In aJAADresearch letter, the authors reviewed 160 of the top-reviewed commercial hand sanitizers among five major retailers. Ingredients were reviewed to determine the proportion of products that had ingredients listed in the North American Contact Dermatitis Group (NACDG) 2017-2018 standard series. Fragrance and cross-reactors were identified with the American Contact Dermatitis Society’s Contact Allergen Management Program database. At least one NACDG standard series allergen was found in 71% of all sanitizers and in seven of the 10 most reviewed sanitizers.
The most common allergens were tocopherol, fragrance, propylene glycol, and phenoxyethanol. Of the hand sanitizers, 84% were marketed with claims such as “dermatologist recommended,” “moisturizing,” “fragrance-free,” or “hypoallergenic.” All products labeled as “moisturizing” contained at least one humectant. Fragrance and cross-reactors were found in 39% of the products labeled “fragrance-free.” Of the “hypoallergenic” sanitizers, 70% had ingredients in the NACDG series and 60% had at least one ingredient with a sensitization rate of more than 1%.
DermWorld Insights and Inquiries: Eccrine syringofibroadenoma — Sweating over the details
While learning about rare entities during our training, we may wonder if we will ever encounter the disorders in “real life.” Eccrine syringofibroadenoma (ESFA), first described in 1963 by Mascaro, was considered a relatively “new” lesion when I was a dermatopathology fellow. I was taken with its striking, distinctive, beautiful (to my eye) histologic appearance of proliferating cords of epithelial cells, with ductal luminae, surrounded by a fibrovascular stroma. Over the ensuing decades, I have only infrequently encountered the lesion (usually in the literature). Recently, I had a “Rip Van Winkle” experience when I diagnosed ESFA on a lesion sent in as a squamous cell carcinoma. Reviewing manuscripts on something I had not thought much about in 37 years was revelatory — the world of ESFA has changed. Keep reading!
Derm Coding Consult: Applying 2021 E/M coding concepts in everyday practice – Part 8
Part eight of the AADA’s clinical vignettes focuses on the application of coding concepts related to E/M encounters. These clinical vignettes continue those of part 7 in this series, demonstrating how a common dermatologic condition, actinic keratosis, can be classified under different categories of problem addressed during the encounter depending on disease severity and patient presenting circumstances at the time of the encounter. View the clinical vignettes.
New AAD guidelines address comorbidities and atopic dermatitis
This month, the American Academy of Dermatology released new guidelines on the comorbidities associated with atopic dermatitis. The guidelines are the first in a four-part series and cover the patient- and population-level burden of disease. View guideline highlights or read them in JAAD.
FDA approves abrocitinib, upadacitinib for atopic dermatitis
The U.S. FDA approved two oral JAK1 inhibitors for patients with moderate-to-severe atopic dermatitis (AD): abrocitinib (Cibinqo®) and upadacitinib (Rinvoq™). These are the first oral JAK inhibitors available for AD in the United States.
Abrocitinib is approved for adults with moderate-to-severe AD at the recommended doses of 100 mg and 200 mg, with the latter dose recommended for patients not responding to the 100 mg dose. The safety and efficacy of abrocitinib was evaluated in three phase 3 clinical trials, which measured improvements in skin clearance, itch, disease extent, and severity. Across the trials, abrocitinib demonstrated a consistent safety profile and improvements in skin clearance, extent of disease, and severity, as well as rapid improvement in itch after two weeks, for some people living with AD versus placebo. A higher proportion of subjects treated with abrocitinib in two monotherapy trials achieved improvement in itch at week 12 compared to placebo. The most common adverse events reported in about 5% of patients included nasopharyngitis, nausea, and headache.
Upadacitinib is approved for moderate-to-severe AD in patients 12 and older. Across three phase 3 trials, both the upadacitinib 15 mg and 30 mg once daily monotherapy met all primary and secondary endpoints at week 16, with some patients achieving higher levels of skin clearance based on the EASI-90 and EASI-100.
The labeling of abrocitinib and upadacitinib include a boxed warning for JAK inhibitors, regarding the risk of serious infections, mortality, malignancy, major adverse cardiovascular events, and thrombosis.
Is there evidence to suggest a true remittive effect of JAK inhibitors for AD? Find out in DermWorld.
On Nov. 12-16, 2021, the AMA Dermatology Section Council (DSC) participated in the AMA S-21, the Virtual Special Meeting of the American Medical Association (AMA) House of Delegates (HOD). The following resolutions of importance to dermatology were adopted:
Resolution 212/221/224/225 – Sequestration/Improve Physician Payments: To address the looming nearly 10% cuts to physician Medicare payments.
Resolution 234 – Permitting the Dispensing of Stock Medications for Post Discharge Patient Use and the Safe Use of Multi-dose Medications for Multiple Patients: To help eliminate medication waste, particularly upon hospital discharge.
Resolution 502 – Advocating for Heat Exposure Protections for Outdoor Workers: To protect workers from heat and sun exposure injuries.
Resolution 505 – Representation of Dermatological Pathologies in Varying Skin Tones: To address the need for greater diversity in dermatology educational materials and increase the chance for early detection of skin cancer and other dermatologic pathologies.
Additional resolution topics of interest from the meeting are summarized below.
Drug pricing and transparency: The AMA will support efforts to publish a standardized real-time prescription benefit tool in electronic health records to help patients and physicians make cost-informed decisions on prescription drugs.
Electronic funds transfer fees: Health insurers are required to offer network physicians a no-charge option for electronic funds transfer; however, some physicians are being inappropriately charged for those transactions. Based on actions of the AMA HOD, the AMA will advocate for CMS to enforce the HIPAA administrative simplification requirements and elimination of health plan fees for electronic claims or payment.
Strengthening public health systems: The lack of infrastructure of the U.S public health systems resulted in delayed detection and response efforts. The AMA is committed to improving and modernizing our public health infrastructure to appropriately respond to the health needs of the community. Based on actions of the HOD, the AMA will facilitate development of an organization-wide strategy on public health to strengthen the health and public health system.
Rural health education and training: Rural communities continue to face physician shortages across medical specialties, widening the existing gaps in patient care. The AMA is dedicated to addressing the rural physician workforce shortages by increasing exposure and developing training programs, eliminating health inequities, and removing barriers to access to care in the rural patient population.
Adolescent telehealth: Telehealth utilization and services may present challenges in providing confidential care to adolescents, who need the privacy and space to discuss sensitive issues with physicians without a parent present. To address these concerns, delegates amended existing policy encouraging physicians to recognize the unique confidentiality concerns of adolescents and their parents associated with telehealth visits and offer private spaces in a telehealth setting for a separate examination and counseling apart from others.
Dermatologists involved in AMA HOD leadership roles:
Jack Resneck Jr., MD, FAAD, is president-elect of the AMA. Dr. Resneck will assume the office of AMA president in June 2022.
Adam Rubin, MD, FAAD, is a member of the Specialty and Service Society (SSS) Governing Council and is running for a seat on the Council on Constitution and Bylaws.
Jessica Krant, MD, MPH, FAAD, served on the AMA Election Reform Task Force. Dr. Krant currently serves on the Surgical Caucus Executive Committee, chairs the Surgical Caucus Nominating Committee, and was newly elected as secretary of the Surgical Caucus.
George Hruza, MD, MBA, FAAD, immediate past president of the Missouri State Medical Association, served on the SSS Governing Council and was appointed to the AMA Election Committee.
Hillary Johnson-Jahangir, MD, PhD, FAAD, served on the SSS Reference Committee and is an appointee to the Women’s Equity and Leadership (WEL) project, a multiorganizational collaboration between the AMA, specialty organizations, and medical leadership organizations.
Marta Van Beek, MD, MPH, FAAD, serves on the Council of Legislation to the AMA leadership roles of dermatologists.
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