Comparing efficacy and safety of laser treatments for tattoo removal
In a recent JAAD study, researchers evaluated all lasers used to remove tattoos and assessed their efficacies and adverse events. Thirty-six studies were included in this systematic review. Q-switched Nd:YAG laser (QSNL) was the most studied of the laser types. It seems to be an efficacious option for black tattoos when treated with a fluence of 10 to 12 J/cm2, even though hyperpigmentation was a common adverse effect. Recently, not many studies have tested the Q-switched ruby laser, and so it is difficult to assess its efficacy. Hypopigmentation, however, was commonly reported.
[What does Europe’s tattoo ingredient ban mean for North America? Read more in DermWorld Weekly.]
Ablative laser systems are most effective when combined with QSNL, but there is a risk of scarring. QSNL 1064 nm plus 532 nm was most effective for red pigments. Both picosecond lasers (PSL) and QSNLs are safe and effective when treating black tattoos. However, PSLs have shown remarkable superiority when treating blue, green, and yellow pigments, achieving more than 75% clearance while being a safe and effective option. Hyper- and hypopigmentation are common with PSLs, whereas scarring was noted with nanosecond lasers. Overall, adverse effects are comparable, but PSLs seem to be less painful.
Laser experts discuss recent advances in laser technology as well as points of consideration before purchasing a device to help colleagues avoid what could be a costly mistake. Read more in DermWorld.
DermWorld Insights and Inquiries: The pressure to prevent pressure ulcers
Pressure ulcers (PUs, aka decubitus ulcers, pressure sores, bed sores) are due to prolonged pressure, characteristically over bony prominences such as the sacrum, occiput, ischial tuberosities, greater trochanters, heels, and lateral malleoli. Interestingly, in the COVID-19 era, with patients being placed in the prone position to improve their respiratory status, facial pressure ulcers (possibly accompanied by purpura) may develop. Advanced PUs may prove fatal. Physical burdens on patients and societal economic burdens of PUs are staggering.
The first step in managing PUs is being confident of the diagnosis, excluding such mimickers as diabetic ulcers, venous ulcers, pyoderma gangrenosum, and underlying osteomyelitis. Keep reading!
Derm Coding Consult: AMA releases new codes for monkeypox virus testing and vaccination
In the wake of the World Health Organization declaring monkeypox a global health emergency, and with case numbers increasing in the United States, the American Medical Association released, for immediate use, one new clinical laboratory test code for the orthopoxvirus and two monkeypox vaccine codes for use to report testing and vaccination for the monkeypox virus. Learn more about the new codes.
Ask the expert: Fighting for fair Medicare reimbursement
Academy President Mark Kaufmann, MD, FAAD, discusses the AADA’s efforts to ensure physicians are positioned to succeed under Medicare reimbursement rules. “Over the last 20 years, payment updates have not kept pace with the rate of inflation, so effectively we have seen a greater than 20% decrease in payments over this period. On top of this, we will see additional cuts in 2023 of about 8.5% due to congressional budget neutrality and PAYGO rules unless Congress takes action. This is just not sustainable for our practices and addressing this is the number one advocacy priority for the AADA right now.” Read more from Dr. Kaufmann about Medicare reimbursement.
AAD mourns the passing of Samuel L. Moschella, MD
The Academy recently learned with sorrow of the passing of former AAD President Samuel L. Moschella, MD, on Sunday, Aug. 21, at the age of 101. Dr. Moschella, who was a member of the International Leprosy Association since 1967, devoted much of his career to medically complex and socially marginalized populations in Africa, Latin America, and also in the U.S. He is perhaps best recognized for his work on behalf of patients with Hansen’s Disease (Leprosy), and for teaching generations of physicians how to mitigate the disease’s broad medical and psychosocial consequences.
Dr. Moschella was an Honorary Member of the Academy who joined in 1953 and served on the Board of Directors, as vice president, and finally as president in 1986-87. He also served as president of the American Board of Dermatology. He was the recipient of dozens of clinical and teaching awards, including the AAD Master Dermatologist Award, the Dermatology Foundation Clark W. Finnerud Award, the AAD Everett C. Fox Award (2006), and the AAD Arnold P. Gold Humanitarian Award (2011). The Board of Directors of the American Academy of Dermatology has made a donation in honor of Dr. Moschella to Camp Discovery.
Dr. Moschella was born in East Boston, Massachusetts, in April 1921. He attended Tufts University, where he earned a Doctor of Medicine (Cum Laude). He subsequently specialized in dermatology and became chief of dermatology and assistant chief of medicine at the U.S. Naval Hospital, Guantanamo Bay, Cuba in 1948-51. He later became clinical assistant of the Municipal Clinic for Leprosy and Syphilis at the same hospital in 1954.
In 1962 Dr. Moschella became a consultant for the U.S. Public Health Service for Leprosy at Carville in Baton Rouge, Louisiana, where he continued his involvement there for over 30 years. From 1962 to 1967 he was also chairman of the Department of Dermatology at the U.S. Naval Hospital in Philadelphia, and in 1967 he became Leprosy Consultant at the Brighton Marine Hospital (now the Lahey Clinic). In 1972, he held three WHO fellowships in leprosy. A member of the Harvard Medical School faculty since 1969, Dr. Moschella became a full clinical professor of Dermatology in 1983 and later held the title of Professor Emeritus.
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