A literature review of adult acne published in the International Journal of Dermatology examines new evidence on the pathophysiology of acne development and newly approved targeted therapeutics. The authors discuss how the gut microbiome appears to play a part in the pathophysiology of many inflammatory disorders, including how patients with severe acne had a specific microbiota that significantly differed from those with mild or moderate acne.
[Acne: Clindamycin-tretinoin vs. benzoyl peroxide-adapalene. Read more in DermWorld Weekly.]
The authors also discuss the latest international guidelines for the treatment of adult acne, which include recommendations about retinoids, the role of antibiotics, isotretinoin, topical antimicrobials, and more. Lastly, the authors highlight therapeutic innovations for acne treatment including pre/probiotics, new molecules, as well as off-label molecules that may show value in treating adult acne.
DermWorld Insights and Inquiries: Granulomatous cheilitis — Back to the Future
I opened my dermatology practice in 1985 — looking retrospectively, life was then both simpler and more complicated. It was the pre-computer era when patients paid their fee at the time of their visit, utilizing a peg-board system. The ledger would balance at the end of the day; patients would take their receipt and submit it to their insurance company for reimbursement (no kidding!). Medically, managing diseases such as severe psoriasis to achieve a PASI 100 was a pipe dream compared to our current biologic reality. Today, for uncommon, recalcitrant disorders such as granulomatous cheilitis our first-line treatments are intralesional steroid injections, antibiotics, and methotrexate — just as in 1985. Appropriately, Back to the Future was released that year. Keep reading!
Derm Coding Consult: Cigna’s new modifier 25 policy
On May 20, 2022, Cigna announced a new policy that will be effective for claims processes on or after Aug. 13, 2022 (regardless of encounter date). This policy requires the submission of office notes with claims submitted with evaluation and management (E/M) Current Procedural Terminology (CPT®) codes 99212, 99213, 99214, or 99215 and modifier 25 when a minor procedure is billed. Protecting appropriate reimbursement for E/M and use of modifier 25 is a longstanding advocacy priority of AADA, and we immediately arranged a call with Cigna to address this policy change and advocate on behalf of dermatology practices. Read more.
Adverse events associated with injectable fillers
A retrospective study published in Dermatologic Surgery identified 18,013 mL of filler administered to 7,659 patients by three board-certified cosmetic dermatologists for a duration of more than 11 years. Types of filler included hyaluronic acid derivatives (74%), poly-L-lactic acid (19%), and calcium hydroxylapatite (6.7%). Overall, four serious adverse events were identified on the cheeks: Three were delayed nodule formation at the treatment site with hyaluronic acid fillers, and the fourth was related to vascular compromise and secondary cutaneous necrosis after calcium hydroxylapatite filler injection. The authors conclude that when injectable fillers are administered by experienced board-certified dermatologists, adverse events are rare and can be successfully managed with appropriate treatment.
As non-physician providers seek authority to perform cosmetic medical procedures, patient safety and the value of specialty medical training is threatened. Read more inDermWorld.
The FDA has approved tapinarof 1% cream (Vtama) for the treatment of plaque psoriasis in patients with mild, moderate, or severe disease. Tapinarof, an aryl hydrocarbon receptor agonist, is the only non-steroidal drug approved for this indication.
The approval was based on data from the PSOARING 1 and 2 phase 3 trials as well as the PSOARING 3 long-term extension study. A statistically significant improvement in PGA score of clear or almost clear, with at least a 2-grade improvement at week 12 was achieved in 36% of patients using tapinarof in the PSOARING 1 trial and 40% of those in the PSOARING 2 trial, compared to 6% of those in each respective vehicle arm. In the extension study, 40% of patients who achieved a PGA of 0/1 during the initial trials showed a remittive effect while off therapy for a median of four months.
MIPS automatic EUC applies to designated areas in New Mexico
In response to the Federal Emergency Management Agency (FEMA) designation of the recent New Mexico wildfires and straight-line winds as a major disaster and declaration of a public health emergency, CMS has determined that the MIPS automatic extreme and uncontrollable circumstances (EUC) policy will apply to MIPS-eligible clinicians in designated areas of New Mexico.
MIPS-eligible clinicians — participating as individuals — in these areas will be automatically identified and have all four performance categories reweighted to 0% during the data submission period for the 2022 performance period (Jan. 3, 2023, to March 31, 2023). This will result in a neutral payment adjustment for the 2024 MIPS payment year.
The MIPS automatic EUC policy does not apply to eligible clinicians participating in MIPS as a group, virtual group, or APM entities. Those who do not fall within CMS’ automatic EUC policy can apply for the 2022 EUC application on the Quality Payment Program website.
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