Can oral nutraceuticals reduce isotretinoin side effects?
In an article published in JAAD, the study authors sought to evaluate the evidence regarding the role of oral nutraceuticals as adjunctive therapy in managing side effects of isotretinoin. Two randomized controlled trials found that omega-3 fatty acids reduced the frequency of mucocutaneous side effects. In the first double-blind trial, the authors found that 1mg/kg/day of omega-3 reduced rates of cheilitis, lip dryness, and xerosis. In the second double-blind trial, the authors found that 1g/day of omega-3 reduced cheilitis, xerosis, and nasal dryness.
[FDA extends flexibilities for iPLEDGE REMS Program. Read more.]
A single-blind trial demonstrated that zinc (1mg/kg/day) with low-dose isotretinoin (0.25mg/kg/day) has similar efficacy but reduced overall treatment-related side effects and cheilitis compared to isotretinoin alone during 20 weeks of treatment.
[Mood changes in adolescents taking isotretinoin. Read more.]
According to the authors, the review highlights that supplements containing omega-3 fatty acids may be useful as adjunctive therapy to reduce mucocutaneous dryness associated with isotretinoin. Zinc may allow for lower dose isotretinoin regimens and thus reduced side effects, although future studies are required to further evaluate the benefit of these nutraceuticals.
How to meet patients’ desire for alternative medicine with evidence-based care. Read more in DermWorld.
DermWorld Insights and Inquiries: Exchanging plasma exchange for a novel approach — The potential of FcRn antagonists in dermatologic autoimmune disease
Pemphigus vulgaris (PV) and pemphigus foliaceus (PF) are potentially life-threatening disorders demanding aggressive therapy with all the finesse and skill that dermatologists can muster. The current first-line treatments for PV and PF are corticosteroids and rituximab. The litany of adverse reactions to these medications are well-known. Because of the crucial role IgGs play in the pathogenesis of these disorders, reducing the autoantibody levels by plasma exchange, immunoadsorption, and intravenous immunoglobulin (IVIg) have been used adjunctively in recalcitrant disease. IVIg infusion adverse events, including infusion site reactions, neurological and renal complications, and thrombotic events, may be severe. A safer alternative in decreasing pathogenic IgGs would be a major advance in PV and PF management. Keep reading!
Risk of rebound psoriasis flare from systemic corticosteroids
In a retrospective cohort study published in JAAD, the study authors explored the relationship between psoriasis flares and corticosteroid use. Of the psoriasis patients, 56% experienced a psoriasis flare with a 10% or more increase in body surface area affected after oral corticosteroid use for any indication.
[What's coming down the psoriasis pipeline? Read more in DermWorld.]
Most patients were also on biologics and required a change in therapy after using corticosteroids. The flares occurred between three and seven weeks after the steroid taper. The authors recommend that dermatologists and the non-dermatologic community should avoid prescribing systemic corticosteroids to psoriasis patients.
A study published in JAMA Dermatology assessed whether patients with melanoma have different fecal microbiota than individuals without melanoma, and whether the microbiome differed based on disease stage. In this study of 228 participants, patients with melanoma had a different structure of microbiome, with lower abundance of multiple beneficial commensals, compared with control participants. The gut microbiota of patients with early-stage melanoma was characterized by higher alpha diversity and a distinct microbiome structure compared with those with late-stage melanoma.
The authors concluded that fecal microbiota profiles were significantly different among patients with melanoma and controls and between patients with early-stage and late-stage melanoma. Prospective investigations of the gut microbiome and changes that occur with disease progression may identify future microbial targets for intervention.
Effective Nov. 1, Elevance Health (formerly Anthem) is reintroducing its E/M leveling program (downcoding) in the following states:
Commercial: CT, GA, IN, KY, MO, NV, OH, WI
Medicaid: AR, DE, FL, GA, KY, MD, MO, NY, WV, WI
Medicare: CA, CO, CT, FL, GA, IN, KY, LA, MD, MO, NV, NJ, NM, NY, OH, TX, VA, WI
Markets that are not live in 2023 will be considered for implementation in 2024
The program will target physicians with relatively higher rates of Level 4 and 5 E/M codes than their peers. The carrier’s process will only review Level 4 and 5 E/M codes and will not change the codes to less than a Level 3 E/M.
The AADA has a call scheduled with Elevance on Nov. 3 to discuss program details and assess the impact on dermatologists. The Academy opposes reimbursement policies implemented by payers that reduce E/M payment when the E/M code is appropriately documented and reported.
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