This month's news from across the specialty
What's hot
February 1, 2021
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
A recent blog in Medical Care reviews how health misinformation has been growing across internet and social media platforms to the benefit of the vitamin and supplement industry. The industry may be facilitating the creation of a new normal with surprising statistics. The United States had an increase of 28% in the use of vitamins and supplement usage due to COVID-19, and currently 80% of Americans take some sort of vitamins or supplements. An online analysis revealed that commercial websites may have supported this growth by increasing their use of the term “immune boosting” during the pandemic with some of the dangerous supplements that have been promoted including colloidal silver (which causes argyria) and oleandrin (which causes deadly arrythmias and blue skin). Unfortunately, unlike medications and cosmetics, the U.S. Food and Drug Administration is limited in its ability to protect the public as it is only allowed to review supplements after they are made available to the public. As less than half of Americans disclose supplement use with health care providers, we might help our patients by emphasizing open and honest conversations about supplements.
Editor's note
The January 2021 issue of DermWorld incorrectly attributed the What’s Hot entry by Rosalie Elenitsas, MD, on a recent study on Lyme disease histopathology, to Bryan Carroll, MD, PhD. DermWorld sincerely apologizes for the error, which has been corrected online.
A recent systematic review in JAMA Dermatology discussed one of the more challenging aspects of dermatologic care: psychodermatology (JAMA Dermatol. 2020 Jun 1;156(6):686-694). The terms "psychodermatology" and more specifically, "delusions of parasitosis" are so loaded that John Koo, MD, one of the leaders in this field in our specialty, does not use either term in his patients’ charts in order to avoid undermining patient trust in the doctor-patient relationship (JAMA Dermatol. 2020. Aug. 26).
Therefore, in the spirit of building a more mutually beneficial doctor-patient relationship, I recommend that dermatologists who care for patients with Morgellons disease take the time to watch Skin Deep: The Battle over Morgellons (currently on Amazon Prime Video). This column will not attempt to masquerade as a movie review…but a few thoughts: As dermatologists, we typically see patients with Morgellons disease for (relatively) brief periods of time. Skin Deep provides an extended look into the long-term suffering of these patients and the resulting desperation that leads some to pursue increasingly bizarre and even dangerous remedies for their symptoms. I found several of the portrayed interactions with medical professionals to be infuriating or frustrating, but it ultimately provides a perspective that we should use to help build a better doctor-patient relationship.
Morgellons disease first came of age in the era of the internet. As we grapple as a society with how dis/information is delivered via online media, it is worth considering how evolving online content will influence how our patients think about skin disease. Skin Deep and content such as the Netflix series Afflicted, which follows patients with controversial diagnoses, may matter more than you think in the clinic.
To some degree, cellulite affects up to 80% of post-pubertal women of all ages and ethnicities. Collagenase clostridium histolyticum (CCH) is composed of two purified collagenases derived from bacteria that hydrolyze type I and II collagen causing an enzymatic metabolization of the fibrous septae. Disrupting these septae can create a skin-smoothing effect. CCH has generally been well tolerated in the treatment of Peyronie’s disease and Dupuytren’s contracture, and in July of 2020, under the name of QWO, it was granted FDA approval for “moderate to severe cellulite in the buttocks of adult women.” It is expected to be available in spring 2021. A randomized, double-blind study in 375 women with moderate to severe cellulite on the buttocks or posterior thighs showed that a significant number of those treated experienced 1-level (44.6%) or 2-level (10.6%) improvement at day 71 after receiving up to three injections (Dermatol Surg. 2019:45(8):1047-56).
The majority of treated patients were “satisfied” or “very satisfied” with treatment results. Injections were generally well tolerated; the most common adverse events (bruising, pain, nodule formation, pruritus, discoloration, swelling and warmth) were self-limited and remained localized to the injection site. However, more severe hypersensitivity reactions, including anaphylaxis, have occurred with CCH and known allergy to collagenase is a contraindication to use. Although a benign condition, this new and novel ambulatory procedure has potential for treating a condition that nonetheless has historically been problematic for many female patients.
There’s an app for that?
Explore the integration and practical usage of apps in dermatology.
How do patients feel about virtual care? In the 1930s, 40% of medical care in the United States was delivered in the home via house calls. COVID-19 has hastened the transition back to in-home medical care as telemedicine has become a more common form of health care delivery. 83% of Americans say they expect to make telehealth visits after COVID-19 has ended. This is especially interesting since only 8% of patients had experienced a telemedicine appointment prior to the pandemic (Medical Economics. 2020: 97(16)37-8). In addition to utilizing telemedicine, patients are turning to health care apps more frequently. There are more than 165,000 mobile health apps available. Smartphone medical apps and other digital tools can be a way for physicians to help patients monitor their behavior or follow medical instructions after their visit, but questions about data storage linger. Also, the traditional method of communicating via telephone is in a state of transition. Many patients do not answer their phone and 19% never check their voicemail. Texting is the preferred way to communicate. 47% of patients would prefer to be able to text back and forth with their physician, but privacy issues are a big concern. There are many areas to address as virtual care increases. There are also many opportunities to enhance the patient experience.
