Managing pain in hidradenitis suppurativa patients: A proposed algorithm
Authors of a study in JAADpropose a hidradenitis suppurativa (HS) pain algorithm geared toward dermatologists that begins with differentiating between nociceptive (aching and gnawing pain due to tissue damage) and neuropathic (burning type pain due to somatosensory nervous system dysfunction) pain.
Acute pain, which emphasizes nociceptive pain treatments, includes lower risk therapies like acetaminophen and topical NSAIDs. For moderate or refractory pain, intralesional triamcinolone, incision and drainage, and/or systemic NSAIDs may offer relief. Limited courses of a short-acting opiate may also be considered for HS pain.
Chronic HS pain management begins with disease-directed therapies, pain severity evaluation, and identification of psychiatric comorbidities and substance abuse risk factors. The authors recommend NSAIDs for chronic, nociceptive pain. For patients with low cardiovascular risk, celecoxib is preferred over non-selective NSAIDS. Second-line therapies for chronic nociceptive pain include SNRIs and TCAs. For chronic neuropathic HS pain, dermatologists may begin with anticonvulsants or SNRIs. Gabapentin and duloxetine are considered first-line, whereas pregabalin and venlafaxine are recommended as second-line due to their increased side effect risk. Tricyclic antidepressants can also be used to treat chronic neuropathic pain.
The authors advise referral to pain specialists when a patient fails at least two pharmacologic therapies; has medically refractory HS and debilitating pain; or is using chronic opioids prescribed by generalists.
Experts discuss the benefits of personalized treatment plans for patients with hidradenitis suppurativa inDermWorld.
DermWorld Insights and Inquiries: Itching to see if polymerase chain reaction mite be the future of diagnosing scabies
The scourge of scabies has been plaguing mankind for millennia. The causal relationship of the itch mite causing scabies was discovered by Bonomo and Cestoni in 1687, earning the distinction of being the first to discover a proven etiology for a human disease. Their brilliance is magnified by my own difficulty in identifying mites, eggs, or scybala within skin scrapings. Thinking of scabies in a differential diagnosis is easy (except in atypical cases!) — securing the diagnosis is another issue. Keep reading!
Medicare increases 2021 conversion factor based on COVID relief bill
CMS confirmed yesterday that it will increase the 2021 Medicare conversion factor, which was previously announced to be $32.41, to $34.89, following the enactment of the COVID relief bill last month. This still represents a drop of 3.3% from 2020’s conversion factor of $36.09, but is a significant improvement from the cut physicians previously faced. The American Academy of Dermatology Association advocated for the inclusion of Medicare physician payment relief in the COVID relief legislation. AADA staff are developing an updated list of values for commonly used dermatology codes, which will be posted on AAD.org as soon as possible.
2021 E/M guidance sunscreen update
The AAD’s FAQ on coding for evaluation and management services in 2021 has been updated to respond to member questions about counseling patients on the use of sunscreen and how it affects the appropriate level of service for skin cancer screening encounters. The updated FAQ notes, “Although the FDA includes broad-spectrum sunscreen with SPF 15 or higher in its list of over-the-counter medications, it is important to document this distinction in the event of a post-claim audit to support the level of service reported.”
According to a presentation at the virtual European Academy of Dermatology and Venereology Congress, regular physical activity in young women with papulopustular acne may help reduce clinical presentation and severity of acne. Clinical examination of acne lesions and enzyme-linked immunosorbent assay of plasma concentration of progesterone were performed during the luteinizing phase of the menstrual cycle.
They examined 72 women with comedogenic and mild to moderate papulopustular acne — 34 who had been exercising regularly for three months and 38 participants who had not. The study results showed a significant difference in acne severity between the two groups with mean plasma level progesterone of 32.9 nmol/L in the exercise group versus 55.9 nmol/L in the control group. Progresterone, a precursor to testosterone is critical in the pathogenesis and clinical presentation of acne, the authors concluded.
Does a physician’s relationship to fitness affect patient care? Find out in DermWorld.
COVID-19 Dermatology Registry accepting vaccine side effect submissions
The COVID-19 Dermatology Registry has been updated to include questions about side effects of COVID-19 vaccination. The registry also continues to capture information about dermatologic manifestations of COVID-19.Learn more and enter your case today.
Academy seeks statements on proposed bylaws amendments
The American Academy of Dermatology is seeking statements regarding the proposed bylaws amendments that will be presented to membership for a vote on the spring 2021 election ballot. Eligible voting members may submit up to three statements in support of and in opposition to the proposed bylaws. Review the amendments and submit your statements by Jan. 18, 2021.
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