In an article published inDermatologic Therapy, dermatologists review the most up-to-date knowledge on nail involvement for those with COVID-19 and those vaccinated against the virus, as well as recommended treatment options. The authors document nail changes induced by COVID-19 infection, including microvascular disturbances, COVID-toe or -finger, and acral gangrene.
Periungual desquamation has been reported in children with severe Kawasaki-like multisystemic inflammatory syndrome (MIS-C) and adults recovering from severe COVID-19. The authors recommend assessing patients with severe COVID-19 for vascular symptoms, like coronary artery lesions. Other nail manifestations include Beau’s lines and onychomadesis, and discolorations of the lunula and the nail plate.
Nail changes may also be induced by COVID-19 treatments. Some patients on favipiravir develop a greenish fluorescence of the lunula and nail plate portion near the proximal nail fold. Green nail syndrome has also been reported in health care workers during the pandemic, which is treated with oral ciprofloxacin. Topical treatment includes removal of the onycholytic part of the nail and brushing of the nail bed with 2% sodium hypochlorite solution twice daily for at least six weeks, and topical nadifloxacin, tobramycin, or gentamycin.
Read about the red half-moon sign nail manifestation in patients with COVID-19 in DermWorld Weekly.
DermWorld Insights and Inquiries: Taking woolly hair to heart
Woolly hair (WH) appears as strongly coiled hair — it may be localized or diffuse, with the latter often associated with syndromes affecting the heart, gastrointestinal tract, or central nervous system. This commentary will briefly touch on localized disease with new information regarding autosomal recessive woolly hair/hypotrichosis. The focus, however, will be on recognizing WH syndromes with cardiac involvement — which could prove lifesaving.
The term “woolly hair nevus” (WHN) describes WH restricted to a limited area of the scalp. WHN has been classified into three types: Type I is not associated with any other cutaneous or scalp problems; Type 2 is associated with a linear verrucous epidermal nevus; and Type 3 is acquired progressive kinking of the hair. Approximately half of WHN are type 2, associated with an ipsilateral verrucous epidermal nevus, which may be considered as a mosaic RASopathy caused by an HRAS p.G12S mutation. WHN have been associated with ophthalmologic, auditory, dental, skeletal, and renal anomalies. Keep reading!
CMS announced reorganizations, edits, and other changes to the Advance Beneficiary Notice of Non-coverage (ABN) section in the Medicare Claims Processing Manual that went into effect Oct. 14. Learn more about the changes and how to comply.
Categorization of cutaneous COVID-19 vaccine reactions
Authors of a registry-based study published in JAAD reviewed reported vaccine reactions that had biopsy reports available. The most common histopathologic reaction pattern was spongiotic dermatitis, which ranged from robust papules with overlying crust to pityriasis-rosea-like eruptions to pink papules with fine scale. The authors proposed using the acronym V-REPP (vaccine-related eruption of papules and plaques) to define a subset of cutaneous COVID-19 reactions. They also suggested 12 other patterns should be on the radar for clinicians managing patients who have received COVID-19 vaccination, including bullous pemphigoid-like, dermal hypersensitivity, herpes zoster, lichen planus-like, and more.
Help the medical community understand the dermatologic manifestations of the COVID-19 virus and vaccines by participating in the COVID-19 dermatology registry.
FDA approves first interchangeable biosimilar to adalimumab
The U.S. Food and Drug Administration (FDA) approved the first interchangeable biosimilar product to treat certain inflammatory diseases. Adalimumab-adbm (Cyltezo), originally approved in August 2017, is both biosimilar to — and interchangeable with — its reference product adalimumab (Humira) for Cyltezo’s approved uses. Adalimumab-adbm is the second interchangeable biosimilar product approved by the FDA and the first interchangeable monoclonal antibody.
[See how the AADA has advocated on biosimilar substitution legislation inDermWorld.]
An interchangeable product is a biosimilar that meets additional data requirements outlined by the FDA. To be approved as interchangeable, the biosimilar must show that the product is expected to produce the same clinical result as the reference product in any given patient, and the risk in terms of safety or efficacy of switching between biological products must be no higher than using the reference product alone.
Read more about what’s keeping biosimilars out of reach and when they will become available in DermWorld.
Facing a trifecta of Medicare physician payment cuts Jan. 1, 2022, here’s what the AADA is demanding on behalf of the specialty
Recently, dermatologists have been threatened with mounting Medicare payment cuts resulting from congressionally-mandated budget policies and recent rulemaking by CMS. As we approach the end of 2021, the fate of Medicare payments to physicians faces uncertainty. In fact, there’s a trifecta of Medicare cuts slated for Jan. 1, 2022, that will disrupt the physician workforce and negatively impact patient care. For dermatologists, it’s possible to see cuts of up to 10% or more, depending on your practice mix. Addressing the problems resulting in these cuts and preserving fair payment for dermatologists’ services is at the top of the AADA’s advocacy agenda for the next three months.
Where are the cuts coming from? Three factors are contributing to the cumulative 10% cut to dermatology, including:
Evaluation and management (E/M) code policy implementation, resulting in a 3.75% cut to procedural and other services to offset increases in E/M services. Current law requires that such changes be budget neutral, meaning increases in one area of the fee schedule must be balanced with cuts elsewhere.
Sequestration: The Budget Control Act of 2011 mandates automatic across-the-board cuts of 2% to Medicare. Congress has provided a moratorium through 2021 on these cuts, but the 2% cut is scheduled to go back into effect in January.
Pay-As-You-Go (PAYGO) Act: Additional cuts of 4% to Medicare to comply with budget rules created under the PAYGO Act of 2010. PAYGO rules were triggered due to increased Medicare costs related to the passage of the American Rescue Plan earlier this year.
What the AADA is fighting for. Over the next several months, the AADA is working alone and in coalitions to avert these steep cuts by communicating the real cost of cutting Medicare spending on specialty care to Congress and CMS. Congress must intervene on behalf of the health care workforce; CMS cannot act alone. The AADA is pursuing the following Medicare priorities on behalf of dermatologists this year:
E/M code implementation: Keep the 3.75% increase to the conversion factor through at least calendar years 2022 and 2023.
Sequestration: Maintain the sequester moratorium for a fourth time.
PAYGO: Waive PAYGO rules to bypass another 4% cut to Medicare payments to physicians.
The AADA incorporated these important asks during this year’s Legislative Conference, where more than 200 Academy members and patient advocates pressed Congress to stop the looming Medicare cuts. We continue to work directly with Congress for a legislative fix in any year-end package prior to Jan. 1, 2022. Additionally, we’re anticipating the release of the 2022 Medicare Physician Fee Schedule Final Rule and will analyze the impact on the specialty. Stay tuned for a full picture of what you can expect in 2022.
The American Academy of Dermatology is a non-profit professional organization and does not endorse companies or products. Advertising helps support our mission.
