This month’s news from across the specialty
What’s hot
July 1, 2022
In this monthly column, members of the DermWorld Editorial Advisory Workgroup identify exciting news from across the specialty.
Social media can be a very useful tool for practices to grow their practice population, and has become a big part of brand advertising, particularly for the field of dermatology. “Skin health” is an ever-growing hot topic among the public, and patients are wanting to consume this information on social media. In the AAD’s May Dialogues in Dermatology, Dr. Joyce Park, a board-certified dermatologist and social media expert, gives us some tips for how we can use social media effectively to promote our brand and educate our patients.
Dr. Park acknowledges that social media can be incredibly time consuming so you should develop strategies to maximize your efficiency. For example, it can be very difficult to create a TikTok video in the middle of a busy clinic. So, Dr. Park recommends jotting down your ideas throughout the week, and then setting dedicated time aside each week (e.g., on the weekends) to batch content. Then you can release your already batched content throughout the week. If you are really pressed for time, you could consider creating your own content, and then outsourcing to a PR firm to help with video editing and strategies to reach a broader audience. Dr. Park’s biggest tip for those starting out fresh on social media is to start consuming the content yourself to see what type of dermatology content already exists and what kind of content works, to find your niche on social media. Incorporating trending audio, trending sounds, and trending movements/dances are all ways to optimize your views on social media. You also need to be posting at least a couple of times a week for your social media account to stay fresh. Dr. Park notes that authenticity is one important key to success. If you can remain authentic in your content, and not just focus on recruiting patients and selling products, you will be able to truly connect with more viewers.
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The diagnosis of cutaneous lymphoproliferative disorders continues to be a difficult challenge for dermatologists and dermatopathologists. In recent years, clonality identified by gene rearrangement studies has provided supplemental information aiding in the diagnosis. Unfortunately, false positive and false negative cases continue to hinder our abilities.
Two recent manuscripts in the Journal of Cutaneous Pathology highlight this issue. Lauren Yi and colleagues (2022. 49; 5:288-92) reported a case of cutaneous and neurosyphilis where the histopathology showed a dense atypical lymphoid infiltrate. T cell receptor rearrangement on two different biopsies showed an identical TCR-gamma clone. The lesions cleared with penicillin G treatment. A separate manuscript (2022. 49; 5:252-60) reported 12 patients with pediatric pityriasis lichenoides. Seven of the 12 patients showed T cell clonality utilizing next generation sequencing, and matching clones were identified from two different anatomical locations in two of the patients. In clinical follow up, nine patients showed complete resolution and three showed marked improvement with therapy. These cases highlight the fact that T cell clonality cannot be interpreted in isolation as a diagnosis for malignancy. Correlation with clinical presentation and routine histopathology is imperative for the best patient care.
Not uncommonly, a patient will present with angioedema with wheals, and we are asked to evaluate the patient for possible hereditary angioedema. It is important to keep in mind that if a patient presents with both angioedema and wheals, the diagnosis is urticaria (40% of patients with urticaria have associated angioedema), whereas hereditary angioedema is characterized by the absence of wheals. Moreover, urticaria is extremely common, affecting up to 20% of the population, and hereditary angioedema is extremely uncommon, affecting 1 in 50,000 to 150,000. Hereditary angioedema is caused by a mutation in the SERPING1 gene, which codes for C1–inhibitor (C1–INH), a serine protease inhibitor (SERPIN). Recently, in an update to the international guidelines for the management of hereditary angioedema, the authors advised against the use of C4 alone as a screening test for C1 inhibitor deficiency (World Allergy Organization Journal. 2022; 15: 100627). Measurements of serum/plasma levels of C1– INH function, C1–INH protein, and C4 are recommended to diagnose hereditary angioedema. With the combined use of these three tests, the diagnostic accuracy for identifying hereditary angioedema is very high — higher than that of any of the three tests alone. If C1–INH function and C1–INH protein tests are not available, the sensitivity of a C4 test can be increased by drawing blood during an emerging attack. (Acknowledgment to Adam Rees, MD, FAAD, for bringing this article to my attention.)
More What’s Hot!
Check out more What’s Hot columns from the DermWorld Editorial Advisory Workgroup at the DermWorld homepage.
The comeback of syphilis in the United States is not a new story. Cases of primary and secondary (P&S) syphilis have increased every year since 2000, when 5,979 cases were reported. In 2021, according to newly released preliminary CDC data, there were 47,234 cases.
The twist is that the epidemiology is changing. For much of the last 22 years, the syphilis epidemic largely affected men who have sex with men, especially those living with HIV. During the past 10 years, however — and particularly the last 5 — syphilis has been increasing markedly among heterosexuals. Tracking those data, unfortunately but unsurprisingly, is a rapid rise of congenital syphilis.
In 2012, 334 cases of congenital syphilis were reported; In 2021, there were 2,268 cases, a nearly seven-fold increase. The impact has been disproportionate, with higher rates among Native Hawaiians and other Pacific Islanders, American Indians or Native Alaskans, Blacks or African Americans, Hispanics or Latinos of any race, and persons of more than one race compared with non-Hispanic whites or Asians.
Congenital syphilis can be devastating, resulting in miscarriage, stillbirth, death shortly after birth, or lifelong health problems. It’s also entirely preventable if syphilis is detected and treated early in pregnancy.
To help reduce congenital syphilis rates, CDC recommends that health care providers be familiar with local syphilis epidemiology; discuss sexual health with their patients; screen for syphilis at the first prenatal visit (and again at 28 weeks if at higher risk for syphilis); and treat syphilis immediately.
