In an article published in Contact Dermatitis, authors investigated the characteristics of patients with facial dermatitis using patch test results from 27 cosmetic-related allergens and a new test series with 21 cosmetic-relevant natural ingredients developed by the study’s authors.
[What challenges and barriers exist when patch testing children? Read more.]
Of 8,740 patch tested patients, allergic contact dermatitis was observed in 90% of cases — 26% of which had facial dermatitis. Of those, 30.6% were diagnosed with facial dermatitis partly or fully caused by cosmetics. The most common patch test-positive cosmetic-relevant natural ingredients were hydroperoxides of linalool (6.1%), propolis (4.5%), and hydroperoxides of limonene (3%). Eight different preservatives were included in the natural ingredients test and were responsible for 17% of positive patch test reactions with methylisothiazolinone (MI) (9.4%) and methylchloroisothiazolinone/MI (7.7%) as the most common preservative allergens. Female gender and age older than 40 years were both associated with a significantly higher risk of cosmetic-induced facial dermatitis.
Are you a rash whisperer? Learn more about diagnosing and treating patients with allergic contact dermatitis inDermWorld.
DermWorld Insights and Inquiries: Humbled again — Alopecic and aseptic nodules of the scalp
I confess. I had never heard of alopecic and aseptic nodules of the scalp (AANS) and have probably beaten around the bush with alternative (incorrect) diagnoses when confronted with probable cases. Although usually observed in younger people, AANS may affect all age groups, being reported in children as young as seven years old to age 72 years. Clinically, AANS presents as one or few dome-shaped, firm or fluctuant, and usually asymptomatic nodules on the vertex or occipital area associated with non-scarring alopecia and surrounding normal scalp. Drainage of the nodules reveals serous, bloody, or purulent exudate. Cultures are routinely negative. Keep reading!
Derm Coding Consult: Applying 2021 E/M coding concepts in everyday practice – Part 7
Part seven of the AADA’s clinical vignettes focuses on the application of coding concepts related to E/M encounters. These clinical vignettes demonstrate how a common dermatologic condition, actinic keratosis in these examples, can be categorized under different categories of problem addressed during the encounter depending on disease severity and patient presenting circumstances at the time of the encounter. View the coding vignettes.
Progression of frontal fibrosing alopecia in Black women
A study published in theBritish Journal of Dermatologyfound that Black women with frontal fibrosing alopecia (FFA) may have more rapidly developing disease compared with white women. Black patients had a higher prevalence of itching (50%) compared with white patients (5%). Black patients had a higher incidence of vertex/central involvement of the scalp (50% vs 27%) compared with white patients. Black women also had higher rates of co-existing hair disorders such as central centrifugal cicatricial alopecia, systemic lupus erythematosus, and alopecia areata.
According to the study authors, increased prevalence of hairline recession along with younger age at presentation may suggest development of more severe clinical disease at a faster pace, which means that treatment may need to be initiated earlier in this population.
What UnitedHealthcare’s Designated Diagnostic Provider program may mean for you: Protect your referral relationship with your dermatopathologist
In preparation for the Jan. 1, 2022, launch of UnitedHealthcare’s (UHC) Designated Diagnostic Provider program (DDP), the AADA needs your specialty perspective and experience with access to dermatopathology. The DDP will impact access to reference labs, including outside independent and outpatient hospital-affiliated labs, with reimbursement tiered based on DDP-approved designation.
If you are contracted with UHC and send your biopsied skin specimens to an outside reference lab for either slide processing and/or interpretation, or both, please be advised that DDP may disrupt your trusted and reliable relationship with your dermatopathology lab of choice. To determine if you and your preferred dermatopathology lab are at risk of being impacted by DDP, view this map that shows which states have approved or are expected to approve DDP before 2022.
The AADA needs your input to protect your patients and practice from unreasonable and unfair restrictive policies. The AADA is requesting you take the following steps:
Please consult with your dermatopathology reference lab to verify if they are either accredited by the College of American Pathologists or the Joint Commission, as well as confirm their current status in obtaining DDP approval from UHC. Reimbursement will be tiered, with DDP-approved labs receiving the maximum allowable rate pegged to the going Medicare rates.
After confirming, let us know if your preferred reference lab runs the risk of not obtaining DDP-approved status.
The AADA continues to advocate for dermatologists and their choice of preferred dermatopathologist. The AADA’s policy reaffirms the unique value of the consultative and diagnostic nexus the exists between dermatology and dermatopathology. Your voice and input as a dermatologist relying on your choice of dermatopathology reference lab is critical. Your patients deserve the right to receive accurate interpretation of skin biopsies based the relationship between you and your preferred dermatopathologist.
Let the AADA know!
Review the two steps listed above and help make dermatology and dermatopathology a unified, stronger voice by sharing your situation with the AADA at privatepayer@aad.org.
To learn more about DDP or if your reference lab has not been contacted by UHC, visit the UHC provider website as UHC continues to identify which labs will be accepted into the DDP program. If your reference lab hasn’t been informed, please reach out to your assigned UHC network provider contact.
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