Which dermatology patients should receive a third dose of mRNA vaccine?
In an article published in JAAD, the authors provide guidance on which dermatology patients should receive a third dose of the mRNA COVID-19 vaccine based on the available data. The Centers for Disease Control and Prevention (CDC) has recommended that certain immunocompromised patients receive a third dose of the mRNA COVID-19 vaccines. Starting the week of Sept. 20, the CDC is recommending all mRNA-immunized Americans receive a booster shot eight months after their second dose. Data for additional doses of the Johnson & Johnson vaccine are not yet available.
Studies have demonstrated reduced seroconversion in individuals with chronic inflammatory diseases such as psoriasis and psoriatic arthritis receiving glucocorticoids, mycophenolate mofetil, methotrexate, and anti-CD20 monoclonal antibodies, including rituximab. While a small decrease in vaccine response was observed among those receiving anti-TNF and anti-IL-17 biologics, no difference in the rate of seroconversion has been observed.
The authors recommend patients taking the following drug treatments receive a third dose of the mRNA COVID-19 vaccine: systemic glucocorticoids; oral immunosuppressants including methotrexate, mycophenolate mofetil, cyclosporine, and JAK inhibitors; B-cell depletion (anti-CD20 monoclonal antibodies).
Other patient populations — such as those receiving TNF blockers and IL-17 inhibitors and those receiving IL-12/23 and IL-4/13 inhibitors — do not appear to need a third dose based on insufficient evidence to suggest a third dose or inadequate real-world data to assess the effect. (The JAAD article was completed before the announcement about a booster shot for all mRNA-immunized Americans.)
DermWorld Insights and Inquiries: Shedding light on the hydroa vacciniforme-like lymphoproliferative
disorder
Hydroa vacciniforme (HV) has always mystified me in every respect — its clinical presentation, pathophysiology, prognosis, and even its name. I understand “vacciniforme” because residual scars may resemble those of smallpox. I was surprised to learn that “hydroa” is derived from the Greek hídrōia (plural) heat spots (literally, sweat eggs), equivalent to hidr(ṓs) sweat + -ōia, plural of ōión egg. Admittedly, for the rare times I have considered the diagnosis of HV, I never conjured an image of “sweat eggs.”
HV is a rare childhood photosensitivity disorder of unknown pathogenesis. Previously, two forms have been recognized: typical HV and severe HV-like eruptions. Typical HV occurs mostly in young children and is characterized by recurrent vesiculopapules on sun-exposed areas. The erythematous vesiculopapules become umbilicated with central necrosis, later healing with small pox–like scars within one to two weeks. Keep reading!
Obesity, diabetes associated with reduced response to biologics
In a recent JAAD study, the authors found that in all biologic classes, comorbid obesity and history of diabetes are independently associated with poorer treatment response to biologics at six months. Obesity was associated with 25-30% lower odds of achieving PASI75 and PASI90 among patients with psoriasis. After controlling for obesity, diabetes was associated with 31% reduced odds of achieving PASI75 and PASI90 by 21%.
After separating biologic classes into its own cohort, obesity was associated with decreased odds of achieving treatment response with TNF inhibitors and IL-17 inhibitors. Diabetes was associated with poorer outcomes when on IL-17 therapy.
Experts break down emerging psoriasis treatment options and what they can offer patients and physicians in this month’sDermWorld.
Authors of a retrospective review published in JAAD examined all no-show and complete dermatology visits from Aug. 1, 2019, to March 1, 2020 (in-person visits), and from Aug. 1, 2020, to March 1, 2021 (22% in-person visits; 78% telemedicine), at a federally qualified health center in New York.
The availability of telemedicine and in-person visits was associated with a nearly 40% reduction in the no-show rate and an increase in the total number of completed visits despite fewer scheduled appointments. The no-show rate for patients treated via telemedicine decreased to 24% and in-person no-shows decreased to 23%.
Read how a novel virus disrupted and transformed health care delivery in DermWorld.
The Office of the National Coordinator for Health Information Technology (ONC) will be hosting a round of clinician-focused webinars on its information blocking rule and invites dermatologists to join the first webinar on Sept. 14, 2021.
Register for the webinar: Share your personal clinical experience and concerns with the current information sharing and blocking regulations.
The AADA recently met with the ONC urging them to revise its current Preventing [Patient] Harm Exception to include emotional and psychological distress as a risk factor when considering a delay in sharing information with a patient, especially when involving dermatopathology results. The AADA will continue to press the ONC for leeway that protects the integrity of the patient-dermatologist relationship.
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