Authors of a JAAD study evaluated the efficacy and safety of paroxetine for moderate-to-severe erythema of rosacea. Paroxetine was effective and well tolerated among patients, with 43% of patients experiencing clear or almost clear results. A total of 97 patients were randomly assigned 25 mg of paroxetine daily or placebo for 12 weeks. While the primary endpoint and multiple secondary endpoints were met, including flushing improvement (44.9% vs. 25%) and burning sensations (46.9% vs. 18.8%), the difference in inflammatory lesion counts at 12 weeks was not significant between the two groups. Adverse events were experienced by nearly a quarter of the paroxetine group and 11% of the placebo group with the most common events being dizziness, lethargy, nausea, and dyspepsia.
Experts reexamine rosacea’s disease classification in DermWorld.
DermWorld Insights and Inquiries: Demodectic eruptions — More than you mite have imagined
Despite the ongoing debate about the precise role of Demodex in the pathogenesis of multiple dermatoses (pityriasis folliculorum, papulopustular and granulomatous rosacea, perioral dermatitis, seborrheic dermatitis, blepharitis, and others), few would argue about the association of the mites with these entities, or that ivermectin — administered either topically or systemically — can be an effective therapy. What has escaped me (until now) is considering the possibility that demodicidosis may cause facial hyperpigmentation. The usual differential diagnosis includes melasma, post-inflammatory hyperpigmentation, drug-induced hyperpigmentation, lichen planus actinicus, or lupus. Although dermatologists are familiar with “classical” disorders such as rosacea where Demodex might (yes, I meant might) play a role, there are other conditions where the mite might be mighty important. Keep reading!
Nonthermal atmospheric plasma for molluscum and verruca vulgaris
According to results presented at the Academy’s 2023 Annual Meeting, use of nonthermal atmospheric plasma (NTAP) is an effective treatment for pediatric molluscum contagiosum (MC) and verruca vulgaris (VV). The researchers assessed data from 17 patients between the ages of four and 21 years who presented with 149 lesions on the body, excluding the face or genitals. In two treatment arms, participants were randomly assigned in a 1:1 ratio to receive either NTAP or a current standard of care therapy, which consisted of cantharidin for MC and cryotherapy for VV. Participants in the NTAP group were treated with the device for two minutes per treatment, which occurred at four-week intervals, with a maximum of three treatments. They were evaluated four weeks after their final treatment.
[A novel treatment for molluscum contagiosum? Read more in DermWorld Weekly.]
There was no statistically significant difference between the interventions. Lesions treated with standard of care therapy showed either no response (12.2%), partial response (27%), or complete response (60.8%). Lesions treated with NTAP showed either no response (10.7%), partial response (36%), or complete response (53.3%). Participants in the standard of care therapy group reported significantly more adverse events, including pain and redness at the treatment site.
As of May 1, 2023, Elevance (formerly Anthem) will restart the E/M leveling program that automatically reviews and adjusts claims of physicians identified as outliers in reporting a high volume of Level 4 and 5 E/M codes. Elevance identifies outliers by reviewing the reported diagnosis codes to the E/M level and comparing them to specialty peers. Level 4 and 5 E/M codes not supported by the diagnosis will be reduced, but not codes below Level 3 E/M. This policy will apply to all of Elevance’s Medicare and Medicaid lines of business in all states — with the exception of Missouri, which will be determined later. The program is currently in operation for Elevance’s commercial line of business in Georgia and Nevada, but a specific date has yet to be set for its commercial plans in the other states served by Elevance.
Additionally, documentation requirements for signatures on office notes were also discussed. Elevance clarified that its documentation requirements for signatures on office notes must include the signatory’s first and last name and credentials. The AADA will continue to monitor and notify members of Elevance policy changes.
Prevalence and treatment of onychomycosis in children
A study published in Mycoses found that the rate of onychomycosis may be increasing among children and is likely underreported. In the study, 2,382 pediatric cases of onychomycosis were identified in the literature, with the number of reported cases increasing over time. The average age of disease onset was 9.8 years, and toenails were most affected (77.6% toenails vs. 18.4% fingernails). Concomitant tinea pedis was noted in 22% of the cases. Systemic therapy was most used, but according to the authors, topical therapies might be beneficial in children due to their thinner, faster-growing nails.
Acitretin: A new therapy for onychomycosis? Read more inDermWorld Weekly.
House of medicine sends joint message of support to congressional champions for legislation tying inflationary update to Medicare physician fee schedule
The AADA joined an AMA-led joint physician organization letter of support for H.R. 2474, the “Strengthening Medicare for Patients and Providers Act,” introduced by Reps. Raul Ruiz, MD (D-CA), Larry Bucshon, MD (R-IN), Ami Bera, MD (D-CA), and Mariannette Miller-Meeks, MD (R-IA). The bill would provide for an inflationary update under the Medicare physician fee schedule tied to the Medicare Economic Index beginning in 2024. The legislation is intended to provide relief to physicians and ensure financial stability and predictability for physician practices.
Why this matters: Since 2001, the cost of operating a medical practice has increased 47%, while economy-wide inflation has risen 73%. During this time, Medicare physician reimbursement has risen just 9%. During the same period, Medicare hospital and nursing facility updates have increased by roughly 70%, significantly outpacing physician reimbursement and inflation. Adjusted for inflation in practice costs, Medicare physician reimbursement declined 26% from 2001 to 2023. Physicians need positive, inflation-based reimbursement updates to maintain financial stability and ensure patients have continued access to care.
The AADA has been strongly advocating for long-term Medicare reform that includes a positive inflationary adjustment for Medicare physician payments. H.R. 2474 is a direct result of AADA advocacy, along with the physician community, on Medicare reform.
Join in, take action, get going! contact your representative and urge them to support this effort to increase Medicare payments and cosponsor H.R. 2474.
AADA meets with White House Cancer Moonshot staff
As a part of the Academy’s ongoing advocacy to raise awareness about skin cancer prevention, the AADA staff met with Anabella Aspiras, associate director of Cancer Moonshot Engagement, to discuss how the Academy can collaborate with the White House on reducing the rates of skin cancer. At the meeting, AADA shared more about our SPOT Skin Cancer™ prevention program, including our Skin Cancer Awareness Month activities next month and our shade structure prevention program. The AADA also discussed various policy reforms to prevent and treat skin cancer.
President Biden relaunched the Cancer Moonshot to cut cancer rates in half in the next 25 years and improve the lives of people at risk for cancer, living with cancer, and their families. Specifically, the White House is looking to work with various organizations to close the cancer screening gap. The AADA will continue to engage with the White House. In the meantime, members are encouraged to share patient stories and ideas with the White House.
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