July 15, 2020
IN THIS ISSUE / July 15, 2020
JAAD study demonstrates link between chilblains and COVID-19
DW Insights and Inquiries: Incysting on understanding pilar cysts
Derm Coding Consult: Practical applications of 2021 E/M coding changes
JAAD study demonstrates link between chilblains and COVID-19
A recent study published in JAAD demonstrates evidence of a link between chilblains and COVID-19. Members of the AAD COVID-19 Task Force evaluated 716 cases of new-onset dermatologic symptoms in patients with confirmed/suspected COVID-19 from an international COVID-19 registry — from the AAD and the International League of Dermatological Societies. Of the 171 patients in the registry with lab-confirmed COVID-19 infections, the most common morphologies were morbilliform (22%), pernio-like (18%), urticarial (16%), macular erythema (13%), vesicular (11%), papulosquamous (9.9%), and retiform purpura (6.4%). Pernio-like lesions were found in patients with mild disease. Retiform purpura were found exclusively in hospitalized patients.
According to the paper, skin symptoms and affected areas of the body varied by lesion. Morbilliform morphologies were often pruritic and involved the trunk. Pernio-like lesions often caused pain and burning on the feet and hands and lasted a median 14 days.
Additionally, 64% of the lesions occurred after other COVID-19 symptoms occurred and 15% occurred concurrently with COVID-19 symptoms. Specifically, 76% of morbilliform, 48% of pernio-like, 67% of urticarial, 57% of macular erythema, 72% of vesicular, 53% of papulosquamous, and 91% of retiform purpura skin lesions occurred after COVID-19 symptoms occurred.
The study authors state, "Given public health risks posed by COVID-19, new onset of pernio-like lesions should prompt patient-provider discussions regarding both testing with PCR and/or antibody assays and the role of self-isolation in concordance with local and national guidelines."
Read the Academy’s statement on dermatologic manifestations of COVID-19 and participate in the COVID-19 dermatology registry.
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DW Insights and Inquiries: Incysting on understanding pilar cysts
Chances are you will see patients with at least one pilar cyst today. You will reassure them of their benignity, stating that the risk of their becoming cancerous is infinitesimal, and perhaps you will excise some lesions. Inquisitive patients will ask you how they got them, and you will likely respond that we really do not know, but pilar cysts may be inherited in many families.
Paraphrasing the National Enquirer — inquiring minds need to know. That time has arrived. What we already know — pilar (PC, trichilemmal cysts) arise from the outer root sheath of the follicle at the isthmus. PCs frequently appear sporadically but may be inherited as an autosomal dominant trait. Patients with familial PCs are usually younger, often presenting with multiple lesions. They are most commonly distributed on the scalp and grow slowly. PCs are usually asymptomatic, although they may calcify, become inflamed, and rupture. Keep reading!
Derm Coding Consult: Practical applications of 2021 E/M coding changes
Part 3 of the “E/M coding changes are coming in 2021” series will focus on the practical application of the changes to dermatology-specific encounters based on medical decision making (MDM) or time. (Review part 1 and part 2.)
On Jan. 1, 2021, E/M coding for office, outpatient, or other ambulatory facility visits will be based on either MDM or total time spent with the patient on the date of the encounter. At that time, the documentation of a medically appropriate history and physical examination will still be required, but the documentation will not factor into the determination of the overall E/M level of service code choice.
The E/M Office Visit Level of MDM Table (PDF download) serves as a guide to assist in the selection of one of the four levels of MDM. There are four types of MDM: Straightforward, Low, Moderate, and High and they are used when reporting an office or other outpatient E/M service code. Learn more.
Browse the Academy’s Coding Resource Center and try out the Academy’s new E/M coding tool.
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AAD seeks member comments for AK guidelines
Submit your comments for the draft clinical practice guidelines of care for the management of actinic keratosis through July 24. The guideline workgroup, which includes experts in AK management and a patient representative, will review your comments and, if applicable, edit the guidelines based on your feedback. Read the draft guidelines and submit your comments.
Caring for their own
Brooklyn, New York, was particularly hard hit by the pandemic. The New York State Governor quickly mandated that SUNY Downstate Medical Center become a designated coronavirus referral center, one of only three in the tristate area. All the residents, attending physicians, and nurses contributed significantly to battling COVID-19. Some residents were deployed to inpatient medicine and the emergency department, while others staffed essential consultation service or worked in collaboration with the Department of Health. Still others staffed in-person clinics for urgent patient visits to take the burden off emergency medicine colleagues for skin-related matters. Everyone contributed, including two resident directors of cosmetic dermatology from SUNY Downstate Medical Center, Jameson Loyal, MD, and Derek Ho, MD.
“Well into the pandemic my colleagues and I started seeing numerous health care providers presenting with PPE-related skin injuries,” said Dr. Loyal. Read more.
Submit nominations for 2021 Academy election
Nominations for Officers, Directors, and Nominating Committee Member Representatives (East Region) are now being accepted through Oct 1. To view reference materials and submit a nomination and letter of support, visit staging.aad.org/aadnominations or email callfornominations@aad.org.
