Background. There is a paucity of published evidence of established teledermatology (TD) services in the UK. An in-house TD service using store-and-forward technology was set up at a large regional dermatology department in 2004. Aim. To review the TD service at our centre, including teleconsultation numbers, coding of diagnoses and patient outcomes. Methods. Retrospective data were retrieved using the electronic patient database, from 31 July 2004 to 31 July 2018. More detailed information on patient outcomes was obtained from patient notes and histology records. A paper questionnaire was distributed to 100 patients to obtain patient feedback. Results. In total, 40 201 teleconsultations were made over 14 years, and 64% of cases were coded (n = 25 555), of which 77% were lesions. The most common coded lesions were benign naevus (25%), seborrhoeic keratosis (22%) and basal cell carcinoma (19%). Of the total number of cases, 50% were discharged to their general practitioner with advice, 34% were booked for surgery and 16% were booked for a face-to-face appointment. In the survey, 82% of patients surveyed felt that the service was 'good' or 'very good'. A detailed study between 1 January 2015 and 1 January 2016 showed that there were 383 patients (10%) with no diagnosis made following teleconsultation, suggesting diagnostic uncertainty. Reasons for this included lack of diagnostic features, possibility of malignancy and service factors. Within this cohort, there was 68% diagnostic concordance. Conclusions. We have set up a successful TD service at a UK centre, which has prevented 16 282 face-to-face appointments over 14 years. Patient feedback has been very good. Review of cases with diagnostic uncertainty provides important information for service improvement and has not previously been documented.
Sweet’s syndrome is an acute febrile neutrophilic dermatosis with classical clinical features. Systemic manifestations in Sweet’s syndrome including fever, arthralgia, myalgia and ocular involvement are common. Pulmonary involvement is a rare manifestation that has been reported previously in 34 cases and can be fatal if left untreated. We report a striking case of Sweet’s syndrome with respiratory failure secondary to bilateral pulmonary interstitial infiltrates, which rapidly responded to intravenous corticosteroid therapy. This case is an important reminder of the systemic manifestations of Sweet’s syndrome and highlights the value of collaboration between different medical specialities to optimise patient management and outcomes.
A n 89-year-old man presented with a 1-year history of a nonhealing groin rash. The rash was not painful or pruritic. He had previously been treated empirically with oral and topical antibiotics, topical antifungal agents, and topical glucocorticoids without improvement. The physical examination revealed an erythematous velvety plaque with superficial white scale affecting the skin of the groin and scrotum (Panel A). Results of an incisional skin biopsy showed epidermal infiltration by large atypical cells that had eosinophilic cytoplasm and prominent nuclei, findings that are consistent with Paget cells (Panel B, arrows). Immunohistochemical staining was strongly positive for cytokeratin stains CK7 and CAM 5.2 (not shown). Extramammary Paget's disease (not associated with Paget's disease of the bone) is an intraepithelial adenocarcinoma that is sometimes misdiagnosed as dermatitis. It most commonly involves the vulva but can also occur in the perianal skin, scrotum, penis, and axilla. In some patients, it is associated with underlying adnexal or visceral cancer. Treatment options include radiotherapy, photodynamic therapy, topical immunomodulators, and surgery. After discussion of the available treatments, the patient opted for regular surveillance because the lesion was asymptomatic and slow-growing. He died of unrelated causes 12 months after diagnosis.
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