According to a study published in the Journal of Cosmetic Dermatology, acne may be a systemic condition capable of triggering other non-skin-related comorbidities, including enthesitis. The study included 90 acne patients (30 with mild acne, 30 with moderate acne, and 30 with severe acne) and 30 people without acne.
[What’s new in acne treatments? Read more inDermWorld.]
The Leeds Enthesitis Index (LEI) score was used to examine tenderness at the insertion of the bilateral Achilles tendon, medial femoral condyles, and the lateral humeral epicondyles. Enthesitis features include hypoechogenicity, enthesophytes, increased thickness, calcifications, and erosions, among other features.
Acne patients had significantly higher thickness compared with the control group participants at all LEI sites. There was no difference between the groups in terms of erosions and calcifications.
A significant association between tenderness and ultrasound increased thickness in the left femoral condyle was observed, which increased left femoral condyle hypoechogenicity on ultrasound. A highly significant association was established between tenderness and hypoechogenicity on ultrasound at three sites (right humerus epicondyle, right femoral condyle, and left humerus epicondyle). Enthesis calcifications were also associated with increased acne severity in the left humerus epicondyle and right Achilles tendon.
DermWorld Insights and Inquiries: Touching on contact pemphigus and pemphigus-like eruptions due to imiquimod
Most astute medical dermatologists are aware of drug-induced pemphigus, but many (including myself) may not be as familiar with topical medications being the responsible culprits. This commentary will focus on imiquimod-induced pemphigus and pemphigus-like eruptions (PLE).
My curiosity was piqued by the case of a five-year-old girl treated for molluscum contagiosum on her legs with 5% imiquimod cream for two months prior to the appearance of a bullous eruption on her scalp, face, and upper trunk. Clinically, the lesions resembled bullous impetigo. Histologically, subcorneal acantholysis (a superficial pemphigus pattern), spongiosis, neutrophils and eosinophils were observed; direct and indirect immunofluorescence studies (DIF, IIF) were negative, as were serum antibodies for desmogleins 1 and 3. Prior to the biopsies, she was treated for presumed bullous impetigo with multiple antibiotics without observed improvement; following the biopsy, she responded rapidly to the discontinuation of imiquimod and the administration of prednisolone followed by dapsone. The authors concluded that their patient had a PLE induced by imiquimod by a mechanism distinct from the classical antibody-mediated pathway. Keep reading!
Derm Coding Consult: Applying 2021 E/M coding concepts in everyday practice – Part 4
In part 4 of the series, four clinical vignettes demonstrate how chronicity and severity impact the level of service provided. A 17-year-old male presents with acneiform papules on his chin for one month. The patient had clear skin prior to starting football practice. The papules are under the area covered by his chin strap. The patient is diagnosed with acne due to physical occlusion from the chin strap. A prescription for topical benzoyl peroxide 5%/clindamycin 1% gel is provided. Review the MDM elements and get the level of service.
Cutaneous adverse events of immune checkpoint inhibitors
In a retrospective analysis published in The Journal of Dermatology, 1,711 patients treated with immune checkpoint inhibitors were evaluated for cutaneous adverse events (CAE). In total, 2.75% of patients treaded with PD-1/PD-L1 inhibitors experienced CAE. The most common events were pruritic, psoriasiform, urticarial, and acneiform eruptions.
Patients being treated for melanoma and genitourinary cancer were most likely to have CAE. Urticarial eruptions occurred earlier in the treatment course while keratoacanthomas developed later in the treatment course. The overall survival times were not significantly different between the two groups.
Pharmaceutical testing detects high levels of benzene in some sunscreen products
The AADA is aware of recent analysis by pharmaceutical company, Valisure, who tested and detected high levels of the industrial chemical benzene, a known human carcinogen, in several batches of sunscreen and after-sun care products. Of all products tested, 78 products (27%) contained benzene.
Some batches contained up to three times the conditionally restricted U.S. Food and Drug Administration (FDA) concentration limit of two parts per million (ppm), the limit when a drug product constitutes a “significant therapeutic advance,” where the use of the chemical is “unavoidable.” For standard drug products, the FDA states the benzene should not be used in the manufacturing of drug substances because of its toxicity, but it does not specifically define limits. As a reminder, sunscreen products are regulated as over-the-counter drugs by the FDA.
The health and safety of the public is paramount, and the Academy remains committed to supporting and enhancing patient care. As media coverage continues, the AADA looks forward to the FDA’s response to the associated citizen petition which urges the FDA to issue a regulation, request recalls, revise industry guidance, or take other action in response to Valisure’s findings.
Timolol as high-value treatment for wounds
According to coverage of AAD VMX 2021 by Healio, a poster presentation highlighted timolol, a beta-adrenergic receptor antagonist, as an effective and inexpensive treatment for wound healing. Partial or complete response to timolol occurred in 91% of patients and in 100% of patients with chronic wounds.
Wound indications included vascular, inflammatory, postsurgical/trauma, sclerosis, malignancy, and unknown. Wounds had persisted for a mean period of 176 days before timolol treatment. They were treated with timolol one to three times daily for a mean of 120 days. The poster authors wrote that, “Topical timolol is an inexpensive medication, with a 5 mL solution priced at $6 to $35 without insurance.”
The live AAD VMX event is over, but you can still register to watch all the sessions on-demand until July 12, 2021.
DataDerm™: 2020 MIPS reporting brief
Despite challenges from the COVID-19 pandemic, the MIPS 2020 performance year was a successful one for DataDerm and Academy members. In 2020, the Centers for Medicare & Medicaid Services (CMS) allowed clinicians to opt for an extreme and uncontrollable circumstances (EUC) exception in which clinicians could exempt themselves from self-selected categories or the entire program for the year. The exemption contributed to a 66% decrease in members reporting via DataDerm — from 1,989 providers in 2019 to 671 providers in 2020. DataDerm staff assisted more than 500 members with completing EUC applications. DataDerm closed the 2020 MIPS reporting year with a 100% accuracy data rate among reporting providers.
The average total MIPS score increased by 18.4% from an average score of 62.89 in 2019, to 74.45 in 2020. This is attributed to the increase of the penalty threshold from 30 points in 2019 to 45 points in 2020. Additionally, there were a total of 3,031 total measures submitted for 2020 comprised of 2,577 MIPS measures and 454 QCDR measures from participating Academy members.
The quality measures reported by the most practices were Melanoma: Recall System, Biopsy Follow-Up, and Documentation of Current Medications. The quality measures reported with the most patients were Documentation of Current Medications, Influenza Immunization, and the Flu Vaccination.
In an effort to help members ease reporting burden, DataDerm staff helped members select measures across MIPS categories that are commonly reported together. For example, practices that report quality measures 265, 440, and AAD 6 also tend to report “Timely Communication of Test Results” (Measure ID: IA_CC_2) for the improvement activity category, which can also be tied to the promoting interoperability Health Information Exchange measure set. This information will be helpful in the transition to reporting to MIPS Value Pathways (MVP), which aim to align and connect measures and activities across the quality, cost, and improvement activities performance categories of MIPS.
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