Is spironolactone use for acne associated with increased risk for venous thromboembolism?
In a recent JAAD paper, researchers conducted a retrospective cohort study to compare the risk of deep venous thrombosis (DVT) or pulmonary embolism (PE) in patients with acne treated with spironolactone versus a tetracycline-class antibiotic.
[Is topical spironolactone effective for acne? Find out inDermWorld Weekly.]
Participants were women who had at least one acne diagnosis and received a minimum of 60 days of treatment with spironolactone or a tetracycline-class antibiotic. A total of 33,543 participants who received spironolactone were matched with 33,543 participants who received a tetracycline-class antibiotic. Of the participants, 8.6% were currently receiving combined oral contraceptives. Patients who were treated with spironolactone were not more likely to experience a DVT (odds ratio, 0.57) or PE (odds ratio, 0.60) compared with those who received tetracycline-class antibiotics.
DermWorld Insights and Inquiries: PRAME sets its eyes on the road to fame
In 1997, the discovery of a protein from cultured metastatic melanoma cell lines excited the pathology community. Preferentially expressed antigen in melanoma (PRAME), in contrast to other melanocytic markers, is differentially expressed in melanocytic nevi and melanomas. Overexpression of PRAME is observed in melanomas and a variety of other cancers including breast, lung, kidney, ovary, and leukemias. Because of the robust differential expression in nevi and melanomas, PRAME is utilized in several gene expression profiling tests for the prognostication of uveal melanomas (Decision Dx-UM), diagnosis of melanomas (myPath Melanoma), and guidance on the decision to biopsy (DermTech). With the availability of PRAME immunohistochemistry (IHC), pathologists have been very busy in the last five years evaluating its potential diagnostic role in melanoma. Keep reading!
How effective is oral ivermectin for scabies patients?
A cohort study published in Clinical and Experimental Dermatology assessed the results of treating patients with scabies with a single dose of oral ivermectin. The authors compared two regimens (single dose vs. two doses). A total of 71 patients received a single dose and 68 patients received two doses one week apart. Clearance of the disease was achieved in 98% of the double dose group. In the single dose group, treatment was successful in only 58% of patients. The authors conclude that a two-dose oral ivermectin intervention is superior to a single dose of the drug, which may be attributed to the life cycle of the scabies mite.
Experts discuss treatment options and tips for successfully diagnosing and treating lice and scabies. Read more in DermWorld.
GPP treatment receives FDA breakthrough therapy designation
The U.S. FDA has granted a Breakthrough Therapy designation for spesolimab to prevent generalized pustular psoriasis (GPP) flares. The designation was granted based on topline data from the EFFISAYIL 2 trial that examined whether long-term treatment with spesolimab, a humanized selective antibody that blocks interleukin-36 receptor (IL-36R) activation, helps to prevent the flares in adolescents as well as adults with GPP. Last year, spesolimab met primary and secondary endpoints in the trial (NCT04399837) showing significant prevention of GPP flares in adolescents and adults for up to 48 weeks.
IL-36 plays an important role in the pathogenesis of pustular psoriasis. Targeting this cytokine therapeutically may have the capability to alter the course of this potentially life-threatening disease. Read more in DermWorld Insights and Inquiries.
Former AAD president to address cutaneous manifestations of fungal infections, emerging drug-resistant species
Former AAD President Boni E. Elewski, MD, FAAD, an expert on cutaneous mycoses and dermatologic clinical trials, will be addressing the cutaneous manifestations of fungal infections with George R. Thompson, III, MD, an expert on fungal diagnostics and treatment, for a Grand Rounds Webinar Series held by the Mycoses Study Group Education & Research Consortium (MSGERC).
They will examine current challenges in the diagnosis and management of the cutaneous manifestations of fungal infections. They will explore the differential diagnosis and treatment of superficial fungal infections such as onychomycosis, tinea pedis, and tinea corporis; implantation mycoses; and skin manifestations of invasive fungal infections. The speakers will also address emerging issues such as antifungal resistance, particularly for dermatophyte infections, including recent U.S. cases of severe tinea infections caused by a novel and frequently drug-resistant dermatophyte species — Trichophyton indotineae.
The webinar will take place Wednesday, May 17, from 12-1 p.m. ET. Register now!
Responding to multiple JAAD Case Reports articles indicating a growing problem, the CDC is investigating whether a pattern of treatment-resistant dermatophytosis is emerging. Read more.
Prepare your practices for Cigna’s modifier 25 policy
As previously reported, Cigna announced its plans to move forward with its modifier 25 policy. The policy takes effect in most states on May 25, 2023. However, the policy comes into effect in California, Colorado, Kentucky, Ohio, and Texas, on June 11, 2023. While the AADA continues to advocate for Cigna to rescind or revise this policy, it wants to ensure that practices can comply so payment is timely and not reduced.
Dermatology practices are encouraged to take the following steps:
IMPORTANT: Check the “Attachment Indicator” on the CMS-1500 form when submitting impacted claims. This step signals that notes will be provided related to the claim, and claims will be processed as normal.
If the above steps are not completed, Cigna will deny the E/M service but still reimburse for the procedure(s). Watch Cigna’s explanatory video on its new policy for more information.
While Cigna is moving forward with its policy, the AADA has been successful in mitigating the administrative burdens to practices as Cigna has agreed to the recommendations made by the AADA to:
Accept batched copies of office notes (instead of separately submitting office notes with each claim).
Rescind the requirement to have a cover page for the office notes if the office notes have the requested information.
Verify that Cigna’s process for collecting and retaining office notes is HIPAA compliant.
Not delay payment as Cigna will pay the claim if the claim form indicates that notes will be sent. Cigna will retrospectively review the office notes after the claims are paid.
Here’s what the AADA is doing for you:
The AADA met with and sent a letter to Cigna advocating against its modifier 25 policy.
The AADA also joined 110 medical societies and health care organizations in an American Medical Association (AMA)-sponsored joint letter to Cigna objecting to this policy.
Through regular calls with Cigna, the Academy has and will continue to share feedback on the negative impact of this policy on AADA members. Your perspective is critical to informing ongoing advocacy. Please share your concerns via privatepayer@aad.org.
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