Isabel Betlloch-Mas

We conducted a two-year retrospective evaluation of infants aged under two years with a confirmed, clinical, or suspected diagnosis of scabies in a healthcare center in Alicante (Spain) to determine possible factors associated with diagnostic delay and poor treatment response. We collected epidemiological, clinical, diagnostic, and treatment variables. After describing our findings as mean values and percentages, we compared categorical variables using the Student’s t-test and the Mann–Whitney U test, and we compared continuous variables with the Chi² test and Pearson’s correlation coefficient. We included 51 infants (19 boys and 32 girls) with a mean age of 15 months. The main source of contagion was the family; half of the infants lived with four or more people. According to the International Consensus Criteria for the Diagnosis of Scabies, confirmed scabies was diagnosed in 45% of cases and clinical scabies in 47%, and 45% of cases had a diagnostic delay. Lesions mainly affected the hands, feet, and trunk, with papules in 92% of cases and burrows in 55%. The predominant symptoms were pruritus (94%) and irritability (69%). Regarding treatment, 98% of the infants received topical permethrin and 35% received oral ivermectin. Treatment failed in 76% of infants. Living in large family units was associated with a higher risk of contagion and therapeutic failure. Diagnostic delay was associated with previous misdiagnosis.

Neonatal herpes is a rare condition and it is normally acquired through vertical transmission in the peripartum period. Delayed diagnosis and treatment of this condition are associated with high morbidity and mortality. We present five cases of neonatal herpes in infants born to asymptomatic mothers. Three of these infants were girls, three were born preterm, three were born after prolonged rupture of membranes, three had herpes simplex virus (HSV) type 2, and one had central nervous system (CNS) involvement. In all cases, the dermatologist played a key role in establishing an early diagnosis. Given the absence of a vaccine or a cost-effective method of screening for HSV infection in asymptomatic mothers, the current management strategies focus on the prevention of maternal infection and mother-to-child transmission, as well as early diagnosis and treatment of neonatal infection.

Background: Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. Objective: This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. Methods: We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. Results: We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. Conclusions: TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome.

BACKGROUND Teledermatology (TD) is a branch of telemedicine focused on the evaluation of cutaneous lesions by dermatologists remotely, in order to avoid unnecessary in-person consults that could be otherwise resolved by this method, and to shorten the time required for prompt evaluation of cutaneous diseases. OBJECTIVE This study aimed to create and validate a questionnaire to evaluate satisfaction with the use of TD among primary care pediatricians (PCPs) and to test the questionnaire in our health area before performing an intervention for the optimization of TD. METHODS We first created a questionnaire based on previous publications. Then, an expert consultation was made before drafting the final version of the questionnaire. We tested it twice among pediatricians of different health areas, with a 1-month gap between both evaluations. Internal consistency, reproducibility, and validity of the questionnaire were evaluated. Finally, the validated questionnaire was tested among the PCPs of our health area, to analyze their responses. RESULTS We registered 38 questionnaire responses. In all, 30 (78.9%) PCPs actively used TD several times within a month or a year; none of them used TD daily. Technical and health care quality of TD was mostly considered as good or very good. TD was regarded as similar or even better than face-to-face evaluation for most PCPs, whereas 7.9% (3/38) of PCPs thought TD was worse than conventional consults. Most PCPs considered TD as an effective, self-learning, and trustable tool, and 10.5% (4/38) of them identified that pictures captured by mobile phones were a barrier for its use, as it affects patient privacy. Technical problems, absence of exclusive devices for image taking, and delayed answers are some other barriers for TD that need to be overcome. Nonetheless, all PCPs were satisfied with TD, and all of them reported they would continue or start to use this tool. CONCLUSIONS TD has demonstrated to be an efficient tool, as it reduces waiting time and costs for dermatology evaluation, and it increases satisfaction among professionals. With our proposed questionnaire, we validated that quality, usability, efficacy, and satisfaction related to TD in our health area had a positive consideration among PCPs in general, but there still are barriers to overcome.

Background: Cutaneous metastasis (CM), while uncommon, is usually an indicator of poor prognosis. With cancer patients living longer, the incidence of CM has increased, which justifies its analysis. Objectives: The objective of this study was to carry out a descriptive study of CM diagnosed for 18 years in a dermatology department of a tertiary care hospital and to assess the epidemiological, clinical, and histological variables that condition them, as well as data on their survival and prognosis. Methods: We performed a descriptive study of cases of CM diagnosed over 18 years in the dermatology department of a tertiary referral hospital analyzing the following variables: patient age and sex, site of primary neoplasm, pathochronology, survival time, histological findings, immunohistochemical markers, the anatomical area affected, the clinical appearance of the metastasis, therapeutic plan, and existence of metastases in other regions. We checked normal distribution using the Kolmogorov-Smirnov test and then compared the quantitative variables using the Student's t-test (unpaired samples), Mann-Whitney test (non-normal distribution), analysis of variance (ANOVA; for more than two groups), and categorical variables using the chi-square or Fisher’s exact test. Results: We included 37 cases (20 men and 17 women), of whom 32 had died. The mean age was 62 ± 15 years. CM detection was defined early in 8% of cases, synchronous in 32%, and metachronous in 60%. The most frequent primary tumor sites were lungs (24%), breasts (21%), and bladders (11%). Most metastases were solitary. The most frequent locations for CM were the scalp, trunk, armpits, and groin. Most lesions had a nodular presentation (81%). Squamous cell carcinoma and adenocarcinoma showed the same frequency in lung cancer CM. Breast cancer leading to CM was the most common invasive ductal carcinoma. The most aggressive cases, with the worst survival, originated in lung neoplasms. Therapeutic management for most patients involved surgery in combination with other procedures. The only difference detected between the lung and breast cancer CM was the predominance of lung tumors in men (89%) and breast tumors in women compared with metastases from other sites; breast cancer CM manifested more frequently as plaques and less frequently as nodules (p < 0.05) and was less frequently associated with multisystemic metastasis. In lung cancer CM, time from tumor diagnosis to CM occurrence was shorter (p < 0.01) and multisystemic metastasis was more frequent than in CM of other tumors. Conclusions: CM tends to affect patients aged above 60 years and arises predominantly from lung cancer in men and breast cancer in women. The most typical locations are the chest and scalp, and the appearance is usually nodular. Survival after CM detection is low, particularly in lung cancer CM.