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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.
54 Episodes
Rosacea diagnosis relies on clinical judgment. Dr. Vincent DeLeo talks to Dr. William James about rosacea classification and its controversies. Dr. James describes the evolution of rosacea classification systems and the need to define the clinical features of rosacea to improve patient care. “There is no gold-standard laboratory diagnosis for [rosacea],” Dr. James explains. “It’s really a diagnosis that’s made on clinical criteria, so those criteria I think should be well defined.” We also bring you the latest dermatology news and research. 1. Beyond sunscreen: Skin cancer preventive agents finding a role A growing list of skin cancer chemopreventive agents is expanding options for risk management. 2. Psoriasis patients on biologics show improved heart health Novel imaging biomarker identifies reduced coronary inflammation in psoriasis patients on biologics. 3. Dupilumab found effective for adolescents with moderate to severe atopic dermatitis The rates of skin infections also were higher in the placebo group, compared with the treatment groups. Things you will learn in this episode: There are three published rosacea classification systems based on clinical presentation, including the original classification schema introduced by the National Rosacea Society in 2002 and updated in 2018 as well as a similar classification system published by the global ROSacea COnsensus panel in 2017. The initial classification system included a list of primary and secondary features that were considered diagnostic of rosacea, but no standardized group of characteristics has been shown to be applicable in all cases of rosacea. The newer classification systems focus more on identifying phenotypic changes in rosacea patients rather than classifying subtypes of disease, as not every rosacea patient presents with a classic constellation of symptoms. Targeting individual symptoms of rosacea allows for more specific treatments based on a patient’s unique clinical presentation rather than designing therapies for broad subtypes. Despite advancements made in the newer classification systems, some of the definitions of primary features of classification still require more refinement; for instance, the classifications address flushing in rosacea as a very quick reaction, occurring within seconds to minutes of a trigger, but they do not address the prolonged nature of the redness, which is not as transient as in people who are simply embarrassed or overheated from exercise. Although it was included in the initial classification schema, granulomatous rosacea was eliminated in the newer classifications, likely because it does not share commonalities with traditional rosacea presentations. When diagnosing rosacea, it is important to consider other disease states that can lead to a red face and are in fact associated with diagnostic laboratory values or histopathologic appearances, such as systemic lupus, dermatomyositis, mastocytosis, carcinoid syndrome, polycythemia vera, and diabetes, as these conditions are more serious from a systemic standpoint. New treatment algorithms for rosacea focus on treating specific phenotypes rather than groups of symptoms, leading to more targeted therapies that can be used to treat individual patient presentations. Hosts: Elizabeth Mechcatie, Terry Rudd, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: William D. James, MD (University of Pennsylvania School of Medicine, 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
Seemal Desai, MD, talks with MDedge editor Elizabeth Mechcatie about the treatment of patients with pigmentary disorders in an interview at the summer meeting of the American Academy of Dermatology. We also bring you the latest in dermatology news and research: Higher dietary vitamin A linked to lower squamous cell carcinoma risk The results of the large prospective cohort study support the protective role of vitamin A against squamous cell carcinoma development. Adam Friedman, MD, takes a closer look at nanotechnology from a dermatology perspective. Ranking the best and worst states for health care Minnesota has more than just 10,000 lakes to brag about, the results of a WalletHub analysis suggest. Hosts: Elizabeth Mechcatie, Terry Rudd Guest: Seemal Desai, MD is in private practice in Dallas and is on the faculty at the University of Texas Southwestern Medical Center, Dallas. Show notes by Elizabeth Mechcatie and Terry Rudd. Dr. Friedman is a professor of dermatology and the interim chair of the dermatology department at George Washington University in Washington. For more MDedge Podcasts, go to      Email the show: Interact with us on Twitter: @MDedgeDerm
Dr. John Koo talks with Dr. Vincent DeLeo about the three main benefits of phototherapy, including its accessibility, safety profile, and wide range of effectiveness. Some physicians may think phototherapy is obsolete, but it continues to be a valuable tool in the dermatologist’s armamentarium. Dr. Koo also provides various clinical scenarios in which phototherapy may be the best treatment option for patients. We also bring you the latest in dermatology news and research: AAD, NPF update use of phototherapy for psoriasis The latest guidelines on psoriasis care includes pros and cons; emphasize patient choice. Sasha D. Jaquez, PhD, says a psychology consult for children’s skin issues can boost adherence, wellness Clinicians should pay attention to nonverbal cues and steer clear of scare tactics to change a child’s behavior. Trained interpreters essential for treating non–English-speaking patients Even in a private office setting, failure to engage a trained translator is discouraged. Things you will learn in this episode:  Phototherapy is universally accessible to millions of patients. Many payers prefer that patients try phototherapy before approving treatment with biologic agents. Because phototherapy is purely an external treatment, systemic safety is among its key advantages, particularly in elderly patients, those with active or history of recent cancer, and immunosuppressed populations in whom biologics and other systemic agents are not advised. There is no convincing evidence that UVB phototherapy increases skin cancer risk in any patient population. Psoralen plus UVA (PUVA) phototherapy has been shown to increase the risk of squamous cell carcinoma in fair-skinned white patients, but this risk has not been seen in nonwhite patients and has been associated only with systemic PUVA, not bath PUVA. Unlike biologics, which target specific molecules to treat individual conditions, phototherapy is a nontargeted treatment with wide effectiveness for many skin conditions. Because the broad-spectrum efficacy is nontargeted, both UVB and PUVA are usable for many different conditions that have nothing to do with one another, reported Dr. Koo. Narrowband UVB was designed to treat psoriasis but also works well for atopic dermatitis, generalized pruritus, vitiligo, urticaria, and seborrheic dermatitis. Psoralen plus UVA can effectively treat up to 50 different conditions, including psoriasis, atopic dermatitis, cutaneous lymphoma, mycosis fungoides, scleroderma, lymphomatoid papulosis, lichen planus, graft-versus-host disease, and alopecia areata. The biggest disadvantage of phototherapy is that treatment may not be convenient for patients. It can take up to 3 months to clear the skin, with patients ideally being treated three times weekly. Proper training and education of patients is critical for safe use of home UVB. “In our practice,” Dr. Koo explains, “we insist that nobody gets home UVB unless they spend some good amount of time where our professional phototherapy nurses or other staff can attest to the fact that the patient knows how to do it right.” Dermatology trainees aren’t always exposed to phototherapy during residency. Dermatology residents should get involved with phototherapy during their training, and those who have already graduated may choose to seek additional training through the National Psoriasis Foundation or by observing another academic or private practitioner. From a financial perspective, phototherapy can be well reimbursed. Hosts: Elizabeth Mechcatie, Terry Rudd, Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guest: John Koo, MD (University of California, San Francisco) Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. Dr.  Jaquez is a pediatric psychologist with Dell Children’s Medical Center of Central Texas, Austin. You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Combined oral contraceptives (COCs) have many uses in dermatology, but dermatologists often underutilize COCs and don’t feel comfortable prescribing them. In this special resident takeover of the podcast, three dermatology residents — Dr. Daniel Mazori, Dr. Elisabeth Tracey, and Dr. Julie Croley — review the basics of prescribing COCs for dermatologic conditions. Beginning at 8:36, they discuss assessment of patient eligibility and selection of COCs, proper use of COCs, and management of risks and side effects. We also bring you the latest in dermatology news and research: 1. iPledge: Fetal exposure to isotretinoin continues  Although pregnancy-related adverse events have decreased, pregnancies, abortions, and fetal defects associated with isotretinoin exposure continue to be a problem. 2. Expert shares contact dermatitis trends Dr. Rajani Katta talks about what's happening in contact dermatitis, including an uptick in allergic reactions to essential oils contained in “all natural” products. Things you will learn in this episode: Acne is the main indication for COCs in dermatology, but other off-label uses include hidradenitis suppurativa, hirsutism, female pattern hair loss, and autoimmune progesterone dermatitis. When prescribing COCs, it is important to consider absolute and relative contraindications such as cardiovascular disease, postpartum status, women 35 years and older and smoking more than 15 cigarettes per day, migraine with aura, and history of diabetes for more than 20 years, plus others. Rule out pregnancy prior to starting COCs via a urine or serum pregnancy test. Dr. Croley points out, “A pelvic exam is not required to start combined oral contraceptives, as is sometimes thought by providers.” Monophasic formulations are considered first-line therapy. For patients who are concerned about symptoms associated with a hormone-free interval during treatment, choose a COC that does not include placebo pills, or encourage the patient to skip the placebo pills altogether and start the next pack earlier. Estrogen-related side effects are a consideration when prescribing COCs. “In general, the lowest possible dose of estrogen that is effective and tolerable should be prescribed,” Dr. Libby advises. Combined oral contraceptives can be started on any day of the patient’s menstrual cycle, but patients should be counseled to use backup contraception for 7 days if the COC is started more than 5 days after the first day of their most recent period. At least 3 months of therapy can be expected to evaluate the effectiveness of COCs for acne, potentially up to 6 months. Breakthrough bleeding is the most common side effect of COCs and can be minimized by taking the COC at about the same time every day and avoiding missed pills. If breakthrough bleeding persists after 3 cycles, consider increasing the estrogen dose or referring the patient to an obstetrician/gynecologist. Discuss the risk of venous thromboembolism with patients using the 3-6-9-12 model. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York Downstate Medical Center, Brooklyn); Elisabeth "Libby" Tracey, MD (Cleveland Clinic Foundation, Ohio); Julie Ann Amthor Croley, MD (The University of Texas Medical Branch at Galveston). Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm  
Are you prepared to treat a U.S. military service member with acne or psoriasis? Civilian specialists are playing a larger role in the care of our military population. Josephine Nguyen, MD, president of the Association of Military Dermatologists, talks with Dr. Kristina Burke to help civilian dermatologists understand the concept of medical readiness. They also discuss skin conditions and treatments that are incompatible with military service and cannot be maintained in a deployed environment. "It’s not [meant] to be discriminatory; but it’s recognizing that, in this unique population, [service members] are going to be put into situations that are totally different than what they would be at home, and they have to be medically ready,” Dr. Burke explains. When treating a service member, you must consider patient satisfaction as well as his/her career and our nation’s security. We also bring you the latest in dermatology news and research: 1. Racial and ethnic minorities often don’t practice sun protective behaviors  Cultural beliefs, stigma, and personal preferences may affect behaviors. 2. Patients with atopic dermatitis should routinely be asked about conjunctivitis New onset conjunctivitis always should be referred to an ophthalmologist, especially in more severe cases when patients do not respond to antihistamine or artificial tears. 3. Measles cases have slowed but not stopped The CDC removes California from the list of active measles outbreaks. Things you will learn in this episode:  Military medicine is focused on medical readiness for U.S. military service members to deploy to locations across the globe and perform their duties. Dr. Burke explains medical readiness as "maintaining a person and a unit that is medically able to perform their military functions, both at home and in a deployed environment." Accession guidelines can disqualify a person from military service if symptomatic. A diagnosis of psoriasis or eczema is potentially disqualifying. Dr. Burke details why these conditions would be incompatible with military service. The key consideration is what’s going to happen when this patient is deployed and not able to access care. While service members are deployed, there is a lack of appropriate medication, a lack of refrigeration, and intense stress that can exacerbate an underlying condition such as psoriasis. She explains, “Mild cases can explode into severe flares when [service members] are under stress; when they’re in a different environment, an austere environment; and they’re not able to routinely access the care and the normal treatment that they would at home.” Acne treatment guidelines are the same in active-duty service members, but the therapies are worked around schedules for deployment and field training. For example, isotretinoin is a nondeployable medication — secondary to its side-effect profile, laboratory monitoring, and maintenance of the iPLEDGE system — and may be used when a service member comes home from deployment or is in between deployments. Unique populations such as aircrew members, special operations, and submariners have more restrictions on medications. For example, a flight crew member on doxycycline for acne will be grounded for a short period of time to monitor for side effects. Spironolactone and minocycline use also grounds aircrew members. “When a pilot takes medication, it can affect his or her spatial orientation,” Dr. Nguyen adds. “You can’t just give them a medication and assume that there will be no side effects.” Civilian dermatologists with questions about how to treat a service member can consult the Association of Military Dermatologists and Military Dermatology columns published in Cutis.  Hosts: Elizabeth Mechcatie; Terry Rudd; Josephine Nguyen, MD (Captain James A. Lovell Federal Health Care Center, North Chicago, Ill.) Guest: Kristina R. Burke, MD (Tripler Army Medical Center, Honolulu) Show notes by Melissa Sears, Alicia Sonners, and Elizabeth Mechcatie.  For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm
Failure to recognize rosacea in the skin of color population presents an important gap in dermatology practice. Beginning at 10:06, Dr. Vincent DeLeo talks with Dr. Susan Taylor about how dermatologists can improve diagnosis and treatment of rosacea in this patient population. “I think that rosacea is underrecognized because it’s often confused for other disorders that occur commonly in skin of color populations,” Dr. Taylor explains. She highlights various clinical clues distinguishing rosacea from mimickers such as connective tissue diseases, seborrheic dermatitis, cutaneous sarcoidosis, and acne vulgaris. We also bring you the latest in dermatology news and research: 1. No increased risk of psychiatric problems tied to isotretinoin Arash Mostaghimi, MD, of Brigham and Women's Hospital in Boston discusses the study's findings and their implications.  2. FDA warning letters fall on Trump’s watch The Food and Drug Administration sent out one-third fewer warning letters to marketers of problematic drugs, devices, or food during the Trump administration's first 28 months. Things you will learn in this episode:  Overall, rosacea does not occur as commonly in skin of color patients as in white patients in the United States, but all types of rosacea can be observed in skin of color. The erythematotelangiectatic and papulopustular subtypes are most common in skin of color populations, with granulomatous rosacea occurring more frequently in black patients. Rosacea is underrecognized and underdiagnosed in skin of color patients because physicians often don’t appreciate that rosacea can and does occur in these populations. It also can be difficult to identify the erythema that is characteristic of rosacea in skin of color. Skin of color patients with rosacea often don’t present to dermatology for treatment because they have no awareness of the disease. Connective tissue diseases such as systemic lupus erythematosus and dermatomyositis can mimic rosacea in patients with skin of color. Seborrheic dermatitis and rosacea have similar clinical features and can occur concurrently in the same patient. Biopsy is needed to accurately distinguish between granulomatous rosacea and cutaneous sarcoidosis, as it can be a challenge to make the diagnosis clinically. Comedones, nodules, cysts, and postinflammatory hyperpigmentation are suggestive of acne vulgaris, as these findings are not observed in rosacea. Most of the same medications used in white patients with rosacea can be used for skin of color patients. The most important factor to keep in mind when treating rosacea in skin of color patients is that irritation from topical agents can lead to postinflammatory hyperpigmentation. “I don’t think you can go wrong being cautious and approaching therapy slowly in this patient population,” notes Dr. Taylor. Daily sunscreen use is important in all skin of color patients, particularly those with rosacea who may have facial skin that is more subject to burning or stinging or those who are photosensitive because of treatment with topical agents. Ultimately, dermatologists should rely on information garnered from patients when rosacea is suspected in skin of color. “I think the key here is you must think about rosacea when you see a skin of color patient who comes to you and complains of burning, tingling, stinging of the facial skin; sensitivity to products; redness of the skin; papules; and pustules. There are times when as clinicians you may not be able to appreciate the erythema, but rest assured that your patient can tell you if his or her facial skin is red.” Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Susan C. Taylor, MD (Perelman School of Medicine, University of Pennsylvania, Philadelphia) References:  Establishing the Diagnosis of Rosacea in Skin of Color Patients Article PDF Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Are you and your staff prepared to handle ocular chemical injuries? Dr. Vincent DeLeo talks with Dr. Shawna K. Langley and Dr. Deborah Moon about common chemical agents used in the dermatology office that can be damaging to the eyes. Dr. Langley shares her experience with a patient who sustained a transient ocular injury following accidental exposure to aluminum chloride during a biopsy of a suspicious lesion on the cheek. Treatment protocols and prevention methods that dermatologists can implement to ensure the best outcome for patients also are discussed. We also bring you the latest in dermatology news and research: 1: Infections linked with transition to psoriatic arthritis 2: Social media use linked to acceptance of cosmetic surgery 3: Severity, itch improvements remain steady with ruxolitinib for atopic dermatitis   Things you will learn in this episode:  On average, approximately 7%-10% of all ocular traumas may be attributed to chemical burns. The two most important factors to consider when evaluating the extent of an ocular chemical injury include the properties of the chemical and the duration of exposure. Damage associated with exposure to acidic chemicals usually is limited to more superficial consequences, while exposure to alkaline chemicals can result in more serious long-term effects such as cataracts or glaucoma caused by deeper penetration of the eye structures. The most common immediate side effects of ocular chemical injuries include a sensation of burning (not necessarily immediate) or pain as well as redness or erythema of the eye and eventually vision changes. “One of the learning points to me was that if somebody complains that something has dripped in their eye, even if it doesn’t seem possible and it doesn’t really make sense, and if you had just worked with a caustic substance right before they said that, have them start flushing immediately anyway,” said Dr. Langley. The Roper-Hall classification outlines the prognosis based on grade of injury (grades I-IV). Immediate irrigation of the eye for 15-30 minutes is the most important variable, which will affect the patient’s long-term prognosis. “This is the one variable that will impact the long-term outcome the most for the patient,” said Dr. Langley. Always ask patients if they are wearing contact lenses, as chemicals trapped underneath can cause prolonged burning of the eye. Do not delay irrigation to remove contact lenses. Start irrigation immediately and remove the lenses when possible under irrigation. Emphasize urgent follow-up with an ophthalmologist following ocular chemical injuries sustained in the dermatology office. If an ophthalmologist is not immediately available, send the patient to the emergency department. Educate support staff about the potential for ocular injuries in the dermatology office and be prepared with the proper equipment to administer immediate treatment.   Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)   Guests: Shawna K. Langley, MD (Loma Linda [Calif.] University Medical Center; Deborah J. Moon, MD (Kaiser Permanente Los Angeles [Calif.] Medical Center and the University of California, Irvine)   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  
Three dermatology residents — Dr. Elisabeth Tracey, Dr. Julie Croley, and Dr. Daniel Mazori — discuss tips for clear communication with patients in this special resident takeover of the podcast. Beginning at 6:11, they talk about challenges with topical therapies and setting expectations with patients. “We, as dermatologists, can optimize patient management by being effective communicators,” said Dr. Croley. They provide communication strategies for improving compliance with therapy and ensuring patients have the correct instructions, as well as clarifying patient misconceptions and the importance of maintenance treatment. We also bring you the latest in dermatology news and research: 1. Topical ruxolitinib looks good for facial vitiligo in phase 2 study. About half of patients on the two highest doses had a 50% improvement after 6 months of treatment. 2. Patients concerned about clinician burnout. Almost three-quarters of Americans are concerned about burnout among health care professionals. 3. Antimalarial may be effective, safe for erosive oral lichen planus. Hydroxychloroquine sulfate may be an effective and relatively safe treatment option for moderate to severe oral lichen planus. Things you will learn in this episode: Review expectations of therapy with patients, such as an intense inflammatory response to topical 5-fluorouracil for actinic keratosis, to ensure that patients remain compliant with the therapy but also feel they can trust you as their physician. If patients are hesitant to use topical minoxidil because they are concerned with the length of time they’ll have to use it, use a metaphor for another lifelong commitment such as brushing your teeth. “What I started actually doing is calling topical minoxidil toothpaste for your hair,” said Dr. Mazori. Talk to patients about spot-treating with acne or applying topical medication appropriately for psoriasis. “A particular challenge in dermatology with topical medications is not just whether or not they use it or pick up the prescription but how they use it,” said Dr. Tracey. Talk to patients about underapplication of sunscreen. Recommend a physical blocker if patients express concerns about systemic absorption. Write down instructions to ensure patients have the relevant information. The teach-back method of communicating with patients often is taught in medical school and ensures that the patients have understood what you’ve said, but it doesn’t ensure that they retained it. Strategies such as having medical students write the instructions or copying notes from your electronic medical record to print for patients can help save time. Emphasize the importance of maintenance treatment for conditions such as intertrigo, seborrheic dermatitis, or onychomycosis to prevent recurrence. Give patients both the trade name and generic name to ensure they use the correct medication. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Julie Ann Amthor Croley, MD (University of Texas Medical Branch at Galveston); and Daniel R. Mazori, MD (State University of New York, Brooklyn). Show notes by Melissa Sears, Alicia Sonners, and Elizabeth Mechcatie.   You can find more of our podcasts at    Email the show: Interact with us on Twitter: @MDedgeDerm
In this episode, Dr. Vincent DeLeo discusses artificial intelligence (AI) with Dr. Babar Rao, beginning at 10:12. Cognitive computing, which mimics human thought processes to analyze data, can be used along with other advances in AI to support clinical decision-making and physician-patient interactions. Where is dermatology in this world of AI? Dr. Rao discusses clinical scenarios in which AI can be implemented to improve patient outcomes, including hair transplantation and skin cancer evaluation. He also forecasts the future of AI in dermatology. We also bring you the latest in dermatology news and research: 1. Scabies rates plummeted with community mass drug administration. 2. Teletriage connects uninsured with timely dermatologist care, plus an interview with study investigator Cory Simpson, MD, PhD, a dermatologist at the University of Pennsylvania, Philadelphia. The study was presented at the World Congress of Dermatology. 3. Response endures in cemiplimab-treated patients with cutaneous squamous cell carcinoma. Things you will learn in this episode:  Cognitive computing not only processes data but makes sense out of the data from multiple perspectives, including human-computer interactions, vision, and language processing. Computer-aided robots can be used to maximize outcomes in hair transplantation. Artificial intelligence (AI) software can be used to analyze biopsy slides to help make skin cancer diagnoses. Electronic medical records allow physicians to input patient data, which can be helpful from a billing and insurance standpoint, but these systems currently are not able to support physicians in making clinical decisions or in choosing treatment plans based on the available patient data. Over the next 10 years, it will become common for clinical decisions to be made based on evidence and data gathered from AI systems and not from research articles or textbooks alone. Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Babar Rao, MD (Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey) Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at     Email the show: Interact with us on Twitter: @MDedgeDerm
In this special takeover episode, guest host Dr. Candrice Heath talks to Dr. Vincent DeLeo about the new sunscreen regulations issued by the US Food and Drug Administration (FDA), beginning at 7:54. Despite heightened concerns about the safety of sunscreen ingredients brought on by these new regulations, the FDA still recommends sunscreen use as an important component of sun protection. “They’re not saying that any of these [ingredients] are necessarily dangerous by any means,” Dr. DeLeo explains, “simply that they need more data.” Dr. DeLeo breaks down the complicated sunscreen regulatory process and provides tips for alleviating patient fears about sunscreen use. He also addresses recent concerns in the media about systemic absorption of sunscreen ingredients. We also bring you the latest in dermatology news and research: 1. AAD issues position statement addressing sexual, gender minority health, featuring an interview with Klint Peebles, MD, co-author of the position statement and co-chair of the AAD's LGBTQ/SGM Expert Resource Group. Dr. Peebles is on twitter @DrKlintPeebles. 2. Tick-borne disease has become a national issue. Things you will learn in this episode:  Sunscreens are regulated by the FDA as over-the-counter drugs. The first proposed rule for sunscreens was issued by the FDA in 1978 with 21 approved chemical agents that were generally recognized as safe and effective (GRASE). A number of preliminary rules have been issued over the last few decades, but a final monograph has never been provided. The 2011 sunscreen final rule included 16 ingredients that were considered GRASE and outlined labeling and testing methods for sunscreens. In the 1970s, consumers typically only used sunscreens 3 to 4 days per year during beach vacations. Today, health care professionals recommend more frequent use of sunscreens with higher sun protection factors, which has led the industry to use sunscreen ingredients at higher concentrations. An important component of the new sunscreen regulations is the requirement of maximal usage trials (MUsTs) to evaluate absorption of sunscreen ingredients into the skin and systemic circulation. Of the 16 approved sunscreen ingredients, only zinc oxide and titanium dioxide are recognized as GRASE per the FDA’s new guidelines. The remaining ingredients are not necessarily considered dangerous but will have to undergo industry testing so the FDA can determine their safety and efficacy. “My guess is that [the final monograph] is going to take years,” Dr. DeLeo speculates. “It will without question cost the industry money to do these tests, so my guess is that when this all shakes out, we will have fewer sunscreens on the market, and those sunscreens almost surely will be more expensive.” In 2014, Congress passed the Sunscreen Innovation Act to encourage the FDA to create a process to fast track the approval process for sunscreen ingredients used in Europe and other countries. Due to media coverage of the new sunscreen regulations and the complicated nature of the approval process, many patients may limit their use of sunscreens. Dermatologists should be prepared to dispel patient fears and give advice on which products are safe to use. The FDA’s recent findings on systemic absorption of sunscreen ingredients were intended to provide risk assessment guidelines for future industry testing, but more data are needed before any true risk can be established. Hosts: Elizabeth Mechcatie; Terry Rudd; Candrice R. Heath, MD (Lewis Katz School of Medicine, Temple University Hospital, Philadelphia)  Guest: Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)  Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie.  You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm    
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