Have cutaneous manifestations of COVID-19 changed during Delta, Omicron waves?
Authors of an article published in the British Journal of Dermatology explored how cutaneous manifestations of COVID-19 have changed during different waves of infection and whether vaccination had any effect on symptom frequency. The study used data from over 348,000 UK users of the ZOE COVID Study app collected during the Delta and Omicron waves of the pandemic. Five cutaneous manifestations were included: acral, burning, erythematopapular and urticarial rash, and unusual hair loss.
There was a significant association between any cutaneous manifestations and a positive COVID-19 test result, with a diagnostic value higher in the Delta compared with the Omicron wave. Cutaneous manifestations were also more common with Delta vs. Omicron (17.6% vs. 11.4%, respectively) and had a longer duration. During both waves, cutaneous symptoms clustered with other frequent symptoms and rarely (in < 2% of the users) as first or only clinical sign of SARS-CoV-2 infection. Vaccinated and unvaccinated users of the app showed similar odds of presenting with a cutaneous manifestation, except for burning rash was less common in vaccinated users.
DermWorld Insights and Inquiries: Complications of silicone injections – persistence, stigma, and treatment
Walking in with a cane and reporting his severe skin pain, a patient of mine recalled traveling with their friend to get buttock injections in a hotel room in another state over a decade ago. The FDA issued warnings in 2017 and 2021 against the use of injectable silicone for large-scale facial and body contouring or enhancement. Of note, silicone has never been approved by the FDA for any dermatologic indications. Stories of unlicensed silicone injectors with disastrous complications have been circulated in the news and within transgender communities. Silicone injections have been disproportionately reported among transgender women: 3% have had silicone injections and 10% want them someday as reported in a large 2015 U.S. survey of transgender persons. Keep reading!
AAD releases updated topical therapy guidelines for atopic dermatitis
The American Academy of Dermatology recently published updated guidelines of care for the management of atopic dermatitis in adults with topical therapies in the Journal of the American Academy of Dermatology. These are the second in a series of revised guidelines the AAD is producing on the condition.
These guidelines update the Academy’s previous AD guidelines, published in 2014, based on new evidence that has emerged regarding the management of AD with topical therapies. The guidelines include strong evidence-based recommendations for several treatments, including:
Moisturizers;
Topical calcineurin inhibitors;
Topical corticosteroids; and
Topical PDE-4 and JAK inhibitors.
Additionally, the guidelines include conditional recommendations for the use of bathing and wet wrap therapy, and recommend against the use of topical antimicrobials, antiseptics, and antihistamines.
View the AD guidelines and access the highlights.
DermWorld Young Physician Focus: Juggling parenting and dermatology
This month’s DermWorld article “A juggling act,” discusses the unique challenges faced by dermatologists who are also parents. For a profession focused on health, medicine has been disappointingly slow to make systematic changes to accommodate physician parents, lagging behind more progressive family-forward policies that exist across corporate America. Lack of support is often a major cause of burnout. Physicians, especially those who are parents, are likely to be acutely familiar with the feeling of a lack of support at work. Read more from DermWorld Young Physician Advisor Bridget McIlwee, DO, FAAD.
AMA House of Delegates recap
On Nov.12-15, 2022, your AMA Dermatology Section Council (DSC) participated in AMA I-22, the Interim Meeting of the AMA House of Delegates (HOD). The HOD Opening Session took place on Saturday, Nov. 12, and opened with a compelling speech by FAAD member and AMA President, Jack Resneck, Jr. MD, FAAD, who spoke about issues facing the profession and patients. During the course of the meeting, the following resolutions of importance to dermatology were addressed:
Resolution 820 — Third-Party Pharmacy Benefit Administrators (TPAs): The DSC co-sponsored this resolution introduced by the American College of Rheumatology. TPAs are similar to pharmacy benefit managers (PBMs) in that they manage formularies, negotiate rebates, process claims, and pay pharmacies for prescriptions. However, due to TPAs being relatively new to the health care landscape, they are not bound to PBM-related regulations and laws. With little transparency, TPAs managing specialty pharmacy benefits use proprietary algorithms to guide decision-making and heavy-handed tactics with patients and physicians to force them to use preferred prescriptions. This resolution calls for transparency and oversight of TPAs and asks that they be subjected to the same licensing, registration, and transparency-reporting requirements that regulators mandate for PBMs.
Resolution 201 — Physician Reimbursement for Interpreter Services: This resolution asks the AMA to advocate for prioritized physician reimbursement for interpreter services and legislative and regulatory changes to ensure federal health programs and commercial plans pay for these services. It also seeks to ensure the financial burden of medical interpretive and translation services do not fall on physician practices.
Resolution 220 — Extend Telemedicine to Out of State Enrolled College Students to Avoid Emergency Room and Inpatient Psychiatric Hospitalizations when in Crisis: This resolution asks the AMA to advocate for extended telemedicine coverage and strengthened continuity of care for out-of-state students who have an established physician-patient relationship and who need treatment.
Resolution 315 — Bedside Nursing and Health Care Staff Shortages: This resolution asks the AMA to identify strategies and solutions to address nursing and all other health care staff shortages, and to promote a stable and sustainable work force.
Resolution 806 — Healthcare Marketplace Plan Selection: This resolution asks the AMA to advocate for expanded plan options on the Healthcare Marketplace beyond current options based on the ZIP code of their residence or where their physician practices.
Resolution 808 — Reinstatement of Consultation Codes: This resolution seeks proactive engagement and advocacy intervention with any commercial insurance company that discontinues payment for consultation codes, or that is proposing to, or considering, eliminating payment for such codes, and requests that the company reconsider the policy change.
Dermatologists involved in AMA HOD leadership roles
Jack Resneck Jr., MD, FAAD, AMA President
Cyndi Yag-Howard, MD, FAAD, DSC chair
Hillary Johnson-Jahangir, MD, PhD, FAAD, Private Practice Physicians Section (PPPS) Advocacy Committee member, Reference Committee on Legislative Advocacy chair
Adam Rubin, MD, FAAD, Specialty and Service Society (SSS) chair-elect, AMA Transplant Caucus founder
Marta Van Beek, MD, MPH, FAAD, AMA Council of Legislation (COL) Executive Committee
On Jan. 11, 2023, the U.S. Department of Health and Human Services (HHS) Secretary, Xavier Becerra, renewed the COVID-19 public health emergency (PHE) for another 90 days. The renewal is until mid-April 2023 and includes extending all Medicare telehealth waivers and other flexibilities in place. The HHS will provide a 60-day notice before the PHE expires.
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