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Publication Trends of Qualitative Research in Dermatology: A Scoping Review

Affiliations.

• 1 School of Medicine, University of Colorado, Aurora.
• 2 Department of Dermatology, University of Colorado, Aurora.
• 3 Division of General Internal Medicine, CU Anschutz, Aurora, Colorado.
• PMID: 37099307
• DOI: 10.1001/jamadermatol.2023.0839

Importance: Qualitative studies serve as a tool for dermatologists and researchers in dermatology to engage with and understand perspectives of populations with different cultures and backgrounds.

Objective: To assess (1) current approaches to qualitative dermatologic research and (2) the publication trends of these studies with the aim to inform researchers regarding qualitative research and its significance and applicability in the field of dermatology.

Evidence review: A scoping review was conducted in which PubMed and CINAHL Plus were searched using dermatology AND qualitative, dermatology, and 7 qualitative methods terms. Studies were selected for inclusion using 3 levels of screening. Level 1 excluded articles published in a language other than English. Level 2 excluded articles of studies involving mixed methods, quantitative methods, systematic review, and meta-analysis. Level 3 excluded articles that were not specific to general dermatology, medical dermatology, pediatric dermatology, dermatologic surgery, dermatopathology, or education and training associated with dermatology. Finally, all duplicates were removed. The searches were conducted from July 23 to 28, 2022. All articles obtained from PubMed and CINAHL Plus searches were recorded in REDCap.

Findings: A total of 1398 articles were reviewed, and of these, 249 (17.8%) were qualitative dermatology studies. Common qualitative methods included content analysis (58 [23.3%]) and grounded theory/constant comparison (35 [14.1%]). Individual interviews were the most common data collection method (198 [79.5%]), and patients (174 [69.9%]) were the most common participant type. Patient experience (137 [55.0%]) was the most common investigated topic. Overall, 131 qualitative studies (52.6%) in dermatology were published in dermatology journals, and 120 qualitative studies (48.2%) in dermatology were published between 2020 and 2022.

Conclusions and relevance: Qualitative research in dermatology is becoming more prevalent. There is value in qualitative research, and we encourage researchers in dermatology to incorporate qualitative methods in their studies.

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As discovery occurs through basic and translational research, our faculty at Johns Hopkins incorporate evidence based knowledge into practice. Many faculty members in the Department of Dermatology are actively engaged in clinical, translational and basic research as principal investigators. Their work is supported by the National Institutes of Health, private foundations and corporate industry.

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Recent and Current Projects

With the exciting advances that are continuously being made in dermatology, there is increasing need to understand the multiple components of dermatologic disease to maximize benefit to patients.  The Vashi Lab’s continued mission is to apply the highest standards of care and rigorous evaluation to questions in dermatology.  We combine clinical expertise with analytical approaches to understand the skin and dermatologic disease in order to improve patient outcomes while advancing healthcare delivery.

Dr. Vashi’s research interests include a wide variety of topics related to both medical and cosmetic dermatology.  A few of her recent projects are described below.

Societal obsession with beauty is deeply engrained in our past, with the appreciation of human aesthetics dating back to early Greek civilization.  Both personal preferences and cultural standards influence our ideas on beauty, and there is substantial agreement as to what constitutes human beauty within a society at any given point in time. In the study below, Dr. Vashi examined how our societal perceptions of beauty have changed over the past 27 years using People Magazine’s World’s Most Beautiful lists from 1990 and 2017.

Maymone MBC, Neamah HH, Secemsky EA, Kundu RV, Saade D, Vashi NA. The Most Beautiful People: Evolving Standards of Beauty. JAMA Dermatol. Published online October 11, 2017. doi:10.1001/jamadermatol.2017.3693

Dr. Vashi had over 100 media exposures including but not limited to NBC News, NewsWeek, MSN News, USNews, Yahoo News, GoodHousekeeping, ABC News, Bazaar, Cosmopolitan, and Chicago Tribune in reference to this study.  With an international presence, it had translation and media exposures in over 20 different countries and languages.  In addition, it was rated the #2 “Most Talked About Article of 2017” by JAMA Dermatology .

See  NBC News’ discussion of the findings of Dr. Vashi’s study in the article “ What Makes Someone ‘Most Beautiful’ Is Changing, Study Says .”

Sun Protection

Hyperpigmentation, a common issue seen by dermatologists, can worsen when exposed to the sun. The study below explores the different ways that patients with hyperpigmentation protect themselves from the sun’s harmful UV rays.

Maymone M, Neamah HH, Wirya SA, Patzelt NM, Zancanaro PQ, Vashi NA. Sun protective behaviors in patients with cutaneous hyperpigmentation: A cross-sectional study. J Am Acad Dermatol. 2017;76(5):841–846.e2.

In April 2017, Yahoo! News published the article “ How Hyperpigmentation Patients Shield Themselves from the Sun ” describing Dr. Neelam Vashi’s findings.

Melasma is a common disorder of hyperpigmentation that can worsen when exposed to the sun and is often difficult to treat. Thus, it is important to know the extent of disease to provide proper patient counseling and treatment guidance. Dr. Neelam Vashi researched different techniques as aids for diagnosing disease extent.

Wirya SA, Maymone MBC, Widjajahakim R, Vashi NA. Subclinical melasma: Determining disease extent. J Am Acad Dermatol. 2017;77(2):e41-e42.

Dr. Neelam Vashi was interviewed on this subject by WCVB-TV, Channel 5.

Aging of the skin is clinically described by wrinkles, sunspots, uneven skin color, and sagging skin; however, these signs vary across ethnicity. This article looks at how variations in cutaneous aging are related to differences in skin structure and function.

Vashi NA, Maymone M, Kundu RV. Aging differences in ethnic skin. J Clin Aesthet Dermatol. 2016;9(1):31-38.

Dr. Neelam Vashi appeared in the article “ Outsmart Aging. Your ethnicity plays a major role in how your skin matures. Face down our challenge with a personalized plan. ” featured in Dr. Oz’s The Good Life magazine.

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A Year in Review: Discussions in Dermatology

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“A Year in Review: Discussions in Dermatology’’ is part of a wider series of Research Topics across Frontiers in Medicine. This Research Topic aims to spark discussion around popular articles published in Dermatology this year. The Dermatology field is continuously evolving, therefore we are seeking ...

Keywords : Dermatology, skin, disease, disorder, therapeutics, diagnostics

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Top 20 trending stories of 2020

For 2020, trending topics can be summed up in one word: COVID-19. But, even during a pandemic, dermatologists and the medical community at large continued to research novel therapies and seek new solutions for providing the best possible patient care. Here, Dermatology Times tracks the most compelling topics of an unprecedented year.

The year 2020 was a rollercoaster ride from start to finish. From the onset of the COVID-19 pandemic to new safety protocols and a rise in the use of personal protective equipment (PPE), this year tested the will and dedication of health care workers to the ir industry—and most importantly—their patients. 

Despite every challenge 2020 brought, th e dermatology industry made major strides   in advancing   treatment   options and improving   patient care—from ground-breaking U.S. Food and Drug Administration (FDA) approvals to the latest top-line research and creation of revolution ary technology. 

While   COVID-19 may have been top-of-mind since early last year, it wasn’t the only topic on   the minds of   dermatologists, dermatologic surgeons, their teams and other health care providers working in the specialty.   Based on analytics,   here’s what Dermatology Times’ readers see as   2020’s hottest trends.

1. Probiotics for psoriasis?

With new and emerging biologic therapies for psoriasis seemingly popping up daily, one research team is seeking a new route for treatment with the development of a probiotic specifically tailored for th is inflammatory skin disease.

Cath O'Niell, chief scientific officer at SkinBioTherapeutics and professor of translational dermatology at the University of Manchester, discuss es her latest research with Dermatology Times and explains how probiotics might be a new viable therapy for other inflammatory skin disease besides psoriasis.

2. Silicone pads aim to reduce mouth lines

While mouth lines can be pesky and appear prematurely due to everyday activities such as drinking out of a straw or bottle, one company is aiming to combat th e se wrinkles and fine lines by introducing a product specifically tailored for the mouth area .

Multi-Area Pads from SilcSkin, are made of medical grade silicone and designed to promote cell growth and stimulate collagen and blood flow to help reduce fine lines and wrinkles in the mouth area.

Similar to the benefits of using silicone to treat scars, the product hydrates wrinkles, refines collagen structure and flattens out lines through prolonged use, according to the company.

3. FDA expands toxic hand sanitizer list

The FDA has reported a sharp uptick in hand sanitizers containing methanol and urges the public to be vigilant of the ingredients in their hand sanitizers.

The agency initially issued a warning at the beginning of July, listing a handful of hand sanitizer manufacturers whose products had been tested by the FDA and found to contain the toxic substance.

Methanol, or wood alcohol, is a chemical found in antifreeze and fuel. When used as an active ingredient and absorbed through the skin or ingested, the substance can be toxic or life-threatening.

4. Antihistamines effective in alopecia areata study

A study published in the Journal of the American Academy of Dermatology (JAAD) evaluated the efficacy of a combination consisting of antihistamines, topical corticosteroids (TC s ) and superficial cryotherapy (SC) for the treatment of alopecia areata.

The study found that after seven months of treatment, 100% of patients taking antihistamines achieved major hair regrowth compared to 79.3% of patients who were treated only with TCs and SC. Also, the study’s authors report no adverse effects resulting from treatment.

5. Skin symptoms observed in COVID-19 patients

The list of   COVID-19   symptoms   continues to   grow. The virus can reportedly affect not only the lungs, but other internal organs as well as the senses . Now, dermatologists are observing skin reactions in patients with the disease.

These reactions include “dengue fever-like rash,” a “hives-like rash,” livedo reticularis, a “measles-like rash” and pernio located on the extremities (also known as “COVID toes”).

6. New picosecond laser treats pigmentary disorders in darker skin types

A case report published  in   The American Society for Laser Medicine and Surgery shows the new 730-nm picosecond laser to have strong efficacy and safety in treating endogenous pigmentary disorders on darker skin types.

The study examines two Korean patients with III-IV Fitzpatrick skin types, as well as melasma, freckles and lentigines , who were treated with 730‐nm Ti:Sapphire picosecond laser (Picoway, Syneron Candela Corp) with a pulse duration of 240 picoseconds.

Researchers saw significant pigmentary reduction within one treatment session, which was well - tolerated without topical anesthesia in both patients. In the 6-week follow-up, there w as no observed post-inflammatory hyperpigmentation/repigmentation in either patient.

7. Can botulinum toxin benefit rosacea patients?

Botulinum toxin may help address erythema and flushing in patients with refractory rosacea, according to data at the American Academy of Dermatology   ( AAD )   2020 Virtual Meeting Experience (VMX) on June 12.

Hema Sundaram, MA, MD, FAAD, explains how botulinum toxin can be used to address erythema and flushing caused by rosacea and details other considerations providers will want to keep in mind when using this treatment in their patients.

8. How safe are cosmetics?

In this Q&A, Zoe Diana Draelos, MD, explains the role of preservatives in skincare products and the general safety and efficacy of products when it comes to protecting the skin against environmental factors.

9. The promise of laser-assisted drug delivery

Hema Sundaram, MA, MD, FAAD, highlights important safety considerations to keep in mind regarding laser-assisted drug deliver y.

This includes using products that are suited for intradermal injections and ensuring they are sterile. She also suggests treating localized body surface areas with laser-assisted drug delivery and consider the indications of the drug that will be delivered. 

She initially presented her findings in her presentation,   What's New in Aesthetic Therapeutics,   at AAD 2020 VMX in June.

10. Topical androgen receptor inhibitor approved by FDA for acne

Clascoterone cream 1% (Winlevi, Cassiopea) has been approved by the U.S. Food   and Drug Administration ( FDA ) for the treatment of acne vulgaris in patients 12 years and older, the company announced.

The topical, a first-in-class androgen receptor inhibitor, restricts sebum production and inflammation caused by androgen hormones.

The approval is backed by positive data from clinical studies investigating the topical, in which clascoterone cream 1% reduced the number of acne lesions and was well- tolerated. The most commonly reported local skin reaction reported was mild erythema.

11. Medical innovation expands hair loss treatment

A variety of topical and injectable therapies show potential for addressing hair loss in both men and women, says Matt Leavitt, DO.

Some of the therapies mentioned include clascoterone (cortexolone 17-alpha proprionate; Breezula, Cassiopea). This androgen receptor inhibitor is being developed as a treatment for both male and female androgenetic alopecia (AGA), topical and oral finasteride, minoxidil, ketoconazole shampoo, platelet-rich plasma (PRP), and exosomes.

12. Alembic Pharmaceuticals launches adapalene gel for acne vulgaris

Adapalene Gel USP 0.3% (Alembic Pharmaceuticals), a bioequivalent and therapeutically equivalent to Galderma’s Differin Gel 0.3% (adapalene), has launched in the United States, according to manufacturer Alembic Pharmaceuticals.

Adapalene Gel USP 0.3% is indicated for the treatment of acne in patients ages 12 years and older. The topical treatment will be available in a 45 mg gel tube, as well as a 45 mg gel pump, the company states.

The abbreviated new drug application (ANDA) for the topical retinoid was approved by the FDA in June 2020. This is the 65th product launch from Vadodara,   India-based Alembic since its introduction of U.S. operations in October 2015.

13. First injectable for cellulite approved by FDA

The FDA has approved collagenase clostridium histolyticum-aaes (Qwo, Endo International) for the treatment of moderate-to-severe cellulite in the buttocks in adult women, making it the first FDA-approved injectable cellulite treatment.

The injectable combines two collagenases, AUX-I and AUX-II, which are purified enzymes produced naturally by the clostridium histolyticum bacterium. Together, the enzymes degrade types 1 and 3 collagen by releasing the fibrous septae, which leads to an improvement in appearance and texture of the skin, according to the company.

The company expects the injectable to be available to aesthetic healthcare providers in the United States beginning in Spring 2021.

14. Injection technique aims to optimize outcomes

A recent study 1 highlighted the advantages of a novel facial rejuvenation protocol that gives special attention to the line of ligaments for optimal and more efficient lifting and volumizing in clinical outcomes.

When re-volumizing the mid-face, the technique allows the clinician to reposition the facial structures while injecting only a small amount of filler product. After repositioning the fat pads, the   clinici an can re-volumize and contour the mid-cheek and face according to treatment goals. 

The technique can be used to correct the tear troughs, nasolabial folds, nasojugal grooves, and enhancing mid-face volume, according to Gabriela Casabona, MD, director of clinical research at the Ocean Clinic , Marbella, Spain .  

15. Allergan, Skinbetter Science announce equity and diversity initiative

Steps are being taken to increase diversity and equity within the aesthetics field by Allergan Aesthetics, an AbbVie company, and Skinbetter Science through the launch of The DREAM Initiative.

DREAM: Driving Racial Equity in Aesthetic Medicine, is focused on implementing measures to increase racial and ethnic diversity, equity, understanding, inclusion and respect within the plastic surgery and dermatology fields.

The initiative plans to create curriculum designed to assist with identification of implicit bias in clinical and academic settings while also demonstrating how to address bias when it occurs . Another aim is to publish The Spectrum of Dermatologic Disease, a photo atlas textbook showing the characteristics of skin conditions across racial and ethnic skin types.

Also, the initiative will organize Forces of Beauty Summits to recognize diverse beauty standards amongst various ethnic and racial groups to help aesthetic providers, companies and the media understand the aesthetic needs of all patients.

16. FDA accepts BLA for tralokinumab for atopic dermatitis

The FDA has accepted the Biologics License Application (BLA) for tralokinumab (Leo Pharma) for treatment of moderate-to-severe atopic dermatitis (AD) in adults.

The BLA acceptance follows published positive results from three phase 3 clinical studies (ECZTRA 1, 2 and 3) that investigated efficacy and safety. Tralokinumab, a fully human monoclonal antibody, works by offsetting the interleukin-13 (IL-13) cytokine, which is believed to be one of the main contributors of inflammation in AD.

Results showed all primary and secondary endpoints were met across all three trials, including an Investigator Global Assessment (IGA) score of clear (0) or almost clear (1) at week 16 and a minimum change from the baseline of 75% or greater at week 16. The secondary endpoints include a change from the baseline in week 16 in SCORing of AD (SCORAD), Pruritis Numeric Rating Scale (NRS) of 4 and Dermatology Life Quality Index (DLQI).

The FDA will make a decision on tralokinumab in the second quarter of 2021.

17. Sunscreen controversies confuse consumers

Media reports about sunscreen use, including its potential harms, can lead consumers to wonder whether they should be using sunscreens for photoprotection and which product to choose.

Adam Friedman, MD, says dermatologists need to be knowledgeable about the controversies and be prepared to answer patients’ questions with information that will reinforce the importance of sunscreen use.

18. Long-term benefits of pembrolizumab in melanoma

Researchers have found pembrolizumab (Keytruda, Merck & Co.) demonstrates long-term survival benefits regardless of BRAF V600E/K mutation status or previous BRAF inhibitor (BRAFi) therapy with or without a MEK inhibitor (MEKi) in metastatic melanoma patients, according to a published 10-year analysis in  The Journal of American Medical Association Oncology.

The analysis pooled data from three clinical trials (KEYNOTE-001, KEYNOTE-002 and KEYNOTE-006), evaluating a total of 1,558 patients with advanced melanoma who have been treated with pembrolizumab and BRAF tumor status (BRAF wild-type or BRAF V600E/K-mutant melanoma).

Results of the analysis demonstrated an overall response rate (ORR) of 39.8% and 34.3% for BRAF wild-type and BRAF V600E/K-mutant melanoma, respectively, as well as a 4-year progression-free survival (PFS) rate (22.9% and 19.8%) and overall survival (OS) rate (37.5% and 35.1%).

19. AbbVie launches hidradenitis suppurative education center for physicians

AbbVie is working to spread awareness of hidradenitis suppurativa (HS) with the launch of their new educational website tailored for physicians.

By gathering feedback from various advocacy and professional organizations, the company has created a website to provide physicians with the best resources to better identify, diagnose, manage , and treat HS.

The website provides a variety of HS resources that physicians can use, including patient case studies, links to organizations advancing HS education, treatment and management information, links to HS support, a differential diagnosis quiz , and an overview of causes of HS and disease progression.

20. The Retinoid Revolution

Dr.   Draelos, MD, shares why retinoids can be found in many anti-aging formulations and how to reduce irritation from this potent antioxidant.

1.   Casabona   G,   Bernardini   FP,   Skippen   B, et al.  How to best utilize the line of ligaments and the surface volume coefficient in facial soft tissue filler injections . J   Cosmet   Dermatol. 2020 Feb;19(2):303-311. [Epub   2019 Dec 15.]

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Google Trends in Dermatology: Scoping Review of the Literature

Torunn elise sivesind.

1 Department of Dermatology, University of Colorado School of Medicine, Aurora, CO, United States

Mindy D Szeto

William kim.

2 University of Colorado School of Medicine, Aurora, CO, United States

Robert Paul Dellavalle

3 Dermatology Service, Rocky Mountain Regional VA Medical Center, Aurora, CO, United States

Associated Data

Number of dermatology-related publications compared to the total number of Google Trends publications by year (2016-2020).

Google Trends is a powerful online database and analytics tool of popular Google search queries over time and has the potential to inform medical practice and priorities.

This review aimed to survey Google Trends literature in dermatology and elucidate its current roles and relationships with the field.

A literature search was performed using PubMed to access and review relevant dermatology-related Google Trends studies published within the last 5 years.

Current research utilizing Google Trends data provides insight related to skin cancer, pruritus, cosmetic procedures, and COVID-19. We also found that dermatology is presently the highest-searched medical specialty—among 15 medical and surgical specialties as well as general practitioners. Google searches related to dermatology demonstrate a seasonal nature for various skin conditions and sun-related topics, depending on a region’s inherent climate and hemi-sphere. In addition, celebrity social media and other viral posts have been found to potentiate Google searches about dermatology and drive public interest.

Conclusions

A limited number of relevant studies may have been omitted by the simplified search strategy of this study, as well as by restriction to English language articles and articles indexed in the PubMed database. This could be expanded upon in a secondary systematic review. Future re-search is warranted to better understand how Google Trends can be utilized to improve the quality of clinic visits, drive public health campaigns, and detect disease clusters in real time.

Introduction

Google Trends is an online database and analytics tool provided by Google (Google LLC, Mountain View, CA) that reports the relative popularity of a particular search term on Google compared to the peak number of Google searches related to that term over a certain period of time [ 1 , 2 ]. A search volume index (SVI) between 0 to 100 is then generated [ 2 , 3 ], reflecting trends and peak popularity for the term over a given timespan. Data are normalized by Google Trends such that ratios are created, which relate the search volume of an individual search term to the aggregate search volume for all queries, for a given geographic location and time range. These ratios are then proportionally transformed to a scale of 0 to 100 based on a search term’s relative magnitude compared to all searches [ 2 , 4 ].

It is also possible to find the true search volume (rather than relative volume) by using the Google Keyword Planner [ 4 ], which allows one to assess a particular term for its total number of Google searches over a specified timeframe in a specific location. Patterns and changes in topic popularity may be examined via investigating different time periods or different locations after separately downloading each result and then comparing these side-by-side. In a similar manner, it is also possible to compare the relative popularity of topics by conducting separate searches utilizing different search terms.

Recently, many medical specialties, including dermatology, have started using Google Trends data to better understand population interest in various topics, such as sunscreen, sunburn, skin cancer, and melanoma [ 1 ]. Knowledge gained from Google Trends has the potential to guide public health interventions, improve patient education, and tailor health care to patient concerns. Google Trends data are of particular interest to the field of dermatology; in a 2018 study, Ransohoff and Sarin [ 5 ] found that, among medical specialists and general practitioners, the most frequently searched physicians were dermatologists.

This study was undertaken to provide a scoping [ 6 ] preliminary review of literature in the field of dermatology that highlights the use of Google Trends, to elucidate the current relationship between dermatology and Google Trends, describe limitations of its use, and guide future directions for research and application to patient care.

A literature review was performed using the PubMed database to tabulate the total number of Google Trends studies from 2016 to 2020. To isolate the relevant dermatology-related publications, the following search string was utilized on August 4, 2020, resulting in 53 articles for initial screening: ((((“Dermatology”[Mesh]) OR “Skin Diseases”[Mesh]) OR “Cosmetic Techniques”[Mesh]) OR “Cosmeceuticals”[Mesh]) AND (google trends AND (y_5[Filter])). The search term “y_5” was included to filter articles published within the last 5 years (2016-2020). Screening of title and abstract for these articles was performed independently by 2 authors with education and experience in dermatology (TS, WK), and of these, 26 were ultimately chosen for inclusion in this review after determination of relevance.

The total number of Google Trends publications over the last 5 years, along with the dermatology-related subset of 26 articles screened is displayed and tabulated by year in Multimedia Appendix 1 .

Summary information for the 26 dermatology-specific articles included in this review is captured in Table 1 .

Summary of dermatology-related Google Trends publications (2016-2020) included in the review.

a SVI: search volume index.

b ASR: age-standardized incidence rate.

c UV: ultraviolet.

d FDA: Food and Drug Administration.

e HS: hidradenitis suppurativa.

Skin-Related Topics of Public Interest

Notably, dermatology was reported by Ransohoff and Sarin [ 5 ] to be the most searched medical specialty in a comparative study of 15 medical specialties. To compare relative specialist popularity using Google Trends data, the study [ 5 ] used the search term “physician,” to enable all specialist search terms to be normalized to the SVI of this term (the most popular term) and thus enabled an accurate comparison across all 15 physician specialties. However, the study by Ransohoff and Sarin [ 5 ] also found that, despite being the most searched specialty, dermatology ranked sixth in number of clinic visits per specialty and revealed that dermatologists had one of the highest percentages of self-referred patients. The authors concluded that the high rate of dermatology Google searches correlates with the proportion of self-referred patients rather than the number of clinic visits, and therefore, changes in online search volume may better reflect how patients initiate care with dermatologists rather than demonstrate real-time vacillations in clinic volume [ 5 ].

Several papers also describe the use of Google Trends to gather information about user searches related to skin cancer and skin cancer prevention. Google Trends searches for “sunscreen” and “sunburn” are growing in the United States, United Kingdom, Canada, Australia, and New Zealand [ 1 ]. Conversely, searches for “skin cancer” and “melanoma” are declining for one or both terms in the United States, Canada, and Australia [ 1 ].

In Germany, the most searched term in the skin cancer–related category was “forms of skin cancer,” followed by “skin alterations” [ 7 ]. Seidl et al [ 7 ] also noted that the most searched anatomic locations of melanoma were “nails” and “eyes,” while for nonmelanoma skin cancer, the most searched locations were “nose” and “face.” A 2018 study [ 8 ] of US-based Google searches discovered that the search terms “Mohs surgery,” “basal cell carcinoma,” and “squamous cell carcinoma” rose during the years 2004 to 2016. This finding aligns with a rise in the use of Mohs micrographic surgery during this time, according to reports from Medicare and the National Ambulatory Medical Survey [ 8 ].

A study by Huang et al [ 9 ] using data from the Queensland Cancer Registry from January 2006 to December 2012 reported that increases in the monthly age-standardized incidence rates (ASR) for melanoma correlated with increases in the monthly SVI for search terms “skin cancer” and “melanoma.” Additionally, through use of a multiple linear regression model, Huang et al [ 9 ] reported that the predictive power of the “skin cancer” SVI to explain variance in melanoma ASR was 17.9%, noting that the search term “skin cancer” includes both melanoma and keratinocyte carcinomas and thus may better predict rates of melanoma than the specific search term “melanoma,” since online users may not be able to distinguish different skin cancer types when performing Google searches.

Google Trends has also been utilized to study pruritus. According to a 2019 study conducted in Germany by Zink et al [ 10 ] that utilized the Google Keywords Planner to determine search volume, it was discovered that for German language Google searches regarding pruritus, the most searched terms included “atopic eczema” (24.3%), the common term for psoriasis, “Schuppenflechte” (17.8%), “psoriasis” (13.4%), and the German word for pruritus, “Juckreiz” (2.9%).

Gauging public interest in certain cosmetic procedures and treatments is another application of Google Trends data. A 2018 study by Motosko et al [ 11 ] found that the number of procedures employing botulinum toxin and/or hyaluronic acid–derived fillers correlated significantly with the search volume for related search terms over the period spanning 2005 to 2016, while Wang et al [ 12 ] noted search volume expansion for “Emsculpt,” a body contouring technique, during 2018. Similarly, a study by Seth et al [ 13 ] reported an increase in the search term “acne light therapy mask” in 2016, reflecting a parallel increase in public interest in light-emitting diode therapy for inflammatory acne.

Of particular interest given the currently evolving pandemic, a 2020 study by Dey and Zhao [ 14 ] examined the relationship between COVID-19 and Kawasaki disease using Google Trends data. The study found that the search frequencies of Kawasaki disease in 2019 and 2020 were similar until April 2020, when reports of a Kawasaki-like disease in children with COVID-19 emerged. From February to May 2019, searches for Kawasaki disease were highest in Indonesia, the Philippines, and Malaysia — regions where the disease is more commonly found. However, from February to May 2020, searches for Kawasaki disease were highest in France, Switzerland, and Italy, a finding that reflects our current knowledge of the multisystem inflammatory syndrome in children (MIS-C), associated with COVID-19 and aligning with MIS-C clusters in Europe during this time [ 22 , 30 ]. While popularity of search terms may be confounded by news or social media–driven popularity, Dey and Zhao [ 14 ] noted that the association revealed through Google Trends data could highlight its potential future utility in identifying real-time disease clusters.

Seasonality of Searches

Google searches related to dermatology demonstrate a seasonal nature for several skin diseases. A 2019 study by Kardeş [ 15 ] found that searches for “psoriasis” were elevated in the late winter and early spring and were lower in the late summer and early fall, with statistically significant results from the United Kingdom, Canada, Ireland, Australia, and New Zealand and noted a trend toward seasonal variation in US-based searches.

In Germany, Google searches for “pruritus” were lowest in the summer [ 10 ] and highest in the winter [ 16 ]. Additionally, “tanning bed” was searched most in March and May, while “sunscreen” search volume was highest in June [ 17 ]. Toosi and Kalia [ 18 ] reported that public interest in tanning for Canada and the United States was highest in March and for Australia, was highest in September. Countries in the southern hemisphere, such as South Africa, demonstrate a reversed seasonal search trend compared to countries in the northern hemisphere; countries without distinct seasons, such as Singapore, were found to have no seasonal variation in searches [ 5 ]. According to Kluger [ 19 ], the term “tattoo” was searched most during the summer and least during winter: Searches for the term “tattoo” are highest from July to August in the northern hemisphere and reach a peak in January for regions in the southern hemisphere. Interestingly, Kluger [ 26 ] found that searches for symptoms of tattoo-related complications, such as pruritus and induration, rose during the period 2004 through 2018 inclusive — however, interpretation of these results is difficult, as the search volume increase could reflect either a real increase in tattoo side effects or be secondary to rising popularity of tattoos [ 26 ].

Search patterns for sunscreen in the United States have shown similar seasonal trends [ 20 ]. A US-based study found the search terms “skin cancer” and “tanning” were highest in the early summer months, while “sunburn” was highest in the late summer; the monthly timing of these trends was noted to be reversed in countries of the southern hemisphere, such as South Africa [ 5 ]. “Melanoma” was found to have the highest searches in the early summer months of either hemisphere [ 5 , 21 ].

In a study of worldwide Google Trends data spanning 5 languages, 4 of these demonstrated peaks in SVI for the term “eczema” in line with seasonal climate changes that are associated with flares of severity for atopic dermatitis, speaking to both the seasonality of searches and to the widespread usage of “eczema” as a synonym for atopic dermatitis [ 31 ]. Hsiang et al [ 3 ] studied “hair loss” search volume, with data from the top 4 most populous countries of both hemispheres and observed the highest SVI occurred in the summer and autumn, with the lowest search volume corresponding to the spring. The authors noted these results suggest a correlative relationship between hair loss and seasonality and that hair loss is greatest in the summer and autumn. This is in line with other studies that have noted the percentage of telogen phase hairs peaks in the late summer, with a smaller peak in the spring, and therefore, maximal hair loss occurs at the end of summer and during the fall [ 32 ].

Social Media’s Impact on Searches

Social media has been found to influence dermatology-related search volume on Google. A 2018 study by Ward et al [ 23 ] found that the average interest level of fillers increased by 30.31 points (relative to a maximum SVI of 100) in the time period after Kylie Jenner stated that she underwent lip augmentation with Juvederm in April 2015, compared to searches conducted in the period prior (January 2004 through March 2015). Additionally, a study by Noar et al [ 24 ] noted that after a highly graphic skin cancer selfie went viral on Facebook, all search queries for skin cancer, skin cancer prevention, and tanning significantly increased, with May 13, 14, and 15 of 2017 being the 6th, 8th, and 40th most searched days for skin cancer since the inception of Google Trends on January 1, 2004.

Limitations and Strengths of Google Trends

The main limitation of utilizing Google Trends to accurately assess public interest in a certain dermatologic topic is that it relies on the ability to access the internet, which is variable [ 25 , 26 ]. Individuals who are of lower socioeconomic status and educational background may not have access to a computer or smart device through which they can use Google. Additionally, individuals who are of older age may choose not to use a computer and thus would not use Google. As a result, certain groups of individuals who may be at higher risk for particular dermatologic conditions may not use Google and are omitted from Google Trends. This would imply that the dermatologic interests of people in older age groups or lower socioeconomic status may not be accurately or fully represented in Google Trends data, which could bias the information it presents and limits extrapolation to the broader population.

Thus, while Google Trends is a powerful tool for assessing the public’s dermatologic interest, it is important to consider which populations are unequally represented with this instrument and find other tools to fill these gaps. While Google accounts for approximately 91% of the market share of online searches worldwide (according to available data from January 2021), it is vital to note that search engines other than Google may be utilized, along with specific health information websites; therefore, analysis of a variety of search engines could potentially capture a more complete picture of current trends in skin-related topics of public interest.

Nevertheless, Google Trends may be a useful tool for dermatologists to gauge areas of skin concern and topics of interest, as patients may perform searches on Google for questions they are not comfortable asking their dermatologists in a clinic visit [ 11 ]. Additionally, the increasing use of Google to search skin diseases may highlight the increased prevalence of self-diagnosis and self-treatment [ 27 , 28 ]. Therefore, it could be useful for professional medical organizations to take note of which skin diseases and dermatology-related terms are most often searched and to notify individual dermatologists, who could then dedicate additional time to patient education, reaffirm facts, and dispel misconceptions and misinformation.

One potential public health benefit of Google Trends would be to focus on highly searched terms in order to guide and drive health campaigns. For example, in 2019, Hopkins and Secrest [ 1 ] recommended online skin cancer prevention campaigns to focus on the search terms “sunburn” and “sunscreen” as these 2 terms have demonstrated increasing search frequency from 2004 to 2016. These public health campaigns can be specifically tailored to complement and make the most of current public interest [ 7 ]. Frequency of searched terms can serve as a proxy for public awareness and speak to the efficacy of public health programs [ 29 ].

Another possible use of Google Trends is for dermatologists to quickly detect the presence of viral social media content related to dermatology, such as the skin cancer selfie that went viral on Facebook in 2017, and to then engage with the online public and utilize this viral content to strengthen public health campaigns [ 24 ]. Lastly, as the study by Dey and Zhao [ 14 ] of COVID-10 and Kawasaki-like disease illustrates, Google Trends has the potential to be utilized in identifying disease clusters in real time, meriting further research to better understand how dermatology may leverage this tool in early identification of public health concerns in the future.

Limitations of This Scoping Review

Limitations of this review article include its simplified search strategy, which included only English language publications, restriction to the PubMed database, and lack of previous studies examining Google Trends and dermatology. Google Trends is a relatively new tool (2006 conception), and therefore, not many dermatology publications highlight the use of Google Trends in dermatology. For example, in 2020, there was only 1 dermatology Google Trends publication out of 174 total publications discussing Google Trends, as illustrated in Multimedia Appendix 1 . This highlights the gap in prior literature on the intersection of these 2 topics, which weakens the conclusions we can generate from existing research. While we lay the groundwork with this survey and scoping review of related literature [ 6 ], in order to better assess the utility of Google Trends in dermatology, further research in this area is required.

Review of the literature illustrates that assessment of Google Trends data related to dermatology has been studied, with topics including skin cancer, pruritus, cosmetic procedures, social media, clinic visits, and the associated Kawasaki-like disease of COVID-19 (MIS-C). Additionally, a seasonal nature of search terms has been widely reported in the literature, varying according to hemisphere. The main limitation of Google Trends as a research tool is access to and use of the internet. Further research is needed to better understand how this search tool can be utilized to improve the quality of clinic visits, drive public health campaigns, and detect disease clusters in real time.

Abbreviations

Multimedia Appendix 1

Conflicts of Interest: RD is a Joint Coordinating Editor for Cochrane Skin, Editor in Chief of JMIR Dermatology, a dermatology section editor for UpToDate, a Social Media Editor for the Journal of the American Academy of Dermatology (JAAD), and a Podcast Editor for the Journal of Investigative Dermatology (JID). He is a coordinating editor representative on Cochrane Council. TS is a section editor for JMIR Dermatology. RD receives editorial stipends (JAAD, JID), royalties (UpToDate), and expense reimbursement from Cochrane Skin. TS receives fellowship funding from the Pfizer Global Medical Grant (58858477) Dermatology Fellowship 2020 (principal investigator: RD) and serves on the Medical Advisory Board of Antedotum Inc.

RD receives editorial stipends (JAAD, JID), royalties (UpToDate), and expense reimbursement from Cochrane Skin . TS receives fellowship funding from the Pfizer Global Medical Grant (58858477) Dermatology Fellowship 2020 (principal investigator: RD) and serves on the Medical Advisory Board of Antedotum Inc.

The Center for Clinical Sciences Research (CCSR)

Research and Elective Opportunities

Our community is strongly committed to encouraging residents to explore other educational and career opportunities beyond those encountered during a traditional dermatology residency.  A high value is placed upon exploring areas of personal interest to help put the trainee on a path of leadership and/or renowned expertise in whatever area excites their passion. 

2+1 Track in Basic Science Investigation

Residents with a strong interest in pursuing a career devoted to laboratory investigation may elect to enter the “2+1” track.  This track is specially designed for trainees to get an early start in establishing their scientific training by replacing the majority of their last (PGY-4) year of clinical training with postdoctoral laboratory work.  In the first two years, participants receive their clinical training similar to fellow residents, while their third year of residency is instead spent largely in their chosen laboratory.  During this third (PGY-4) year participants continue to spend 25% of their time learning clinical dermatology—this time is comprised of a weekly continuity clinic and typically 6 weeks of additional clinical rotation. 

Interested applicants may apply to this track through the ERAS process if they have already chosen to commit to this career path. Current residents can also apply to this track by November of their PGY-2 year.

 Residents are encouraged to perform research related to cutaneous biology, which includes the areas of cell biology, biochemistry, molecular biology, immunodermatology, and pathology.  All investigation is conducted in well-equipped modern facilities in the Department of Dermatology, or in the laboratories of other members of the faculty of the School of Medicine. The faculty members who head these laboratories have contributed widely to the scientific literature in their respective fields.

Clinical Scholars Track (CST)

Our program recognizes that a career in academic dermatology does not necessarily mean bench research.  In fact, most modern dermatology departments are comprised largely of physicians that have devoted their career to education and/or clinical investigation.  We recognize that many trainees with astounding promise in academics may never choose this career path if they are not formally exposed to these options during their residency training. 

Participants can choose to participate with a focus on education (Educator Track) or clinical research (Investigator Track), or a combination of both.

The Clinical Scholars Track is designed for those residents that would like a more structured exposure to these disciplines—participants can choose to participate with a focus on education, clinical research, global health, quality improvement and/or innovation.  The goals of the program are to foster academic leadership skills, enhance networking at a national level, develop skills in effective teaching and junior mentorship (Educator Track), and enhance skills in clinical study design/protection of human subjects/epidemiology and statistics (Investigator Track).  The goals will be accomplished with a combination of formal training courses, attendance at national dermatology retreats, and completion of a mentored project.  With the exception of a week-long course in education and/or clinical research, participation in this track generally involves time spent in addition to their requirements of the clinical residency.  Residents are encouraged to declare their interest in entering the CST by January of their PGY-2 year.

Clinical Elective

Residents have an opportunity to complete a 1-month clinical elective during their training, which is provided with the goal of supplementing their education with unique opportunities that might not be available within Stanford.  Residents are asked to complete a proposal outlining the opportunity which is subject to approval by the Residency Advisory Committee prior to the rotation. 

Prior electives have included rotations in infectious disease dermatology, skin of color, and procedural dermatology with national experts in these fields.

After the elective, all residents make a formal presentation providing educational highlights from their elective experience.  Prior electives have included rotations in infectious disease dermatology, skin of color, and procedural dermatology with national experts in these fields.  Residents have also completed electives abroad, including recently an elective in Taiwan through the Stanford Center for Innovation in Global Health and an elective in Botswana through the AAD Residents’ International Grant.  Funding for international electives is available through Stanford via the Center for Innovation in Global Health with the opportunity for additional training in global health during residency for interested residents.

Research Elective

In lieu of a clinical elective, residents may choose to dedicate a month of their training to a research experience.  In the past, residents have used this opportunity to complete projects initiated through the Clinical Scholars track or to explore a new academic area of interest.    Previous research electives have included completing a clinical trial evaluating the efficacy of tofacitinib in the treatment of alopecia areata and an investigation of a novel clinical finding in a subset of patients with dermatomyositis.  Residents are asked to make a formal presentation after the elective to discuss the results of the project. 

On this page

Prajakta Jaju (Class of 2020) at the Deenanath Mangeshkar Hospita and Research Center in Pune, India.

Nisha Varadarajan (Class of 2019) at the Princess Marina Hospital in Gaorone, Botswana.

Stephen Lewellis (Class of 2019) at the Dhulikhel Hospital in Nepal.

Betsy Bailey (Class of 2015) at the Princess Marina Hospital in Gaborone, Botswana

Leon Hsu (Class of 2016) at the National Taiwan University

Paul Khavari Lab

Anthony Oro Lab

M. Peter Marinkovich Lab

Howard Y. Chang Lab

Anne Chang Lab

Jean Tang Lab

Kevin Wang Lab

Carolyn Lee Lab

Youn Kim Lab

Eleni Linos Lab

Innovative Skin Cancer Prevention Strategies

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Efficacy of Herbal Treatments for Atopic Dermatitis Remains Unclear

Although certain herbal substances may have beneficial effects as treatment for patients with atopic dermatitis (AD), additional rigorous research is still needed to clarify the role of herbal therapy in this setting, according to study results published in Dermatitis .

In previous investigations of the efficacy of herbal medicine in patients with AD, it has been determined that many additional rigorous, high-quality studies are needed before conclusions can be drawn regarding their clinical benefit. To determine whether current research has shed new light on benefits and harms of herbal treatments for children and adults with AD, investigators in Germany performed a systematic review and meta-analysis.

Following PRISMA guidelines, they conducted a literature search of multiple databases to identify relevant randomized controlled trials (RCTs) of systemic and topical herbal medicine in the treatment of pediatric and adult patients with AD . Publication dates ranged from database inception through April 12, 2023. Overall, the review included 51 RCTs with a total of 3744 patients with AD.

Of the RCTs included in the analysis, 13 compared systemic therapy with evening primrose oil (EPO) vs olive oil (6 studies), paraffin oil (3 studies), sunflower oil (2 studies), coconut oil (1 study), and soybean oil (1 study). Patients received EPO 500 mg at a dosage of 1 to 12 capsules daily for treatment periods ranging from 8 weeks to 5 months. Outcomes with EPO vs comparator treatments were similar among the total patient subgroup (standardized mean difference [SMD], -0.15; 95% CI, -0.72 to 0.42), the pediatric subgroup (SMD, 0.14; 95% CI, -0.80 to 1.07), the adult subgroup (SMD, 0.20; 95% CI, -0.23 to 0.63), and the mixed pediatric and adult subgroup (SMD, -1.14; 95% CI, -4.03 to 1.74).

Among RCTs evaluating systemic therapies, a single study in newborn patients showed significant benefits of black current seed oil relative to the olive oil comparison group in reducing AD severity.

In single studies of topical treatments, statistically significant benefits relative to comparator treatment for AD were reported with the following herbal medicines:

• Coconut oil;
• Indigo naturalis ;
• Mondo grass;
• Prinsepia utilis Royle;
• St John’s wort;
• Aloe vera and olive oil; and
• A combination of currant seed oil, sunflower oil, balloon vine, dexpanthenol 5%, and ceramide.

Many of the studies showing benefits of herbal substances for the treatment of AD included pediatric patients. While significant benefits were reported with use of certain other topical herbal interventions, patient outcomes in these studies were not significantly better than the comparator treatments.

A total of 22 RCTs reported safety data. All adverse events (AEs) were mild or moderate, with AE frequency similar to those with comparator treatments. The most common AEs reported with systemic preparations were flu-like symptoms, headache, vomiting, diarrhea, and infant colic, but most of these effects were not directly attributed to the intervention. The most common AEs with topical herbal preparations were itching and erythema. No allergic reactions were documented.

The overall risk for bias was low in 4 RCTs and unclear in 16 studies. Biases associated with randomization, deviation from the intended intervention, missing outcomes, measurement of outcomes, and selection were reported.

The investigators noted that the question of efficacy of herbal substances in AD is a nuanced one, given that certain herbal preparations evaluated in the RCTs yielded promising results whereas the EPO meta-analysis in particular failed to show an appreciable benefit of herbal therapy vs placebo.

The major limitations of this review are the low or very low quality of evidence and limited sample sizes across studies. Additionally, apart from borage oil or EPO, most interventions were only tested in a single study.

The investigators concluded, “Due to the insufficient number of RCTs investigating individual, locally administered herbal medicines for AD, no specific recommendations for or against their use can be made at this time.” They added, “Further studies with larger sample sizes and methodologically rigorous designs are necessary before a general recommendation can be established.”

References:

Anheyer M, Cramer H, Ostermann T, Anheyer D. Herbal medicine in children and adults with atopic dermatitis: a systematic review and meta-analysis. Dermatitis . Published online July 4, 2024. doi:10.1089/derm.2024.0132

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• Practice Management

Challenges and Opportunities for the Dermatology Specialty

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Post-pandemic dermatology is curiously similar to pre-pandemic dermatology, yet also dramatically changed. We revel as things have gone “back to normal.” We can finally practice without masks or shields and see patients in person. We celebrate returning to meetings and interactions with colleagues and industry. Nevertheless, the challenges of the pandemic brought forth rapid changes in medicine and dermatology was not left unscathed. It seems that 2023 will be another year of both challenges and opportunities for dermatology.

One of the greatest challenges to board-certified dermatologists is the erosion of our status as the dermatology experts. The pandemic has seemed to usher in a trend in medical and cosmetic training with elevation of mid-level providers as experts and injectors. Industry meetings and training sessions that for many years were attended by a majority of physicians now have seen a dwindling of core physicians to a small minority. We are seeing a shockingly rapid transformation of the cosmetic expert injector or lead panel speaker from board-certified dermatologist with years of clinical experience, trainings, clinical trial experience and research, to anyone whom the sponsor company deems as an “expert.” This was recently highlighted in a social media post on “National Woman Physicians Day” in which industry ignored our distinction, education, and sacrifices we have made as physicians, to instead elevate others lacking our education, expertise, or credentials.

Scope of practice will continue to be a major challenge for our field. Across dermatology, there are mid-levels practicing independently who are not properly trained or supervised. We can have different practice models in dermatology and can support various types, but the board-certified dermatologists must be the leaders of the practice and be supported in providing the highest quality patient care. Failure of this required leadership has diminished the quality of care and public perception in a way that damages our specialty. This should serve as a wakeup call for all dermatologists: we need to join together as we never have before and support our fellow physicians, societies, and educational institutions so that advocacy for a physician-led model is maintained.

We have an opportunity to come together as a specialty and support initiatives that train residents and young physicians. We should not accept from industry that they have no access to the dermatology residents and therefore cannot support injectables training for them. Academic and cosmetic dermatologists need to collaborate to make this possible. We have a challenging relationship to re-define with an industry that on one hand makes our meetings possible, supports our research, and forges science ahead and on the other hand quotes market demand and short-term growth potential as a reason to undermine our entire medical hierarchy and risk damaging our future and the future of many generations of physicians to come. We must recognize that their fiscal goals do not always align with a healthy future for cosmetic and medical dermatologists. The future of our specialty should be our compass. We must elevate our own young physicians and residents, support our independent thought leaders, and not let industry decide who will become the next generation of dermatology experts and “KOLs.”

Another challenge for dermatology is the rapid decline in independent dermatology practices. Financial demands of private practice have shifted many board-certified dermatologists to private equity-backed practices. Escalating cost of lasers and laser maintenance, Medicare reimbursement reduction, and inflation have made private practice even more difficult to navigate. We should not allow our voice to be diminished even if our independence has. We as a specialty need more unified education and support for independent practices. There are challenges with management, billing, HIPPA, OSHA, compliance, and legal issues just to name a few. We need to demand equal pricing of injectables for small physician practices. There are great efforts happening for our specialty and all of medicine at the national level for reimbursement, and we are all appreciative. However, there is little help for navigating your local contracts, and very little traction for improvement in rates if you are a small-physician practice. Supporting the American Academy of Dermatology (AAD) and American Society of Dermatologic Surgery (ASDS) and other societies in their support of dermatologist as business owners is crucial.

Another major challenge will be the prevention of burnout for our generation of dermatologists. We have, for many years, scored on surveys as one of the “happiest” specialties and seeing our descent down this list is jarring. With telemedicine, store-and-forward technology, text, email, and web portals, we have lost the buffer of work vs personal time. Patients want access and quick turnaround times for addressing their issues. With eroded boundaries, we need to practice self-care and be aware that we must thoughtfully set limits and prioritize our personal needs in a way that supports and facilitates our professional lives.

Our biggest opportunity in dermatology is that we are one of the most intelligent, highly functioning, overachieving groups in all of medicine. If we join together to look at our future and foresee possible adversities, we can navigate together to maintain our place in the house of medicine. We have a chance to lead the charge in closing gaps in diversity in our field and in our patient care across diverse ethnic and gender backgrounds. We can spearhead future research in the science of aging and cancer genomics. We may live in the era of medicine that eliminates cancer and we need to lead skin cancer treatments and advances. Improvements in artificial intelligence can help us with early detection and we need to guide that technology and align it with our examinations. We as physicians are scientists, lifelong learners, and experts in our field. It is imperative that we remain at the forefront of dermatology.

Another opportunity is to increase our voice. There are many dermatologists who are uninvolved or critical of our societies. There are certainly areas for improvement that need to be addressed. However, in the landscape of the future of medicine and dermatology, there is no way we can survive unless we unite as board-certified dermatologists. This means getting involved, donating, attending meetings in person, and supporting our physician societies. The AAD, the ASDS, The American Medical Association, The Dermatology Foundation, The Women’s Dermatological Society, The Skin of Color Society, many other national physician societies, and especially all our local and state physician societies need our support.

Advocacy, scope of practice, reimbursement, physician burnout, and many other issues will continue to be trials for physicians. United we, as board-certified dermatologists, can face the challenges that the future brings us, and seize the many opportunities that lie ahead.

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Yellow Card Biobank: call to contribute to study of genetic links to side effects

Support this initiative to explore whether there is a genetic basis of side effects associated with direct-acting oral anticoagulants (DOACs) and allopurinol.

About the Biobank

The Yellow Card Biobank is a collaboration between the MHRA and Genomics England. The goal is to improve understanding of how a patient’s genetic makeup may increase their risk of experiencing harmful side effects to medicines.

Adverse drug reactions, or side effects, continue to be a significant burden on the NHS and account for one in 6 hospital admissions. [footnote 1] The Yellow Card Biobank forms part of a long-term vision for more personalised medicine approaches. By collecting biological samples from patients who have experienced suspected side effects, the Yellow Card Biobank aims to create a rich resource of genetic information that could help researchers to determine whether a suspected side effect was caused by a specific genetic trait. Ultimately it is hoped this would support the development of pharmacogenetic testing strategies.

If a patient under your care has experienced one of the side effects included in the pilot phase of the study, please report without delay to the Yellow Card scheme, providing as much information as possible.

Study details

Side effects covered in this pilot study are:

• severe bleeding events with a DOAC - apixaban, dabigatran, edoxaban, rivaroxaban – see Drug Safety Update for a reminder on this risk
• rare severe skin reactions with allopurinol, including Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome

Once reported, the MHRA may contact you directly to discuss the case further and may ask you to contact the patient on our behalf to ask if they will participate in the Yellow Card Biobank study. The patient will be able to choose whether or not to take part. Having consented to participate the patient may then be asked to provide a blood sample for genetic analysis.

If you have already submitted a Yellow Card report in the past relating to either of the 2 study topics, we may also contact you directly in the coming months to discuss the case further.

Patients who report directly to Yellow Card will also be contacted to be included in the study.

How the biobank works

The MHRA will be responsible for patient recruitment and sample collection. Genomics England will work alongside the MHRA to sequence and analyse genomes from patients and add this genomic data to the National Genomic Research Library, a secure national database of de-identified genomic and health data. In addition, Genomics England’s secure research environment will enable approved researchers to access the data.

All the information collected about you and patients through Yellow Card Biobank will be de-identified before researchers see it. Details of our privacy policy can be found in the Biobank Privacy Policy.

If you have any questions about the biobank, you can email [email protected] or call 0203 080 6600 (lines are open Monday-Friday, 9am-12pm excluding bank holidays. Calls are charged at the standard rate). For general queries or more information, contact [email protected]

Article citation: Drug Safety Update volume 18, issue 1: August 2024: 1.

Osanlou R and colleagues. ‘Adverse drug reactions, multimorbidity and polypharmacy: a prospective analysis of 1 month of medical admissions.’ BMJ Open 2022; volume 12, article e055551. 4 Jul. 2022, doi:10.1136/bmjopen-2021-055551  ↩

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