RESUMEN
BACKGROUND: Since devices for digital epiluminescence microscopy and for telemedicine have become affordable, a critical evaluation of this new method has been needed. OBJECTIVE: Our aim was a critical evaluation of teledermatoscopy under routine conditions in private practice. METHODS: Pigmented skin lesions (PSLs) scheduled for excision were documented with a digital epiluminescence microscopy (DELM) system. Images were sent to the PSL consultation at the Department of Dermatology of the University Hospital Geneva, where a diagnosis was established. The histopathologic report including the initial diagnosis was sent afterward. Both approaches were compared concerning diagnostic accuracy. RESULTS: Over a period of 6 months, 55 lesions on 51 patients have been included in this study. Picture quality was good or very good in more than 90%. Diagnostic accuracy of the teledermatoscopy approach was superior to that of the conventional approach for malignant melanocytic lesions. CONCLUSION: We have shown the feasibility of a teledermatoscopic consultation. The gain of diagnostic accuracy in this teledermatoscopic approach, especially for malignant melanocytic lesions, suggests that patients might benefit directly from such a consultation at distance.
Asunto(s)
Consulta Remota , Neoplasias Cutáneas/diagnóstico , Estudios de Factibilidad , Humanos , Mediciones Luminiscentes , Microscopía/métodos , Neoplasias Cutáneas/patologíaRESUMEN
In a multicenter study, photopatch test results from more than 1500 patients were evaluated between 1985 and 1990 and from 614 patients between 1990 and 1992. Photopatch testing was conducted according to a standardized procedure. Nearly half of the photoreactions were unclassifiable according to the classic definitions of photoallergic or phototoxic reactions. To facilitate the interpretation of these remaining photopatch test reactions, we developed a computerized substance specific reaction pattern analysis. By sequential readings from immediately after irradiation up to 72 h later and by morphological qualification of the reactions, the time course and morphological changes of each individual reaction were monitored. The summation of each individual photoreaction resulted in an overall reaction pattern of a specific substance. Four main categories could be distinguished. The first category was characterized by a peak immediately after irradiation followed by a descrescendo reaction. The second category comprized reactions combining an immediate with a delayed reaction. The third category exhibited a plateau-like delayed reaction. The fourth category showed delayed reactions in a crescendo pattern. Whereas category 1 represents classic phototoxic and category 4 classic photoallergic reaction patterns, the underlying mechanisms of categories 2 and 3 remain to be investigated. Typical substances of category 1 were many of the tested systemic drugs, such as furosemide, most of which are well-known phototoxic agents. Disinfectants, nonsteroidal anti-inflammatory agents and phenothiazines showed the reaction patterns of categories 2 and 3. A delayed type reaction (category 4) could be demonstrated for well-known photoallergens such as fenticlor, musk ambrette, and ultraviolet adsorbents in sunscreens.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Pruebas del Parche/clasificación , Trastornos por Fotosensibilidad/diagnóstico , Alérgenos , Vesícula/patología , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/patología , Dermatitis Fotoalérgica/diagnóstico , Dermatitis Fotoalérgica/patología , Dermatitis Fototóxica/diagnóstico , Dermatitis Fototóxica/patología , Eritema/patología , Sistemas Especialistas , Humanos , Hipersensibilidad Tardía/patología , Hipersensibilidad Inmediata/patología , Irritantes , Pruebas del Parche/métodos , Trastornos por Fotosensibilidad/patologíaRESUMEN
The causes and the pathological mechanisms of psoriasis are only partially understood. The different treatments tend to inhibit the proliferation of the keratinocytes as well as the dermal inflammation. Anthralin ("minute treatment"), tar, corticosteroids, photochemotherapy and retinoids are the most frequently used treatments, some by the general practitioner, other by the dermatologist.
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Atención Ambulatoria , Psoriasis/terapia , Corticoesteroides/uso terapéutico , Antralina/uso terapéutico , Humanos , Terapia PUVA , Psoriasis/tratamiento farmacológico , Retinoides/uso terapéutico , Breas/uso terapéuticoAsunto(s)
Cuero Cabelludo , Neoplasias Cutáneas/patología , Adenoma de las Glándulas Sudoríparas/patología , Adolescente , Adulto , Carcinoma Adenoide Quístico/patología , Femenino , Humanos , Hiperplasia/patología , Masculino , Meningioma/patología , Persona de Mediana Edad , Nevo Pigmentado/patología , Lesiones PrecancerosasAsunto(s)
Dermatomicosis/diagnóstico , Dermatomicosis/epidemiología , Femenino , Humanos , Masculino , Suiza , Población UrbanaRESUMEN
Thermography is investigated as a tool for the diagnosis of malignant melanoma. A correlation between hyperthermia and malignancy is demonstrated in about two-thirds of the cases examined.