Reliable, rapid identification of terbinafine resistance in dermatophytic nail and skin infections
Authors of a study published in the Journal of the European Academy of Dermatology and Venereology identified the incidence of terbinafine resistance among a large cohort of Trichophyton rubrum and Trichophyton mentagrophytes/Trichophytoninterdigitale isolates. Additionally, they developed and validated tools for detecting terbinafine resistance in these isolates.
Over an eight-year period, the proportion of fungal skin infections resistant to terbinafine increased from 0.63% in 2013 to 1.3% in 2021. A minimum inhibitory concentration cutoff of 0.015 μg/mL proved to be a reliable predictor of terbinafine treatment failure. Squalene epoxidase gene sequencing and hyphal growth on culture medium with 0.2 μg/mL terbinafine were the other suggested tools for determining terbinafine resistance.
DermWorld Insights and Inquiries: Can tocilizumab deep six recalcitrant morphea?
Glenda’s middle-aged ankles still hurt badly. I have been treating morphea enveloping her ankles for several years. With therapies including methotrexate, mycophenolate mofetil, clobetasol, calcipotriene, and physical therapy, her tenderness has improved from exquisite to barely tolerable. Examining her lesions, I reminded myself of a question posed in the preface from every edition of Treatment of Skin Disease – “Now what do I do?” Tocilizumab is a humanized monoclonal antibody to the IL-6 receptor and competitively inhibits the binding of IL-6 to both membrane-bound and soluble IL-6 receptors. Tocilizumab has recently been reported to be beneficial in patients with the following morphea variants that were refractory to standard therapies (all are case reports or small case series): juvenile localized scleroderma, pansclerotic morphea, ECDS and Parry Romberg, and checkpoint inhibitor-induced generalized morphea. Keep reading!
Trends in hair, skin, and nails supplement use
Authors of a JAAD research letter examined characteristic and temporal trends of hair, skin, and nails (HSN) supplement use from 2011-2020. The researchers’ outcome of interest was past-month HSN supplement use, defined as past 30-day self-reported consumption of vitamins, minerals, herbals, and other dietary supplements for “healthy skin, hair, and nails.” Of 40,959 participants, 3.9% reported past-month HSN supplement use. HSN supplement users were more often younger (20-39 years old) and female. Individuals with more than high school education were more likely to report HSN supplement use than those that did not graduate high school.
[Are nutritional supplements aimed at skin care helpful, harmful, or simply a placebo for patients? Read more in DermWorld.]
Individuals surveyed in 2015-2016 and 2017-2020 were more likely to report HSN supplement use than individuals in 2011-2012. Overall, participants reporting past-month HSN supplement use increased from 2.5% in 2011-2012 to 4.9% in 2017-2020.
TikTok as a tool to engage with public health and promote dermatologic expertise. Read more in DermWorld.
Tapering of dupilumab in atopic dermatitis patients with low disease activity
Authors of an article published in the British Journal of Dermatology evaluated dupilumab dosing regimen daily practice and assessed prognostic factors for successful tapering. This prospective multicenter cohort study investigated the effect of dupilumab dose reduction in 401 patients with atopic dermatitis (AD) for at least one year and those with controlled AD for at least six months. A significant proportion (83.3%) of the patients were able to successfully reduce their dose (with the majority using dupilumab every three or four weeks) without a significant flare of their AD. Although increases in Eczema Area and Severity Index and Numeric Rating Scale–pruritus scores were seen, especially early in dose reduction, they did not seem clinically meaningful, according to the study authors.
AADA members and patients take message to Capitol Hill at 2023 Legislative Conference
From Sept. 10-12, the American Academy of Dermatology Association hosted its 2023 AADA Legislative Conference in Washington, D.C., in which 168 attendees came together to learn about the policy issues affecting dermatology patients and practices. Attending the conference were 156 members, which included 118 Fellows of the AAD and 38 graduate members. Other participants included patient advocates, practice administrators, and state dermatology society leaders. The conference concluded with advocates going to Capitol Hill on Sept. 12 to advocate on the need to stop pending Medicare cuts and other important issues facing dermatologists and their patients. In total, AADA members participated in over 190 meetings with members of Congress and congressional staff.
In the House, cosponsor the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would provide for an annual inflation update equal to the Medicare Economic Index for Medicare physician payments. In the Senate, support similar legislation if introduced or brought to a vote.
Cosponsor and support passage of the Safe Step Act (H.R. 2630/S. 652), and in the Senate support similar step therapy reform provisions included in the Pharmacy Benefit Manager Reform Act (S. 1339).
In addition to contacting your federal lawmakers, remember to save the date for the 2024 Legislative Conference, which will be held from Sept. 8-10.
AADA hosted physician summit on Medicare payment
On Sept. 6, the AADA hosted a virtual summit titled Creating Momentum on Inflation Adjustment, Patient Access, and Medicare Payment. Nearly 300 people joined the event in which physician leaders and key members of Congress came together to energize and equip physicians to educate policymakers about the impact of Medicare payment cuts on patient care access. The group also discussed strategies to urge Congress to enact an inflation-based Medicare payment adjustment as would be created under the “Strengthening Medicare for Patients and Providers Act” (H.R. 2474). Advocating to avert the cuts is the AADA’s number one legislative priority this year.
CMS announces MIPS EUC for applicable Hawaii counties
CMS announced that the MIPS automatic extreme and uncontrollable circumstances (EUC) policy will apply to MIPS-eligible clinicians in certain counties in Hawaii. This decision was made in response to the public health emergency declaration and FEMA disaster declaration for the wildfires in the state of Hawaii. MIPS-eligible clinicians in the specified counties will have all performance categories reweighted to 0% for the 2023 performance period and receive a neutral payment adjustment for the 2025 MIPS payment year. Learn more about the 2023 automatic EUC policy.
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