Is roflumilast effective in patients with seborrheic dermatitis?
Researchers of a study published in JAMA Dermatology investigated the efficacy and safety of once-daily roflumilast foam 0.3% in adult patients with seborrheic dermatitis. In this double-blind, vehicle-controlled clinical trial, 226 patients with moderate to severe seborrheic dermatitis were randomized to receive either roflumilast foam 0.3%, a PDE-4 inhibitor, or a vehicle foam.
[Low-dose isotretinoin for severe seborrheic dermatitis? Read more.]
Patients treated with roflumilast foam had significantly better outcomes in terms of achieving IGA success scores at weeks two and eight of treatment and greater improvement in erythema and scaling scores compared with those treated with the vehicle foam. Adverse events were infrequent and comparable between the two groups. Roflumilast 0.3% foam may be an effective and well-tolerated nonsteroidal option for patients with seborrheic dermatitis, according to the authors.
We have all been there, probably daily. You’re an hour behind schedule, and the patient in front of you has a laundry list of complaints demanding that you address them. You shift to autopilot, using your keen observational acumen and management skills, as you glide through your diagnoses. Cognitive biases (CBs) are cerebral shortcuts that simplify decision-making. Diagnostic errors occur in at least 5% of the outpatient department and emergency room cases, leading to fatalities in approximately one in every 1,000 cases, resulting in an estimated 40,000-120,000 deaths annually in the United States. CBs exist at every stage of the patient-physician encounter, from taking a history, to performing a physical examination, generating a differential diagnosis, and in managing the patient. All dermatologists are subject to cognitive biases that could result in diagnostic and therapeutic errors. Keep reading!
JAK inhibitors for granulomatous dermatoses
A systematic review published in JAAD summarizes the outcomes of JAK inhibitor therapy for granulomatous dermatoses, including both oral and topical therapies. With oral tofacitinib, complete resolution was observed in 58.3% of patients treated for cutaneous sarcoidosis, 53.8% of patients treated for granuloma annulare, and 12.5% of patients treated for necrobiosis lipoidica. Adverse events were noted in nearly a quarter of patients, with one case of treatment discontinuation owing to worsening neurosarcoidosis. The authors conclude that JAK inhibitor therapy is a promising treatment for patients with granulomatous dermatoses; however, adverse events should be carefully monitored.
Is there an association between atopic dermatitis and alopecia areata?
A research letter published in JAAD suggests that there is a significant relationship between atopic dermatitis (AD) and the occurrence of alopecia areata (AA) via associated genetic variations. Summary statistics were generated from 7,024 patients with AD vs. 198,740 controls and 289 patients with AA vs. 211,139 controls, including all patients with AD and AA diagnosis codes, respectively.
In particular, the authors’ findings identify IL-13, a primary cytokine in AD — also associated with increased AA severity — as one of the most predictive single nucleotide polymorphisms of a significant relationship between the two diseases, strengthening the evidence that AD is an important risk factor for AA. Additionally, HLA-DQA1, which affects autoimmune susceptibility, had a negative association with AA. Given that variants of HLA-DQA1 are associated with AA, it is likely that variants contributing to the development of AA and AD are different.
Survival outcomes after Mohs surgery in patients with early-stage MCC
A retrospective cohort study published in JAMA Dermatology investigated the impact of surgical approach on survival outcomes of patients with localized T1/T2 Merkel cell carcinoma (MCC). The study found that Mohs micrographic surgery was associated with better survival outcomes in patients with localized MCC with confirmed negative lymph nodes compared with the use of wide local excision. High-volume MCC centers demonstrated a significantly greater tendency to use Mohs surgery over wide local excision.
Life-changing advances and a multidisciplinary approach give new hope to patients with Merkel cell carcinoma. Read more in DermWorld.
Reminder: AMA-Mathematica physician practice expense survey
The AADA is one of more than 170 health care organizations supporting a new national study by the American Medical Association (AMA) and Mathematica that will collect representative data on physician practice expenses. The aim of the AMA Physician Practice Information Survey is to better understand the costs faced by today’s physician practices to support physician payment advocacy.
Dermatologists and their practices should look for invitations to complete the survey. Invitations and reminders about the costs survey will come from PPISurvey@mathematica-mpr.com with the subject line: “American Medical Association requests your input on physician practice expense and patient care hours.” Invitations and reminders about physician hours worked will come from PhysicianHoursSurvey@mathematica-mpr.com with the subject line: “Please help to update accurate physician payments.” Physicians will be randomly selected to participate; your individual practice data will be kept private. Participation is voluntary but critical to the success of efforts to support accurate resource-based physician payment.
The study will serve as an opportunity to communicate accurate financial information to policymakers, including members of Congress and CMS. The survey will be administered from July 2023 through April 2024. Any questions about the survey should be directed to Mathematica.
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