Acne: Clindamycin-tretinoin vs. benzoyl peroxide-adapalene
In a split-face study published in the Journal of Drugs in Dermatology, 20 acne patients used clindamycin 1%-tretinoin 0.025% (CT) and benzoyl peroxide 2.5%-adapalene 0.1% (BA) gels for 21 days. CT was better tolerated and the BA formulation was associated with significant increases in erythema, dryness and scaling, and stinging. While participants reported reduced acne with BA, the blind evaluators found a similar reduction in acne lesion counts with both treatments.
DermWorld Insights and Inquiries: Do not get burned by missing Staphylococcal scalded skin syndrome
I would be surprised if any first-year dermatology resident could not differentiate Staphylococcal scalded skin syndrome (SSSS) from toxic epidermal necrolysis (TEN). What is straightforward now was a source of confusion for decades. The following is an elegant summation by Mockenhaupt et al of how dermatology has arrived at the current understanding of SSSS:
“Staphylococcal scalded skin syndrome (SSSS) is a rare, systemic blistering skin disorder. The clinical features were first described in 1878 by Baron Gottfried Ritter von Rittershain, who observed 297 cases among children in a single Czechoslovakian foundling asylum in a 10-year period. Presumably, in 1891 Staphylococcus aureus (S. aureus) was isolated from a patient with SSSS. The disease received little attention until Alan Lyell in 1956 described toxic epidermal necrolysis (TEN), a skin eruption resembling scalding of the skin. It soon became apparent that exfoliation associated with S. aureus infection occurred specifically in the zona granulosa of the epidermis, whereas the condition without association to bacteria showed splitting at the dermoepidermal junction.
What can possibly be new about SSSS? Four aspects: 1) epidemiology; 2) causation; 3) the clinical spectrum; and 4) therapeutic approach. Keep reading!
Is daylight photodynamic therapy effective for actinic keratosis?
In a randomized single-blind trial published in JAAD, the tolerability and safety of daylight photodynamic therapy (PDT) was assessed for the treatment of actinic keratosis (AK) on the face and scalp. Participants were randomly selected to three treatment groups.
All patients underwent topical application of aminolevulinic acid HCI (ALA) solution 20%. Group A had conventional treatment consisting of one hour of incubation and about 17 minutes of 417-nm blue light photodynamic therapy. Group B received combination therapy of 15 minutes of incubation and about 17 minutes of blue light photodynamic therapy, and 45 minutes of daylight. Group C received 15 minutes of incubation and one hour of daylight therapy.
Pain was lower during treatment in combination and daylight groups compared with the conventional group. Composite local skin reaction score (LSR) peaked on day eight for all groups and was significantly higher in the combination group compared with the conventional group. At day 84, mean AK reductions were 63.9 ± 24.9%, 66.4 ± 29.5%, and 61.8 ± 59.9%, for the conventional, combination, and daylight groups, respectively. Daylight and combination PDT have a similar safety profile to conventional PDT.
Derm Coding Consult: Applying the 2021 E/M coding concepts in everyday practice – Part 3
Part three of the AADA’s clinical vignettes focus on the application of the more challenging concepts related to the review and analysis of data in the AMA Medical Decision-Making table. Understanding the application of these concepts will assist you in determining when data may impact the level of service provided. View the next four clinical vignettes.
OIG plans report on dermatologist use of modifier 25
The Office of the Inspector General recently updated its Work Plan to include developing a report on “dermatologist claims for evaluation and management services on the same day as minor surgical procedures.” In part, the notice of the report reads, “In 2019, about 56% of dermatologists’ claims with an E/M service also included minor surgical procedures (such as lesion removals, destructions, and biopsies) on the same day. This may indicate abuse whereby the provider used modifier 25 to bill Medicare for a significant and separately identifiable E/M service when only a minor surgical procedure and related preoperative and postoperative services are supported by the beneficiary’s medical record. We will determine whether dermatologists’ claims for E/M services on the same day of service as a minor surgical procedure complied with Medicare requirements.”
The AADA has been advocating for appropriate coverage and reimbursement for services billed with modifier 25 by payers for years, and offers members numerous resources to ensure they are using the modifier appropriately. Stay tuned to DermWorld Weekly for updates as the AADA and physician leadership gathers more information about this report.
Comorbidity screening for hidradenitis suppurativa patients
Authors of a review published in JAADprovided evidence-based screening recommendations for comorbidities linked to hidradenitis suppurativa (HS). Systematic reviews were performed to summarize evidence on the prevalence and incidents of 30 comorbidities in patients with HS relative to the general population.
The authors recommended screening HS patients for the following comorbidities: acne, dissecting cellulitis of the scalp, pilonidal disease, pyoderma gangrenosum, depression, generalized anxiety disorder, suicide, smoking substance use disorder, and polycystic ovary syndrome, among other conditions.
Experts discuss the benefits of personalized treatment plans for patients with HS in DermWorld.
What does the PHE extension mean for telehealth codes?
The extension of the Public Health Emergency (PHE) means that for those practices providing audio-only telehealth services, Medicare will continue allowing the reporting of these services until July 21, 2021. As a reminder, the audio-only telehealth services furnished via telephone only are based on time, reported with CPT codes 99441-99443 and reimbursed at the same rate as the established patient E/M codes 99212-99214.
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