In the Journal of Allergy and Clinical Immunology, an international team of researchers reviewed the benefits and harms of dietary elimination as a treatment for atopic dermatitis (AD). They analyzed 10 randomized controlled trials with dietary eliminations ranging from two to 32 weeks. The studies evaluated the effect of dietary elimination on eczema severity using SCORAD, for which an 8.7-point improvement was considered a minimally important difference. Among 547 patients, a greater portion of those who participated in dietary elimination achieved this minimally important difference than those who did not eliminate foods (50% vs. 41%). Three studies found that dietary elimination slightly improved skin pruritus compared with no elimination, although the researchers noted that the results had low certainty.
[Take this short quiz to evaluate your knowledge of diet’s impact on the skin.]
Considering the slight effect that dietary elimination had on eczema severity, through ingestion or contact, food may be a minor contributor to the causes and perpetuation of AD, with allergic or nonallergic mechanisms, according to the researchers. The researchers concluded that patients need to be fully informed as they weigh the modest benefits in eczema severity, pruritus, and sleeplessness that may come with dietary elimination against its potential risks.
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DermWorld Insights and Inquiries: Promising therapeutic developments for cutaneous lupus erythematosus — Interfering with interferon
Disfigurement due to scars and dyspigmentation complicating discoid lupus erythematosus (DLE) can be devastating. The cornerstones of therapy for cutaneous lupus erythematosus (CLE) are steroids and antimalarials. Secondary agents include immunosuppressive drugs, other immunomodulatory agents, retinoids, topical immunomodulators, and sun protection. Anifrolumab is a human, IgG1K monoclonal antibody that binds to the type 1 interferon receptor, thereby blocking type 1 interferon signaling. Anifrolumab was approved by the FDA for SLE in July 2021. Controlled trials are warranted to study to the potential of anifrolumab for CLE.Keep reading!
The AAD/A coding team continues to monitor the utilization of frequently reported services in dermatology through the Medicare Part B National Utilization Data. This article reviews and compares the Medicare Part B national utilization of dermatology-related injection codes for calendar years 2019 and 2020. Read more.
DermWorld Young Physician Focus: Pulling back the curtain on pharmacy benefits managers
For entities wielding such influence in health care, you’d think physicians and the public would know more about who pharmacy benefits managers (PBMs) are and what they do. While they were established in the 1960s as fee-for-service outfits processing claims for insurance companies, nowadays PBMs control most pharmaceutical sales in the U.S. The three largest American PBMs own or are owned by health insurance companies — CVS Health/Caremark, Cigna/Express Scripts, and UnitedHealth/OptumRx — and processed nearly 80% of all U.S. prescription claims last year. Read more from DermWorld Young Physician Advisor Bridget McIlwee, DO, FAAD.
At-home treatment of cutaneous warts combining in-person, telederm consultations
According to a study published in Dermatologic Therapy, treating cutaneous warts at home with a cryogenic pen is safe and effective when combined with face-to-face and teledermatology consultations. The patients were asked to submit a photo of the treated lesion at weekly intervals. A final face-to-face evaluation was used to verify the response to home treatment.
[Could wart immunotherapy open a therapeutic window for congenital nevi at risk for melanoma? Read more in DermWorld Insights and Inquiries.]
The trial included adult patients with single or multiple untreated cutaneous warts on the trunk or extremities during the COVID-19 pandemic. Participants were instructed to treat the lesions with a prescription-free cryogenic pen with nitrous oxide. The treatment included one (maximum of three) application to be repeated after two weeks. After treatment, complete clinical and dermoscopic resolution occurred in 80% of lesions after an average of 1.2 applications per lesion. The authors suggest that the combination of face-to-face consultations for initial and final visits and teledermatology during the treatment phase could represent a model for other dermatologic conditions, including acne, rosacea, psoriasis.
Remedies for warts abound, but high-quality studies are lacking. Read more in DermWorld.
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