A high-fiber diet may affect immunotherapy response for melanoma patients
According to an article published inScience, dietary fiber intake and probiotic use may impact the therapeutic response to immunotherapy for melanoma. The researchers found that of 128 patients on immune checkpoint inhibitors, higher dietary fiber from fruits, vegetables, legumes, and whole grains was associated with significantly improved progression-free survival. The most pronounced benefit was seen in patients with sufficient fiber intake who did not take probiotics.
The researchers found that every five-gram increase in daily fiber intake correlated with an approximately 30% lower risk for cancer progression or death. Additionally, 82% of patients who reported both sufficient fiber intake and no probiotic use responded to immunotherapy, compared with only 59% of patients who reported either insufficient fiber intake or probiotic use.
Learn how changes to the TNM system enhance prognostication for cutaneous cancers inDermWorld.
DermWorld Insights and Inquiries: An old dog with a new trick — High dose intralesional steroids in hidradenitis suppurativa
Hidradenitis suppurativa (HS) is hitting its stride academically — deservedly so. In 2000, there were two publications about HS in the Journal of the American Academy of Dermatology; in 2010, nine manuscripts; and, in 2020, 69 articles were published. Dr. Ginette Okoye was our recent Grand Rounds speaker at Cooper Medical School of Rowan University, offering a fabulous discussion of HS management. It was not the newest biologic that got my attention — it was her advocacy of intralesional steroids for HS, at higher doses than I had been accustomed to, that got my attention. Have I been underdosing intralesional triamcinolone all these years?Keep reading!
Derm Coding Consult: CMS announces new Place of Service code for telehealth services provided to patients in their homes
CMS has announced a new Place of Service code, POS 10, for use in reporting telehealth services provided to patients who are in their own homes. Additionally, CMS has revised POS 02 for reporting telehealth services provided to patients not located in their own homes. Learn more.
2022 physician depression, burnout survey
According toMedscape’s National Burnout and Depression Report 2022, many physicians are struggling to maintain their own well-being amid the pandemic. In last year’s report, 42% of physicians said they were burned out while this year the number increased to 47%. This year’s survey has shown that burnout increased for both genders: 56% of women and 41% of men reported burnout. For those physicians who reported burnout, 54% reported that burnout has a strong or severe impact on their lives.
The major contributing factor to burnout was too much paperwork (60%), lack of respect from administrators/employers/staff (39%), too many hours at work (34%), and a lack of control over one’s life (32%). About 12% noted causes related to societal issues stemming from the pandemic, and 10% attributed their burnout to treating COVID-19 patients.
Nearly 20% of physicians said they suffered from clinical depression, and 64% reported feeling “blue, down, or sad.” When asked about seeking help for depression, half said they believed they could deal with the emotional stress on their own. Fear of medical boards finding out about their depression prevented 43% of physicians from reaching out for help, according to the survey.
Experts discuss available resources, and how the conversation surrounding physician mental health has changed inDermWorld.
Topical calcineurin inhibitors for pediatric atopic dermatitis
In a letter published in JAAD, the authors reviewed use patterns of topical calcineurin inhibitors (TCIs) in 8,015 patients with atopic dermatitis (AD). Individuals with mild-to-moderate AD were required to use pimecrolimus for at least six weeks out of the six months preceding enrollment, after which they could choose to discontinue. At six-month intervals, the individuals reported presence and location of disease and use of topical medication for more than 40,000 person-years of follow-up.
Over time, pediatric patients tended to use TCIs less regardless of the location of the AD, including the face (odds ratio, 0.880), upper extremities (odds ratio, 0.895), and lower extremities (odds ratio, 0.897). There was an increased tendency toward use of topical corticosteroids over time, which persisted after adjusting for sex, race, and income. The authors suggest insurance coverage difficulties, TCI tolerability, or patient and clinician preferences may have influenced these trends.
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