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Dermatology Weekly

Author: MDedge

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Stay current on medical, surgical, and aesthetic dermatology developments with Dermatology Weekly, a podcast featuring news relevant to the practice of dermatology, and peer-to-peer interviews with Doctor Vincent A. DeLeo, who interviews physician authors from Cutis on topics such as psoriasis, skin cancer, atopic dermatitis, hair and nail disorders, cosmetic procedures, environmental dermatology, contact dermatitis, pigmentation disorders, acne, rosacea, alopecia, practice management, and more. Plus, resident discussions geared toward physicians in-training. Subscribe now.

The information in this podcast is provided for informational and educational purposes only.
96 Episodes
In the news portion of episode 64, Nick Andrews welcome Dr. Amy Paller, MD, to discuss the different dermatologic manifestations of COVID-19 especially as it pertains to pediatric patients. *  *  * Grand Rounds are not only a teaching opportunity but also a vital patient care activity. Dr. Vincent DeLeo talks to Dr. William Huang about results of a study that surveyed how patients perceive clinical case-viewing sessions in dermatology. “I think we can easily lose track of [the patient’s experience] because it is something very routine for us as an activity that we have participated in as medical students, as residents, and as faculty, but for the invited patient this is something strange, like something they saw on a medical television drama,” Dr. Huang explains. They discuss how patients felt before vs after participating in Grand Rounds as well as patients’ suggestions for how to improve the process. *  *  * Things you will learn in this episode: The goal of Grand Rounds is to get clinical opinions from a number of different physicians at the same time to achieve better outcomes in patients with conditions that are difficult to diagnose or treat.  Patients were surveyed before and immediately after participating in clinical case-viewing sessions to assess their feelings and attitudes regarding this activity. “We could not find where this had been looked at before in our specialty,” Dr. Huang explains. Patients generally felt that participating in clinical case-viewing sessions met their expectations and was a beneficial experience. “They were also very likely to participate again, which demonstrates that they had a good experience overall,” Dr. Huang says. Anxiety went down after participating in Grand Rounds vs before, but patients’ feelings of being a science experience or guinea pig went up after the session was over. It is important to recognize that patients generally are not familiar with the process of Grand Rounds and may not know what to expect or how it benefits them. “Communicate to the patient before they are scheduled what the session will actually entail from start to finish to follow-up,” Dr. Huang recommends. *  *  * Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: William W. Huang, MD, MPH (Wake Forest School of Medicine, Winston-Salem, N.C.) Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Dr. Huang reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
How is dermatology handling this change in practice toward telehealth? Guest host Dr. Candrice Heath talks with Dr. George Han about how dermatologists can adapt their clinical practice to conduct quality teledermatology visits with their patients. “Last year ... I think overall in the health system we probably had about 2,000-3,000 telehealth visits ... by the end of March [this year], I think the numbers I saw [were] around 30,000, so it’s absolutely just kind of been a huge change in the way we practice medicine,” Dr. Han explained. They discuss potential use cases for teledermatology during the current health crisis and beyond as well as how to address technological barriers to care. *  *  *   We also bring you the latest in dermatology news and research: 1. Novel inflammatory syndrome in children possibly linked to COVID-19 2. Case reports illustrate heterogeneity of skin manifestations in COVID patients 3. COVID-19 Dermatology Registry   *  *  * Things you will learn in this episode: Despite recent HIPAA relaxations, dermatologists still should be aware of privacy and security issues when conducting telehealth visits with patients. Existing resources -- such as noninvasive tests that can be self-administered by patients -- may be useful for concerning lesions that are difficult to diagnose during video visits. “There’s this genomic test for melanoma. ... I hadn’t used it very much before the COVID pandemic because we could biopsy patients in the office. ... But now that the whole paradigm has changed, I’ve actually used it more than I ever did before,” Dr. Han explained. Common conditions such as psoriasis, acne, and eczema are relatively easy to triage via telemedicine. “We’re going to have to do a lot more experimentation, certainly, if there’s a lesion that’s scaly and erythematous. ... But I think as long as you’re up front with the patients, they understand it, too,” Dr. Han said. In most cases, total-body skin examinations and evaluation of pigmented or potentially cancerous lesions still warrant an in-person visit. Biologics often can be started in patients with psoriasis or atopic dermatitis without first seeing them in person. “If it’s a pretty clear case of psoriasis, I would say that your treatment options are not limited by the fact that we’re handling over telemedicine, and I think that’s really nice for our patients. There are a number of treatments out there that you don’t need laboratory screening for, so those are helpful to have on hand,” Dr. Han said. For older patients who may not have the necessary technology skills or devices to participate in video consultations, the Centers for Medicare & Medicaid Services recently issued a guidance that telephone visits will now be paid at the level of an established visit (levels 2–4). “The recognition is there that we’re still doing important work for our patients and you don’t necessarily need that video signal to be able to do this, and we certainly don’t want to create any artificial barriers to access to care,” Dr. Han said. Prior to COVID-19, telehealth services use was low because patients did not think of it as a legitimate option, but the marketplace will demand these services moving forward now that they are seeing the benefits. “I think it’s important as we go ahead in the next phase ... we use the lessons we’ve learned during this pandemic of just large numbers of people utilizing teledermatology services to help map out what makes sense for our specialty ... as well as technical requirements that we should be asking of our vendors providing these services,” Dr. Han advised. Beyond the parameters of the COVID-19 pandemic, teledermatology also provides access to care for patients in parts of the country with limited access to dermatologists, such as in rural areas. Dermatologists can use telehealth services for short hands-off visits, such as to counsel patients, check in before titrating doses, or follow-up after a cosmetic procedure. “Those are situations where you actually might improve your show rate by offering telemedicine services,” Dr. Han noted. A tip sheet is available online that provides information to help dermatologists adopt telehealth in their practice. It describes what you need, how to select a software platform, and how to monitor workflow.  Patients should be asked to provide high-quality photographs before the visit via a HIPAA-secured chat or email. “We always recommend that you get a HIPAA-secured email server account if you can if you’re asking for patients to send in photos, because what happens is that once they send those photos to you, you are responsible for the safety and security of that photo,” Dr. Han explains.  Set expectations for patients up front and be realistic about what you think is reasonable for implementing telehealth services in your practice. “If you’re not comfortable seeing concerning lesions, suspicious moles, those things, you should make it very clear to your schedulers that patients should be told that if it is one of those problems, they cannot be seen by this methodology,” Dr. Han recommended. *  *  *   Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guest: George Z. Han, MD, PhD (Icahn School of Medicine, New York) Disclosures: Dr. Heath and Dr. Han report no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Transparency about industry-supported interactions among physicians was the goal of the online Open Payments database created by the Centers for Medicare & Medicaid Services. Dr. Vincent DeLeo talks to Dr. Allen F. Shih about a retrospective review of how accurately dermatologists presenting at a major medical meeting disclosed industry conflicts of interest, compared with the OP database. They discuss possible reasons for data discrepancies and provide tips for dermatologists to ensure their COIs are disclosed appropriately. “I think it’s very important for dermatologists to continue to review industry-reported interactions listed on the online Open Payments database and to make sure it is as accurate as possible,” recommends Dr. Shih. *  *  *   We also bring you the latest in dermatology news and research: Private equity: Salvation or death sentence? Depending on whom you ask, the continuing growth of private equity purchases of dermatology practices is either a death sentence -- or salvation -- of the specialty. *  *  * Things you will learn in this episode: All U.S. companies that produce or purchase drugs or devices that are reimbursable by a government-run health care program are required by the Physician Payments Sunshine Act to announce all payments to physicians using the online OP database: “Once a year, the government gives the companies a particular time frame to establish these payments. ... and list the physician, the amount, and the type of payment that they are giving out,” Dr. Shih explains. Speakers at meetings of the American Academy of Dermatology must publicly disclose a full list of industry COIs in the meeting program, including the company name and type of interaction.  A comparison of industry interactions disclosed at the AAD 73rd Annual Meeting in March 2015 vs. the 2014 OP database showed a discrepancy between the two sets of data for about 30% of dermatologists.  The most commonly reported industry relationships among dermatologists were investigator, followed by consultant and advisory board member. “Specifically, among these three roles, the form of payments that dermatologists reported were, number one and number two, honoraria and grants and research funding,” Dr. Shih notes. Overall, 66% of interactions were accurately and fully disclosed by dermatologists when the AAD and OP data were compared. “It looks like [dermatologists] are in line with what other specialists are seeing from other specialties,” Dr. Shih said. Data discrepancies could be industry-reporting inaccuracies, which are not audited. “If you have a payment that you see, you can check it online to make sure it’s not something that was entered under your name erroneously, which has happened before,” Dr. Shih advised. Dermatologists speaking at meetings may fail to report industry payments they feel are outside the scope of their presentation topic. “For example, a dermatologist who goes to AAD to speak about psoriasis may not feel the need ... to disclose items that may be related to a laser,” Dr. Shih explained. Patients can search the Centers for Medicare & Medicaid Services website for a list of all interactions and type of payments received by any physician by calendar year. “One of the reasons that Congress decided to include Open Payments [in the Affordable Care Act] was to include the transparency and objectivity ... so that patients and providers and the general public alike would be able to find if there were particular biases that physicians were having based on financial interactions that were yet to be revealed,” Dr. Shih explained. Every year, CMS gives physicians a 45-day period to review reported industry interactions for the previous calendar year. For 2019, the review period started on April 1, 2020, and goes until May 15, 2020, during which time physicians can submit corrections to CMS if an error is noted.  *  *  * Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Allen F. Shih, MD, MBA (Boston University) Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Dr. Shih reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Dermatologists play an important role in disease management for patients with Muir-Torre syndrome (MTS). In this resident takeover, Dr. Daniel Mazori talks to Dr. Mohammed Dany about the pathogenesis of MTS and its associated malignancies. “We are the ones who usually make the diagnosis, and we should know that these patients are at risk for developing several visceral malignancies and thus require screening,” Dr. Dany explained. They also review diagnostic clues and tools for dermatologists when treating patients with solitary sebaceous tumors. *  *  *   We also bring you the latest in dermatology news and research: 1. COVID-19 spurs telemedicine, furloughs, retirement 2. Evidence on spironolactone safety, COVID-19 reassuring for acne patients 3. COVID-19 decimates outpatient visits *  *  * Things you will learn in this episode: Muir-Torre syndrome is an autosomal-dominant genetic disorder that predisposes patients to both cutaneous neoplasms and visceral malignancies. Sebaceous tumors are the hallmark of MTS and are rarely seen outside of this condition: “All three types of sebaceous tumors can be present in these patients: the adenomas, the epitheliomas, and the carcinomas,” Dr. Dany explains. Nonsebaceous skin tumors also can present in MTS, including rapidly growing keratoacanthomas and basal cell carcinomas. Patients with MTS should be further screened for colorectal, endometrial, ovarian, breast, lung, genitourinary, hematobiliary, hematopoietic, and central nervous system cancers. “Every Muir-Torre syndrome patient [also] should definitely see a dermatologist at least once a year for skin cancer screening,” Dr. Dany advises. In MTS, germline mutations in DNA mismatch repair genes lead to microsatellite instability, which drives the formation of tumors; however, MTS is not always genetic and is not always inherited. More research is needed on whether specific mutations put MTS patients at higher or lower risk for developing certain kinds of tumors. All patients presenting with a solitary sebaceous tumor should be worked up for MTS. Tumor location can be a helpful diagnostic indicator. “A sebaceous tumor that is inferior to the neck is most likely associated with Muir-Torre syndrome; on the other hand, sebaceous tumors on the head and neck can be either a manifestation of Muir-Torre but can also be spontaneous,” Dr. Dany advises. The Mayo MTS score is a helpful tool for risk stratification in MTS patients. “The score ranges from 0 to 5, and then a risk of 2 or more has 100% sensitivity for Muir-Torre syndrome and has an 81% specificity for predicting a germline mutation in the [DNA mismatch repair] genes,” Dr. Dany explains. Molecular testing should be performed to confirm the diagnosis. Solitary sebaceous tumors in patients with low Mayo scores may be sporadic; therefore, further laboratory work-up is recommended to avoid misdiagnosis of MTS. Muir-Torre syndrome type 2, also known as autosomal-recessive colorectal adenomatous polyposis, is a new subtype of MTS that demonstrates an autosomal-recessive pattern of inheritance and microsatellite stability. Future research is needed to delineate pathways for targeted therapies that can shut down the formation of new sebaceous tumors, particularly sebaceous carcinomas. “If we are able to find a way to prevent the formation of those sebaceous tumors from showing up, then we will end up with less follow-up, [fewer] biopsies, and less concern from our end,” Dr. Dany explains. *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guests: Mohammed Dany, MD, PhD (University of Pennsylvania, Philadelphia) Disclosures: Dr. Mazori reports no conflict of interest. Dr. Dany reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Hosts of the dermatology podcast Dermasphere, Luke Johnson, MD, and Michelle Tarbox, MD, join MDedge host Nick Andrews to talk about COVID-19 and dermatology as well as how their podcast works. Dr. Johnson is assistant professor of dermatology at the University of Utah School of Medicine in Salt Lake City, and Dr. Tarbox is assistant professor of dermatology at Texas Tech University Health Science Center in Lubbock. You can find Dermasphere on Apple Podcasts, Google Podcasts, Spotify, and wherever podcasts are found. *  *  *   Hair salon closures during the coronavirus pandemic have left women of African descent to care for their own hair -- whether natural, processed, or synthetic -- at home. Dr. Lynn McKinley-Grant, president of the Skin of Color Society, talks to Dr. Susan C. Taylor about hair care products these patients can use so that dermatologists can help African American women take care of their hair and manage dermatologic conditions. “With COVID-19, many women are at home -- me included -- and it’s important for women to understand that they have to continue to groom their hair. Just because no one sees you doesn’t mean that you don’t regularly shampoo and condition as well as comb and style your hair,” says Dr. Taylor. *  *  * Key takeaways from this episode: Dermatologists should know how to recognize and differentiate between natural, processed, and synthetic hair in women of African descent to inform diagnosis and treatment recommendations. Regardless of hairstyle, it is important for all African American patients to shampoo, condition, detangle, and style their hair with products that contain appropriate ingredients. Shampoos with sodium lauryl sulfate contain the harshest detergents that can dry out the hair and scalp. “For our skin of color patients, or African American patients, we suggest shampoos that contain sodium laureth sulfate, which is a much milder detergent to clean the hair, and it helps to leave the hair moisturized,” Dr. Taylor explains. Social distancing provides an opportunity for African American women to concentrate on conditioning the hair while taking a break from damaging hair care practices. “I personally think this is a great time to minimize what you do to your hair in regard to heat from blow-dryers and flat irons and curling irons. I also think it’s a great time if you have a weave or braids and extensions to take them out to really give your hair a rest,” Dr. Taylor recommends.  Many patients seek to avoid products containing controversial ingredients such as parabens, mineral oil, and tetrasodium EDTA because of concerns that they may be carcinogens or endocrine disruptors. “I think the jury is still out. There are a whole host of products that do not contain those particular ingredients, so I think our patients have to have choices,” Dr. Taylor says. Prescription shampoos for seborrheic dermatitis in people of African descent can dry out the scalp. “What I suggest to my patients is that they apply the shampoo directly to the scalp with a 4- to 5-minute contact time and then rinse the shampoo out of the scalp, followed by the use of a conditioning shampoo to actually shampoo their strands of hair. That way they’re minimizing the contact time with the prescription shampoo,” Dr. Taylor advises. Although daily shampooing typically is not recommended for individuals of African descent, health care workers and first responders will need to wash their hair more frequently during the coronavirus pandemic. “I think rinsing the hair with water, not necessarily doing a full shampoo every day, could be helpful. [Also] putting in a leave-in conditioner and reapplying the leave-in conditioner every day I think can really help combat potential dryness they can experience,” Dr. Taylor suggests. It also is important to thoroughly dry the hair after each wash so it doesn’t stay damp, which could lead to infection. *  *  * Hosts: Nick Andrews; Lynn McKinley-Grant, MD (Howard University, Washington) Guest: Susan C. Taylor, MD (University of Pennsylvania, Philadelphia) Disclosures: Dr. Taylor reports no conflict of interest. Dr. McKinley-Grant reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm  
Patients, medical students, residents, and even attendings often seek reliable information about nail biopsy procedures on the Internet. Dr. Vincent DeLeo talks with Dr. Shari Lipner about the quality and credibility of nail biopsy videos on YouTube. “There is a need for reliable information for dermatologists and students and residents to learn more about this, and I do think we have the resources to put together a good instructional video,” Dr. Lipner says. *  *  *   We also bring you the latest in dermatology news and research: 1. COVID-19: What Now? 2. Presymptomatic or asymptomatic? ID experts on shifting terminology 3. Cardiology groups push back on hydroxychloroquine, azithromycin for COVID-19 *  *  *   Key takeaways from this episode: Not all nail biopsy videos on YouTube are produced by reliable sources. In a recent analysis, the top 10 most relevant nail biopsy videos on YouTube were associated with a number of shortcomings. Medical students, residents, and dermatologists are advised to seek other more reliable opportunities to learn about nail biopsy procedures: “Probably the best would be to learn in person how to do a biopsy from a nail specialist or a Mohs surgeon,” Dr. Lipner suggests. She also recommends didactic sessions in which physicians can practice biopsy procedures on cadaver nails. The American Academy of Dermatology offers a hands-on nail surgery course at its annual meetings, where dermatologists can work on cadaver nails under the direction of at least 10 nail specialists. The most reliable resource for patients on nail biopsies is education from a board-certified dermatologist. There is a need for more patient education materials that explain the procedure in detail. *  *  *   Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Shari R. Lipner, MD, PhD (Weill Cornell Medicine, New York) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Lipner reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Body lice present an important public health concern due to the potential spread of infectious diseases. Dr. Vincent DeLeo talks with Dr. Dirk Elston about how to identify and manage human body lice infestations. *  *  *   We also bring you the latest in dermatology news and research: 1. Skin manifestations are emerging in the coronavirus pandemic 2. NCCN panel: Defer nonurgent skin cancer care during pandemic 3. iPLEDGE allows at-home pregnancy tests during pandemic *  *  *   Key takeaways from this episode: Human body lice are similar in appearance to head lice but can be differentiated based on the location of the infestation: “Body lice tend to lay their eggs in seams of clothing and on the fibers of hair in clothing rather than on the hairs on the head,” Dr. Elston notes. Body lice are transmitted through prolonged person-to-person contact associated with mass crowding, refugees, poverty, and homelessness. Patients with body lice typically present with generalized pruritus, maculated ceruleae, and hemosiderin deposits in the skin where the lice have fed, as well as lice and nits in the clothing. Body lice can be treated entirely with treatment of the clothing. “Pharmacologic intervention in the case of body lice is more for disease that the body louse may have spread,” Dr. Elston explains. Clinical signs and symptoms of body lice infestation include sepsis or more serious infection, typhus, eschar associated with other rickettsial-type diseases, endocarditis, cat scratch fever, acral splinter hemorrhages, and Osler-type nodes. “Most of these patients won’t present to us in clinic but more likely to [the] emergency department,” says Dr. Elston. Unlike body lice, head lice can be treated by shaving the head or other topical treatments. Combing through the hair has shown low efficacy rates. “Head lice are widespread. They know no economic or social boundaries. ... Fortunately, they are not known to be significant vectors of disease, but they are certainly a nuisance and something that carries a significant social stigma,” advises Dr. Elston. Transmission of lice is highly preventable. “[The] simple separation of clothing is the greatest intervention that we can do to prevent spread among schoolchildren, and it’s really a very simple and common-sense thing to do,” Dr. Elston says. If a patient has very coarse curly hair, pubic lice are more likely to infest the scalp than head lice. Pubic lice also are common in body hair, particularly in males, and are not just restricted to the pubic region. *  *  *   Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Dirk M. Elston, MD (Medical University of South Carolina, Charleston) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Elston reports no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
As the nation’s health care system braces for COVID-19 cases, physicians who’ve faced the pandemic first have critical lessons for everyone. In this bonus episode of Dermatology Weekly, two Seattle-area critical care leaders explain how their medical centers are preparing for and responding to their region’s early outbreaks. And they share some creative approaches that are uniting Seattle’s critical care departments.
Patients with severe psoriasis may be at higher risk for infection because of increased inflammation in the body. Dr. Lawrence Green discusses how to counsel patients who are taking biologics to control their psoriasis during the COVID-19 pandemic. “What I recommend [is to] stay on your biologic as long as you can unless you have exposure [or] you start to feel feverish,” Dr. Green advises. *  *  *   We also bring you the latest in dermatology news and research: 1. CMS implements temporary regulatory changes to aid COVID-19 response 2. FDA issues EUA allowing hydroxychloroquine sulfate, chloroquine phosphate treatment in COVID-19 3. FDA okays emergency use of convalescent plasma for seriously ill COVID-19 patients 4. Physician couples draft wills, face tough questions amid COVID-19 *  *  *   Key takeaways from this episode: Patients with uncontrolled psoriasis symptoms are at higher risk for developing infection and other comorbidities. “In general, I have told patients that if they stop the biologic for some time and the psoriasis comes back so that it’s severe again, I think that it’s significantly more risky for getting COVID-19 than if they continue to take their biologic,” says Dr. Green. There currently are no data on whether biologics help or harm patients with COVID-19. Anti–tumor necrosis factor (anti-TNF) agents may be useful in helping control pneumonia, but they also are associated with an increased risk for infection, compared with other biologic agents. It may be safer for patients to switch to or continue treatment with anti–IL-17 or anti–IL-23 agents during the COVID-19 pandemic. Patients should stop biologic treatment if they have exposure to someone with COVID-19 or start to show symptoms. “Stopping a biologic for a few weeks will not bring your psoriasis back. ... [but] a few months off can make a difference,” Dr. Green explains. Patients currently on biologics should take extra precautions to practice social distancing, stay at home when possible, wash hands, use hand sanitizer, and avoid touching the face, as recommended by the Centers for Disease Control and Prevention. For additional resources, dermatologists can consult the American Academy of Dermatology or the National Psoriasis Foundation guidelines on psoriasis treatment during the COVID-19 pandemic. *  *  *   Host: Nick Andrews Guest: Lawrence J. Green, MD (George Washington University, Washington) Show notes by: Alicia Sonners, Melissa Sears *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
In residency, transitioning care to different providers can be a complicated process. Dr. Vincent DeLeo talks to Dr. Sophie Greenberg about strategies to improve patient handoffs among dermatology trainees. Dr. Greenberg identifies key issues that may hinder patient handoffs and poses evidence-based solutions that can help keep dermatology residents organized. * * *   We also bring you the latest in dermatology news and research: 1. Coronavirus resources from AAD target safe office practices, new telemedicine guidanceAAD President George J. Hruza, MD, assured members that AAD will maintain updated resource pages in a situation that’s changing by the day. 2. How to ramp up teledermatology in the age of COVID-19Dr. Adam Friedman discusses the steps his institution is taking to prepare for more virtual visits. *  *  *   Things you will learn in this episode: Handoff problems are one of the top issues that are more prevalent in malpractice cases involving medical trainees vs nontrainees. Issues with handoffs occur between trainees as well as between trainees and attendings. “Communication skills may be underemphasized in residency, with lack of formal teaching on this matter,” Dr. Greenberg notes. Many electronic medical records have built-in functions to assist with patient handoffs, and there also are several HIPAA-compliant electronic apps that can help providers collaborate and stay organized. Mnemonics and other standardized tools that have proven effective in internal medicine inpatient settings may be easily implemented in the dermatology setting. “I also keep a notebook with stickers of each patient I see and jot down things to follow up. At the end of each day, I double check and periodically update my electronic handoff,” Dr. Greenberg explains. *  *  * Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: Sophie A. Greenberg, MD (Columbia University Medical Center, New York); Adam Friedman, MD (George Washington University, Washington) Show notes by: Alicia Sonners, Melissa Sears *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
The Fitzpatrick skin type (FST) often is used as a proxy for constitutive skin color, which can lead to confusion. Dr. DeLeo speaks with Dr. Susan Taylor and her colleagues Olivia Ware and Jessica Dawson about the racial limitations of FST in clinical practice. They discuss other classification systems for assessment of skin type and highlight the challenges of creating one system to classify an infinite number of skin tones. * * *   We also bring you the latest in dermatology news and research: 1. Paper from Wuhan on dermatology and coronavirus 2. Patients accept artificial intelligence in skin cancer screening 3. Dermatologists best at finding work satisfaction in the office *  *  *   Things you will learn in this episode: In its early stages, the Fitzpatrick scale was designed to guide dosage for patients undergoing phototherapy by determining who burned and who tanned on exposure to UV light. The Fitzpatrick skin type has been incorrectly associated with visual stereotypical skin color cues, most likely because there is no other widely adopted classification system for skin color that can be applied to all skin. In clinical practice, many providers inappropriately use the FST to describe patients’ constitutive skin color or race/ethnicity rather than their propensity to burn. The FST is automatically included in the physical examination portion of many standardized note templates, even for patients without phototherapy needs. Providers who do not identify as having skin of color may be more likely to use FST to describe constitutive skin color, compared with providers with skin of color. A more detailed and diverse system to describe constitutive skin color in clinical practice is needed. “The world is becoming so diverse, and there are so many different hues, races, ethnicities, and as dermatologists in the forefront we need to be able to identify pigmentary disorders, identify who will have adverse reactions to a variety of procedures, and thinking about how to do that is really the first step in accomplishing our goal,” explains Dr. Taylor. *  *  * Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: Susan C. Taylor, MD (University of Pennsylvania, Philadelphia); Olivia R. Ware (Howard University, Washington); Jessica E. Dawson (University of Washington, Seattle) Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Consider poor adherence rather than recalcitrant disease in psoriasis patients who do not respond to topical treatment. Dr. Vincent DeLeo talks with Dr. Nwanneka Okwundu and Dr. Steven Feldman about strategies to promote better treatment adherence. They discuss factors that contribute to poor adherence and offer tips to motivate patients to stick to their treatment regimens. “There’s a lot we can do to get people to use their medicine better.  ... Our job is to get people well. And to do that, we have to make the right diagnosis, prescribe the right therapy, and do those things that need to be done to get patients to put the medicine on,” explains Dr. Feldman. * * *   We also bring you the latest in dermatology news and research: 1. Coronavirus outbreak prompts cancellation of AAD annual meetingThe American Academy of Dermatology annual meeting is the latest large medical conference to be canceled because of the coronavirus disease 2019 (COVID-19) outbreak. 2. Antifungal drug terbinafine appears safe for pregnancyTreatment with terbinafine during pregnancy does not appear to increase the risk of major malformations or spontaneous abortions. 3. Toys may be the culprit for children with contact allergiesA variety of toys such as video game controllers, tablets, dolls, bikes, and toy cars, can cause contact dermatitis in children because of the nature of their respective ingredients. *  *  *   Things you will learn in this episode: A recent study evaluated whether psoriasis patients who were resistant to topical corticosteroids responded under conditions designed to promote treatment adherence, which included telephone reminders, frequent study visits, and use of a spray vehicle vs. an ointment. Most participants improved in all measurement parameters, but the randomized group of patients who received telephone calls showed more improvement in disease severity than those who did not receive telephone calls. “This idea that topical therapy doesn’t work, I think, is based on a misconception. It’s based on our observations that it doesn’t work, but we’re not seeing how poorly compliant patients are. If we take people who fail topical therapy and do things to really get them to use their topical medication well, their skin disease clears up,” Dr. Feldman explains. In addition to making the diagnosis and prescribing treatment, dermatologists play an important role in getting psoriasis patients to use their medications: “If you tell people, ‘Here, put this topical therapy on. It’s messy, I’ll see you in 3 months,’ you’ll be like a piano teacher saying, ‘Here’s a really complicated piece of music, practice it every day, I’ll see you at the recital in 3 months.’ It’s just not going to sound like a very good recital,” Dr. Feldman notes. Practical alternatives to frequent office visits that dermatologists can use to answer patient questions and promote treatment adherence include virtual visits (teledermatology) and electronic interactions (telephone calls, email correspondence). It is important to prescribe therapies that are consistent with a patient’s preferred vehicle. “If the patient prefers a spray, give them a spray. If they want an ointment, give them an ointment. They are more likely to use it that way,” Dr. Okwundu recommends. When starting patients on a new treatment, hold them accountable by having them check in with you to let you know how they are doing. “Maybe we don’t need to see people every 3 days, but we need to make sure patients realize we care about them, because they don’t want to let us down if we have the kind of strong human relationship with them and then we have to hold them accountable,” Dr. Feldman advises. *  *  *   Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: Nwanneka Okwundu, DO; Steven R. Feldman, MD, PhD (both are with Wake Forest University, Winston-Salem, N.C.). Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Hyperbaric oxygen therapy (HOT) is an effective second-line treatment option anytime there is a chronic complicated wound or tissue with vascular compromise. Dr. Josephine Nguyen, president of the Association of Military Dermatologists, talks with Dr. Emily Wong and Dr. Jonathan Jeter about how dermatologists can use HOT. “The most common scenario ... would be a situation where you have a compromised flap or graft after a surgery,” says Dr. Jeter “[The site is] not getting enough blood flow that’s threatening it to necrose ... hyperbaric oxygen therapy can come in [and] can increase the oxygen delivery to those sites,” says Dr. Jeter. They discuss the mechanism of action for HOT, tips for treatment, and potential complications. * * *   We also bring you the latest in dermatology news and research: 1. What medical conferences are being canceled by coronavirus? Despite COVID-19, most U.S. medical conferences are moving forward as planned. 2. Nemolizumab tames itching in prurigo nodularis patients in phase 2 study Adults with moderate to severe prurigo nodularis who were treated with the investigational drug nemolizumab showed significant improvement in itching, compared with patients who received placebo. 3. Esophageal stricture signals urgent treatment in kids with butterfly skin A quarter of urgent contacts in 20 children with generalized severe recessive dystrophic epidermolysis bullosa were tied to esophageal narrowing. * * *   Things you will learn in this episode: Hyperbaric oxygen therapy is best known for treating decompression sickness (e.g., "the bends" in scuba divers or aircrew members) and carbon monoxide poisoning. “[HOT] occurs in a specialized chamber that gradually becomes pressurized in order to increase the ambient pressure,” Dr. Wong explains. “Then the pressure can return to atmospheric pressure in a controlled, slow manner.” In addition to persistent wounds and compromised grafts and flaps, other dermatologic applications for HOT include radiation-induced ulceration, vasculitis/vasculopathy, and autoimmune reactions. Patients may inquire about HOT for anti-inflammatory conditions such as psoriasis, but there currently is no evidence to support its effectiveness. Only published dermatologic indications for HOT are recommended until more research is conducted. According to the Undersea & Hyperbaric Medical Society, there currently are nearly 200 accredited HOT locations in the United States. Hyperbaric oxygen therapy is most likely to be available within large medical centers and is less common in rural areas. In cases in which tissue is threatened, it is important to refer patients for HOT sooner rather than later. “The longer it goes since the initial injury or loss of blood flow, the less likely [HOT is] going to be effective,” notes Dr. Jeter. Dermatologists typically need to refer patients to large academic medical centers with wound care centers to receive HOT. Potential complications of HOT include fire, middle ear barotrauma, and reversible myopathy. More severe but rare complications include central nervous system symptoms, seizures, and pulmonary toxicity. The only absolute contraindication for HOT is an untreated pneumothorax. Treatment sessions can last anywhere from a few minutes up to several hours. “The longer [the sessions] get, the more likely you are to have complications, but generally around an hour to an hour and a half is a pretty reasonable time period,” Dr. Jeter recommends. In a hyperbaric oxygen chamber, the patient sits or lays down and breathes in pressurized 100% oxygen through a mask or a tight-fitting hood, and the affected skin stays covered with a bandage or the patient’s clothing. “Ultimately, it is the increased level of systemic oxygen that promotes wound healing and graft or flap survival. The systemic oxygen improves the fibroblast function, blood flow, vascularity, and mitigates the ischemia-reperfusion injury,” explains Dr. Wong. *  *  *   Hosts: Nick Andrews; Josephine Nguyen, MD Guests: Emily B. Wong, MD; Jonathan P. Jeter, MD (San Antonio Uniformed Services Health Education Consortium, Joint Base San Antonio–Lackland, Tex.) Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Low-dose naltrexone can suppress inflammatory markers, making it a potential therapy for some inflammatory skin conditions with a pruritic component. In this resident takeover, Dr. Daniel Mazori talks to Dr. Nadine Shabeeb about the benefits of off-label low-dose naltrexone (LDN) for the treatment of inflammatory skin conditions. “These anti-inflammatory effects aren’t seen at the higher doses of naltrexone; they’re only seen at the lower dose,” Dr. Shabeeb notes. She provides a practical perspective on prescribing LDN in the dermatology setting and discusses how to counsel patients about potential side effects, including concerns about its abuse potential. * * *   We also bring you the latest in dermatology news and research: 1. Advising patients on morning and evening skin protectionMDedge Dermatology Editor Elizabeth Mechcatie speaks with Dr. Brooke C. Sikora about what clinicians can recommend for their patients for skin protection, both in the morning and in the evening. 2. Patient counseling about expectations with noninvasive skin tightening is key Dr. Nazanin Saedi advised that it is important to counsel patients about the degree of improvement to expect with noninvasive skin-tightening procedures. 3. Banning indoor tanning devices could save lives and money Banning indoor tanning devices outright in the United States, Canada, and Europe could prevent as many as 448,000 melanomas and save billions of dollars. * * *   Things you will learn in this episode: Naltrexone is approved by the U.S. Food and Drug Administration to treat alcohol and opioid addiction. At its approved dose of 50-100 mg/day, naltrexone blocks opioid effects for 24 hours. In dermatology, naltrexone is used off-label at lower doses of 1.5-4.5 mg/day. “At this dose, naltrexone only binds partially to the opioid receptors, so this ends up leading to a temporary opioid blockade and ultimately increases endogenous endorphins.” Dermatologic conditions that may benefit from LDN include Hailey-Hailey disease, lichen planopilaris, psoriasis, and pruritus. Low-dose naltrexone has a favorable side-effect profile. Known adverse effects include sleep disturbances with vivid dreams and gastrointestinal tract upset. Low-dose naltrexone can alter thyroid hormone levels, especially in patients with a history of thyroid disease. “If they haven’t had a normal TSH [thyroid-stimulating hormone test] in the past year, then you can consider checking one at baseline and then check every 3 or 4 months for patients who do have a history of thyroid disease while they’re on treatment,” Dr. Shabeeb advises. “I’d also recommend counseling patients about symptoms related to hyper- and hypothyroidism so that they’re aware of symptoms to look out for.” There is no known abuse potential for LDN, but it is important to ask patients if they are using any opiates or opioid blockers before prescribing it. “If [LDN is] taken with an opiate, it can cause withdrawal symptoms and also decrease the effectiveness of the opiate, and if it’s taken with other opioid blockers, there’s also a higher risk for opioid withdrawal,” Dr. Shabeeb explains. Patients should be counseled that the cost of LDN will not be covered by insurance because it has no FDA-approved dermatologic indications. There is a lot of potential for LDN in the treatment of inflammatory skin diseases, but current research is limited to case report and case series; therefore, more data is needed. * * *  Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guests: Nadine Shabeeb, MD, MPH (University of Wisconsin Hospital and Clinics, Madison); Brooke C. Sikora, MD, is in private practice in Chestnut Hill, Pa.; Nazanin Saedi, MD (Jefferson University Hospitals, Philadelphia Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Phototherapy is a viable option for many patients with psoriasis. Dr. George Han speaks with Dr. Jashin Wu about the recent national guidelines from the American Academy of Dermatology and the National Psoriasis Foundation on phototherapy, particularly narrowband UVB. They discuss treatment advantages, potential side effects, combination regimens, and patient reimbursement for at-home phototherapy. “Phototherapy serves as a reasonable and effective treatment option for [psoriasis] patients requiring more than topical treatments but also wishing to avoid systemic medications or if they are simply seeking an adjuvant to a failing regimen,” advises Dr. Wu. * * *   We also bring you the latest in dermatology news and research: 1. How the mutant selection window could reshape antibiotic use Dr. Hilary Baldwin describes a concept in the infectious disease literature that could help dermatologists strike a careful balance between treatment and resistance. 2. What oral therapies work best for hyperhidrosis Dr. Jashin Wu examines the nondevice options for treating patients with the condition. * * *   Things you will learn in this episode: Narrowband UVB is the primary type of phototherapy used in dermatology. It acts by three major pathways: alteration of the cytokine profile, apoptosis (programmed cell death), and UV-induced immunosuppression of epidermal Langerhans cells. Phototherapy offers advantages for a wide range of patients. “If a patient has failed topical treatment but they may not be interested in systemic therapy -- they don’t want a biologic or they don’t want an oral therapy --phototherapy still is a good option for these patients. In particular, I like it for patients with moderate disease ... between 3% and 10% body surface area,” Dr. Wu explains. Phototherapy also is a good option for pregnant women who may be concerned about potential fetal side effects associated with most systemic agents. Acitretin (Soriatane) is one of the most common agents used in combination with phototherapy: “In theory, phototherapy could increase the risk of skin cancer, especially if [the patient has] several hundreds of episodes of phototherapy,” Dr. Wu notes. “Acitretin in theory may improve the risk of skin cancer, so actually this has a protective effect and also may reduce the number and length of phototherapy [treatment sessions] that [are] needed.” It is recommended that patients undergoing phototherapy use genital shielding to reduce the risk of skin cancers in the genital area and wear goggles to reduce the risk of cataracts. Skin cancer risk in patients treated with both narrowband and broadband UVB has been correlated with the number of treatments received, but the risk has not shown to be significantly greater than in the general population. “If [the patient has] had a prior history of skin cancers, I probably wouldn’t be choosing phototherapy as one of my first-line agents,” Dr. Wu says. Home phototherapy is a good option for patients who are not able to come to the office for treatment two or three times per week. “Sometimes the insurance carriers would actually prefer this,” Dr. Wu explains. Some patients may request to stop treatment temporarily during warmer months when they are more likely to get exposure to natural sunlight. When resuming phototherapy, these patients will need to repeat the induction phase before returning to a maintenance regimen. Hosts: Nick Andrews; George Han, MD, PhD (Icahn School of Medicine at Mount Sinai, New York, New York) Guests: Hilary E. Baldwin, MD (State University of New York, Brooklyn); Jashin J. Wu, MD (Dermatology Research and Education Foundation, Irvine, California) Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
At the 2020 ODAC Dermatology, Aesthetic & Surgical Conference in Orlando, Angelo Landriscina, MD, revealed how dermatologists can help their LGBTQ+ patients. Dr. Landriscina, and MDedge reporter Jeff Craven join producer Nick Andrews to discuss how dermatologists are uniquely suited to treat sexual- and gender-minority patients.   As patients are becoming more involved in their own care, physicians must stay up to date on trends such as the ketogenic (keto) diet to encourage better health and steer patients away from dangerous online advice. Dr. Vincent DeLeo spoke with Dr. Daren Fomin about benefits of the ketogenic diet for dermatologic conditions such as acne, diabetic skin diseases, and cutaneous malignancies. Dr. Fomin also provided tips for safely and effectively implementing this diet. “Coming alongside [patients] as more than just a diagnoser and treater of disease but [as a] promoter of health, I think that’s very valuable, and honestly I think that’s where medicine is moving,” Dr. Fomin said. *   *   * Things you will learn in this episode: Ketosis is the state of producing ketones, which is necessary to maintain proper organ function in the absence of sufficient dietary carbohydrates. Ketosis can be achieved through fasting; prolonged aerobic activity; certain physiologic states (e.g., pregnancy or the  neonatal period); and processes such as the ketogenic diet, which tricks the body into a low glucose state that results in metabolic and cellular benefits without famine or fasting. Some dermatologic conditions might theoretically respond to a ketogenic diet. “From our reading of the literature, we think potential candidates would be acne, hidradenitis suppurativa, autoinflammatory syndromes, definitely diabetic skin diseases, melanoma, and perhaps other skin cancers, psoriasis, morphea, and ... obesity-related skin disease,” Dr. Fomin explained. Ketogenesis may provide a multiangle approach to acne treatment. Beta-hydroxybutyrate, the main ketone produced during ketogenesis, can potentially decrease or inhibit the inflammatory response in acne vulgaris. Ketogenesis also helps prevent the hyperproliferation of keratinocytes seen in acne and optimizes androgens to reduce sebum production. Low-carbohydrate regimens such as the ketogenic diet have been associated with risk reduction of such diabetic skin diseases as diabetic peripheral neuropathy, ulcers, acanthosis nigricans, microangiopathy, and cutaneous infections: “This is due to several known mechanisms,” Dr. Fomin noted. “Less glucose entering the body and less fat deposition as a product of that, less end-product glycation, less free radical production, enhanced fat loss and metabolic efficiency, increased insulin sensitivity, and then decreased inflammation, as well.” Because cancer cells from melanoma and other malignancies survive only in the presence of glycogen, there is serious potential that cancer could be “starved out” by feeding normal tissues with ketones. “Honestly, it’s my hope and kind of my optimistic thought that in 10-20 years, maybe we’ll see an increase in the number of patients being put on some sort of either endogenous or exogenous ketone therapy as an adjunct to their cancer treatments,” Dr. Fomin said. “I’d be curious to see if we can start adding this on to adjunctive melanoma therapy and see if there’s an improved outcome in our patients.” The ketogenic diet generally is well tolerated, but potential transient adverse effects include dehydration, acidosis, lethargy, hypoglycemia, dyslipidemia, prurigo pigmentosa, and gastrointestinal distress. Chronic side effects include nephrolithiasis and unintended weight loss. The ketogenic diet approach to managing skin disease takes a lot of self-motivation and work from patients. It is important to make sure patients know to expect a few days to weeks of potentially noticeable physiologic effects (e.g., hyperglycemia, lethargy) before they become adapted to the diet. When working with patients to initiate the ketogenic diet, dermatologists are encouraged to involve educated nutritionists if they have access to them. *   *   * Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Angelo Landriscina, MD (George Washington University, Washington); Daren A. Fomin, DO (Walter Reed National Military Medical Center, Bethesda, Md.). Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie *  *  *   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Dermatologists had concerns about the maintenance of certification (MOC) program and the American Board of Dermatology (ABD) listened. Dr. Vincent DeLeo speaks with Dr. Erik Stratman about how CertLink, the ABD’s new web-based assessment platform, makes continuing certification activities more accessible and more meaningful to clinical practice. Dr. Stratman notes, “We [ABD] recognized that the program [MOC] had faults. In 2015, after our first 10 years of experiences, we decided to take a hard look at the program. . . . The American Board of Dermatology decided to take on some of the education on its own shoulders and create activities that could be made more affordable, more meaningful, less time, and that’s where ideas such as CertLink . . . came to be.” *   *   * We bring you the latest in dermatology news and research: Social media may negatively influence acne treatment Patients follow advice found on social media that doesn't match up with AAD guidelines. High cost of wound dressings for epidermolysis bullosa highlightedDressing and bandage costs were highest for study participants with the generalized severe subtype, at about $112,450 per patient annually. New Barbie lineup includes a doll with vitiligoThe doll debuts much to the delight of clinicians who treat children and adolescents with the condition. *   *   * Things you will learn in this episode: CertLink is a web-based longitudinal assessment platform designed as an alternative to the high-stakes sit-down examination. Rather than generating questions on random medical knowledge, CertLink allows dermatologists to tailor the test to highlight specific subspecialties that are more relevant to their individual areas of clinical practice. “It allows the diplomate to tailor the assessment to be more relevant to what they do in practice every day,” advises Dr. Stratman. “And that’s one of the ways that we’ve tried to tackle the question of relevance so that [diplomates are] maximizing the kinds of questions that reflect their practice.” Once ABD diplomates start the CertLink program, they are issued a set of 13 questions every quarter for the rest of their active board-certified lives. The questions can be accessed all at once or one at a time, depending on how the dermatologist wants to take the assessment. Questions come in 3 varieties: core questions (general dermatology); concentration, vignette-based questions (subspecialties); and article-based questions (eg, new guidelines, therapies, side effects). Because the new assessment program is designed to be taken continuously throughout one’s career, all diplomates are permitted to take 1 quarter off each year as a break from the testing. Larger-scale participation in the CertLink program over time will be necessary to develop accurate measures of performance for the new test. “We want to get as many diplomates as possible on board with this testing platform so that they can gain experience, and we recognize that within these early years there’s going to be a nonuniform uptake of joining on to CertLink, so there’s basically a 2-year onboarding window that we anticipate,” Dr. Stratman notes. CertLink includes a learn-to-competence element that allows diplomates to learn from wrong answers without penalty. “When you first see a question in a particular quarter and you answer that question and you happen to get it wrong . . . you will get an explanation of why was that right answer right and why were each of the wrong answers wrong, so there’s a little opportunity for learning,” Dr. Stratman explains. The diplomate then will receive a very similar question in the following quarter, and only then will the response count toward the assessment grade. The CertLink platform launched on January 6, 2020, to a cohort of more than 4500 board-certified dermatologists. In the first week, more than 800 dermatologists answered test questions with a correct response rate of more than 97%. The next sign-on period for CertLink is in May 2020. “When you see an inbox email from the [ABD], it’s worth opening and reading. We don’t try and sell you products, we aren’t spamming you. If there’s something from the [ABD], it’s worth the read,” Dr. Stratman advises.   Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Erik J. Stratman, MD (Marshfield Clinic Health System, Wisconsin) *   *   * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
In this resident takeover, three dermatology residents -- Dr. Daniel Mazori, Dr. Elisabeth Tracey, and Dr. Julie Croley—recap some of the dermatology issues and controversies that made headlines in 2019. They provide an overview of noteworthy topics such as chemical sunscreen safety, measles and vaccinations, drug approvals, and recalls of popular over-the-counter products and discuss how they have addressed these issues with their patients. *   *   * We bring you the latest in dermatology news and research: European marketing of Picato suspended while skin cancer risk reviewed The Food and Drug Administration is gathering information to investigate the safety concern raised in Europe. Frequent lab testing is common, but low-yield, for isotretinoin patients Low rates of abnormalities can inform clinicians looking for an optimal testing strategy. Celebrating 50 years of Dermatology News  Click the above headline to read our debut issue from January 1970! *   *   * Things you will learn in this episode: Laws restricting the sale of chemical sunscreens containing organic UV filters such as oxybenzone were passed in Key West, Fla., as well the U.S. Virgin Islands.   The Food and Drug Administration asked sunscreen manufacturers to perform additional studies on safety parameters, such as systemic absorption for 12 organic UV filters, to determine if they can continue to be listed as generally recognized as safe and effective. “The FDA is not currently discouraging sunscreen use and is not saying that these 12 organic UV filters that were studied are unsafe, so for now, both physical sunscreens and chemical sunscreens with those organic filters are considered acceptable,” advises Dr. Tracey. The measles outbreak in New York City, which was fueled by undervaccinated communities, ended in 2019 after becoming the city’s largest measles outbreak in nearly 30 years. “[Questions about vaccination] probably doesn’t come up in our clinic as much as a primary care provider’s office but it is relevant to many dermatologic conditions and so I think it is our duty when approached with this issue to be advocates for what we know has scientific data to back it up,” states Dr. Croley. Dupilumab was FDA approved for adolescent atopic dermatitis, making it the third biologic with a pediatric dermatology indication. Trifarotene cream and minocycline foam were approved for treatment of acne in patients 9 years and older. Apremilast became the first FDA-approved medication for oral ulcers from Behçet disease. Afamelanotide became the first FDA-approved medication for erythropoietic protoporphyria. One lot of Johnson’s Baby Powder was recalled because of possible asbestos contamination, but no asbestos was found when the bottles of interest were retested. The Neutrogena Light Therapy Acne Mask was recalled because of rare reports of visual side effects from insufficient eye protection as well as risk for potentially irreversible eye injury in patients taking photosensitizing medications or with certain underlying eye conditions. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York, Brooklyn); Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Julie Ann Amthor Croley, MD (The University of Texas Medical Branch at Galveston) *   *   * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
This week, Nick Andrews talks with reporter Kari Oakes, whose feature for our January print issue highlighted the dermatologists working in Africa and here in the United States to promote inclusivity and provide care for people with albinism. The condition is much more common in parts of East Africa, where people with albinism are stigmatized and even hunted and maimed for body parts. The segment features David Colbert, MD, a Manhattan dermatologist whose foundation has partnered with the United Nations for an awareness-raising campaign. He also talks about the nuts and bolts of how even busy dermatologists can get involved in philanthropic and nonprofit work. *   *   * Hair loss from central centrifugal cicatricial alopecia (CCCA) often is attributed to hairstyling practices used by black women, but the scarring process actually is similar to other scarring conditions. Dr. Vincent A. DeLeo talks with Dr. Crystal Aguh about the pathogenesis of CCCA and its systemic implications. “Before you can even start to ask what causes [CCCA], you have to believe that there is a biological basis of disease, and so when you put the onus on the patient and the blame on the patient, then in reality you’re saying, 'Well if you didn’t do this, this would not occur,' and we’re really not seeing that in our patients,” explains Dr. Aguh. *   *   * Things you will learn in this episode: When CCCA was first described in the 1960s, it was initially called hot-comb alopecia. When hairstyling practices changed but CCCA persisted, it later became known as chemically induced alopecia. Later, it was associated with weaves and extensions. Research has shown there is a considerable overlap in gene expression patterns in CCCA and other scarring disorders such as uterine fibroids, hepatic fibrosis, and idiopathic pulmonary fibrosis. “This scarring process is very similar to other diseases of systemic scarring, and that really starts to shed light into the presentation of this disease,” explains Dr. Aguh. In one study, black women with CCCA were 5-times more likely to have uterine fibroids than black women who did not have CCCA, which speaks to a systemic process. The gene implicated in uncombable hair syndrome, PADI3, has been found to be upregulated in patients with CCCA, suggesting that disorders of hair shaft formation may subsequently lead to the abnormal scarring seen in CCCA patients. The inheritance pattern of CCCA still is unknown but is an avenue for future research. The systemic implications of CCCA, such as the link to uterine fibroids, show that it is more than an aesthetic disease: “The skin and the hair are really kind of window into what’s going on systemically, and [CCCA] is really important not just because the patient feels like they don’t look the way they want to but because it can adversely affect their health,” notes Dr. Aguh. Unlike other scarring alopecias, you cannot reliably use erythema or inflammation as a measure of activity in CCCA, as many patients have no clinical evidence of disease. As a result, topical treatment options such as intralesional steroid injections often are continued for years because it is difficult to tell if they are working. *  *  *   Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Crystal Aguh, MD (John Hopkins University, Baltimore) *   *   * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
Leukemia cutis should be high on the differential in patients presenting with leukemia. Dr. Vincent DeLeo talks with Dr. Lindsay Strowd and Wasim Haidari about their research on the presentation of leukemia cutis and clinical implications. “For us as dermatologists, to recognize that you may not know that the patient has leukemia at the time that you’re actually evaluating them I think points to the need to biopsy any spots that look unusual or a little bit different in nature,” notes Dr. Strowd. *   *   * We bring you the latest in dermatology news and research: Oral lichen planus prevalence estimates go global Dr. Daniel Siegel discusses the translational science behind natural ingredients *   *   * Things you will learn in this episode: Leukemia cutis tends to present in patients with acute myeloid leukemia (AML) but also can present in other forms of the disease. Clinically, leukemia cutis is thought to present most commonly as solitary nodules, but recent research revealed that the primary presentation may include multiple papules or other unusual presentations such as mucosal and ulcerative lesions. Thorough and comprehensive full skin examinations are important in patients with leukemia: “Biopsy for leukemia cutis certainly is most times diagnostic for the disease, but I think paying attention to the entire skin surface of a patient with leukemia is also vitally important because [lesions] are not always going to present on the trunk or the arms or legs where they’re easily identifiable. Some of our patients have lesions on the scalp, the mucosal surfaces like the oral mucosa, and in the genital region as well,” says Dr. Strowd. Leukemia cutis can present at various stages during the course of leukemia, and time to diagnosis varies depending on subtype. For AML, study results indicated that the average interval between diagnosis of leukemia and leukemia cutis was about 5 months; however, many patients developed cutaneous findings at the onset of leukemia or with relapse. Leukemia cutis is considered a negative prognostic factor and may be associated with a shorter overall mortality in leukemia patients. It is important for dermatologists to have a good close working relationship with their oncology colleagues to facilitate prompt evaluation of leukemia patients who may present to their oncologist or another specialist with cutaneous findings. Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Lindsay Strowd, MD, and Wasim Haidari, BS, BA (Wake Forest School of Medicine, Winston-Salem, North Carolina) *   *   * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
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