Novel treatments for chronic spontaneous urticaria
A review published in the Journal of Allergy and Clinical Immunology discusses novel therapies trialed in patients with chronic spontaneous urticaria (CSU). With expanding knowledge of the pathogenesis of CSU and the role of mast cells, novel therapeutic agents targeting unique pathways important in CSU are in development.
[What treatment is most effective for chronic spontaneous urticaria? Find out inDermWorld Weekly.]
Agents under investigation include monoclonal antibodies against IgE (with higher affinity than omalizumab), IL-4, c-KIT, tryptase, sialic acid-binding immunoglobulin-like lectin 8, and oncostatin as well as Burton’s tyrosine kinase inhibitors. Currently, omalizumab is the only FDA-approved option for treating CSU, although a significant percentage of patients still do not respond to the combination of antihistamines and omalizumab. Numerous other agents are in development in clinical trials.
Read about factors that may predict chronic spontaneous urticaria recurrence inDermWorld Weekly.
DermWorld Insights and Inquiries: Unrestricted fascination with restrictive dermopathy
Barely a week into our fellowships at the University of Pennsylvania in 1984, my wife (a geneticist) asked her favorite dermatologist (me) if I had any thoughts about a neonate with skin that was thin, taut, and translucent. Nearly four decades later, I can still visualize the apparent vasculature on the trunk and the “O” shaped mouth of this neonate who expired within weeks of birth. There were other features such as scaling skin and joint contractures. Other than being astounded by the presentation, I had nothing to offer. My wife presented this case as an abstract entitled, “A lethal ichthyosis variant with arthrogryposis” at the American Society of Human Genetics in 1985. Keep reading!
DermWorld Young Physician Focus: Academy staff offer refresher on top E/M coding errors
In this month’s DermWorld Coding Consult, Academy staff provide pertinent reminders to help dermatologists ensure that we are coding for our services appropriately. With the E/M guidelines having changed so dramatically in 2021, some dermatologists may remain set in the “old ways.” Academy staff report they have heard from many dermatologists who say, “I have never billed a level 4 for this type of visit,” or “How can this be a level 4 when my history and physical exam are not comprehensive?” Dermatologists must remember that the old, complex rules for counting history elements and physical exam bullet points are now obsolete and have no bearing on the new E/M coding guidelines. Read more from Bridget McIlwee, DO, FAAD, DermWorld Young Physician Advisor.
Selecting the right biologic treatment for psoriasis patients
In a recent JAMA Dermatology study, researchers investigated the drug survival associated with effectiveness and safety of adalimumab, ustekinumab, secukinumab, ixekizumab, and guselkumab in patients with psoriasis.
[Which biologics are most effective for psoriasis? Read more in DermWorld Weekly.]
For drug survival associated with effectiveness, guselkumab had the higher overall drug survival and adalimumab had the lower survival compared with ustekinumab. Secukinumab and ixekizumab had similar survival curves over time. Psoriatic arthritis, nail involvement, previous biologic exposure, and ethnicity were patient factors that affected drug survival in association with treatment effectiveness. For drug survival associated with safety, guselkumab, ustekinumab, and secukinumab had similar survival curves while adalimumab and ixekizumab had lower drug survival compared with ustekinumab. The study results suggest that guselkumab had the highest drug survival rate for effectiveness and safety.
Do e-visits for isotretinoin management cause interruptions in care?
Authors of a JAAD research article explored how e-visits affect continuity of isotretinoin management. In this study, an e-visit is a patient-initiated, asynchronous store-and-forward submission via an EHR’s patient portal.
[Patient portals: Pros and problems. Read more in DermWorld.]
The retrospective study found similar treatment interruption rates (defined as >1 week without an isotretinoin prescription), with isotretinoin therapy for acne during office-only visits between July 2018 and June 2019 (19%) and after the implementation of combination office visits, e-visits, and video visits from October 2019 to March 2021. Most interruptions led to a less than one-month delay of the prescription and did not differ between time periods. The authors found no change in interruption rate or duration after isotretinoin e-visits were instituted.
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