How does wearing occlusive gloves impact hand eczema?
A study published in Advances in Dermatology and Venereology found that wearing occlusive gloves greatly increased the density of Staphylococcus aureus in patients with hand eczema.
Patients with moderate-to-severe hand eczema wore an occlusive glove on one hand for four hours with a 30-minute break. Bacterial swabs were collected from the most severe eczema lesion on the hand before and immediately after glove exposure. Among 30 patients, 63% were colonized with S. aureus. After wearing the glove, S. aureus colony-forming units increased by a factor of 1.72. There was no increase in S. aureus colonization after occlusion on the non-lesional skin.
Read about how dupilumab may possibly induce various forms of arthropathy, enthesitis, or tendinopathy inDermWorld Insights and Inquiries.
DermWorld Insights and Inquiries: What’s up in Down syndrome?
Being married to a geneticist has served me well as a dermatologist. Just as dermatologists can instantly diagnose many dermatoses based on pattern recognition, geneticists skilled in dysmorphology can identify many syndromes in a heartbeat. Physicians of all stripes need to recognize Down syndrome (DS, Trisomy 21) because of its vast multiorgan manifestations.
DS is the most common chromosomal abnormality accounting for 8% of all registered cases. The incidence of Down syndrome is every 1 in 700 live births in the United States. DS is caused by the presence of all, or part of a third copy of chromosome 21. This extra genetic material is responsible for the classical facial characteristics, multiple malformations, intellectual disability, immune and endocrine dysfunction associated with DS. Although DS has a variable phenotype there are many common physical manifestations such as hypotonia, epicanthic folds, flat nasal bridge, single palmar crease, and sandal toe gap. This commentary will focus on some newer dermatological literature about DS. Keep reading!
Relief funds available for health care providers, including some reserved for rural practices. Apply by Oct. 26.
In 2020, the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, and the Coronavirus Response and Relief Supplemental Appropriations Act provided $17 billion in relief funds to health care providers. In addition to the fourth phase of Provider Relief Fund (PRF) funding, the American Rescue Plan Act, signed in 2021, provided $8.5 billion for rural providers through the American Rescue Plan (ARP) Rural fund. Health care providers may apply for either or both of these funds, depending on eligibility criteria.
ARP Rural is intended to address the disproportionate impact that COVID-19 has had on rural communities and rural health care providers. The funding will be available to providers who serve patients in rural areas and must be used to cover lost revenue and eligible expenses used to prepare, prevent, and respond to COVID-19 from Jan. 1, 2019, through Sept. 30, 2020.
Providers who bill Medicare and Medicaid would be eligible for the PRF funding, and those providers who bill Medicare and Medicaid for their rural patients would be eligible for the ARP Rural fund. Learn more about these funding opportunities by viewing the Health Resources & Services Administration’s (HRSA) fact sheet.
Apply by Oct. 26. Providers may apply for both programs in a single application. Providers are expected to adhere to the reporting requirements for payments greater than $10,000 during the recovery period. HHS maintains its right to audit providers to ensure that funds are being used appropriately.
New AAD-supported ICD-10 codes for moisture-associated skin damage approved
The new ICD-10-CM codes that became effective Oct. 1 included several codes for moisture-associated skin damage. The Academy supported efforts by the Wound, Ostomy, and Continence Nurses Society to have these codes added. They include:
L24A0 Irritant contact dermatitis due to friction or contact with other body fluids, unspecified
L24A1 Irritant contact dermatitis due to saliva
L24A2 Irritant contact dermatitis due to fecal, urinary, or dual incontinence
L24A9 Irritant contact dermatitis due to friction or contact with other specified body fluids
L24B0 Irritant contact dermatitis related to unspecified stoma or fistula
L24B1 Irritant contact dermatitis related to digestive stoma or fistula
L24B2 Irritant contact dermatitis related to respiratory stoma or fistula
L24B3 Irritant contact dermatitis related to fecal or urinary stoma or fistula
FDA warns against use of needle-free devices for dermal filler injections
The FDA has issued a warning to the public and health care professionals against the use of needle-free devices such as hyaluron pens for injection of hyaluronic acid (HA) or other lip and facial fillers. Earlier this year, the AADA urged the FDA to prohibit the “DIY” administration of cosmetic fillers by consumers and nonphysicians without direct physician supervision, and stressed the importance of taking steps to ensure that persons performing injections of dermal fillers have a detailed knowledge of facial anatomy vasculature as well as extensive training on use of fillers.
In its safety communication, the FDA indicated that it has not evaluated the safety and effectiveness of needle-free devices for injection of any dermal filler, and that it has not approved the marketing of needle-free devices for injection of these products, adding that FDA-approved dermal fillers are intended for prescription use only and for use with a syringe with a needle or cannula. Additionally, the FDA indicated that serious injuries and, in some cases, permanent harm to the skin, lips, or eyes with the use of needle-free devices for injection of lip and facial fillers have occurred.
If physicians encounter a patient who has experienced adverse effects from a procedure that involves the use of needle-free devices to inject fillers, they can file a report through MedWatch, the FDA Safety Information and Adverse Event Reporting program.
The Centers for Medicare and Medicaid Services (CMS) recently released information regarding updates to 2020 MIPS performance feedback and 2022 MIPS payment adjustments. A targeted review found that the system was not recognizing patient-reported outcome measures as outcome measures. This affects the quality scoring for about 30,000 participants. The majority of affected clinicians will see a modest increase in their quality performance category score and MIPS final score as a result of this correction. However, approximately 4,400 clinicians will see a decrease in their quality performance category score and MIPS final score. The revisions to the system were completed Sept. 27.
Also, CMS announced that requests to reweight performance categories for performance year 2020 due to COVID-19 have been extended through Nov. 29, 2021. Eligible clinicians should request category reweighting by using the Targeted Review form on the Quality Payment Program website. (The EUC Exception Application form currently accessible is for 2021 applications only.)
United adjusts dermpath program, delays until 2022
In response to outreach from the AADA’s payer policy team, UnitedHealthcare (UHC) has clarified and delayed the tiered benefit design of their Designated Diagnostic Provider Program (DDP) until Jan. 1, 2022. The DDP would have pushed unaccredited labs out of the network and decreased rates for some starting this year. United clarified that the DDP will only impact dermatopathology reference labs — including independent reference labs and those in hospital-affiliated academic medical centers. Applicants contracted with and reimbursed by UHC will be required to indicate whether they are accredited by either the College of American Pathology or the Joint Commission. Those that are not accredited will remain in network but may experience decreased rates starting next year.
The AADA wants to understand how this will impact dermatology and is asking members with unaccredited labs and those that are only CLIA-certified that are contracted with UHC to let the Academy know by emailing privatepayer@aad.org. These labs are most vulnerable under the DDP program.
To learn more about DDP or if your reference lab has not been contacted by UHC, visit the UHC provider websiteas UHC continues to identify which labs will be accepted into the DDP program. If your reference lab has not received notice, please contact your assigned UHC network provider contact.
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