Authors of a JAAD research letter describe risk factors for onychomycosis and assess adherence to the AAD guidelines that recommend confirmatory testing before oral antifungal therapy is prescribed. During 2018, among more than 21 million outpatients, onychomycosis prevalence was 1.6% overall and 12.7% among patients 65 years of age and older. Male gender and nonrural residence were associated with onychomycosis. Common underlying conditions included diabetes (23%), immunosuppressive conditions (21.8%), and non-unguium tinea (12.6%).
[Acitretin: A new therapy for onychomycosis? Read more inDermWorld Weekly.]
Across specialties, confirmatory lab testing was infrequent (15.3%); 12% of patients received a histopathology test, 2.8% a fungal culture, 2.1% direct microscopy, and 2.1% fungal polymerase chain reaction; 0.5% received antifungal susceptibility testing. Patients seen by dermatologists more frequently received confirmatory testing (31%) than those seen by podiatrists (16.9%) or general practitioners (5.2%). Of the patients prescribed an oral antifungal drug, only 9.7% received confirmatory diagnostic testing. The authors conclude that confirming the diagnosis of onychomycosis with lab testing is important for avoiding unnecessary antifungal exposure as a global resistance to terbinafine has emerged.
DermWorld Insights and Inquiries: Lending a helping hand to our patients with Dupuytren’s disease
When patients trust you, they want your opinion, even if the disorder in question is out of your bailiwick. Although likely to refer patients with Dupuytren’s disease (DD, aka Dupuytren’s contracture, DC) directly to an orthopedic (hand) surgeon, we dermatologists should have at least a rudimentary knowledge of the malady to help guide our patients. DD is a connective tissue disorder of the hand characterized by excessive fibrosis of the palmar and digital fascia that may progress to a disabling contracture. DD is common, affecting approximately 3% of the population, and 12% in those older than 55 years. Keep reading!
GoodRx launches provider-facing tool for point-of-care savings
GoodRx has developed a new drug cost tool specifically for health care providers, according to reporting in Fierce Healthcare. The new platform, called Provider Mode, is designed to allow health care providers and office staff to review medicine cost information during appointments. Providers can input location, dosing, and quantity to find local stores with the lowest cost. Staff can also access coupons to share with patients. Medication pages show comparisons to other drugs in the same class, home delivery options, and the most frequently searched drugs. In the coming months, GoodRx plans to add insurance coverage information to the cost-estimation tool.
Distinguishing features of pseudocellulitis in pediatric inpatients
In a retrospective study published in Pediatric Dermatology, data was reviewed from 588 pediatric inpatients with a diagnosis of cellulitis. Of these patients, 4.9% had an initial cellulitis diagnosis that was changed to a different diagnosis (pseudocellulitis group). There was no difference in laboratory abnormalities between the two groups.
Higher rates of pseudocellulitis were identified in cases involving specialist consultation by both dermatology (44.8% pseudocellulitis, 4.1% true cellulitis) and infectious disease (48.3% pseudocellulitis, 27.0% true cellulitis). Among patients evaluated by dermatology, the features associated with true cellulitis included fever, purulence, and tachycardia. The authors find that early specialist consultation may improve the diagnostic accuracy in cases of suspected cellulitis.
"For the past few Mondays, I have been asked to see the following ‘emergency’ patients who called in with the diagnosis of cellulitis after the COVID-19 vaccination." Read more in DermWorld Insights and Inquiries.
Deucravacitinib vs. apremilast for plaque psoriasis
A multicenter, randomized, double-blinded, phase 3 trial published in JAAD compared the efficacy of deucravacitinib — an oral tyrosine kinase 2 inhibitor — with that of apremilast for the treatment of adults with moderate-to-severe plaque psoriasis. At week 16, 53% of patients taking deucravacitinib achieved PASI 75, 39.8% for apremilast, and 9.4% for placebo. Efficacy was maintained until week 52 with continuous deucravacitinib. The authors find that deucravacitinib demonstrated superiority versus placebo and apremilast and was well tolerated.
The FDA has approved deucravacitinib for the treatment of patients with moderate-to-severe plaque psoriasis. Read more in DermWorld Weekly.
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