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Our objective was to examine the prevalence and predictors of delayed medical care due to transportation barriers among children with atopic dermatitis (AD) living in the United States (US). We analyzed data from the 1998-2018 National Health Interview Survey, a nationally representative survey of US households. In 2018, transport-delayed care was reported for 3.4% of US children with AD, representing approximately 279,000 children annually given the National Health Interview Survey's weighted survey design, and was more common among patients of lower socioeconomic status. Targeted interventions aimed at reducing transportation barriers to healthcare among at-risk AD patients may reduce health disparities related to AD.

Background Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction. Methods Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales. Results Analysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8–59.2), representing a “difficult” level of reading. Mean readability grade levels (range 9–13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health. Conclusions Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

INTRODUCTION The American Society for Dermatologic Surgery (ASDS) established a cosmetic dermatologic surgery fellowship in 2013. Programs often outline details of fellowships on their websites to help prospective applicants make informed decisions. Our primary goal was to evaluate the content quality of online information for all ASDS-accredited cosmetic dermatologic surgery fellowships on program websites and the ASDS website. Our secondary goal was to describe program activity on social media platforms as another avenue for applicant recruitment. METHODS Program websites were assessed using an aggregate score from twenty-one standardized content quality variables. Social media activity on Facebook and Instagram from January 6 2021, to March 6, 2021, was categorized. RESULTS Among 24 cosmetic dermatologic surgery fellowship programs, 23 had websites. Basic information was provided across most websites or the ASDS website (eg, address, 95.8%), but more qualitative variables like research opportunities or didactic schedule were not consistently reported. Most programs had highly active social media accounts (91.7% on Facebook and 79.2% on Instagram). CONCLUSION There is a gap of information availability between the ASDS website and individual cosmetic dermatologic surgery fellowship websites. Increasing information availability may enhance the applicant recruitment process and serve as a low-cost intervention to ensure optimal fit.

Background Bronchiolitis is the leading cause of hospitalization for United States infants. Blood eosinophil and serum specific IgE (sIgE) levels are separately linked to clinical severity but few studies have examined these biomarkers together. Objective Among infants hospitalized for bronchiolitis, we investigated the association between (1) blood eosinophilia and severity, (2) sIgE sensitization and severity, and (3) interaction between the two biomarkers on severity. Methods We enrolled 1016 infants hospitalized for bronchiolitis between 2011 and 2014 across 17 U.S. hospitals into a prospective cohort study. Of those, 873 (86%) had eosinophils measured and all had sIgE levels from blood collected at hospitalization. We investigated higher bronchiolitis severity using intensive care therapy as the outcome (i.e., intensive care unit admission, intubation, and/or receipt of continuous positive pressure ventilation). Results Among 873 infants in the analytic cohort, 18% had blood eosinophilia of ≥3%, and 20% were positive for sIgE. With regard to bronchiolitis severity, 15% received intensive care therapy. In unadjusted analyses, eosinophils ≥3% was not associated with intensive care therapy, while sIgE was associated with a significantly higher risk (odds ratio [OR]: 1.44, 95% confidence interval [CI]: 1.08-1.92; p = .01). In a multivariable model for intensive care therapy, eosinophilia remained unassociated with severity, and sIgE remained associated (OR: 1.60, 95% CI: 1.05-2.45; p = .03). Also, sIgE did not modify the association between eosinophil level and intensive care therapy (pinteraction = .14). Conclusion Blood eosinophilia of ≥3% was not associated with bronchiolitis severity. By contrast, sIgE was independently associated with bronchiolitis severity and did not modify the association between eosinophil level and severity.

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic inflammatory skin disease that significantly impairs quality of life. There are high direct and indirect financial burdens associated with HS, which may compel patients to turn to online crowdfunding for assistance covering HS-related costs. Crowdfunding is the financing of a specific initiative by pooling many smaller donations from numerous individuals, and has previously been used to fund dermatologic care.

Background Labiaplasty is an increasingly popular procedure performed for both cosmetic and pathologic etiologies. Questions have been raised regarding the efficacy of the procedure, especially for cosmetic etiologies. Objectives The aim of this study was to examine the complication profiles of labiaplasties for both cosmetic and pathologic etiologies. Methods The 2005 to 2017 National Surgical Quality Improvement Program database was analyzed for patients who, according to the relevant Current Procedural Terminology code, had undergone labiaplasties. Our cohort was further separated into cosmetic and pathologic groups based on International Classification of Diseases codes. Information was collected on patient demographic characteristics, patient comorbidities, and operative variables. Outcomes of interest included surgical complications and delayed length of stay (DLOS). A univariate analysis and multivariate logistic regression were applied to determine statistically significant predictors of our outcomes of interest for both etiologies. Results There were 640 patients in the cosmetic cohort and 1919 patients in the pathologic cohort. There were no significant differences in rates of surgical complications between the 2 groups, but there was a statistically significant increase in length of stay for the pathologic group. Univariate analysis revealed operative time and plastic surgeon specialty to be predictive of DLOS in the cosmetic cohort. No covariates were implicated with multivariate analysis for either surgical complications or for DLOS in the cosmetic cohort. Conclusions Our findings suggest that cosmetic labiaplasty is a safe and efficacious procedure with low complication rates and no predictors of adverse outcomes. Level of Evidence: 4

Nail squamous cell carcinoma (nSCC) is the most common nail unit malignancy. However, no studies to date have evaluated treatment options for nSCC based on recurrence data while controlling for invasion.To identify temporal trends in nSCC treatment modalities and compare treatment outcomes based on invasion.The authors performed a systematic review of articles published on PubMed, MEDLINE, and Scopus from inception to April 2020 reporting treatment of nSCC. The primary outcome was disease recurrence.Reports of nSCC treatments have increased in the past decade. Mohs micrographic surgery (MMS) is the most common treatment reported overall. The lowest recurrence rates for in situ nSCC were seen with wide surgical excision (WSE) and MMS. For invasive disease, the recurrence rates were lowest with amputation, MMS, and WSE.Complete surgical excision of nSCC with either WSE or MMS is associated with lower recurrence rates than limited excision and nonsurgical therapies, regardless of degree of invasion. The prognostic significance of in situ versus invasive disease remains unclear. Confirmation of complete excision may improve outcomes. Digital amputation is indicated for nSCC with bone invasion. Prospective studies and randomized controlled trials are needed to directly compare surgical modalities for nSCC.

This cohort study explores inconsistences in cutaneous melanoma staging within the Surveillance, Epidemiology, and End Results Program registries to determine if miscoding of staging variables related to cutaneous melanoma would result in inconsistencies in final tumor staging.

Although dermatology is one of the most competitive specialties to match into, there is limited transparency in the residency match process. In this retrospective cohort study of 2234 allopathic medical graduates, we identify applicant characteristics associated with matching into research oriented dermatology programs. Many of the statistically significant variables in our study, including PhD/MD status, graduating from a Top-25 NIH funded medical school, increasing total number of pre-residency publications (PRPs), and increasing number of high-impact PRPs, correlate with future academic employment. Although literature shows an association between an increasing number of first author PRPs and future academic employment, we did not find number of first or last author PRPs to be predictive of matching into a research oriented residency program. A more comprehensive evaluation of an applicant's research output, considering both the final products of an applicant's research endeavors and an applicant's role in various projects, may better approximate an applicant's commitment to academics.

Knowledge regarding the inpatient burden of scabies is limited, as previous studies have focused on epidemiologic trends in the outpatient setting. Using the National Inpatient Sample to identify sociodemographic factors associated with scabies in hospitalized patients, we found that patients who were aged 40-64, male, homeless, Medicaid-insured/uninsured, and admitted to hospitals in ZIP codes of the lowest income quartile were more likely to be diagnosed with scabies.

We enjoyed reading Roche et al.'s recent article published in Clinical and Experimental Dermatology, in which the authors discussed the potential for propagation of false, misleading, or harmful dermatologic information on TikTok.1 In reply, Nikookam and Guckian provided an interesting perspective regarding TikTok's potential for education in dermatology.2.

Background Merkel cell carcinoma (MCC) primary site has not been fully investigated as a potential prognostic factor. Objective To determine the incidence by tumor primary site of death due to MCC. Methods We undertook a retrospective analysis of the Survival, Epidemiology, and End Results database. MCC patients treated between 1973 and 2016 were grouped by tumor primary site and a competing risks analysis was performed to test the impact of primary site on disease-specific death. Cumulative incidence of Merkel cell carcinoma-specific mortality (CMMI) at 5 years was estimated for each primary site. Results Of 9407 MCC patients identified, 6305 (67.0%) had localized disease, 2397 (25.5%) had regional metastasis, and 705 (7.5%) had distant metastasis. Tumor primary site was predictive of CMMI and varied by stage at diagnosis. Tumors involving the scalp/neck carried the highest CMMI among localized MCC (26.0%). Tumors involving the lip had the highest CMMI among MCC with regional metastasis (56.7%) and distant metastasis (82.1%). Limitations Tumor size data were missing for a large proportion of patients, precluding stratification by stage according to current American Joint Committee on Cancer guidelines. Conclusions Probability of MCC disease-specific death varies by primary site. The primary site of the tumor may be useful as a prognostic indicator for MCC.

Our objective was to assess the quality of acne-related medical information present on TikTok, the world's fastest growing social media platform. We queried the TikTok mobile application for videos tagged with "#acne" on May 1, 2020, and assessed the top 100 videos meeting inclusion criteria for content quality using DISCERN, a validated and reliable instrument for evaluating consumer health information. The mean content quality rating of videos was 2.03 (SD 0.47) which, according to the DISCERN instrument, indicates information with serious to potentially important shortcomings. Dermatologists should be aware that adolescents are using TikTok to gather acne-related information, and should prioritize acne education in this patient demographic due to the generally low content quality of such information.

OBJECTIVE: To investigate the relationship between socioeconomic factors and bronchiolitis severity among hospitalized infants. METHODS: We performed a 17-center, prospective cohort study from 2011 to 2014. Children $80,000 (aOR 2.05, 95%CI 1.19–3.53). No significant associations were found for the other socioeconomic factors (all P>0.30). While there were no significant differences in clinical presentation between income groups (all P>0.25) or in receipt of mechanical ventilation alone (P = 0.98), infants with estimated MHI ≥$80,000 were significantly more likely to specifically have been admitted to the intensive care unit (P = 0.01). CONCLUSIONS: In this multicenter study of infants hospitalized with bronchiolitis, we identified higher median household income as a risk factor for intensive care treatment. This work may yield important biological or non-biological insights for the future management of infants with bronchiolitis.