A beneficial botanical extract for actinic keratosis?
A multicenter, randomized controlled, open-label, three-arm study published in Photodermatology, Photoimmunology & Photomedicine studied the differences between self-administered sun protection, topical treatment, and topical plus oral treatment for the management of actinic keratosis in a cohort of subjects displaying severe actinic damage. The treatments administered to the topical and topical plus oral treatment groups included the botanical extract Fernblock (an extract of Polypodium leucotomos), which has demonstrated photoprotective activity.
[How effective are field treatments for actinic keratosis? Read more.]
In total, 131 subjects were distributed randomly into three groups, and followed up with at the beginning of the study, after six months, and after 12 months. Analysis of clinical data and examination using reflectance confocal microscopy (RCM) revealed that the topical group and topical plus oral treatment displayed decreased clinical AK and field cancerization parameters, including the number of new lesions, and reduced the need for additional interventions in these patients. RCM revealed normalization of the keratinocyte layer. According to the authors, improvements in AK and field cancerization parameters were greatest in the topical plus oral treatment group, suggesting that topical and oral photoprotection improves the clinical and anatomical outcome compared to control conditions.
A review of calcipotriol plus 5-fluorouracil for actinic keratosis. Read more.
DermWorld Insights and Inquiries: Dermatologic ergonomics — Straighten up and fly right
My posture has never been proper, having a proclivity to slouch. “Stand up straight, son!” my father would admonish. When I was young and supple, I would half-listen to the advice, usually reverting to my standard (incorrect) position. I still do, unfortunately, although I consciously try to adjust. As our practice has grown, I increased the number of microscope hours for dermatopathology. I needed to invest in ergonomically suitable microscope eyepieces and a chair with excellent lumbar and back support. Without those modifications, by the end of the day, I felt as though I needed a chiropractic adjustment. During my residency 40 years ago, the only training on ergonomics I recall was an impromptu conversation with my stellar attending Gary Brauner, MD, FAAD, who told me that when I open up my office (that was the expectation then) to invest in adjustable examination tables, or one day my back would regret it. Great advice! Keep reading!
FDA approves alopecia areata treatment in adults and teens
The FDA has approved the Janus kinase (JAK) inhibitor ritlecitinib (Litfulo®) for the treatment of adult and adolescent patients 12 years and older with severe alopecia areata (AA). The once-daily pill is the first systemic treatment approved for alopecia areata in adolescents.
[As biologic therapies expand indications to children and adolescents, what do dermatologists need to know about balancing the risks and benefits? Read more in DermWorld.]
The efficacy and safety of ritlecitinib in AA was studied in a double-blind, placebo-controlled trial with 718 patients who had at least 50% scalp hair loss. The primary measurement of efficacy was a score of 20 or lower on the Severity of Alopecia Tool, meaning patients had 80% or more scalp coverage after treatment.
Patients received either a placebo, 10 mg, 30 mg, or 50 mg of ritlecitinib daily with or without an initial four-week 200 mg loading dose, for a total of 24 weeks. This was followed by a 24-week extension period. 23% of patients treated with 50mg of ritlecitinib had SALT scores below 20 at 24 weeks, compared to 1.6% of placebo patients.
What has research revealed about the pathogenesis of alopecia areata and other hair disorders as well as new potential therapeutics? Find out inDermWorld.
AAD launches innovative project to improve outcomes for patients with generalized pustular psoriasis
The AAD, with critical support from Boehringer Ingelheim, and powered by OM1’s data aggregation system and its PhenOM™ artificial intelligence (AI) platform, is launching an innovative breakthrough project to develop educational resources to improve the evaluation, diagnosis, and treatment of patients suffering from generalized pustular psoriasis (GPP).
The AAD’s new Generalized Pustular Psoriasis Education Initiative aims to transform the care of these patients by leveraging the power of data in the Academy’s DataDermTM dermatology patient registry. The project will connect DataDerm’s 50 million deidentified patient encounters with OM1’s AI-based Patient FinderTM tool to improve understanding of GPP patients’ journey, treatment patterns, disease progression, and outcomes. The insights gathered will help inform the development of a range of breakthrough educational resources and tools for dermatologists, referring physicians, and patients aimed at improving the quality of life for GPP sufferers, many of whom currently experience delayed diagnosis and care. Read the press release.
Does your EHR integrate with DataDerm? Find out now.
Academy’s Medicare physician payment resolution is passed
On June 9 – 14, 2023, the AMA held its Annual Meeting of the House of Delegates (HOD). In keeping with the Academy’s strategic plan that Medicare physician payment reform should be a top priority, the AMA Dermatology Section Council (DSC) authored one resolution on Medicare physician payment reform and co-sponsored another resolution that ultimately led the AMA to officially declare that Medicare physician payment reform is an urgent advocacy and legislative priority of the AMA. Dermatology was the only specialty society in the entire AMA HOD to author or co-sponsor a resolution on the topic, yet the final resolution, as amended by the reference committee, passed unanimously in the HOD.
With passage of the resolution, the AMA is committed to implementing a comprehensive advocacy campaign, including a sustained national media strategy engaging patients and physicians in promoting Medicare physician payment reform. In addition, the AMA will prioritize significant increases in funding for federal and state advocacy budgets specifically allocated to achieve Medicare physician payment reform to ensure that physician payments are updated annually at least equal to the Medicare Economic Index and are sufficient to cover the full cost of a sustainable medical practice. The AMA will continue advocating to eliminate budget neutrality and ensure that physician payments keep pace with rising practice costs. Finally, the AMA will report updates to its advocacy progress until predictable, sustainable, fair physician payment is achieved.
In a passionate speech by AMA President Jack Resneck Jr., MD, FAAD, he stated, “This [Medicare payment reform] cannot wait; we are past the breaking point.” When adjusted for inflation, Medicare physician payment has effectively declined (PDF) 26% from 2001 to 2023. According to Dr. Resneck, “Congress must urgently address physician concerns about Medicare to account for inflation and the post-pandemic economic reality facing practices nationwide.” He added, “Our patients are counting on us to deliver the message that access to health care is jeopardized by Medicare’s payment system. Being mad isn’t enough. We will develop a campaign — targeted and grassroots — that will drive home our message.”
A bill, HR 2474, has also been introduced in Congress to tie the Medicare physician payment schedule to the Medicare Economic Index, a move that is essential to protecting access to high-quality care for the 65 million older adult Americans covered by Medicare. By instituting an annual inflation-based update, the legislation would put physicians on equal footing with virtually all other health professionals and organizations paid by Medicare.
CMS opens MIPS Final Score Preview period, hardship exemption applications open
CMS has opened the final score preview period for the Merit-based Incentive Payment System (MIPS). Authorized representatives of practices, virtual groups, and APM entities can now login to the Quality Payment Program (QPP) website to preview 2022 MIPS final scores. The Final Score Preview includes performance category-level scores and weights, bonus points, measure-level performance data and scores, and activity-level scores. The Final Score preview does not include payment adjustment information or patient-level reports. The MIPS Final Score Preview period is available until final performance feedback, including payment adjustments, is released in August 2023.
Also, CMS is accepting 2023 Hardship Exception applications. Apply for the Extreme and Uncontrollable Circumstances Exception and Promoting Interoperability category exception through CMS’s online portal. Applications can be submitted until 8 p.m. ET on Jan. 2, 2024. Learn more about the 2023 QPP exceptions.
AAD’s Good Skin Knowledge program receives vitiligo awareness award
Incyte has announced the recipients of its 2022 Ingenuity Awards in Vitiligo. The American Academy of Dermatology’s Good Skin Knowledge program was selected for the maximum possible award. The AAD Community Outreach team will develop new Good Skin Knowledge modules that aim to destigmatize vitiligo by increasing awareness and equipping educators and community leaders with English and Spanish training modules that teach children about vitiligo.
AADA action request: Support the Resident Physician Shortage Reduction Act
Ask your members of Congress to act on impending physician shortages and cosponsor the Resident Physician Shortage Reduction Act of 2023 (S. 1302/H.R. 2389).
The shortage of physicians in our country is a growing problem, particularly in many rural and underserved communities where patients often travel long distances to receive care. The Resident Physician Shortage Reduction Act of 2023 would work to solve this by raising the number of Medicare-supported GME positions by 2,000 per year for seven years, for a total of 14,000 new slots. Contact your member of Congress and ask them to address the growing shortage of physicians by supporting the Resident Physician Shortage Reduction Act (S. 1302/H.R. 2389).
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