Volume 47, Issue 12, 1 December 2022

Applying educational theory to medical education research is no different to the way theory drives research and practice in other domains. However, the practical application of theory to research in medical education can often be challenging for many different reasons. This article seeks to help researchers by exploring some important questions about educational theory, including what theory is, why it is important, and how it can be used in medical education research.

Qualitative research has long been considered the poor cousin to quantitative research. However, recently it has gained more prominence and respect, particularly within health professions education. This article aims to introduce the novice researcher to the fundamental principles of qualitative research.

Evaluating education and training in dermatology is important if they are to be efficient and effective in improving outcomes. Where appropriate, evaluation should be linked to a theory of change, including both process and outcome evaluation to determine how and if the education has met its purpose. There are helpful theories and methods that can support high‐quality evaluation, and we illustrate these with an example in dermatology.

The diverse world of dermatology has a wealth of protracted and at times tenuous names encompassing diseased conditions, characteristic clinical description, and signs, among others. Many dermatological entities are identified by toponyms or place names. Although some sound irrelevant and archaic (with only historical importance reminding us of the lively history of the subject), other terminologies aid in easy recollection. In this review, we have succinctly summarized various toponymous descriptions in dermatology covering diseases, signs, scales, criteria and treatment.

Menopause is associated with falling oestrogen levels due to ovarian follicle depletion. Oestrogens and androgens are involved with regulation of the hair cycle. Both female pattern hair loss and frontal fibrosing alopecia are associated with menopause.

Click here for the corresponding questions to this CME article.

Click here for the corresponding questions to this CME article.

The low oestrogen levels during menopause lead to physical and physiological changes to the female genitourinary tract. This can lead to the characteristic changes known as genitourinary syndrome of menopause (GSM). The symptoms and signs of GSM can overlap or coexist with other vulval dermatoses. Expert opinion is needed to diagnose and manage vulval dermatoses in menopause.

Click here for the corresponding questions to this CME article.

This review was carried out with the aim of summarizing literature on off‐label use of apremilast in dermatology, in order to guide clinicians regarding the currently available evidence. Randomized controlled trial data were available for use of apremilast in vitiligo, alopecia areata, hidradenitis suppurativa and atopic dermatitis. Case series and case reports describing apremilast were also reviewed. Owing to its broad spectrum of immunomodulatory activity, apremilast may be useful, either alone or in combination with other drugs, to treat a number of chronic inflammatory skin diseases recalcitrant to conventional therapies.

This review article aims to raise awareness of the Panton–Valentine leucocidin toxin, to aid clinicians with diagnostic pointers and to provide guidance with treatment, with an emphasis on the need for further population‐based studies.

Click here for the corresponding questions to this CME article.

We studied the use of perceptual learning modules (PLMs) in dermatology teaching. Digital PLMs improved the diagnostic accuracy of skin conditions and self‐perceived confidence in undergraduate students. There is considerable potential for a wider use of PLMs to improve visual skills and strengthen implicit learning in dermatology.

We present the results of a trial of acupuncture and osteopathic medicine for treating atopic dermatitis (AD). Although no differences in disease severity were found, our findings indicate that acupuncture might reduce itching in patients with AD. Furthermore, acupuncture and osteopathic medicine show a trend towards reducing topical corticosteroid use in patients with AD.

This economic analysis utilized data from a systematic review and network meta‐analysis to assess the relative cost‐effectiveness of topical pharmacological, oral pharmacological, physical and combined treatments for mild‐to‐moderate and moderate‐to‐severe acne vulgaris. All of the assessed treatments were found to be cost‐effective compared with treatment with placebo (modelled as general practitioner visits without active treatment). The findings of this study, along with findings on efficacy and other clinical considerations, informed the national guidance on the management of acne vulgaris, published by the National Institute for Health and Care Excellence.

The absolute numbers of peripheral regulatory T (Treg) and natural killer cell subsets are significantly decreased in SSc, leading to an imbalance of T helper (Th)17 Treg cells in these patients. After therapy with low‐dose interleukin (IL)‐2, the patients improved in line with the rebalancing of the Th17/Treg ratio. Low‐dose IL‐2 treatment could restore the balance of the two types of immune cell and reduce disease activity without obvious adverse effects.

This large case series highlights the adverse effects of benzalkonium chloride (BAK) on the skin used as a laundry sanitizer, and hypothesizes a link between BAK exposure and formation of hyperkeratotic flexural erythema Further studies are needed to assess the microbiome in patients who have been exposed to BAK, aiding our understanding of the underlying aetiology.

Congenital melanocytic naevi (CMN) are known to be associated with mosaic NRAS or BRAF variants. We identified NRAS p.Q61R/K (61.8%) and BRAF p.V600E as the predominant variants (10%) in 110 patients with CMN and found higher allele load of NRAS p.Q61R/K was indicated in extremities and trunks and also in larger size, higher colour variation, the more significant hypertrichosis, surface rugosity and asymmetry phenotypes of CMN. The findings of this study potentially facilitate a more accurate and comprehensive classification of CMN in clinical practice.

We performed a randomized controlled trial to evaluate the usefulness of regular structured support by dermatological nurses delivered every 4 weeks for 48 weeks to patients with psoriasis treated with topical drugs. The support improved long‐term (48 weeks) use of topical drugs and there was an improvement from baseline in severity of psoriasis (measured by Lattice System Physician Global Assessment) at Week 24 (2.21 vs. 1.28, P = 0.001) compared with standard support by a dermatologist. The difference in favour of the intervention lasted throughout the remaining study period. These results indicate that there is potential for improving treatment outcome by delivering regular support to patients with psoriasis.

Feature comparison (vertical and horizontal) with cellular resolution between line‐field confocal optical coherence tomography, reflectance confocal microscopy and haematoxylin and eosin in benign, atypical and malignant melanocytic tumours.

There are scant data available on the comorbidities of patients with psoriasis in South America. Multicentre, cross‐sectional study involving 16 hospitals and clinics in Chile utilized a 48‐item questionnaire to study clinician and patient reported outcomes and comorbidities. In total, 598 adult patients with psoriasis were included. Comorbidities were reported in 60.2% of all patients with psoriasis. Frequent concomitant diseases were obesity (25.3%), hypertension (24.3%), Type 2 diabetes (18.7%), dyslipidaemia (17.4%), metabolic syndrome (16.7%) and depression (14.4%). Significant associations were found between moderate to severe psoriasis and obesity, type 2 diabetes and nonalcoholic fatty liver disease compared with mild psoriasis.

In this study, we assessed the effects on psoriasis of sodium‐glucose co‐transporter 2 inhibitor (SGLT2i) treatment in patients who also had diabetes. We did not find any protective effect of SGLT2i treatment on psoriasis. In fact, we found that SGLT2i treatment increased the risk of psoriasis by 2.7‐fold in patients with diabetes with renal diseases.

Sea urchin injuries can cause chronic inflammation implicating skin and less commonly, deeper structures. Surgical measures are often undertaken, particularly when there is evidence of retained spines, but other options exist. We demonstrate that conservative management, surgery and intralesional corticosteroids may all be associated with satisfactory outcomes.

Several studies, including our previous study, have reported the risk of venous thromboembolism (VTE) in patients with autoimmune blistering disease (AIBD). However, we have also experienced multiple cases of pemphigus or pemphigoid that developed severe complications related to abnormal blood coagulation other than VTE, e.g. severe bleeding and cerebral infarction. This study summarizes those cases and discusses the risk of thromboembolism and bleeding in patients with AIBD.

The purpose was to examine the efficacy of daily use of MitoHeal^® supplementation (i.e. patented redcurrant and blackcurrant extract) on adult's skin, hair and nail quality. The photo and self‐report assessments revealed that MitoHeal supplementation compared with placebo resulted in significant improvements in face, hair and nail quality from Day 0 to Day 30, with a dose–response relationship often evidenced (P < 0.05).

Systemic retinoid therapy may be associated with potentially rare adverse effects (AEs) such as skeletal hyperostosis. This paper highlights the significance of retinoid‐induced skeletal hyperostosis in patients prescribed long‐term, high‐dose retinoid therapy for disorders of keratinization. Patients commencing systemic retinoid therapy, particularly women of childbearing age, should be counselled of this important and potentially serious AE, especially if long‐term treatment is indicated.

Using the psoriasis regimen, administration of secukinumab 150 mg led to a significant reduction in inflammation and some reduction in scaling in four paediatric cases of autosomal recessive congenital ichthyosis.