October 2, 2019
IN THIS ISSUE / October 2, 2019
- Does gluten increase risk for psoriasis and AD in women?
- DW Insights and Inquiries: Cutting giant congenital nevi down to size molecularly
- Upcoming coding changes: Differentiating intermediate from complex repairs
- Apple cider vinegar soaks to treat AD: Yea or nay?
- Which dermatologic conditions have the highest hospital readmission rates...and what's the cost?
Does gluten increase risk for psoriasis and AD in women?
According to study results published in JAAD, increased gluten intake does not put adult women at increased risk for psoriasis, psoriatic arthritis, and atopic dermatitis (AD). The investigators analyzed data from a cohort of women nurses from 1989 to 2015 in which food intake data was provided every four years starting in 1991. In total, 85,185 participants were included in the psoriasis analysis, 85,324 in the psoriatic arthritis analysis, and 63,443 in the atopic dermatitis analysis.
Hazard ratios calculated for the three diseases were 1.15 for psoriasis, 1.12 for psoriatic arthritis, and 0.91 for AD. Since the study showed no association between gluten intake and new-onset psoriatic disease and AD, the researchers concluded that their findings do not support restricting gluten as a means of preventing inflammatory skin and musculoskeletal conditions.
Does the Mediterranean diet help ease psoriasis severity? Find out in DW Weekly.
Related content:
- Can the elimination diet hurt pediatric AD patients? – DW Weekly (April 2019)
- Psoriasis clinical guidelines
- Taking aim at psoriasis – Dermatology World (November 2017)
- Got milk? Got acne? – DW Insights and Inquiries (July 2016)
- AAD product: Dialogues in Dermatology podcast subscription
DW Insights and Inquiries: Cutting giant congenital nevi down to size molecularly
Personally, I find giant congenital melanocytic nevi (GCMN) to be among the most unnerving skin lesions imaginable. The risk of melanoma, leptomeningeal melanocytosis, and psychosocial stresses are profoundly burdensome to patients, their families, and health care professionals. With increasing understanding of the molecular pathways of GCMN, we are on the cusp of targeted therapy for GCMN becoming a reality.
GCMN are usually defined as melanocytic lesions that are present at birth that will reach a diameter of ≥ 20 cm in adulthood. Its incidence is estimated as < 1:20,000 newborns, of which about 6% develop melanoma at the site of the nevus. GCMN usually appear sporadically, although rare familial cases have also been reported. The etiology and pathogenesis of GCMN are not fully understood. Defects in neural crest development, activating mutations leading to uncontrolled melanocyte proliferation, cutaneous mosaicism, and paradominant inheritance may all be contributory. Keep reading!
Upcoming coding changes: Differentiating intermediate from complex repairs
Starting Jan. 1, 2020, guideline changes to the intermediate complex repair codes go into effect. The AADA’s Upcoming Coding Changes October live webinar introduces and explores the new CPT® intermediate complex repair coding guidelines and ICD-10-CM code changes, including history of melanoma and carcinoma in-situ of the skin. Register and learn more about this month’s live webinar.
Related content:
- AADA Practice Management Center: Coding Resource Center
- 2020 Coding Webinar All-Access Pass
- 2020 Coding & Billing for Dermatology
- Principles of Documentation for Dermatology, Third Edition
Apple cider vinegar soaks to treat AD: Yea or nay?
According to a study published in Pediatric Dermatology, among patients with atopic dermatitis (AD), apple cider vinegar soaks did not significantly improve skin barrier integrity — and in most subjects, led to skin irritation. Participants soaked a forearm in dilute apple cider vinegar (0.5% acetic acid) and the other forearm in tap water for 10 minutes daily for 14 days. Transepidermal water loss (TEWL) and skin pH were recorded from the forearms at baseline; at 0, 15, 30, and 60 minutes after the first soak; and 24 hours after the completion of the 14-day treatment.
Nearly 73% of participants had mild side effects from the apple cider vinegar that improved upon cessation of the soaks. Immediately after treatment with the vinegar soak, TEWL increased and pH declined, but the effects were not maintained one hour later. Among patients with AD, the effect of 14 days of apple cider vinegar soaks on TEWL and pH was comparable with soaking in water alone.
Should dermatologists be anti-antihistamine for atopic dermatitis? Find out in DW Insights and Inquiries. Also, check out a new Dialogues and Dermatology podcast on ‘Treatment of Atopic Dermatitis.’
Related content:
- Navigating “natural” medicine – Dermatology World (April 2019)
- Should systemic steroids be avoided in atopic dermatitis? – Dermatology World (July 2018)
- Academy clinical guidelines: Atopic dermatitis
- Academy product: Eczema / Atopic Dermatitis patient pamphlet
Which dermatologic conditions have the highest hospital readmission rates...and what's the cost?
According to a study recently published in JAAD, dermatologic hospital readmission rates in the U.S. have remained constant and costs high. Using the Nationwide Readmissions Database from 2010 to 2014, researchers identified 3,602,599 dermatologic hospitalizations, of which 9.8% were readmitted with any cause within 30 days; 3.3% were admitted for the same cause within 30 days and 7.8% were readmitted for the same cause within the calendar year. The cost of all dermatology-related hospitalizations was $27.8 billion, while the cost of calendar year same-cause readmissions was $2.54 billion.
The most common diagnosis for hospitalization was cellulitis, which comprised nearly 84% of all dermatology-related admissions and had the highest calendar year same-cause readmission costs at $1.94 billion. The highest 30-day all-cause readmission rates were due to mycosis fungoides (32%), Sezary syndrome (29%), and graft-versus-host disease (28%). The highest 30-day same-cause readmission rates were vascular hamartomas (21%), dermatomyositis (18%), and thrombotic microangiopathy (14%). The highest calendar year same-cause readmission rates were dermatomyositis (31%), systemic lupus erythematosus (SLE) (24%), and vascular hamartomas (23%).
The total cost of all calendar year same-cause readmissions was $508 million per year while the cost of readmissions in cellulitis was $389 million per year.
Inpatient consultative dermatology: Where are we now? Find out in Dermatology World.
Related content:
- Advances in disease pathogenesis and treatments offer new promise for patients with CTD –Dermatology World (June 2019)
- Calculating the cost savings of inpatient dermatology – Dermatology World (May 2019)
- Need for inpatient dermatologic care increases – Dermatology World (September 2017)
- For your patients: All about cellulitis
