What topical psoriasis treatments do patients prefer?
Researchers of a study published in the Journal of Drugs in Dermatology assessed patients’ psoriasis treatment experience, expectations, and preferences. If the treatment is disliked, 75% of patients will use a medication one week before discontinuation.
Most patients reported using a topical treatment at least once weekly (76%); however, nearly 73% reported the additional use of oral medication, biologics, cyclosporine, or methotrexate. Water-based creams emerged as the preferred topical treatment type for psoriasis (75.7%), closely followed by oil-based foam (70.8%). A significant decline in preference was observed in the remaining topical options, including gels (48.7%), solution (42.8%), lotion (21.2%), non-oil-based foam (17.5%), ointment (16.5%), and spray (6.3%).
When asked what formulation attributes were most important in topical therapy, 55% of patients said application feel, 50% said non-staining quality, and 46.7% said quick absorption. Other important characteristics included non-sticky texture (39.7%), application ease (28.5%), absence of unpleasant smell (22.4%), non-greasy feel (16.8%), rapid efficacy (14.1%), no stinging or burning (10%), lack of adverse skin reactions (9.7%), and once-daily application (6.8%).
DermWorld Insights and Inquiries: Leadership succession — Sunrise, sunset
Topol’s recent passing unleashed an avalanche of emotion. I watched Fiddler on the Roof for the first time in the 1971 Norman Jewison production with my parents. Topol played the role of Tevye, a weary milkman with five daughters, as he navigated the pressures of a changing, antisemitic world countered against his penchant for tradition. There are so many poignant scenes in this movie, but (for me) none more than when Tevye and his wife Golde sing “Sunrise, Sunset” as their eldest daughter Tzeitel takes her marriage vows with the poor tailor Motel. Somberly accepting how one season follows another, Tevye asks himself, “What words of wisdom can I give them? How can I help to ease their way?” I am asking myself that question to assist our new Division Head of Dermatology at Cooper Medical School of Rowan University, Dr. Camille Introcaso. Keep reading!
FDA extends approval of at-home pregnancy tests under iPLEDGE
In an AADA advocacy win, the Food and Drug Administration (FDA) officially extended certain COVID-19-related flexibilities through fall 2023, including accepting at-home pregnancy tests and other non-CLIA tests for the iPLEDGE Risk Evaluation and Mitigation Strategy (REMS). The AADA has been advocating for the use of at-home pregnancy tests under iPLEDGE, most recently at an FDA Advisory Committee meeting. At that meeting, the committee supported permanently allowing non-CLIA pregnancy tests for at-home testing or in-office testing, and the AADA has sent a follow-up letter to the FDA requesting that they accept this recommendation and make other necessary changes to the program.
Reducing the administrative burden of iPLEDGE remains a top advocacy priority, and the AADA continues to press the FDA to make this change permanent. Additionally, the AADA urges the FDA to remove the monthly physician attestation requirements for patients who cannot become pregnant, remove the 19-day “lockout” period if a patient misses an initial window period, and increase transparency and improve the inclusion of stakeholders, including dermatologists in the program.
CDC announces first reported U.S. cases of tinea caused by Trichophyton indotineae
During the past decade, an epidemic of severe, antifungal-resistant tinea has emerged in South Asia because of the rapid spread of Trichophyton indotineae, a novel dermatophyte species. In the May 12 edition of the Morbidity and Mortality Weekly Report, the CDC reports that on Feb. 28, 2023, a New York City dermatologist notified public health officials of two patients who had severe tinea that did not improve with oral terbinafine treatment. Both skin cultures were sequenced and identified as T. indotineae infection. T. indotineae infections are highly transmissible and characterized by widespread, inflamed, pruritic plaques on the body (tinea corporis), the crural fold, pubic region, and adjacent thigh (tinea cruris), or the face (tinea faciei).
The CDC notes that both cases highlight several important points. The first patient had no recent international travel history, suggesting potential local U.S. transmission of T. indotineae. Clinicians should consider T. indotineae infection in patients with widespread tinea, particularly when eruptions do not improve with first-line topical antifungal agents or oral terbinafine. Culture-based identification techniques used by most clinical laboratories typically misidentify T. indotineae as T. mentographytes or T. interdigitale. Genomic sequencing is required for correct identification. Clinicians who suspect T. indotineae infection should contact their state or local public health department for assistance with testing.
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.
AADA gains critical clarification on Aetna’s Claim and Coding Review Program
Because of AADA’s consistent advocacy, Aetna clarified its Claim and Coding Review Program that reduces payment for levels 4 and 5 evaluation and management (E/M) codes.
The AADA was concerned since Aetna did not directly communicate to impacted physicians about payment reduction while the E/M code level remained unchanged and advocated for increased transparency. The insurer alerted physicians about the reimbursement change through their explanation of benefits (EOB) notifications. The notification will vary depending on whether Aetna provides an electronic or paper EOB.
For paper EOB Action Code: R11
Patient EOB: There is a more appropriate code for this service. Our payment reflects that code.
Physician EOB: The consult, billed diagnosis, or services do not match the E/M service reported. Our payment reflects the more appropriate E/M code. If you believe that the consult code or E/M service billed accurately reflects the services provided, you have the right to dispute. Please submit any new information, such as medical records or related documents, to us through the normal dispute process.
For electronic Patient and Physician EOB Action Code: N22
“Alert: This procedure code was added/changed because it more accurately describes the services rendered.”
Aetna responded to the AADA’s questions on the carrier’s claim review program that evaluates the coding for level 4 and 5 E/M codes (CPT codes 99204, 99205, 99214, 99215, 99244, 99245, 99204, and 92014). Based on the review outcome by Aetna’s subcontractor Availity, payment may be decreased but does not change the reported CPT code.
Aetna clarified that this program applies to its commercial plans in Arizona, Washington, D.C., Maryland, New Jersey, New York, Indiana, Michigan, Illinois, Ohio, Pennsylvania, Utah, and Wisconsin. At the AADA’s urging, Aetna researched and stated that of the total of 10,870 physicians that are included in the E/M payment adjustment program, only 214 (2%) are identified as dermatologists.
FDA update: Use of Renuvion/J-Plasma device for certain aesthetic procedures
In March 2022, the FDA warned physicians against the use of the Renuvion/J-Plasma device by Apyx Medical for aesthetic procedures intended to improve the appearance of the skin through dermal resurfacing or skin contraction. Last June, the FDA updated its safety communication to inform physicians about a new handpiece for the Apyx Renuvion/J-Plasma device system that can be used for certain aesthetic skin procedures. In July 2022, the FDA informed physicians about the FDA clearance of a Renuvion/J-Plasma handpiece that can be used under the skin in certain procedures intended to improve the appearance of loose skin.
Last week, the FDA informed physicians and consumers about an additional FDA clearance for a Renuvion/J-Plasma handpiece that can be used under the skin in certain procedures intended to improve the appearance of the skin. On April 27, 2023, the FDA cleared the Renuvion APR handpiece for coagulation of subcutaneous soft tissues following liposuction for aesthetic body contouring. A separate handpiece, the Renuvion Dermal Handpiece, is indicated for the treatment of moderate to severe wrinkles and rhytides in patients with Fitzpatrick Skin Types I, II, or III.
Current indications for the Renuvion APR Handpiece include:
The Renuvion APR Handpiece is intended for the delivery of radiofrequency energy and/or helium plasma where coagulation/contraction of soft tissue (including subcutaneous tissue) is needed.
The Renuvion APR Handpiece is intended for the coagulation of subcutaneous soft tissues following liposuction for aesthetic body contouring.
The Renuvion APR Handpiece is indicated for use in subcutaneous dermatological and aesthetic procedures to improve the appearance of lax skin in the neck and submental region.
The Renuvion APR Handpiece is intended for the delivery of radiofrequency energy and/or helium plasma for cutting, coagulation, and ablation of soft tissue during open surgical procedures.
Watching for signs of Marburg virus disease, non-itchy rash
The CDC reported two confirmed outbreaks of Marburg virus disease (MVD) — one in Equatorial Guinea and one in Tanzania. As of May 8, 2023, no suspected, probable, or confirmed cases related to these outbreaks have been reported in the United States. While the overall risk of MVD in the U.S. is low, physicians should be aware of the potential for imported cases.
Marburg virus can spread between humans via direct contact (through broken skin or mucous membranes) with infectious blood or body fluids of infected people or animals (living or deceased), and from needles or other surfaces and materials contaminated with the virus. MVD is not spread through airborne transmission and a person is not contagious until symptoms appear. With an incubation period ranging from two to 21 days, MVD has a similar presentation to Ebola virus disease, typically starting with the abrupt onset of high fever, severe headache, and severe malaise. In addition to gastrointestinal issues, other common symptoms include muscle and joint pain, neurological symptoms, and a non-itchy rash.
View the CDC’s guide for clinicians evaluating a patient suspected of MVD.
Academy Advisory Board invites members to submit policy resolutions by July 3
The Academy’s Advisory Board invites all Academy members as well as state, local, and specialty dermatology groups to submit proposed AAD/A policy resolutions on issues of interest or concern. The Advisory Board convenes twice a year at the AAD Annual Meeting and Innovation Academy to deliberate on issues of importance to individual practitioners, which may be forwarded to the Academy’s Board of Directors for consideration. Resolutions should ask for the Academy to take specific action relating to advocacy or a general Academy policy.
The author or Advisory Board representative of the resolution must be present during the Reference Committee Hearing to introduce and discuss the resolution. Even if you do not submit a resolution, the Academy encourages all members to attend the Reference Committee Hearing to hear the debate on the proposed resolutions. The full Advisory Board will vote on the resolutions at the General Business Meeting, which will take place at the AAD’s 2023 Innovation Academy.
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