 5 rating dermatologists was 0.93 (95% CI 0.911-0.939). A total of 170 lesions were photographed, and the difference in mean scores was 1.32, 1.13, and 1.43 between in-person and remote evaluations based on photographs taken by a DSLR camera, a smartphone without flash, and a smartphone with flash, respectively. Conclusions: In terms of quality, remote atopic dermatitis severity assessments based on photographs are comparable to in-person assessments, and smartphone photos can be used to assess atopic dermatitis severity to a similar degree as photographs from a DSLR camera. Further, the variation in how the dermatologists in this study rated the iSCORAD based on the photographs was very low. %M 34032580 %R 10.2196/24766 %U https://formative.jmir.org/2021/5/e24766 %U https://doi.org/10.2196/24766 %U http://www.ncbi.nlm.nih.gov/pubmed/34032580 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 3 %N 1 %P e17171 %T Assessment of Patient Satisfaction With Dermatology Clinics According to Clinic Type: Mixed Methods Study %A Costigan,Jennifer %A Feldman,Sue S %A Lemak,Mark %+ Department of Health Services Research, School of Health Professions, University of Alabama at Birmingham, 1716 9th Avenue South, SHPB #590K, Birmingham, AL, 35294, United States, 1 205 975 0809, suefeldman1009@gmail.com %K Consumer Assessment of Healthcare Providers and Systems survey scores %K patient satisfaction %K dermatology %K private dermatology clinic %K rapid access dermatology clinic %K wait time %K patient resource stewardship %K communication %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Dermatol %G English %X Background: Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses are considered significant indicators of the quality of care and patient satisfaction. There is a pressing need to improve patient satisfaction rates as CAHPS survey responses are considered when determining the amount a facility will be reimbursed by the Centers of Medicare and Medicaid each year. Low overall CAHPS scores for an academic medical center’s dermatology clinics were anecdotally attributed to clinic type. However, it was unclear whether clinic type was contributing to the low scores or whether there were other factors. Objective: This study aimed to determine where the efforts of patient satisfaction improvement should be focused for two different types of dermatology clinics (private and rapid access clinics). Methods: This study used a concurrent mixed methods design. Secondary data derived from the University of Alabama at Birmingham Hospital’s Press Ganey website were analyzed for clinic type comparisons and unstructured data were qualitatively analyzed to further enrich the quantitative findings. The University of Alabama at Birmingham Hospital is an academic medical center. The data were analyzed to determine the contributors responsible for each clinic not meeting national benchmarks. Thereafter, a review of these contributing factors was further performed to assess the difference in CAHPS scores between the private and rapid access clinics to determine if clinic type was a contributing factor to the overall scores. Results: The data sample included 821 responses from May 2017 to May 2018. Overall, when both private clinics and rapid access clinics were viewed collectively, majority of the patients reported stewardship of patient resources as the most poorly rated factor (367/549, 66.8%) and physician communication quality as the most positively rated factor (581/638, 91.0%). However, when private clinics and rapid access clinics were viewed individually, rapid access clinics contributed slightly to the overall lower dermatology scores at the academic medical center. Conclusions: This study determined that different factors were responsible for lower CAHPS scores for the two different dermatology clinics. Some of the contributing factors were associated with the mission of the clinic. It was suspected that the mission had not been properly communicated to patients, leading to misaligned expectations of care at each clinic. %R 10.2196/17171 %U http://derma.jmir.org/2020/1/e17171/ %U https://doi.org/10.2196/17171 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 4 %P e15218 %T Dermatologists’ Adherence to the Latest Recommendations for Screening of Hydroxychloroquine Retinopathy in Saudi Arabia: Cross-Sectional Study %A Mleeh,Nouf Talal %A Alzahrani,Nujood Abdulwahed %A Hariri,Jehad Osama %A Mortada,Hatan Hisham %A Algethami,Mohammed Ridha %+ Department of Dermatology, Faculty of Medicine, King Abdulaziz University, Al Fayha'a, Jeddah, , Saudi Arabia, 966 50 005 747, Nmileh@kau.edu.sa %K Saudi Arabia %K dermatologist %K adherence %K hydroxychloroquine %K retinopathy %D 2019 %7 19.12.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Hydroxychloroquine (HCQ) has been used to manage many inflammatory skin conditions. Nevertheless, retinopathy continues to be its most significant adverse effect. The American Academy of Ophthalmology (AAO) recommends baseline ophthalmologic screening in the first year of HCQ treatment. However, a recent study found an inadequate awareness of the recommendations. Furthermore, limited data are available regarding the implementation of the recommendations among dermatologists. Objective: The aim of this study was to assess dermatologists’ adherence to recommendations pertaining to their current practice regarding HCQ toxicity detection. Methods: A self-administrated questionnaire was distributed between February 2 and May 4, 2018, among members of the Saudi Society of Dermatology. The questionnaire comprised demographic-related questions and questions pertaining to each physician’s routine practice about the follow-up of HCQ-treated patients. Results: A total of 76 dermatologists completed the questionnaire. We achieved a response rate of 62.54%. More than half (43/76, 56%) of the dermatologists were male. Furthermore, more than half (41/76, 53%) of them reported treating 1 to 3 patients with HCQ during the last year. Furthermore, two-thirds (47/76, 61%) of them reported screening patients before initiating HCQ treatment. Regarding follow-up recommendations, 59% (45/76) of dermatologists reported yearly after starting treatment for no-risk patients, whereas 94% (72/76) reported “yearly within 5 years of treatment” for at-risk patients. Data were considered significant at P<.05. All analyses were performed using SPSS, version 20 (IBM). Conclusions: Dermatologists in Saudi Arabia are not well informed about some aspects of the latest recommendations regarding screening for HCQ toxicity in terms of tests, follow-up timing, cessation of the drug, and causative agents. Therefore, we recommend conducting more studies in Saudi Arabia to determine the adherence of more physicians to the AAO recommendations. Furthermore, patient education regarding HCQ toxicity and increased patient awareness are recommended for effective and safe HCQ use. %M 31855186 %R 10.2196/15218 %U http://www.i-jmr.org/2019/4/e15218/ %U https://doi.org/10.2196/15218 %U http://www.ncbi.nlm.nih.gov/pubmed/31855186