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May 28, 2020
Patients may be relying more on over-the-counter (OTC) skin care products during the current health crisis due to limited access to dermatologists. In this resident takeover, Dr. Daniel Mazori talks to Dr. Sophie Greenberg about selection of OTC topicals to avoid potential adverse effects. “I started looking into regulation and safety data and realized there’s a gap in formal treating on this topic, so I wanted to provide a guide to residents so they can be adequately informed,” Dr. Greenberg explains. They discuss how the Food and Drug Administration categorizes and regulates OTC products as well as resources to learn more about common ingredients in OTC topicals.  *  *  * We also bring you the latest in dermatology news and research: New rosacea clinical management guidelines focus on symptomology Dermatologists saw small income drop before pandemic Remdesivir shortens COVID-19 time to recover in published study Things you will learn in this episode: Choosing the wrong OTC products can cause or exacerbate skin conditions, such as allergic contact dermatitis, eczema, and acne, or even result in systemic toxicity. The FDA categories for OTC products that are most relevant to dermatology include drugs (both prescription and nonprescription medications), cosmetics, soaps, and dietary supplements. Each category has its own unique set of regulations. Drugs include topical steroids, antibiotic ointments, acne treatments, antifungals, and sunscreens. “Most of these products were previously available by prescription only but became available over-the-counter after sufficient postmarketing safety information,” says Dr. Greenberg. Regulations for chemical sunscreens currently are in flux in light of data that demonstrate serum levels above the FDA limit for drugs that are exempt from further testing for carcinogenicity. The FDA prohibits use of 11 categories of ingredients in all cosmetics but does not require approval, testing, or disclosure of safety data prior to products going to market. “A lot of patients and lay public have expressed concerns over the safety of over-the-counter [cosmetics], especially since regulation varies across the world,” Dr. Greenberg notes. It is important to be vigilant and educate patients about imported cosmetics containing ingredients such as clobetasol that can be harmful if used incorrectly. “When we prescribe [products containing these ingredients], we have a chance to counsel patients on how to properly use [them], but the fact that people can purchase them over-the-counter is very scary,” Dr. Greenberg says. Soap is categorized independently by its ingredients and its intended purpose to be used as a cleansing agent. The FDA evaluates safety and labeling of dietary supplements before marketing but does not directly test these products. “Clinicians can refer patients to third-party agencies that verify ingredients and test for contaminants. ... since there have been reports of supplements not containing the ingredients that they said they contain or containing toxins or potential allergens,” Dr. Greenberg explains. The Environmental Working Group’s Healthy Living app allows users to scan a product’s barcode to see all of its ingredients and safety rating. Clinicians can scan pharmacy aisles to familiarize themselves with available OTC products and also try products on themselves to better understand and address patient concerns. “You can get samples at conferences or purchase different products each time you restock your own supply,” Dr. Greenberg recommends. *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guests: Sophie A. Greenberg, MD (Columbia University Medical Center, New York) Disclosures: Dr. Mazori reports no conflicts of interest. Dr. Greenberg reports no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
May 21, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
May 14, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
May 7, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
April 30, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
April 23, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm  
April 16, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
April 9, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
April 7, 2020
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.
April 2, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
March 26, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
March 18, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
March 12, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
March 5, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
February 27, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
February 20, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
February 13, 2020
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 www.mdedge.com/podcasts.      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
February 6, 2020
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
January 30, 2020
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 http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
January 23, 2020
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 http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
January 16, 2020
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 http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
January 9, 2020
Costs associated with dermatology residency applications average $10,000 per applicant. Dr. Daniel Mazori talks to Dr. Aamir Hussain about ways to reduce costs for applicants, particularly during the interview process when frequent long-distance travel may be required. “Right now we’re in this lose-lose situation where applicants feel like they need to apply to every single program to maximize their chances and program directors are overwhelmed by hundreds of applications for one or two spots,” advises Dr. Hussain. *   *   * We bring you the latest in dermatology news and research: Dupilumab-induced head and neck erythema described in atopic dermatitis patients It’s a common side effect that’s underreported in clinical practice and clinical trials. Calif. woman poisoned by methylmercury-containing skin cream The patient has undergone extensive chelation therapy, but she remains unable to verbalize or care for herself. *   *   * Things you will learn in this episode: Many dermatology applicants apply to residency programs they are not genuinely interested in to maximize their chances of matching in a very competitive specialty. Program directors who are overwhelmed by hundreds of applications for one or two may use arbitrary metrics to weed out candidates because there currently is no way to evaluate who has a genuine interest in the program. A cap on the number of applications permitted per applicant would reduce application fees and help students focus on programs that are the best fit for them. According to Dr. Hussain, 50-60 applications generally is a reasonable number: “After that point, there seem to be diminishing returns in the number of interviews you’re getting for every application you send out in addition to that.” Dermatology applicants often choose to write separate personal statements or contact their programs of choice directly. An option to flag applications for the programs a candidate is most interested in may be an effective way to formalize this process. Regional interview coordination among all the dermatology programs in certain cities or areas of the country would allow applicants to interview with multiple programs at the same time and save on travel costs, in addition to providing neutral ground for home applicants; however, that would require coordination and buy-in from every dermatology program in the region. Video conferencing could reduce travel costs during the interview process but would need to be standardized for every applicant, as candidates who participate in video interviews are consistently rated lower than those who have in-person interviews. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York, Brooklyn); Aamir Naveed Hussain, MD, MAPP (Northwell Health, Manhasset, N.Y.) *   *   * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
January 2, 2020
In the Resident Takeover episodes of Dermatology Weekly, Cutis Resident Corner columnists Drs. Daniel Mazori, Elisabeth Tracey, and Julie Croley have discussed lifestyle issues such as burnout in residents as well as management concerns such as treating hidradenitis suppurativa. In this episode, Dr. Mazori counts down the top downloaded Resident Takeovers in 2019. Psychodermatology, Episode 26: Drs. Tracey, Croley, and Mazori discussed the challenges of treating patients with both psychiatric and dermatologic diseases. They reviewed medical treatment modalities and considered when referral to a mental health professional is needed. Effective communication with patients, Episode 16: The three residents discussed how to set expectations with patients about therapeutic management and provided communication strategies for improving compliance with therapy and ensuring patients have the correct instructions. Being on-call as a dermatology resident, Episode 12: They talked about premade biopsy kits, tricks for achieving hemostasis in the hospital, portable electronic gadgets, and creative alternatives for basic items.  Prescribing combined OCs, Episode 20: In the most-accessed Resident Takeover of 2019, they talked about prescribing combined oral contraceptives (COCs). COCs have many uses in dermatology, but dermatologists often underutilize them and don’t feel comfortable prescribing them. They also reviewed the basics of prescribing COCs for dermatologic conditions. Hosts: Elizabeth Mechcatie, Terry Rudd Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
December 26, 2019
Dr. Vincent DeLeo counts down the top downloaded peer-to-peer interviews of Dermatology Weekly in 2019. Along with his colleagues, Dr. DeLeo has covered important topics to help change the way dermatologists practice medicine, from treating rosacea in the skin of color population to understanding the sunscreen regulatory process for improving sunscreen ingredients. Nail education, Episode 10: Dr. Shari Lipner discussed nail education gaps in the American Academy of Dermatology Basic Dermatology Curriculum and strategies to close the gaps to improve nail education for medical students and dermatology residents. Dr. Lipner also broke down the mnemonic for identifying nail melanomas. Pediatric wart management, Episode 9: Dr. Nanette B. Silverberg provided a detailed treatment paradigm for managing pediatric warts. She also reviewed new and established treatment options in six therapeutic categories. Rosacea in the skin of color population, Episode 18: Dr. Susan Taylor discussed how dermatologists can improve the diagnosis and treatment of rosacea in the skin of color population. She highlighted clinical clues to distinguish rosacea from mimickers such as connective tissue diseases, seborrheic dermatitis, cutaneous sarcoidosis, and acne vulgaris. Sunscreen update, Episode 14: Dr. Candrice Heath interviewed Dr. Vincent DeLeo on the new sunscreen regulations issued by the U.S. Food and Drug Administration. Dr. DeLeo explained the complicated sunscreen regulatory process and provided tips for alleviating patient fears about sunscreen use. Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
December 19, 2019
In this resident takeover of the podcast, three dermatology residents—Dr. Elisabeth Tracey, Dr. Julie Croley, and Dr. Daniel Mazori—discuss how to talk with patients about hidradenitis suppurativa (HS) myths, tobacco use, and weight loss. They also provide strategies for managing flares and weigh medical vs. surgical treatment of HS. We bring you the latest in dermatology news and research: 1. Atopic dermatitis in egg-, milk-allergic kids may up anaphylaxis risk Egg- and milk-allergic patients with atopic dermatitis had more incidents of anaphylaxis; no impact seen in cases of peanut allergies. 2: iPLEDGE vexes dermatologists treating transgender patientsIn a survey, half of dermatologists report uncertainties when registering transgender patients in iPLEDGE. *   *   * Things you will learn in this episode: Dispel the myths of HS. Some patients may worry that HS is contagious or infectious, sexually transmitted, or a result of poor hygiene. “I think this often stems from misinterpretation of the fact that HS is multifactorial and may implicate skin flora in part of the pathogenesis,” Dr. Croley says. “I think this really highlights the importance of patient education.” When recommending smoking cessation, avoid sounding accusatory and discuss how tobacco use has been correlated with HS. “I like to follow this by asking about the patient’s personal smoking status,” Dr. Croley explains. “I find the strategy useful in making the patient feel comfortable about talking about this topic.” Suggest weight-loss strategies to address obesity in HS, such as diet, exercise, and referral to a nutritionist, to give patients strategies to achieve that goal. Adopt a policy that allows patients who experience a flare to visit the clinic without an appointment. “I think part of it is giving them the anticipatory guidance that flares may happen, probably will happen,” says Dr. Mazori. Consider prescribing short courses of either oral antibiotics or oral steroids in the event that patients with HS experience a flare. Reserve surgery for severe or refractory disease. Laser hair removal (eg, with the Nd:YAG laser) is helpful for mild to moderate disease. Evidence supports using this intervention for treating affected areas and the pilosebaceous unit. For patients who cannot afford laser treatment, suggest cosmetic clinics that are affiliated with a residency program, “because I think in general those tend to make it more accessible,” Dr. Mazori suggests. *   *   * Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation, Ohio); Julie Ann Amthor Croley, MD (The University of Texas Medical Branch at Galveston); Daniel R. Mazori, MD (State University of New York Downstate Medical Center, Brooklyn) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
December 12, 2019
Dermatologists often are the first to notice allergic contact dermatitis exposure patterns in the pediatric population. Vincent DeLeo, MD, talks with Dr. Margo Reeder, Dr. Amber Reck Atwater, and Jennifer M. Tran about patch test practices in children for the diagnosis of ACD. Because children have unique product and environmental exposures, panels should be customized based on the patient’s exposure history. “Not only is ACD prevalent in children but also that the allergen profile is unique when compared to adults,” advises Dr. Reeder. *   *   * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *   *   * We bring you the latest in dermatology news and research: Repeat LTBI testing best in patients taking biologics with new risk factors Just 1.2% of patients taking biologics with negative tuberculosis test results converted to positive results in annual tuberculosis screenings. More states pushing plans to pay for telehealth care But fair payment remains a challenge for providers. *   *   * Things you will learn in this episode: Two studies – the North American Contact Dermatitis Group and the Pediatric Contact Dermatitis Registry – have shown positive patch test reactions in children at rates of 57% and 48%, respectively. Improve patch testing your pediatric patients by learning about nuances such as their unique exposures and how to work with the smaller surface area of their skin. Take a thorough history by asking parents to “walk through a day in the life of their child” to uncover exposures from personal care products, topical medications, hobbies, and any individuals who interact with them. “It’s where you truly have to bring out your inner Sherlock Holmes to determine what and where potential allergens are,” Ms. Tran advises. Common allergens found in the pediatric population include nickel, cobalt, neomycin, balsam of Peru, lanolin, fragrance mix I, and propylene glycol. Reassure worried children about patch testing by providing education and using distraction techniques. “We have photos, including photos of kids undergoing patch testing that we can show before we apply the patches just to show them exactly what’s going to happen,” Dr. Reeder says. “Distraction is important too.” Currently, three pediatric patch test screening series are available: T.R.U.E. Test, North American Pediatric Patch Test Series, and Pediatric Baseline Patch Test Series. Consult the Table online for information on these forms of patch testing. Allergen exposure can occur from sports equipment, jewelry, braces, keys, zippers, school chairs, electronics, and toys. “Musical instruments have also been implicated in contact dermatitis in children,” Dr. Atwater adds, “and believe it or not, toilet seat dermatitis has also been reported.” Consider patch testing in atopic dermatitis when the patient’s dermatitis has changed, is significantly different, or involves new areas of the skin. Guests: Margo Reeder, MD (department of dermatology, University of Wisconsin, Madison); Amber Reck Atwater, MD; (department of dermatology, Duke University, Durham, N.C.); Jennifer M. Tran (department of dermatology, University of Wisconsin, Madison) *   *   * Show notes by Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
December 5, 2019
Hidradenitis suppurativa literature has expanded in the last few years, but there is still a delay in diagnosis for most patients due to a lack of familiarity with the condition. Dr. Vincent DeLeo talks with Dr. Alexandra P. Charrow about treatment recommendations based on disease severity and for patient lifestyle modifications. *   *   * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *   *   * Are you a fan of our podcast? Recommend it to a friend on Twitter by tagging @MDedgeDerm, and we’ll give you a shout-out in our next episode. *   *   * We bring you the latest in dermatology news and research: Certolizumab safety profile varies widely across indicationsSystemic corticosteroid use and body mass index affect the risk of serious adverse events with certolizumab. Naturopaths emphasize role of diet in atopic dermatitis Allopathic and naturopathic providers diverge in opinions on the role of diet in cause and treatment of AD. *   *   * Things you will learn in this episode: Many patients with hidradenitis suppurativa present to the ED because they have a severe flare. “We find that patients have a very long lag time from when they come in to all these different specialists and to the emergency department and the time in which they’re given a definitive diagnosis,” according to Dr. Charrow. Monitor for severe infection. “Hidradenitis is a complicated condition because it is a chronic inflammatory condition, and for that reason, patients will often have labs that mimic an infection,” said Dr. Charrow. The Hurley staging system, used in both surgical and clinical settings, can be used for HS and is divided into three disease stages: stage I is isolated nodules or isolated abscesses; stage II is wide areas separated by sinus tracts or scarring; and stage III includes multiple lesions with near-diffuse involvement and formation of sinus tracts and scarring. Recommend lifestyle modifications, such as taking medications for smoking cessation that are not nicotine replacements, as these could aggravate disease; avoiding hair removal strategies that cause regrowth and the possibility of developing ingrown hairs; and avoiding progestin-only and first-generation oral contraceptives. Use a short course of antibiotics to control flares for Hurley stage I disease. A longer course of an antibiotic, such as tetracycline for 3-6 months, can be used to prevent further flaring. Consider a combination of spironolactone and tetracycline for Hurley stage II. Depending on whether these medications work, adalimumab also can be considered for stage II. Medications for Hurley stages I and II can be used for stage III, but if these are ineffective, providing care could be “tough” because the clinician might need to negotiate with insurance companies for other medications such as infliximab. “There’s only one medication that has been FDA approved for hidradenitis and that’s Humira, and only 50% of the patients in the pioneer trial demonstrated significant improvement, which means that there’s half of patients who have no FDA-approved treatment for their disease,” Dr. Charrow noted. “We are reaching for things for which there is no FDA approval but for which there is some pretty good evidence.” Consult a table of treatment considerations for HS based on severity, which is available online. Ensure that patients with HS feel safe and have an emotional outlet during the visit because they can have a high psychiatric and psychological comorbidity profile. “The disease can be exceptionally isolating. Many patients find they can’t work, they can’t live normal lives . . . It’s helpful to be mindful of just how stigmatizing this condition can be,” Dr. Charrow advised. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Alexandra P. Charrow, MD, MBE (Brigham and Women’s Hospital, Boston) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie *   *   * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
November 28, 2019
This week’s episode features highlights of the AAD 2019 Summer Meeting.  Adam Friedman, MD, takes a closer look at nanotechnology from a dermatology perspective. Topical therapies often “have a very hard time getting to where they need to be, and nanotechnology, just by size alone, can really offer some unique benefits,” says Dr. Friedman, professor of dermatology and the interim chair of the dermatology department at George Washington University, Washington. Justin Ko, MD, director and chief of medical dermatology, Stanford (Calif.) Health Care, spoke with MDedge reporter Ted Bosworth about the use of augmented intelligence in dermatology. Dr. Ko is the coauthor of the American Academy of Dermatology’s position statement on augmented intelligence, which was released in May 2019. Henry W. Lim, MD, Henry Ford Hospital, Detroit, spoke with MDedge reporter Kari Oakes about potential environmental effects of sunscreen ingredients (particularly coral reef bleaching), as well as the FDA’s widely reported sunscreen absorption study published in May – and whether sunscreen use may be contributing to the increase in frontal fibrosing alopecia. Andrew Alexis, MD, professor and chair of the department of dermatology, Mount Sinai St. Luke’s, New York, provided practical information on treating hyperpigmentation in an interview with MDedge reporter Ted Bosworth. He details his views on the length of time he considers the use of hydroquinone-based therapies to be safe, as well as the use of non–hydroquinone based. Seemal R. Desai, MD, who is on the faculty at the University of Texas Southwestern Medical Center, Dallas, talked with MDedge editor Elizabeth Mechcatie about the treatment of patients with pigmentary disorders. The increasing interest in pigmentary disorders, particularly in patients with skin of color, “continues to be something that’s very relevant and very valid” to dermatologists, said Dr. Desai, who is the immediate past president of the Skin of Color Society. *  *  *   Help us make this podcast better! Please take this short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *  *  *   Show notes by: Elizabeth Mechcatie   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
November 21, 2019
Mohs micrographic surgery (MMS) entails many controversies – from specialty certification to the types of tumors treated. Three dermatology residents – Dr. Julie Croley, Dr. Elisabeth Tracey, and Dr. Daniel Mazori – discuss MMS for melanoma and other tumors as well as reimbursement for and the cost-effectiveness of the procedure. They also highlight controversies surrounding the Mohs Appropriate Use Criteria (AUC). “It appears further investigation is needed to elucidate and optimize solutions to many of the current controversies associated with Mohs micrographic surgery,” Dr. Croley says.  * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *   *   * Are you a fan of our podcast? Recommend it to a friend on Twitter by tagging @MDedgeDerm, and we’ll give you a shout out in our next episode. *   *   * We bring you the latest in dermatology news and research: Apremilast for Behçet’s oral ulcers: Benefits maintained at 64 weeksReassuring results of a long-term extension of the phase 3 RELIEF trial. Melanoma incidence drops in younger age groups Fewer teens and young adults developed melanoma between 2006 and 2015, while incidence increased in older adults. In Oregon, ‘war on melanoma’ takes flight A research project hopes to shrink melanoma mortality by emphasizing education, screening. *   *   * Things you will learn in this episode: The 5-year survival in metastatic rates for melanomas treated with Mohs micrographic surgery (MMS) with frozen sections were the same or better when compared with historical controls treated with conventional wide local excision. Immunostaining in melanoma may improve accuracy but includes many challenges: It is time-consuming, reagents can be costly and could expire, some cases are equivocal, clinicians’ exposure to immunostaining education is limited, and training is required to interpret margins. “So there are a lot of barriers to using immunostaining,” Dr. Croley says, “but I think it has a lot of potential in the future.” Utilization of MMS has increased in recent years, possibly due to superior efficacy for appropriately chosen cases and it is being expanded to treat other tumors such a melanoma and Merkel cell carcinoma. There is wide variation in mean number of Mohs stages among dermatologic surgeons. Mailing out individual reports of practice patterns to high-outlier physicians resulted in a reduction in mean stages per tumor as well as an associated cost savings when compared with outlier physicians who did not receive these reports. Codes for MMS are frequently reviewed by a Relative Value Scale Update Committee, and the procedure is listed as a potentially misvalued service according to the Centers for Medicare & Medicaid Services. “Reimbursements for Mohs surgery and reconstructive surgery have gone down by more than 20% in the last 15 years – at least, in part, as a result of this scrutiny,” Dr. Tracey states. Mohs AUC has been criticized for classifying most primary superficial basal cell carcinomas as appropriate for MMS and for not considering variables such as operating on multiple tumors on the same day and operating on a tumor that is incorporating into an adjacent wound. Specialty certification in MMS has been a split issue. “Proponents have argued that certification could bring more consistency and decrease divisiveness among dermatologists,” Dr. Mazori says. “Opponents of certification have argued that it could disenfranchise many dermatologists.” Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Julie Ann Amthor Croley, MD (University of Texas Medical Branch at Galveston); Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Daniel R. Mazori, MD (State University of New York, Brooklyn) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie *  *  *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
November 14, 2019
Vitiligo is not the only condition that can lead to depigmentation; there are other conditions that dermatologists see less commonly that can result in vitiligolike depigmentation, such as photolichenoid dermatitis. Consider underlying diagnoses such as human immunodeficiency virus when treating patients with photolichenoid dermatitis. Dr. Vincent DeLeo talks with Dr. Nada Elbuluk about the common causes and clinical presentation of photolichenoid dermatitis. Dr. Elbuluk emphasizes the importance of screening for underlying medical conditions by describing a case of a photolichenoid eruption in a patient with undiagnosed HIV. “It’s fascinating to see patients like this who remind us that depigmentation or pigmentary changes can be associated with underlying medical conditions,” advises Dr. Elbuluk. “Keeping that kind of differential in the back of our minds is really important so we don’t miss important underlying diagnoses such as HIV.” *   *   * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *   *   * We bring you the latest in dermatology news and research: 1. Patients taking TNF inhibitors can safely receive Zostavax Investigators found no confirmed varicella infection cases at 6 weeks. 2. AAD-NPF pediatric psoriasis guideline advises on physical and mental care Topics in this guideline for pediatric psoriasis include systemic and topical treatments, management of comorbidities, and quality of life. 3. Expert reviews strategies for diagnosing, treating onychomycosis The ideal treatment for onychomycosis would not pose a systemic risk to the liver, heart, or other organs, and would not require lab monitoring. *  *  *   Things you will learn in this episode: Common histopathologic findings of photolichenoid dermatitis include a dense bandlike lymphocytic infiltrate in the superficial papillary dermis abutting the upper dermis, which can be accompanied by an interface change at the dermoepidermal junction. NSAIDs and sulfamethoxazole-trimethoprim are the most common medications that cause photolichenoid eruptions, particularly in patients with HIV, among others. Patients with HIV who have photolichenoid eruptions typically have advanced HIV or AIDS with a low CD4 count. Taking a photosensitizing medication is not required to develop a photolichenoid eruption in patients with HIV. Biopsy patients who have photolichenoid eruptions can confirm that there is no underlying medical condition. “When our patient came in, actually we were worried more about discoid lupus,” Dr. Elbuluk describes. “So as part of that [work-up], we ordered an ANA.” Laboratory workup should include HIV and a hepatitis panel. Consider HIV when seeing a patient with a photodistributed eruption that is more lichenoid or presents with depigmentation. Ask screening questions about sexual history and order bloodwork. “This is a really good case and example of how we, as dermatologists, can be so instrumental in diagnosing internal disease,” Dr. Elbuluk adds.   Guest: Nada Elbuluk, MD (formerly of the department of dermatology at New York University; currently with the University of Southern California, Los Angeles) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie *  *  *   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
November 7, 2019
Pediatric atopic dermatitis (AD) is more prevalent in African American children. Dr. Lynn McKinley-Grant, president of the Skin of Color Society, talks with Dr. Amy McMichael about the quality-of-life impact on pediatric patients with AD as well as skin care in this patient population. They also discuss the clinical presentation of AD in the skin of color population. “We have to open our minds up to all of the ways that atopic dermatitis can look in every skin type,” Dr. McMichael says. “Then we don’t miss it, and we don’t minimize how severe it is when we’re taking care of those patients.” *   *   * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *   *   * We bring you the latest in dermatology news and research: 1. Nemolizumab for prurigo nodularis impresses in phase 2b study Interleukin-31 signaling is a promising therapeutic target in prurigo nodularis. 2. Acoustic pulse boosts laser tattoo removal  Device “clears” skin cells after single passes and allows single office visits to pack more punch. 3. Severe psoriasis associated with increased cancer risk, mortalityBecause these were associations only, any underlying mechanism is still unclear. *  *  *   Things you will learn in this episode: African American children with AD (aged 2-17 years) have a 1.5-fold higher chance of being absent for 6 days in a 6-month school period than do non-Hispanic children, and they have higher chronic absenteeism, compared with white children. Some parents/guardians purchase topical products with fragrances that are inappropriate for patients with AD. “Consumers have no idea what’s good, so they just buy them and they use them,” Dr. McMichael says. “They can often make things a lot worse.” Resident training should focus on learning how skin diseases present in all skin types. “You do have to be cognizant of pigment being present and wonder, ‘OK, is this postinflammatory or is this truly inflammatory?’ ” Dr. McMichael advises. For children who want to engage in athletics, treatment should be more aggressive. Consider using systemic treatments more readily or prescribing dupilumab (Dupixent). “We have to be cognizant of when flares occur that perhaps these patients should not participate in activities at that time, but if they want to -- and certainly it’s healthy to do so -- then we need to step up to the plate and treat them appropriately,” emphasizes Dr. McMichael. Patients with AD have a higher prevalence of contact sensitization to fragrances, including balsam of Peru. It is essential to find out what products your patients with AD are using on their skin. Ask them such questions as: What are you using to cleanse your face? What are you using as a moisturizer? Do you put anything else on your face or skin? Debunk inaccurate information that your patients and parents are consuming about AD medications. “You have to encourage them that it’s not all about steroids. We have other options now and that they need to consider them,” Dr. McMichael adds.   Hosts: Lynn McKinley-Grant, MD (Howard University College of Medicine, Washington, DC) Guests: Amy McMichael, MD (department of dermatology, Wake Forest University, Winston-Salem, N.C.) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
October 31, 2019
How can you integrate decision-making resources into your clinical practice? In this resident takeover of the podcast, three dermatology residents — Dr. Daniel Mazori, Dr. Elisabeth Tracey, and Dr. Julie Croley — discuss clinical decision support tools such as scoring systems and other resources available for dermatologists. These tools should be used as a supplement, not as a substitute for one’s clinical judgment. “The optimal treatment for patients in a complex medical system requires not just coming to the correct diagnosis and using your clinical judgment to make a decision but effectively communicating that decision to the insurance companies [and] to the primary team that’s taking care of them on the inpatient service. ... Some objective data can really be useful in those situations,” advises Dr. Tracey. *   *   * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *   *   * We bring you the latest in dermatology news and research: 1. No tacrolimus/cancer link in atopic dermatitis in 10-year study 2. PASI-75 with ixekizumab approaches 90% in pediatric psoriasis study 3. NAM offers recommendations to fight clinician burnout *  *  *   Things you will learn in this episode: Evaluate for psoriatic arthritis with the Psoriasis Epidemiology Screening Tool (PEST). “It’s the kind of thing that I’ll use in addition to asking a patient with psoriasis questions about symptoms like joint pain and morning stiffness,” Dr. Mazori says. Consider UpToDate.com and VisualDx.com for clinical decision support, to formulate differential diagnoses, and as a resource for patient education. “The other day, I had a patient who was diagnosed with scabies,” Dr. Tracey explains. “We were counseling the patient on how to decontaminate their environment. I wanted to get the exact number of hours their belongings needed to be in a plastic bag or how to wash their clothes. So, we went on UpToDate and read it together in the clinic.” The SCORTEN system predicts hospital mortality from Stevens-Johnson syndrome/toxic epidermal necrolysis and is useful for the primary team. “I’ve found it useful ... as a measure of risk to communicate to the primary team, even the patient’s family,” Dr. Mazori says. But the SCORTEN isn’t perfect. “There are studies that have found it can overestimate or underestimate mortality,” he warns. To differentiate cellulitis from pseudocellulitis in adult patients, consider the ALT-70 score. “It gives me an objective measure of risk to communicate to the primary team in support of one diagnosis or another in addition to my clinical judgment,” advises Dr. Mazori. The Mohs Appropriate Use Criteria (AUC) helps guide decision making for Mohs micrographic surgery, but it has been scrutinized for classifying most primary superficial basal cell carcinomas as appropriate for treatment, omitting important European trials, and for having ratings that are based on expert opinion rather than evidence. The MyDermPath+ app can assist clinicians in forming differentials based on histopathologic patterns. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York Downstate Medical Center); Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Julie Ann Amthor Croley, MD (University of Texas Medical Branch at Galveston) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
October 24, 2019
Skin appearance is a sign of internal health, and patients who have appropriate vitamin levels naturally have healthier skin. Dr. Vincent DeLeo talks with Dr. Gary Goldenberg about the data on vitamins and supplements that have been shown to improve the skin’s appearance and health. Dr. Goldenberg discusses the controversies surrounding the quality of products and the need for dermatologists to remain up-to-date on products their patients may be taking already. “A discussion of nutrition and supplements really is a part of any dermatologic evaluation, just like skin care should be part of every dermatologic evaluation,” advises Dr. Goldenberg. *   *   * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *   *   * We bring you the latest in dermatology news and research: 1. Rituximab bests mycophenolate in pemphigus vulgaris Rituximab showed a superior overall benefit/risk profile, compared with mycophenolate mofetil. 2. Once-daily oral JAK inhibitor for atopic dermatitis effective in phase 3 study Abrocitinib may have taken a step closer to becoming the first once-daily oral Janus kinase 1 inhibitor to be approved for atopic dermatitis. 3. Online resources influencing cosmetic treatment choices Rate and review websites affect almost 70% of consumers seeking providers for cosmetic procedures. *  *  *   Things you will learn in this episode: Patients who have good nutrition also will have appropriate vitamin levels, which contributes to having healthier skin. Dr. Goldberg explains, “Patients who have really low vitamin D levels will not be as healthy and cannot have as healthy skin as those who have more normal vitamin D levels.” Studies have shown that internal vitamin C levels reduce oxidative stress and help with the appearance of fine wrinkles, lines, and pigmentation. “As far as topical vitamin C goes, I think that there [are] good data showing that vitamin C improves the appearance of skin. But the issue with vitamin C is the delivery of the product into the skin,” advises Dr. Goldenberg. Vitamin E is one of the best antioxidants, according to Dr. Goldenberg, and is especially helpful for UV-induced oxidative stress. Carotenoids, which are derived from vitamin A, can help reduce oxidative stress associated with UV-induced radiation and UV-induced erythema. “We also know that carotenoids actually improve UV-damaged cells such as for patients with a history of skin cancer,” says Dr. Goldenberg. Studies have reported that oral collagen supplements can improve skin health and appearance. However, Dr. Goldenberg remains skeptical: “It’s still unclear to me if the improvement is due to the actual collagen or to the water that patients may be taking the collagen in, especially if it’s a powder.” Hydration is very important for skin appearance and health, he adds. Imedeen supplementation has some data that show antioxidant properties. Although it’s too early to say that Imedeen is completely effective, studies report efficacy for skin appearance and health. In terms of side effects associated with vitamins and supplements, Dr. Goldenberg advises that not all supplements have the same quality, and patients should consult a nutritionist for advice on which vitamins and supplements are needed. “Not all supplements are going to have the same quality. So if you’re going with the least expensive ones, they may have the least absorption. Now the most expensive ones may have the prettiest packaging and not necessarily be the highest quality of the vitamin.” Dermatologists, as skin experts, need to be aware of the data on vitamins and supplements because diet or nutrition is a common question among patients. For example, patients with acne, psoriasis, eczema, or rosacea may inquire if their condition is caused by a supplement they take or by the lack of supplements. “[We] have to be aware of all of the positive and negative data that’s out there and what I call ‘pseudo’ data, which is blogging, Instagram influencers, etc.,” Dr. Goldenberg says. Guests: Gary Goldenberg, MD (Icahn School of Medicine at Mount Sinai, New York, and Goldenberg Dermatology, PC, New York) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm Gary Goldenberg on Twitter: @Goldenberg_Derm
October 17, 2019
There is a consumer trend to avoid additives in hair care products and consider natural alternatives. Dr. Lynn McKinley-Grant, president of the Skin of Color Society, talks with Dr. Amy McMichael about shampoo ingredients and the importance of cleansing the scalp in the skin of color population. Dr. McMichael also discusses how hairstyling practices in this population can lead to hair loss and damage to the hair shaft. “We just have to be more healthy in our choices of how we do those styles and how we cleanse our scalp and our hair when we’re wearing those styles,” advises Dr. McMichael. We bring you the latest in dermatology news and research: 1. Psoriasis registry data provide evidence that adalimumab reduces mortality 2. Tape strips useful to identify biomarkers in skin of young children with atopic dermatitis 3. Short-term statin use linked to risk of skin and soft tissue infections *  *  *   Things you will learn in this episode: Do patients need to avoid shampoos containing sulfates and parabens? “Sulfates are just one of the many ways that we can cleanse the scalp and the hair. It is a detergent, and when that detergent is removed, in order to cleanse the hair another detergent has to be put into its place,” explains Dr. McMichael There are "no data to suggest that these other detergents are better or safer or even helpful for our hair shaft.” Only patients with a true allergic contact sensitization to parabens need to avoid products with this ingredient. Patients need to understand that the “no-poo” method and dry shampoos are not cleansing the scalp. “There’s an idea that you can shampoo as infrequently as you want,” says Dr. McMichael. “That’s really not true. In order for your scalp to be healthy and to grow healthy hair, you need to have it cleansed. And once weekly is preferred but certainly every 2 weeks is reasonable.” Patients may rinse their hair with water and baking soda, apple cider vinegar, and tea tree oil without knowing how they interact with the bacterial and yeast components on the scalp. “And they can be bad for the hair shaft,” Dr. McMichael adds. Conditioners are not a good replacement for shampoo, especially for patients with a scalp condition. “Conditioners alone are not meant to cleanse,” Dr. McMichael explains. For women of African descent, consider dandruff shampoo products that are manufactured and tested for this patient population. Central centrifugal cicatricial alopecia (CCCA) is the most prominent form of hair loss in the United States in women of African descent. Clinicians should help patients with or who are at risk for CCCA to minimize traction, tension, and trauma to the scalp caused by some hair care practices. In a recent study of more than 5,000 patients, CCCA seems to have an association with type 2 diabetes mellitus. “As we move forward, we need to start thinking about the whole patient,” Dr. McMichael advises. “It’s not just the scalp that we’re dealing with. It’s not just the hairstyle. But what is the health and underlying metabolism issue of some of these patients and can we as dermatologists be helpful in getting them to better health.” Dermatologists in residency need more training in hair care practices of patients with skin of color that encompasses the wide cultural differences in hairstyling methods and scalp conditions across different populations.   Host: Lynn McKinley-Grant, MD (Howard University, Washington) Guest: Amy McMichael, MD (Wake Forest University, Winston-Salem, N.C.) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
October 10, 2019
Atopic dermatitis (AD) is associated with various ocular comorbidities that can result in permanent vision loss if left untreated. Dr. Soo Jung Kim talks with Dr. Vincent DeLeo about the incidence of keratoconjunctivitis, keratoconus, glaucoma, retinal detachment, and other ocular conditions associated with AD. Dr. Kim offers tips on spotting these complications and managing them but also indicates when referral to an ophthalmologist is necessary.  We also bring you the latest in dermatology news and research. 1. Nivolumab-ipilimumab nets long-term survival in advanced melanoma An update of CheckMate 067 finds that with combination nivolumab and ipilimumab therapy, 52% of patients were alive at 5 years. 2. Lifetime indoor tanning raises risk of cutaneous squamous cell carcinoma Researchers found a dose-response association between number of indoor tanning sessions and SCC risk in Norwegian women. 3. FDA approves afamelanotide for treatment of rare condition with light-induced pain This is the first treatment approved to help patients with erythropoietic protoporphyria increase their exposure to light.   *  *  *   Things you will learn in this episode: Patients with AD may develop blepharitis, presenting with itching and irritation of the eyelids, as well as tearing, foreign body sensations, and even photophobia. The mainstay treatment of blepharitis is good eyelid hygiene with the use of warm compresses and gentle scrubbing of the lid margins. About 25%-52% of patients with AD have atopic keratoconjunctivitis. Clinicians should look out for red conjunctivae, hyperemia, and papillary hypertrophy of the conjunctivae. “Ultimately, if this is not treated in a timely manner, patients could have visual impairment,” explains Dr. Kim. Keratoconus is the progressive thinning and bulging of the cornea that can affect the cornea’s topography. “Patients experience imaging blurring as well as imaging distortions,” Dr. Kim describes. “We’re not exactly sure why atopic dermatitis patients develop more keratoconus, but it’s been believed that chronic, habitual eye rubbing is most likely to be the cause due to the periocular itching.” “Glaucoma is not necessarily a complication of atopic dermatitis; it’s more a complication of the steroid use,” explains Dr. Kim. Glaucoma in AD may be asymptomatic until advanced stages; therefore, clinicians should regularly screen patients who have a prolonged history of topical steroid application around the eye area, a family history of glaucoma, or a history of other ocular problems. Cataracts occur in 8%-25% of patients with AD, usually younger adults. Interior or posterior subcapsular cataracts are more common in these patients compared to nuclear and cortical cataracts, which are more common in the general population. Routine periodic screening by an ophthalmologist is required when patients have onset of periorbital atopic dermatitis, prolonged use of topical or systemic steroids, or a family history of cataracts. The incidence of retinal detachment is 4%-8% in patients with AD. “This is a lot higher than the general population, which is around 0.005%,” Dr. Kim says. “This retinal detachment occurs usually more bilaterally at a younger age, compared to cases without atopic dermatitis.” These patients should be quickly referred to an ophthalmologist for surgical repair. Patients with AD are at greater risk for herpetic ocular disease, and active ocular herpetic infections require urgent referral to an ophthalmologist. Dupilumab has been associated with ocular complications in patients with AD. Host: Vincent DeLeo, MD  Guest: Soo Jung Kim, MD, PhD (Baylor College of Medicine, Houston, Texas) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
October 3, 2019
Atopic dermatitis (AD) is a highly challenging dermatologic condition for U.S. military members, especially for those deployed overseas with less-than-ideal access to care. Dr. Josephine Nguyen, president of the Association of Military Dermatologists, talks with Dr. Emily Wong about the military’s medical standards for evaluating individuals with AD who want to join the service. They also discuss how deployment can exacerbate symptoms of AD. “What is most important to understand regarding the military and any medical issue, including atopic dermatitis, is that we do not want a person’s medical condition to worsen because of their military service, or for them not to be able to receive the medical care they need,” advises Dr. Wong. “On the other hand, medical standards are in place to also ensure that the overall mission of the military can be done safely.” We also bring you the latest in dermatology news and research. 1. Apple cider vinegar soaks fall short in atopic dermatitis Acetic acid, particularly apple cider vinegar, has become prominent among emerging natural remedies for atopic dermatitis. 2. Long-term opioid use more common in hidradenitis suppurativa The results suggest that periodic assessment of pain and screening for long-term opioid use may be warranted. *  *  *   Mark your calendars for our upcoming MDedge Dermatology Twitter Chat on skin cancer, this Tuesday, Oct. 8, beginning at 8 p.m. EDT. You can join the discussion with Dr. Julie Amthor Croley, Dr. Candrice Heath and Dr. Anthony Rossi as they review what’s new in sunscreen, skin of color, melanoma, and more. *  *  *   Things you will learn in this episode: Individuals with AD that persists after 12 years of age may be disqualifying to enter the military. Additionally, any history of recurrent or chronic dermatitis within the last 2 years that requires frequent treatments also is disqualifying. “I will say, in some cases, waivers are possible,” Dr. Wong adds. “Usually those waivers occur when the diagnosis wasn’t quite accurate to begin with. Maybe they had one case of contact dermatitis from poison ivy, but it’s not actually a chronic condition.” Atopic dermatitis is one of the main conditions that affect military service members overseas, not battle injuries. Military members with AD may be hard pressed to find relief from environmental factors that provoke or exacerbate symptoms. When military members are deployed, there are few choices for maintaining hygiene. “They certainly don’t often have choice of soap,” Dr. Wong says. “They don’t have the ability to necessarily carry around moisturizers. So a lot of the things we typically would use to treat our atopic dermatitis patients are just simply not available.” Access to systemic medications for AD also can be difficult. Stress while being deployed is a concern in military members with AD. “Military deployments create an environment – a stress – that many people have not experienced before,” explains Dr. Wong. “Even if they really understand their skin and what flares their skin, they may not know what to expect in some of these environments that military members are expected to work in.” Military uniforms and gear can exacerbate AD. In a deployed setting, if a service member experiences a severe exacerbation of AD that prevents him/her from performing the job, then he/she may need to leave the unit, leaving the rest of the unit unexpectedly without those skills. “That is really the impact that we try to avoid,” explains Dr. Wong, “in setting some of the medical standards that we have, in making sure we appropriately evaluate and screen people before they go on deployment.” Smallpox is considered a potential biologic weapon that could be used by adversaries. Military members receive the smallpox vaccine before being deployed overseas. However, members with a history of or current AD or any skin condition that compromises the epidermis are exempt from receiving the smallpox vaccine. If the service member has a family member at home who has AD or is pregnant, then that military member will receive the smallpox vaccine after reaching the deployed location. “Certainly, patients who are receiving the smallpox vaccination need to be very careful when around other patients with atopic dermatitis,” advises Dr. Nguyen.   Host: Josephine Nguyen, MD Guest: Emily B. Wong, MD (Uniformed Services Health Education Consortium, Joint Base San Antonio–Lackland, Tex.) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
September 26, 2019
Dermatology residents may be among the least burned-out residents across specialties, but burnout syndrome still affects almost one in three dermatology residents. In this special resident takeover of the podcast, three dermatology residents — Dr. Julie Croley (@dr.skinandsmiles), Dr. Elisabeth Tracey, and Dr. Daniel Mazori — discuss sources of stress for dermatology residents as well as tools to identify and combat burnout to ultimately be a better provider. “The low-stress perception of dermatologists may counterintuitively or paradoxically make recognizing burnout within others and ourselves challenging, so I think it’s important for residents and faculty to be aware that this occurs in such a high prevalence,” reports Dr. Croley. We also bring you the latest in dermatology news and research. 1. Parent survey sheds some light on suboptimal compliance with eczema medications Nearly half of children with atopic dermatitis were not getting their medications as prescribed. 2. Meta-analysis finds platelet-rich plasma may improve hair growth Five studies reported statistically significant increases in hair density in favor of PRP over placebo. 3. Business case for interoperability remains elusive Bringing ownership of health data to the individual and setting a clearer definition of health IT standards are important drivers of interoperability. Things you will learn in this episode: Jeffrey Benabio quipped in a Dermatology News column, “The phrase ‘dermatologist burnout’ may seem as oxymoronic as jumbo shrimp, yet both are real.” Burnout is a syndrome of emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. For dermatology residents, the preliminary internship year plus the first year of residency can be the most stressful. “You have 2 years of being the least experienced person in your department,” explains Dr. Tracey, “and so that adds to the stress of the sense of lack of accomplishment during that time.” Board examinations are a top stressor for dermatology residents. Institutions are recognizing and addressing burnout among residents by offering wellness lectures, yoga classes, and social events to counteract the stresses of residency. Some also hold town hall meetings and forums that allow residents and other department members to raise concerns and find concrete solutions to shared problems. Formalizing feedback to residents, especially positive feedback, also is important. Residents — and all health care providers — need to take care of themselves to provide the best care to their patients. “It’s all about balance and about creating time for those other things that are important to you and not feeling guilty about setting aside time to do those things. We don’t always need to be productive and always be working,” Dr. Tracey adds. Setting both short- and long-term goals may be helpful in preventing burnout. Don’t lose sight of the ultimate goal — becoming a dermatologist — but set and focus on goals for the day or the week. First-year residents can help to create a positive culture within their departments. Instead of commiserating with colleagues only about a hard day, “sharing cool cases or talking about interesting things that you’ve learned” can create a better environment for everyone, Dr. Tracey advises. The idea that dermatology residents can’t or don’t experience burnout is a myth. “Just like a rare diagnosis, it’s sometimes harder to spot than something that we see all the time,” says Dr. Mazori. If a resident is starting to feel burned out, it is essential to reach out to a trusted friend or colleague to address the issues. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Julie Ann Amthor Croley, MD (University of Texas Medical Branch at Galveston); Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Daniel R. Mazori, MD (State University of New York, Brooklyn). Show notes by: Ann M. Hoppel, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
September 19, 2019
The flea bite is a problem for a variety of populations — from those in natural disaster scenarios to pet owners. Dr. Vincent DeLeo talks with Dr. Dirk M. Elston about cat fleas and other issues in environmental dermatology. Dr. Elston discusses vector-borne diseases, including endemic typhus and cat-scratch disease, caused by organisms transmitted by fleas, as well as interventions to remove fleas and treat their bites. Dr. Elston also gets personal and talks about how he got interested in bugs following his time in the military. We also bring you the latest in dermatology news and research. 1. States pass record number of laws to reel in drug prices Measures include authorizing imported prescription drugs, screening for excessive price increases by drug companies, and establishing oversight boards to set drug prices. 2. Peanut allergy pill gets thumbs-up from FDA advisory panel The approval of Palforzia is on condition that a black-box warning and medication guide are included in the packaging. 3. Dr. Henry W. Lim takes a closer look at new data on sunscreens. Things you will learn in this episode: All fleas are vectors for disease in humans. “You see dog fleas on cats, and cat fleas on dogs,” Dr. Elston explains. “You’ll see poultry fleas on dogs, especially in the Carolinas. But there are certain fleas that historically have been the ones that carry most disease.” Cat fleas (Ctenocephalides felis) can carry endemic typhus and are typically found in south Texas and southern California. Oriental rat fleas are a vector for disease in other parts of the United States, including areas of California and the Southwest. One of the clues for identifying endemic typhus would be a small rickettsial or black depressed eschar at the site of the original bite. Flea bites — presenting as papular, vesicular, intensely pruritic— tend to occur on the lower parts of the body. “The fact that they’re grouped on the lower extremity, the papular vesicular or bolus quality does suggest the possibility of fleas,” reports Dr. Elston. For houses or abodes that have long been unoccupied (e.g., 2-3 years), new owners walking on the floorboards may rapidly activate the pupae living in them. Flea treatments for animals include fipronil, which is applied on the animal’s neck and spreads like an oil over its body. Oral agents containing ivermectin for heart worm and fleas; however, ivermectin can be fatal for some animals, such as collie dogs. Disease depends on the type of vector. “If you have the organism transmitted by a louse, you’re likely to get endocarditis,” Dr. Elston explains. “Whereas if it’s a flea, you are more likely to get cat-scratch disease rather than sepsis and endocarditis.” Long-term therapy with macrolides is a mainstay treatment of cat scratch disease. Children with cat-scratch disease who present with systemic disease, including neurologic disease, should be managed together with an infectious disease specialist. Guests: Dirk M. Elston, MD (Medical University of South Carolina, Charleston); Henry W. Lim, MD (Henry Ford Medical Center, Detroit) Show notes by Jason Orszt, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
September 12, 2019
Household and personal care products are common sources of contact allergy in dermatology patients. Dr. Vincent DeLeo talks with Dr. Amber Atwater and Dr. Margo Reeder and about the epidemic of allergic contact dermatitis associated with methylisothiazolinone (MI), a common preservative found in many water-based products. Dr. Reeder and Dr. Atwater discuss the emergence of MI as a contact allergen and highlight some of the common and lesser-known sources of MI exposure. We also bring you the latest in dermatology news and research. 1. Thread lifts making a comeback, but long-term effects remain unclear Patients with moderate skin sagging are better candidates than those with severe skin sagging. 2. New evidence supports immune system involvement in hidradenitis suppurativa Microscopy identifies signs of immune dysregulation in the blood of hidradenitis suppurativa patients. 3. Dr. Andrew Alexis discusses topical treatment options for pigmentary disorders Things you will learn in this episode: Methylisothiazolinone (MI) has been used for decades as a preservative in combination with methylchloroisothiazolinone; however, higher concentrations of MI alone have been used in personal care products beginning in the 2000s: “That’s really when we began to see patients being exposed to MI and subsequently developing contact allergy,” notes Dr. Reeder. Common sources of MI exposure include liquid and water-based products such as dish soaps, shampoos, household cleaners, hair conditioners and dyes, laundry products, and soaps and cleansers. Latex-based paints containing MI can result in airborne contact dermatitis from off-gassing when the paint is curing on the wall. Another common source of MI contact dermatitis is slime, a sticky play substance that children concoct out of household products such as glue or cleaning agents that contain MI. Contact allergy to MI may present in a photodistributed pattern and also has been associated with photoaggravation. Patients also may demonstrate lasting photosensitivity even when avoiding the allergen; therefore, it is important to consider including MI when performing photopatch testing. Two additional potentially allergenic isothiazolinones found in household products and industrial chemicals include benzisothiazolinone and octylisothiazolinone. The T.R.U.E. Test includes MI in a mix with methylchloroisothiazolinone but not on its own, which has been known to miss a considerable number of patients who are allergic to MI; therefore, patch testing to MI alone may be beneficial in patients with allergic contact dermatitis who test negative for MI contact allergy using the T.R.U.E. Test. Many patients are sensitized to MI when it is used in leave-on products. The European Union has banned MI from use in these products, but currently there are no regulations in the United States. Hosts: Elizabeth Mechcatie, Terry Rudd, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Margo Reeder, MD (University of Wisconsin, Madison); Amber Reck Atwater, MD (Duke University, Durham, North Carolina); Andrew F. Alexis, MD, MPH (Icahn School of Medicine at Mount Sinai, New York. Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
September 5, 2019
More patients are being admitted to the hospital with skin problems, and specialized dermatologists are needed to provide effective treatment. Dr. Vincent DeLeo talks with Dr. Michi M. Shinohara about the evolving role of the dermatology hospitalist in the inpatient setting. Dr. Shinohara highlights some key takeaways about job satisfaction and barriers to care from a recent survey of members of the Society for Dermatology Hospitalists. We also bring you the latest dermatology news and research: 1. Cephalosporins remain empiric therapy for skin infections in pediatric atopic dermatitis “When a patient with AD walks into your office and looks like they have an infection of their eczema, your go-to antibiotic is going to be one that targets MSSA [methicillin‐sensitive Staphylococcus aureus].” 2. Should you market your aesthetic services to the ‘Me Me Me Generation’? By 2020, spending by millennials will account for $1.4 trillion in U.S. retail sales. Things you will learn in this episode: Inpatient care is getting increasingly complex, but dermatology has become more outpatient-centric overall: “There has really been a shift over time from dermatologists acting as the primary admitting service to more of a consulting service,” Dr. Shinohara explains. As a result, inpatient dermatology has become more specialized, leading to the development of the dermatology hospitalist. The Society for Dermatology Hospitalists was created in 2009 by a group of medical dermatologists to develop the highest standards of clinical care in hospitalized patients with skin disease. Most requests for inpatient dermatology consultations come from medical services for conditions commonly seen in an outpatient clinic. However, the hematology/oncology service is a common source of dermatology consultations, requiring a separate knowledge base. Dermatology hospitalists typically dedicate 25%-50% of their time on inpatient consultations. Time that dermatology hospitalists spend in the hospital is fundamentally different than time spent in clinic: “You have a lot more time to think about your patients and to teach about them to your trainees,” Dr. Shinohara notes. “It’s really one of the few places that I find you still have the opportunity to work as a team together.” Personal fulfillment is high among dermatology hospitalists, which can help combat burnout. A key challenge that dermatology hospitalists face is that most don’t generate the same revenue doing consultations as they do in clinic. Financial support from medical institutions and recognition of the value of the work is crucial to the longevity of dermatology hospitalists, who tend to be a younger workforce. Hosts: Elizabeth Mechcatie, Terry Rudd, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Michi M. Shinohara, MD (University of Washington, Seattle) Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
August 29, 2019
Psychiatric disease is seen in 30%-60% of dermatology patients. In this special resident takeover of the podcast, three dermatology residents – Dr. Elisabeth Tracey, Dr. Julie Croley, and Dr. Daniel Mazori – talk about the challenges of treating patients with both psychiatric and dermatologic disease. “In some instances, although ideally, we would like to refer [patients to a mental health professional], we do have to develop good skills during our training to be well equipped to handle these cases,” explains Dr. Croley. Beginning at 4:29, they discuss common psychiatric disorders seen by dermatologists, appropriate therapies, and strategies for building a strong rapport with these patients prior to referral. We also bring you the latest dermatology news and research. Recent progress in vitiligo treatment might be heading to vitiligo cure Clinical trials are now actively being planned to target interleukin-15, a cytokine thought to be essential for maintaining memory T cells. In murine models, this approach led to rapid and durable repigmentation without apparent adverse effects.  Dermatologists lack training about skin of color The results of a small survey argue for enhanced training in treating patients with skin of color, an emphasis on culturally sensitive and competent care, and greater diversity in the dermatology workforce. Things you will learn in this episode: Dermatologists often see psychiatric disease in two forms: a condition that is primary and drives a cutaneous disease or a condition that is comorbid or secondary to a dermatologic disorder. Delusional infestation (also known as delusions of parasitosis) is a common primary condition in dermatology. Patients with delusional infestation have a fixed false belief that an organism or other nonliving matter is present in or under the skin, which they may bring to the office in a matchbox as proof of infestation (known as the matchbox sign). Dr. Mazori adds, “Now that about 80% of Americans own smartphones, instead of the matchbox sign, I’ve seen patients increasingly present with photos of the specimens.” Obsessive-compulsive disorder and other related disorders represent a broad category of primary conditions, including body dysmorphic disorder (BDD), olfactory reference syndrome, excoriation disorder, trichotillomania, and trichophagia. An estimated 12% of dermatology patients have BDD, which presents more commonly in cosmetic dermatology. In the general dermatology population, BDD occurs at the substantial rate of 7%. In patients with dermatitis artefacta, a condition in which the individual has deliberately self-afflicted skin lesions, the motive for the behavior is unconscious. This illness should be distinguished from malingering, in which patients have a conscious goal of secondary fame. Useful treatment modalities for primary neurodermatoses include antidepressants, antipsychotics, and cognitive-behavioral therapy. Selective serotonin reuptake inhibitors (SSRIs) are a first-line treatment of BDD and also may be useful for olfactory reference syndrome. The antipsychotics risperidone and olanzapine have achieved full or partial remission in two-thirds of delusional infestation cases. A mental health referral is warranted for patients who have a psychiatric condition secondary to or comorbid with a skin disorder. Avoid referring patients in the first visit. Build a strong therapeutic alliance or rapport to gain their trust before making a referral. Consider focusing on symptomatic treatments for patients. For patients with delusions of parasitosis, offer strategies to reduce skin picking. If a patient brings a sample of a parasite, examine it and then review the results in a matter-of-fact way. “Always try to be sympathetic,” advises Dr. Mazori. “Even though we shouldn’t confirm their delusions, we can still acknowledge that they’re experiencing symptoms that are real.” For pediatric patients, interview parents/guardians to elicit history and perhaps an underlying cause of a psychiatric component. A psychiatry-dermatology multidisciplinary clinic can help destigmatize referral to a mental health professional. “The dermatologist sees a patient with a psychiatrist,” explains Dr. Tracey. “The patient feels like they are coming to see the dermatologist. Then we tell the patient [that] everyone in this clinic sees both of these providers and that’s the way we are able to help these patients see a psychiatrist.” If you know someone in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255. Hosts: Nick Andrews, Carol Nicotera-Ward Guests: Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation, Ohio); Julie Ann Amthor Croley, MD (The University of Texas Medical Branch at Galveston); Daniel R. Mazori, MD (State University of New York, Brooklyn). Show notes by Jason Orszt, Melissa Sears, Kathy Scarbeck You can find more of our podcasts at http://www.mdedge.com/podcasts. Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm    
August 28, 2019
Julie Croley, MD, also known as @dr.skinandsmiles on Instagram, joins MDedge producer and host of the Postcall Podcast, Nick Andrews.  You can find more interviews like this on the Postcall Podcast at https://www.mdedge.com/podcasts/postcall-podcast  
August 22, 2019
Dr. Justin Ko speaks with MDedge reporter Ted Bosworth about the use of augmented intelligence in dermatology. Dr. Ko is the coauthor of the American Academy of Dermatology’s position statement on augmented intelligence, which was released in May 2019. Dr. Ko addressed this topic during the plenary session at the AAD’s summer meeting in New York City, in a presentation titled “Augmented intelligence: Fusing technology with human expertise to enhance dermatologic care.” “Augmented intelligence is a term that’s specifically used so that we can move people away from conceptions about artificial intelligence,” Dr. Ko explained in the interview. “When we use that term, the first thing that pops into people’s minds are robots, terminators … other things that seem intimidating … that misconception is one that I really want to draw attention towards.” This week, we also bring you the following news: 1: Hidradenitis suppurativa linked to higher NAFLD risk https://www.mdedge.com/dermatology/article/206828/medical-dermatology/hidradenitis-suppurativa-linked-higher-nafld-risk  2: Nebraska issues SUNucate-based guidance for schools https://www.mdedge.com/dermatology/article/206581/dermatology/nebraska-issues-sunucate-based-guidance-schools  Hosts: Elizabeth Mechcatie, Carol Nicotera-Ward, Vincent A. DeLeo, MD, of the Keck School of Medicine at the University of Southern California, Los Angeles Guest: Justin Ko, MD, of the department of dermatology at Stanford (Calif.) University. He is also on the faculty of Stanford’s Center for Artificial Intelligence in Medicine & Imaging.   Show notes by Elizabeth Mechcatie You can find more of our podcasts at  http://mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
August 15, 2019
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
August 8, 2019
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
August 1, 2019
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
July 25, 2019
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm  
July 18, 2019
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 mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
July 11, 2019
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) Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
July 4, 2019
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm  
June 27, 2019
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 http://www.mdedge.com/podcasts.    Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
June 20, 2019
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 http://www.mdedge.com/podcasts.     Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
June 13, 2019
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 http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm    
June 6, 2019
In this episode, Dr. Vincent DeLeo talks to Dr. Eden Lake about outpatient management and follow-up recommendations for adverse drug reactions (ADRs), beginning at 11:28. There’s a lot of literature on what to do for an inpatient who has an ADR, but what do you do once they’re discharged? Dr. Lake reviews the clinical features of three serious ADRs — AGEP (acute generalized exanthematous pustulosis), DRESS syndrome (drug rash with eosinophilia and systemic symptoms), and SJS/TEN (Stevens-Johnson syndrome/toxic epidermal necrolysis) — and provides preliminary guidelines for outpatient dermatology care. We also bring you the latest in dermatology news and research: 1. Systematic review indicates cutaneous laser therapy may be safe during pregnancy. 2. Dr. Raymond Cho discusses the promise molecular profiling shows for treating unusual skin rashes. Dr. Cho, a dermatologist and geneticist at the University of California, San Francisco, based his comments on his presentation at the annual meeting of the Society for Investigative Dermatology. 3. Some "slime"-related contact dermatitis is allergic. Things you will learn in this episode:  Adverse drug reactions are very common in dermatology, particularly in the inpatient setting. There are approximately 2 million serious ADRs per year in the United States with more than 100,000 deaths. Acute generalized exanthematous pustulosis (AGEP) develops very quickly after exposure to an insulting medication but generally is considered self-limiting and benign. Internal involvement has been seen in up to 20% of patients. DRESS syndrome (drug rash with eosinophilia and systemic symptoms) is a severe morbilliform drug eruption that can persist for months after discharge from the hospital. It presents with systemic symptoms such as eosinophilia, but any visceral organ can be involved. SJS/TEN are overlapping conditions with mucosal involvement and cutaneous exfoliation of a necrotic epidermis. Mortality rates are high, and treatment in a burn unit is recommended. Visceral involvement in AGEP patients may be similar to DRESS syndrome and requires more long-term follow-up. Adverse drug reactions are trauma to the skin and therefore can be associated with an isomorphic phenomenon. DRESS syndrome requires laboratory testing, particularly for glucose and thyroid-stimulating hormone levels, as well as a thorough review of systems in the outpatient setting. Taper high-dose steroids in DRESS syndrome patients in the outpatient setting very slowly. Ocular and pulmonary function should be monitored for 1 year after diagnosis of SJS/TEN. Patients also should undergo psychologic evaluation due to high rates of posttraumatic stress disorder. Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)  Guest: Eden Lake, MD (Loyola University Medical Center, Maywood, Ill.) Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie.  You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm Rate us on iTunes!  
May 30, 2019
In this episode, three dermatology residents — Dr. Daniel Mazori,  Dr. Julie Croley, and Dr. Elisabeth Tracey — discuss items they keep in their on-call bags in this special resident takeover of the podcast. Beginning at 14:50, they talk about premade biopsy kits, tricks for achieving hemostasis in the hospital, portable electronic gadgets, and creative alternatives for basic items. They also discuss bedside diagnostics and unique cases while being on-call. “After rotating through the consult service, you really do grow as a dermatologist,” reports Dr. Croley. “You see rare things; you see severe disease processes. You learn to be efficient and self-sufficient.”  We also bring you the latest in dermatology news and research: 1. Study finds inconsistent links with aspirin, nonaspirin NSAIDs, and reduced skin cancer risk. 2. Justin M. Ko, MD, MBA, of Stanford (Calif.) University discusses the American Academy of Dermatology's position statement on augmented intelligence. Dr. Ko is director and chief of medical dermatology for Stanford Health Care at Stanford Medicine, Redwood City, Calif. He is the chair of the AAD's Ad Hoc Taskforce on Augmented Intelligence, which wrote the position statement. 3. Prior authorizations for dermatology care nearly doubled in the last 2 years at one center. Things you will learn in this episode: Recommendations on what type of bag to use for your on-call bag. Premade biopsy kits are key for your on-call bag so that you can perform shave or punch biopsies. Tricks for obtaining hemostasis in the hospital. The utility of dermatoscopes has been expanding in recent years, and it can be a helpful bedside electronic device. Purple surgical markers can be used as a topical antimicrobial. Normal saline or honey can be used if you run out of Michel solution. Nonmedical items to keep in your on-call bag may include a handheld guide for drug eruptions and consult templates. Examples of unique cases of misdiagnosed Stevens-Johnson syndrome, highlighting the expertise of dermatologists: “In our field, especially as a consultant, our expertise can be so crucial in the care of complex patients.” Be comfortable with bedside diagnostics such as Tzanck smear to diagnose viral infections and a positive Nikolsky sign for staphylococcal scalded skin syndrome. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York, Brooklyn); Julie Ann Amthor Croley, MD (the University of Texas Medical Branch at Galveston); and Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation). Show notes by Melissa Sears, Alicia Sonners, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm Rate us on iTunes! To subscribe to this podcast and more, go to mdedge.com/podcasts.
May 23, 2019
In this episode, Dr. Vincent DeLeo talks to Dr. Robert G. Micheletti about managing patients with calciphylaxis, a rare but potentially fatal condition classically seen in patients with end-stage renal disease (ESRD). Early recognition and diagnosis of calciphylaxis are essential to reducing morbidity and mortality. Dr. Micheletti describes the clinical features of calciphylaxis that dermatologists may encounter bedside, noting that biopsy often is nondefinitive. “It’s a tough disease to have," Dr. Micheletti explains, "which is why you do need multidisciplinary care and the help of a good dermatologist to be able to make the diagnosis and address the wound situation.”  We also bring you the latest in dermatology news and research: Atopic dermatitis in adults is associated with increased risk of dementia. U.S. measles total sees smallest increase in 2 months. Dr. Dee Anna Glaser, professor in the department of dermatology, Saint Louis University, discusses diagnosis and treatment advice for hyperhidrosis. Things you will learn in this episode:  Although calciphylaxis commonly is associated with ESRD, nonuremic calciphylaxis can be triggered by other clinical factors in a subset of patients without ESRD. Risk factors for calciphylaxis include various medications, clotting disorders, and autoimmune diseases, whether the patient also has ESRD. The clinical presentation of calciphylaxis depends on the point at which the area is examined. Early stages of calciphylaxis may present as a tender subcutaneous nodule, while late stages may present with more severe pain and ulceration. Maintain a high index of suspicion for calciphylaxis in patients with ESRD on chronic dialysis presenting with severely painful livedoid plaques or retiform purpura, particularly in fat-rich body sites. Biopsy often is nondiagnostic because of insufficient tissue sample size. Calcium stains will help highlight areas of vascular calcification, but “don’t assume just because the biopsy doesn’t show calcification that it is not calciphylaxis.” To improve diagnostic accuracy, biopsy specimens should be evaluated by experienced dermatopathologists who have seen calciphylaxis before. End-stage renal disease patients with calciphylaxis who are not currently on dialysis may benefit from starting it. Dermatologists should work in conjunction with nephrologists to optimize dialysis and other medications to treat underlying issues associated with calciphylaxis in the setting of ESRD. Data-driven diagnostic criteria and management guidelines for calciphylaxis are needed to improve patient care. The Society for Dermatology Hospitalists is working on pooling cases of calciphylaxis to generate a data-driven model of factors associated with the diagnosis. Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (University of Southern California, Los Angeles).  Guest: Robert G. Micheletti, MD (Departments of Dermatology and Medicine, University of Pennsylvania, Philadelphia). Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm Rate us on iTunes! To subscribe to this podcast and more, go to mdedge.com/podcasts.    
May 16, 2019
In this episode, Dr. Vincent DeLeo talks to Dr. Shari Lipner about nail education gaps in the American Academy of Dermatology Basic Dermatology Curriculum. Although the curriculum is designed to introduce medical students to essential concepts in dermatology, nail-related topics such as diagnostic techniques, biopsy procedures, and skin cancers of the nail unit are inadequately covered. Dr. Lipner discusses strategies to close these gaps and improve nail education for medical students and dermatology residents. She also breaks down the mnemonic for identifying nail melanomas. We also bring you the latest in dermatology news and research: 1. Gentamicin restores wound healing in hereditary epidermolysis bullosa. 2. Measles complications in the U.S. unchanged in posteradication era. 3. Dr. Adam Friedman outlines oral treatment options for hyperhidrosis. Things you will learn in this episode:  A thorough full-body skin examination should include the skin, hair, and scalp, as well as the nails. Even while the patient is initially speaking, pay attention to the nails. Many dermatology residents and attendings are not familiar with the ABCDEF nail melanoma mnemonic, which is more complex than the mnemonic for cutaneous melanoma. There is a gap in educating dermatology residents on nail biopsies and surgical procedures. Nail education can be improved by encouraging medical students and residents to be aware of the nails, get comfortable with the nails, and incorporate nails into the didactics during medical school and training. More lectures at national and local conferences and hands-on learning also are helpful. “By understanding nails, both diagnosis and management, potentially we can improve patients' quality of life, and it can also be lifesaving in the case of malignancies.” Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of University of Southern California, Los Angeles)  Guest: Shari R. Lipner, MD, PhD (Weill Cornell Medicine, New York, New York)  Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm Rate us on iTunes!
May 9, 2019
In this episode, Vincent DeLeo, MD, talks to Nanette B. Silverberg, MD, about the successful management of warts in the pediatric population. Warts are superficial viral infections of the skin that are extremely common in children and account for a large proportion of pediatric dermatology office visits. Although over-the-counter treatments for warts are widely available to patients, they are not universally effective. Dr. Silverberg outlines a detailed treatment paradigm for managing pediatric warts and reviews a variety of new and established treatment options in six therapeutic categories. She also reviews the latest human papillomavirus (HPV) vaccine recommendations for children. We also bring you the latest in dermatology news and research: 1. Sunscreen ingredients found in bloodstream, but health impact unknown. 2. Females with acne stay on spironolactone longer than antibiotics in real-world usage study. 3. Employed physicians now outnumber independent doctors. Things you will learn in this episode:  Warts are benign epidermal lesions caused by infection with HPV, which replicates in skin cells to induce a state of hyperkeratosis. There are more than 200 types of HPV, and warts have variable clinical and histologic features depending on type and location. The incidence of pediatric warts appears to peak in preadolescence. Children with atopic dermatitis may be at higher risk for developing warts and other extracutaneous infections. Warts in the setting of AD may indicate that a child is prone to other dermatologic or allergic conditions. Most warts in children are transmitted in close household, classroom, or sports settings. Evaluation for signs of sexual abuse always is warranted in children presenting with condyloma. Dermatologists should be aware of respiratory complications associated with HPV infection in children. The majority of warts likely will spontaneously resolve, but those that spread or do not resolve following observation or traditional therapies may require alternative treatment mechanisms. Treatment options for pediatric warts generally fall into six therapeutic categories: destructive, immune stimulating, immune modulating, irritant therapy, vascular destructive, and nitric oxide releasing. The therapeutic ladder for warts in children consists of seven rungs, beginning with diagnosis. If the clinical presentation is not clear, suspected warts should be biopsied prior to treatment to avoid unnecessary procedures or exacerbation of the condition. Avoid painful procedures in children. The most recent HPV vaccine offers broad protection and should be offered to both girls and boys before they become sexually active. The dosing schedule should be reviewed with the pediatrician. Cohosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of University of Southern California, Los Angeles) Guest: Nanette B. Silverberg, MD (Icahn School of Medicine at Mount Sinai, New York, New York) Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm Rate us on iTunes!
May 2, 2019
In this episode, Dr. Vincent DeLeo discusses consumer misconceptions about parabens with Dr. Margo Reeder and Dr. Amber Atwater. Although consumers believe parabens are associated with health risks such as breast cancer and endocrine disruption, the data have not been conclusive regarding any harmful effects in humans. Dr. Reeder and Dr. Atwater explain the use of parabens as preservatives in cosmetic products, and they discuss the American Contact Dermatitis Society’s selection of parabens as the 2019 nonallergen of the year. We also bring you the latest in dermatology news and research: 1. Surprise! Methotrexate proves effective in psoriatic arthritis. 2. Positive psoriatic arthritis screens occur often in psoriasis patients. 3. Tips for preventing complications in resurfacing skin of color. Things you will learn in this episode:  Parabens are present in a number of cosmetic and household products and medications, but the maximum concentrations permitted generally are much lower than consumers may think. Consumers associate parabens with health risks such as breast cancer and endocrine disruption, but the actual data on estrogenic effects in humans are limited. Although parabens have been found in breast cancer tissue, findings have not been directly linked to use of topical axillary personal care products containing parabens, such as deodorants. Application of these products directly after shaving also has not been shown to increase breast cancer risk. Because of their low rate of associated allergic contact dermatitis, the American Contact Dermatitis Society named parabens the nonallergen of the year for 2019. Parabens are a safe choice for preservatives given their low allergenic potential. Dermatologists can ease patient concerns about parabens by explaining that a causative role in adverse health effects has not been proven. Guests: Margo Reeder, MD (University of Wisconsin School of Medicine and Public Health, Madison); Amber Reck Atwater, MD (Duke University School of Medicine, Durham, N.C.)  Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm
April 25, 2019
Three dermatology residents -- Dr. Julie Croley, Dr. Elisabeth Tracey, and Dr. Daniel Mazori -- discuss their use of social media and its impact on patient care in this special resident takeover of the podcast. Beginning at 6:29, they talk about social media accounts they follow and medical influencers, as well as the use of social media as a marketing tool for practicing physicians. Social media also is a source of misinformation for patients, and they discuss how it can be used as an important tool to educate patients when advice comes from a validated source such as a health care professional. As a dermatologist, do you have a duty to take to social media to provide reputable health information? We also bring you the latest in dermatology news and research: 1. First North American clinical guidelines for hidradenitis suppurativa released. 2. Dr. Jeniel Nett discusses the dangers of Candida auris. Things you will learn in this episode: Possible social media accounts to follow for educational purposes, such as dermoscopy and lifestyle topics in medicine. Social media influencers in dermatology for cases, dermatopathology, and suture techniques. How to manage using social media for personal vs. professional purposes. Marketing and advertising on social media to optimize the reach of your dermatology practice. Ways in which patients are misinformed through social media, such as improper use of medications, and the need for patients to assess the source of the information they are reading online. Dr. Croley asks, “Do we, as dermatologists, have a duty to take to social media to provide reputable health information?” Movements such as #VerifyHealthcare help physicians to practice transparency and ensure integrity of information posted on social media. Patient education via social media to reinforce concepts discussed in the office for treatment compliance, such as patient handouts or videos with instructions on applying tretinoin properly, using wet wraps for atopic dermatitis or bleach baths for children, and applying topical steroids under occlusion. Campaigns such as #dontfryday for sun safety awareness, which can be used to encourage preventative care for patients. Support groups on social media also can be helpful for patients. The utility of hashtags on social media to filter out noise. Should certain medical hashtags be restricted to health care professionals who have been verified? Guests: Julie Ann Amthor Croley, MD (the University of Texas Medical Branch at Galveston); Elisabeth Tracey, MD (Cleveland Clinic Foundation, Ohio); Daniel R. Mazori, MD (State University of New York Downstate Medical Center, Brooklyn). Show notes by Melissa Sears, Alicia Sonners, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm
April 18, 2019
Today, Dr. Vincent DeLeo talks to Dr. Candrice Heath about managing postinflammatory hyperpigmentation (PIH) in children with skin of color. Many inflammatory conditions commonly seen in childhood and adolescence can result in pigmentary changes in darker-skinned individuals. Beginning at 5:05, Dr. Heath outlines various treatment plans for some of these conditions, such as atopic dermatitis, acne, and arthropod bites, and shares some early prevention strategies to limit the development of new and worsening PIH in pediatric skin of color patients. Plus, Dr. A. Yasmine Kirkorian talks with Dr. Adam Friedman about some of the immunomodulators he turns to for treating inflammatory skin diseases. Their discussion begins at 22:09. We also bring you the latest in dermatology news and research: 1. Low-dose isotretinoin plus pulsed dye laser found effective for papulopustular rosacea. 2. Cost gap widens between brand-name, generic drugs. 3. Busiest week yet brings 2019 measles total to 555 cases. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm
April 11, 2019
In this episode, Dr. A. Yasmine Kirkorian and Dr. Adam Friedman share their clinical pearls for using immunomodulators to treat pediatric skin diseases. We also bring you the latest in dermatology news and research: 1. Survey finds high rate of complications from laser tattoo removal in non-clinic settings. 2. Survey finds psoriasis patients seek relief with alternative therapies. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm
April 4, 2019
In this episode, Dr. Vincent DeLeo talks with Dr. George Han about recent advances in topical psoriasis therapies. Despite the growing popularity of systemic injectables, the vast majority of psoriasis patients are still being managed with topical treatments. Dr. Han reviews some newly available and upcoming agents with novel mechanisms of action that may present safer, more efficacious options for topical treatment of psoriasis. We also bring you the latest in dermatology news and research: 1. Dr. Jill Waibel says treatment with gold microparticles plus lasers is a viable option for acne. https://bit.ly/2IbzHEX 2. Dr. Tina Alster talks about how to cope with patients who get under your skin. https://bit.ly/2IaB2Mb 3. A proinflammatory diet may not trigger adult psoriasis, psoriatic arthritis, or atopic dermatitis. https://bit.ly/2G14tyH Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm  
March 28, 2019
In this episode, Dr. Vincent DeLeo discusses the increasing incidence of workplace bedbug infestations with Dr. Bart Wilkison and Dr. Brandon McNally. They discuss how to help patients check for bedbugs both at home and in the office setting, and they provide tips on how patients can work with employers to eradicate potential infestations. Read their related article on MDedge Dermatology: https://bit.ly/2MueLZE We also bring you the latest in dermatology news and research: 1. Herpes zoster risk increased with some psoriasis, psoriatic arthritis treatments. https://bit.ly/2FwBVM1 2. Preview of ASLMS annual meeting coverage in Denver.  3. FDA panel calls for changes to breast implant rupture screening. https://bit.ly/2HUCXUV Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm  
March 23, 2019
Today, we’re bringing you a special episode featuring exclusive coverage from the annual meeting of the American Academy of Dermatology in Washington. In a wide-ranging discussion, Dr. Julie Harper and Dr. Jonette Keri sum up their key insights and take-home messages from the meeting’s acne sessions. We also bring you the latest in dermatology news and research from the meeting: 1. Food allergies and atopic dermatitis: What is the evidence? https://bit.ly/2CayGcp 2. Many common dermatologic drugs can be safely used during pregnancy. https://bit.ly/2HmZLfY 3. 31-GEP test predicts likelihood of metastasis for cutaneous melanoma. https://bit.ly/2NO3dkK 4. Bermekimab reduces lesions, cuts pain in patients with hidradenitis suppurativa. https://bit.ly/2H6NuNe Contact us: podcasts@mdedge.com On Twitter: @MDedgeDerm  
March 21, 2019
In this first episode of the new Dermatology Weekly podcast, Dr. Vincent DeLeo talks with Dr. Daniel Siegel and Ramiz Hamid about indoor tanning behaviors among adolescents, and they outline tips for communicating with patients about the harmful effects of tanning. You can read their related article on MDedge Dermatology: https://bit.ly/2Jpetpf. We also bring you the latest in dermatology news and research: 1. Fluorouracil beats other actinic keratosis treatments in head-to-head trial. https://bit.ly/2SNmWC5 2. Match Day 2019: Dermatology steps up growth after slow 2018. https://bit.ly/2unA8Ud 3. Don't miss baby scabies. https://bit.ly/2Tkd0jF Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm          
December 15, 2018
In this episode of the “Peer to Peer” podcast series, Dr. Vincent DeLeo speaks with Dr. Loren Krueger about how to identify frontal fibrosing alopecia (FFA). Dr. Krueger emphasizes that FFA is indistinguishable from lichen planopilaris on histopathology and also appears clinically similar to traction alopecia. Therefore, dermatologists should be familiar with the various clinical findings associated with FFA in order to ensure accurate and timely diagnosis, particularly in women with skin of color.
November 30, 2018
In this episode of the “Peer to Peer” podcast series, Dr. Vincent DeLeo speaks with Dr. Sahand Rahnama-Moghadam about managing DRESS syndrome in the hospital setting. Dr. Rahnama provides tips for screening for systemic involvement and also discusses treatment options and recommendations for long-term follow-up in this patient population.
November 7, 2018
In this episode of the “Peer to Peer” podcast series, Dr. Vincent DeLeo speaks with Drs. Allireza Alloo and Sergey Rekhtman about the future of inpatient dermatology. They discuss how dermatologic consultation impacts both patient care and health care economics in the hospital setting and also highlight the role of the Society for Dermatology Hospitalists in developing best practices for managing inpatient dermatologic conditions and creating an educational model for both dermatology trainees and medical professionals in other specialities.
October 31, 2018
In this episode of the “Peer to Peer” podcast series, Dr. Vincent DeLeo speaks with Dr. Susan Taylor about the changing face of vitiligo.
October 3, 2018
In this episode of the “Peer to Peer” podcast series with Dr. Vincent A. DeLeo, Dr. Babar Rao highlights the increasing role of artificial intelligence (AI) in dermatology and explains how cognitive computing, which mimics human thought processes to analyze data, can support clinical decision-making and physician-patient interactions. He also discusses clinical scenarios in which AI can be implemented to improve patient outcomes, including hair transplantation, skin cancer evaluation, and electronic medical records, and forecasts the future of AI in the field of dermatology.
September 6, 2018
In this episode of the “Peer to Peer” podcast series with Dr. Vincent DeLeo, Dr. Steven Feldman discusses results from a recent study he and his colleagues conducted on topical corticosteroids and treatment-resistant atopic dermatitis. He notes that poor use of medications can be a cause of topical corticosteroid tachyphylaxis and provides some tips on how physicians can get patients to better adhere to treatment.
August 23, 2018
In this episode of the “Peer to Peer” podcast series with Dr. Vincent DeLeo, Dr. Eric W. Hossler discusses the effects of provider attire in the clinical dermatology setting. He outlines the results from a recent study he and his colleagues conducted evaluating perceived care and patient satisfaction scores at an outpatient dermatology clinic before and after switching from formal provider attire (eg, white coats) to fitted scrubs. He also explains how provider attire impacts the transmission of microorganisms and infection risk in the clinical setting.
July 31, 2018
In this edition of the “Peer to Peer” podcast series with Dr. Vincent DeLeo, Dr. Lorraine L. Rosamilia outlines some underlying factors that lead to the variable cost of acne medications. She explains how she addresses the issue of cost when implementing treatment plans for acne patients, including making notes for pharmacists when writing prescriptions and estimating costs for patients when possible. She also suggests ways dermatologists can lobby to lower patient costs for acne medications at state and federal levels.
June 28, 2018
In this episode of the “Peer to Peer” podcast series with Dr. Vincent DeLeo, Dr. Neda Black highlights an unusual case of ectopic extramammary Paget disease (EMPD). She outlines distinguishing factors of the various forms and classifications of EMPD and provides recommendations for workup and diagnosis to rule out other potential malignancies.
June 18, 2018
In this episode of the “Peer to Peer” podcast series with Dr. Vincent DeLeo, Dr. Gary Goldenberg breaks down new management guidelines from the American Academy of Dermatology on nonmelanoma skin cancer, specifically basal and squamous cell carcinomas. He explains how dermatologists can implement the new guidelines in their practice and summarizes some of the latest options for diagnosis and treatment of nonmelanoma skin cancers.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series with Dr. Vincent DeLeo, Dr. Sean Branch provides an overview of Merkel cell carcinoma (MCC), an uncommon neuroendocrine tumor of the skin. He discusses the clinical presentation, incidence, and pathogenesis of MCC and also highlights a case of spontaneous regression in a 96-year-old woman.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Eleni Linos about the benefits of increasing diversity in the dermatology workforce. According to Dr. Linos, dermatology is one of the least diverse medical specialties, and therefore supporting diversity must be an explicit goal. She discusses the benefits of diversity in improving patient care and reducing health disparities. She also emphasizes the importance of diversity in education and leadership to inspire the next generation of dermatologists and leaders in the field.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Babar K. Rao about mobile dermatology apps for patient education. Considering the growing popularity of apps for all kinds of information, Dr. Rao notes that it is important for physicians to recommend dermatology and other medical apps that will ultimately be beneficial to patients.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Ted Rosen about the dermatologist’s role in the treatment and diagnosis of syphilis. Dr. Rosen shares current data on the incidence of syphilis in the United States and discusses some of the driving factors behind what has become an epidemic over the last 5 years. He also lists some common skin findings associated with syphilis and explains that, as the only specialists of infectious and noninfectious diseases of the anogenital skin, dermatologists play a crucial role in managing the growing number of syphilis patients.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Lela A. Lee about the new American Board of Dermatology Certification Examination. According to Dr. Lee, the new certification process shifts the focus from fact memorization to clinical decision-making and is designed to mimic the process of becoming a good dermatologist. She walks the listener through the 3 parts of the certification process—the basic, core, and applied exams—and notes how these changes will impact current and future dermatology residents.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Philip D. Shenefelt about the nocebo effect and how it can affect dermatologists’ interactions with their patients. Dr. Shenefelt explains that the nocebo effect, which is the converse of the more widely known placebo effect, leads to adverse treatment outcomes that may occur based on negative beliefs of both patients and physicians. He offers tips for physicians regarding how to speak to patients without encouraging negative expectations or beliefs that could possibly impact treatment.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Jashin J. Wu about adalimumab for the treatment of hidradenitis suppurativa (HS). Dr. Wu reviews the specifics of the approval of adalimumab for HS, including dosing information. He also discusses his own treatment algorithm for managing patients with HS. Finally, Dr. Wu speculates on future targets for current biologics that already have been approved for other indications.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Susan C. Taylor about hair and scalp disorders in patients with skin of color. Dr. Taylor discusses the causes of common conditions that dermatologists may see in patients with skin of color, including central centrifugal cicatricial alopecia and pseudofolliculitis barbae, and offers tips for management and treatment. She also discusses how to approach parents of children with skin of color who present with concerns that their child’s hair is not growing.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Thomas D. Horn about the importance of the Maintenance of Certification (MOC) process in improving the quality of care delivered in dermatology practices. Dr. Horn notes that MOC represents the best structure for physician self-regulation, which is crucial to ensuring the integrity of practice parameters within the specialty while avoiding third-party oversight. He also provides an in-depth explanation of how the MOC practice improvement and self-assessment modules are stuctured. Finally, Dr. Horn outlines some key changes in the MOC process that are pertinent to physicians.
June 12, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Andrew F. Alexis about skin cancer mortality in patients with skin of color. Although malignant melanomas and other skin cancers are less prevalent in nonwhite racial ethnic groups, Dr. Alexis notes that the morbidity and mortality is worse in these patient populations. He discusses some of the reasons why this disparity exists, including low public awareness of skin cancer, differences in clinical presentation, low clinical suspicion among both patients and health care providers, and low access to specialty care among patients with skin of color. He also offers some tips as to how physicians can address and manage the increased risk for skin cancer mortality in this patient population.
June 12, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Adam V. Sutton about patient satisfaction as an assessment of quality of care in dermatology practices. Dr. Sutton provides an overview of the results of a recent survey conducted in an urban dermatology clinic setting that evaluated patient demographics and how they perceived the quality of care that was delivered. He notes that satisfied patients are one of the best sources of referrals for a dermatology practice and therefore picking up on trends and making changes based on patient experiences may improve the overall outcome of a practice. He also offers tips for how dermatologists can improve their online profiles and respond more proactively to ratings and reviews from patients about their care experiences.
June 12, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Cynthia L. Chen about the prescribing practices of US dermatologists regarding oral contraceptives (OCPs) for acne treatment. Dr. Chen describes the results of a recent survey that was used to collect data about the demographics and practice settings of dermatologists who prescribe OCPs in the United States as well as how their knowledge and beliefs about OCPs inform their prescribing practices. She also discusses the use of 4th-generation drospirenone-containing OCPs, which have been shown to be slightly more effective for acne than other combined OCPs but also are associated with an increased risk of venous and thromboembolic events. Dr. Chen also explains her process for prescribing OCPs for acne treatment, including how to discuss the effects of hormonal treatments with patients.
June 11, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Dirk M. Elston about the lone star tick (Amblyomma americanum) and how to identify and manage skin manifestations of tick-borne diseases. He also asks about patient susceptiblity to delayed anaphylaxis associated with lone star tick attachment, which can be triggered by consuming red meat.
June 11, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Susan T. Nedorost about using patch testing as a diagnostic tool for suspected drug eruptions. Dr. Nedorost discusses challenges dermatologists may encounter when using patch testing in cohorts that present with potential drug eruptions and describes settings in which this technique may be most useful for patients. She also emphasizes that drug reactions sometimes may be caused by the product's excipients, not the drug itself.
June 11, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. George Han about the dermatologist's role in treating psoriatic arthritis (PsA). Dr. Han shares his algorithm for evaluating psoriasis patients for signs of arthritis, including nail dystrophy and nonspecific persistent joint pain, and notes that dermatologists should enlist the help of a rheumatologist as soon as possible for a multidisciplinary approach to PsA treatment. He also discusses imaging for PsA and the use of methotrexate for disease management.
June 11, 2018
In this edition of the “Peer to Peer” audiocast series, Dr. Vincent DeLeo speaks with Dr. Steven Feldman about treatment compliance and addressing patient concerns about treatment safety data. They discuss strategies for reassuring patients about risks associated with biologics for psoriasis and other drugs, particularly risks patients may read about on the Internet.
June 11, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Robert Brodell about the malignant potential of nevus spilus compared to other congenital nevi. They discuss the characteristic clinical features of nevus spilus and review how the presence of hair may impact its malignant potential.
June 11, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Anthony Rossi about full-body skin examinations for melanoma detection and 3D body imaging. They also discuss how to encourage patients to perform self-examinations.
June 11, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Andrew Alexis about the complications that may occur from using lasers in patients with darker skin types and parameters to lower the risks. He also discusses the use of lasers for pseudofolliculitis barbae, acne scarring, and pigmentation disorders such as melasma and postinflammatory hyperpigmentation.
June 11, 2018
In this edition of the "Peer to Peer" audiocast series, Dr. Vincent DeLeo speaks with Dr. Nanette Silverberg about atopic dermatitis in children. He asks about strategies for counteracting the negative effect on disease incidence in wealthier countries, racial differences in incidence, food and eczema, and treating severe atopic dermatitis in children.
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