Authors of a rapid communication published in JAAD performed a systematic review of outcomes of seborrheic dermatitis (SD) treated with isotretinoin. Of 443 studies identified, seven studies involving 229 patients were included. All studies investigated moderate-to-severe SD, with the most common sites being the face and scalp. The most prevalent concomitant skin conditions included acne vulgaris and rosacea, which did not appear to impact treatment outcomes. Six studies evaluated low-dose isotretinoin (≤0.5mg/kg/d) and the pooled average dose was 9.20-mg/d for four months.
Isotretinoin treatment resulted in greater improvements in SD symptoms when compared to oral itraconazole, antifungal shampoo, or salicylic acid-containing soap. Patients reported less pruritus with isotretinoin (82%) than itraconazole (65%). Of three studies reporting SD severity on validated scales, four patients (4%) reported little-to-no benefit with isotretinoin. The remaining 100 patients (96%) had at least some improvement with isotretinoin and 47 patients (45%) had complete clearance. According to the authors, all studies supported isotretinoin, even at low doses, as a potentially effective treatment for moderate-to-severe SD.
Low-dose isotretinoin for severe seborrheic dermatitis? Read more inDermWorld Weekly.
DermWorld Insights and Inquiries: Cellular neurothekeoma: A tribute to Barnhill and Mihm and a remembrance of Martin C. Mihm Jr., MD
Since the term neurothekeoma (NT) was introduced in 1980 there has been ongoing confusion as the designation has persisted in the literature. I usually detail the history of how terms have been utilized, but I fear it will leave you even more confused. Suffice it to say that the original lesion described as a NT is a nerve sheath myxoma and the cellular NT (CNT) is a distinct lesion of probable fibrohistiocytic origin. Rendering this diagnosis is essential to avoid misdiagnosis and potential overtreatment. The following is the abstract of the seminal work of Barnhill and Mihm in 1990 clarifying the nature of CNT that is still apt today: “We describe the clinical, histopathologic, and immunohistochemical characteristics of five examples of a distinctive subtype of neurothekeoma we term ‘cellular neurothekeoma’ (CNT). These lesions are nondescript papules or nodules primarily involving the head and neck areas of young adults.Keep reading!
AADA analyzes impact on dermatology from proposed Medicare Fee Schedule
As previously reported, CMS released the 2024 Medicare Physician Fee Schedule (PFS) proposed rule, with a proposed -3.4% cut to the conversion factor. The AADA has conducted a thorough analysis of the proposed rules and summarized the policies in the PFS affecting dermatology practices.
The AADA also evaluated the impact on dermatologic codes and estimates a decrease ranging from approximately -1.00 to -4.00% per code. The proposed payment rates for each code reflect the impact of various policy changes related to physician work, practice expense, and malpractice relative value units (RVUs). Access AADA’s analysis of the top dermatology codes and RVUs for nearly 400 dermatology codes.
The AADA, alongside the house of medicine, has succeeded in mitigating payment cuts for the last several years, but physicians need Congress to act to stabilize the Medicare payment system. We encourage members to register for the 2023 AADA Legislative Conference, which provides an opportunity to engage with members of Congress, voice concerns about the proposed payment cuts, and urge Congress to take immediate action to stop the cuts affecting dermatology practices while finding a lasting solution for Medicare payments that ensures uninterrupted patient care.
Is nasal decongestant oxymetazoline a novel therapeutic option for post-acne erythema?
Authors of an article published in the Journal of Dermatology investigated the efficacy and safety of topical oxymetazoline hydrochloride solution for post-acne erythema (PAE). In this split-faced, double-blind, randomized, placebo-controlled trial, participants with PAE applied topical oxymetazoline hydrochloride 0.05% solution to one side of the face and a placebo to the contralateral face twice daily for 12 weeks. The treatment side had a significantly greater reduction in PAE lesion count and erythema index. Patient satisfaction and clinician erythema assessment on the treatment site were superior to the placebo side.
Patient preferences for pain control after Mohs surgery
A study published in JAMA Dermatology explored to what extent the theoretical risk of opioid addiction is associated with patients’ choice of pain medications after Mohs micrographic surgery. This prospective experiment was conducted at a single academic medical center from August 2021 to April 2022 among patients undergoing Mohs surgery. A survey was given to all participants.
Of the 295 respondents, 34% stated that they would never consider opioids for pain management regardless of the pain level experienced, and 50% expressed concern regarding possible opioid addiction. Across all scenarios, 224 respondents 76% preferred only OTCs vs. OTCs plus opioids after Mohs surgery for pain control. When the theoretical risk of addiction was low (0%), half of the respondents expressed a preference for OTCs plus opioids given pain levels of 6.5 on a 10-point scale. At higher opioid addiction risk profiles (2%, 6%, 12%), an equal preference for OTCs plus opioids and only OTCs was not achieved. In these scenarios, patients favored only OTCs despite experiencing high levels of pain.
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