Identify common dermatoses presentations in patients with skin of color (SOC)

Describe how to assess patients with diverse cultural backgrounds, SOC, and sexual orientation

Review treatment options for common dermatoses seen in diverse patient populations

Employ strategies to effectively communicate with patients with diverse cultural backgrounds, SOC, and sexual orientation

Difficult Dermatology Conversations: Improving Care for Diverse Patient Populations 

Discuss the treatment of psoriasis and related disorders with evolving therapies

Recognize the various therapies available for acne and their role in clinical practice

Translate the role of therapies for eczema in clinical practice

Describe the modalities for diagnosing and managing skin cancer

Identify optimal patients for the use of fillers and botulinum 

Describe strategies to prepare and administer fillers and botulinum

Illustrate strategies to manage dermatologic conditions effectively in clinical practice

2023 Virtual Grand Rounds Session 14: November 15, 2023 - Fall Clinical 2023- Your Questions Answered

Recognize that IL-4 and IL-13 are signature cytokines of type 2 inflammatory response

Understand that Type 2 inflammatory response involves mast cells, eosinophils, and basophils 

Recognize the common signs and symptoms of Staph Scalded Skin Syndrome

Understand treatment of Staph Scalded Skin Syndrome

Recognize the rare benign vascular disorder of Achenbach Syndrome

Understand the differential diagnosis and workup of Achenbach Syndrome

2023 Virtual Grand Rounds Session 13: September 27, 2023 - Challenging Cases in Dermatology

Dermatology

WEDNESDAY, Nov. 15, 2023 -- Religion should be integrated into existing cultural humility training in order to better address the unique needs of Muslim dermatology patients, according to a study published online Nov. 15 in JAMA Dermatology.Ghida El-Banna, M.D., from the Stanford University School of Medicine in Redwood City, California, and colleagues explored the perceptions of Muslim patients of their dermatology care in a qualitative mixed-methods study composed of surveys and semistructured interviews. Twenty-one patients participated in the study: five men and 16 women, including 10 who wore hijab.According to the researchers, the survey results demonstrated variation of the impact of Islamic practices on dermatology care. Based on interviews, dermatology care was not perceived as a priority by Muslim patients, and they expressed interest in community events highlighting general dermatology education. Stigmatization of their skin disease and cosmetic care was experienced. The Muslim patient-dermatologist relationship and disclosure of the need for accommodations was hindered by prior experiences with Islamophobia and colorism. Participants described instances of bias and poor cultural humility from dermatologists. Religious and cultural needs pertinent to their care, including clinician gender concordance, adjustment of medication timing while fasting, and halal medication ingredients, were unique to Muslim participants."Clinical and educational interventions to address gaps in the care of Muslim patients in dermatology are needed," the authors write. "Future research should focus on the epidemiology of skin disease in Muslim subpopulations and Muslim patients' health-seeking behaviors."

Incorporation of religion into cultural humility training recommended, as well as dermatology education at community events

How Can Dermatology Care Be Improved for Muslim Patients?

THURSDAY, Nov. 2, 2023 (HealthDay News) -- Skin diseases can cause a psychosocial burden and feelings of stigmatization, according to a study published online Oct. 8 in the Journal of the European Academy of Dermatology and Venereology.Paolo Gisondi, M.D., from the University of Verona in Italy, and colleagues evaluated the burden of the most common dermatological diseases in adult patients across Europe in terms of quality of life, work life, and stigmatization. The analysis included survey responses from 19,915 individuals.The researchers found that quality of life was particularly impaired in people with hidradenitis suppurativa and sexually transmitted diseases. A modest to extremely large effect on quality of life was seen in roughly half of participants with acne, alopecia, or chronic urticaria and about 40 percent of those with atopic dermatitis, skin cancers, or psoriasis. Overall, 88.1 percent of participants considered their skin disease as embarrassing slightly more in their personal life than in their work life (83 percent). Furthermore, roughly half of the respondents reported sleeping difficulty, feeling tired, and impact of the disease on taking care of themselves. Roughly one in seven (14.5 percent) believed they have been rejected by others because of the skin disease, and 19.2 percent believe they have been looked at with disgust. Across diseases, anxiety and depression were frequently reported."Our study highlights the psychosocial burden experienced by people with skin diseases, and the need to address their impact on quality of life and stigmatization in the context of patient management," the authors write.

Effect seen on patients' daily and work life

Skin Diseases Pose a Psychosocial Burden

WEDNESDAY, June 14, 2023 -- In 2021, more than 70 percent of populated zip codes with dermatologists had fewer than four dermatologists per 100,000 people, according to a brief article published in the May issue of SKIN.Christopher N. Nguyen, M.D., from Northside Hospital Gwinnett in Lawrenceville, Georgia, and colleagues retrieved the distribution of dermatologists in three-digit zip code areas using membership data from the 2021 American Academy of Dermatology database.The researchers found that 71.6 percent of the 712 populated zip codes with dermatologists had less than four dermatologists per 100,000 people compared with 72.3 percent in 2016 (compound annual growth rate, –0.19 percent). There was a significant difference observed in the dermatologist density of the 100 most versus least populated areas (median, 4.5 versus 1.6 dermatologists per 100,000)."Consistent with 2016, over 70 percent of areas do not meet that target density and nearly 60 percent have less than three per 100,000. These results may indicate that initiatives aimed at redistribution of dermatologists have not made a major difference," the authors write. "This complex issue likely needs a multifaceted solution with continual effort and thought from leaders in the field."

71.6 percent of 712 populated zip codes with dermatologists have fewer than four dermatologists per 100,000

Maldistribution of Dermatologists Persisted in 2021

Diversity gaps persist in the dermatology workforce pipeline, according to a study published online Nov. 16 in
 
 JAMA Dermatology
 
 .




 Yi Gao, M.D., from the University of Minnesota in Minneapolis, and colleagues conducted a secondary analysis of a repeated cross-sectional study involving 58,077 graduating allopathic medical students to examine their demographic characteristics and intended career goals.




 Of the graduating students, 49.0 percent were female, 14.5 percent were from racial and ethnic groups underrepresented in medicine (URM), and 6.3 percent were sexual minority (SM) students. The researchers found that the likelihood of identifying as URM or SM was lower for female students pursuing dermatology versus other specialties (11.6 versus 17.2 percent and 1.9 versus 5.7 percent, respectively). Students pursuing dermatology versus other specialties had reduced odds of intending to care for underserved populations, practice in underserved areas, and practice public health (adjusted odds ratios, 0.40, 0.40, and 0.44, respectively), but they had increased odds of intending to pursue research in their careers (adjusted odds ratio, 1.76). Female, URM, and SM identities were independently associated with increased odds of caring for underserved populations and practicing public health among students pursuing dermatology.




 "Addressing health inequities and improving care for underserved patients is the responsibility of all dermatologists, and efforts are needed to increase diversity and interest in careers focused on underserved care among trainees in the dermatology workforce pipeline," the authors write.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2798235" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2798240" target="_blank">
 Editorial (subscription or payment may be required)
 </a>

Students pursuing dermatology have lower odds of intending to care for underserved populations, practice in underserved areas

Diversity Gaps Persist in Dermatology Workforce Pipeline

Significantly more adults with dermatomyositis receiving intravenous immune globulin (IVIG) versus placebo have a response of at least minimal improvement, according to a study published in the Oct. 6 issue of the
 
 New England Journal of Medicine
 
 .




 Rohit Aggarwal, M.D., from the University of Pittsburgh School of Medicine, and colleagues conducted a randomized, placebo-controlled trial involving patients with active dermatomyositis who were randomly assigned to receive either IVIG or placebo (47 and 48 patients, respectively) every four weeks for 16 weeks. Patients receiving placebo and those without confirmed clinical deterioration while receiving IVIG could enter a 24-week open-label extension phase. The primary end point was a response, defined as a Total Improvement Score (TIS) of at least 20 at week 16, indicating at least minimal improvement, and no confirmed deterioration.




 The researchers found that 79 and 44 percent of patients in the IVIG and placebo groups, respectively, had a TIS of at least 20 at 16 weeks. With respect to the secondary end points, including at least moderate improvement and major improvement, the results were generally in the same direction, except for the change in creatine kinase level, which did not differ meaningfully between the two groups. There were 282 treatment-related adverse events in the IVIG group over 40 weeks. Nine serious events that could be considered related to IVIG occurred.




 "Larger and longer trials to determine the long-term effects and risks of IVIG in patients with dermatomyositis are warranted," the authors write.




 The study was funded by Octapharma Pharmazeutika.




 <a class="rm-stats-tracked" href="https://www.nejm.org/doi/full/10.1056/NEJMoa2117912" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>




 <a class="rm-stats-tracked" href="https://www.nejm.org/doi/full/10.1056/NEJMe2209117" target="_blank">
 Editorial (subscription or payment may be required)
 </a>








 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>

More adults receiving IVIG versus placebo had Total Improvement Score of at least 20 at 16 weeks

IV Immune Globulin Bests Placebo for Dermatomyositis

The U.S. Food and Drug Administration on Tuesday issued warning letters to three companies, including Amazon, for selling unapproved products for removing moles and skin tags.




 No over-the-counter medications have FDA approval for that purpose, and the Food, Drug, and Cosmetic Act prohibits interstate sale of unapproved drugs and cosmetics.




 "It is the FDA's duty to protect public health from harmful products not approved for the U.S. marketplace," Donald Ashley, director of the compliance office in the FDA Center for Drug Evaluation and Research, said in a statement. "This includes where online retailers like Amazon are involved in the interstate sale of unapproved drug products. We will continue to work diligently to ensure that online retailers do not sell products that violate federal law."




 Besides Amazon, the FDA issued warning letters to Ariella Naturals and Justified Laboratories. The agency emphasized that it has not examined the mole and skin tag removal products sold by these companies for safety, effectiveness, or quality.




 The warning letters put the companies on notice that failure to address the violations cited by the FDA may result in legal action, including seizure. Once they receive the warning letter, the companies have 15 days to inform the agency of any corrective measures they have taken.




 The FDA said Tuesday that it will continue to use all the tools available to protect public health and remove fraudulent or unproven drug products from the American market. The warning letters were just the first step.




 <a class="rm-stats-tracked" href="https://www.fda.gov/news-events/press-announcements/fda-issues-warning-letters-three-companies-selling-unapproved-new-drugs-mole-and-skin-tag-removal" target="_blank">
 More Information
 </a>




 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>

No over-the-counter medications have FDA approval for the removal of moles and skin tags

FDA Warns Amazon, Other Vendors About Sale of Skin Tag Removal Products

Edgewell Personal Care Co. has recalled three batches of its Banana Boat Hair &amp; Scalp Sunscreen Spray SPF 30 because trace levels of benzene were found in some samples during an internal review. Though this sunscreen product is not meant to contain benzene, it may have come from the propellant that sprays the product out of the can.




 The
 <a class="rm-stats-tracked" href="https://edgewell.com/pages/edgewell-personal-care-issues-voluntary-nationwide-recall-of-banana-boat-hair-scalp-sunscreen-due-to-the-presence-of-benzene" target="_blank">
 recall
 </a>
 is voluntary, and the U.S. Food and Drug Administration is aware of it, the company said. Specific batches are affected by the recall, which does not apply to other batches of the product. No other Banana Boat products are part of the recall. The products are packaged in aerosol cans and were distributed throughout the United States to retailers and online. Retailers have been alerted to the recall.




 Banana Boat said it will reimburse consumers who have purchased a recalled product. Consumers can determine whether their cans of sunscreen have been recalled by looking for the lot codes on the bottom of the can and comparing them to the recalled
 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/edgewell-personal-care-issues-voluntary-nationwide-recall-banana-boat-hair-scalp-sunscreen-due" target="_blank">
 product list
 </a>
 .




 Edgewell said it has not received any reports of adverse events and noted that benzene is in the environment and humans are exposed to it regularly from multiple sources.




 Information is also available online at
 <a class="rm-stats-tracked" href="https://www.bananaboat.com/" target="_blank">
 www.bananaboat.com
 </a>
 . Consumers should contact their physician or health care provider if they have any questions or concerns or have experienced any problems related to using these aerosol sunscreen products.




 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/edgewell-personal-care-issues-voluntary-nationwide-recall-banana-boat-hair-scalp-sunscreen-due" target="_blank">
 More Information
 </a>




 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>

Company says it has not received any reports of adverse events

Banana Boat Sunscreen Recalled Due to Benzene

The chronic inflammatory skin condition, lichen sclerosus (LS), which primarily affects the anogenital area in women, is associated with depression and anxiety, according to a research letter published online June 15 in JAMA Dermatology.

 Ryan Fan, from the Yale School of Medicine in New Haven, Connecticut, and colleagues conducted a nested, matched, case-control study involving U.S. women aged 18 years or older to examine the association of LS with depression and anxiety. Using nearest-neighbor propensity score matching with replacement, each case patient was matched to four controls based on age, sex, and race and ethnicity. Data were included for 765 women with LS (mean age, 66.2 years) and 3,060 matched controls.

 The researchers found that compared with controls, women with LS were significantly more likely to have a diagnosis of depression (42.5 versus 24.4 percent) or anxiety (42.6 versus 22.6 percent). LS remained significantly associated with depression and anxiety in a multivariable analysis (odds ratios, 2.16 and 2.50, respectively).

 "Health professionals treating patients with LS should recognize the increased risk of depression and anxiety, consider mental health screening, and refer patients with LS to mental health professionals when appropriate," the authors write.

 <a href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2793096" class="rm-stats-tracked" target="_blank">Abstract/Full Text (subscription or payment may be required)</a>

Lichen sclerosus remained significantly associated with depression and anxiety in multivariable analyses

Lichen Sclerosus Linked to Depression, Anxiety in Adult Women

Adjunctive use of reflectance confocal microscopy (RCM) for suspect lesions reduces unnecessary excisions in a real-life setting, according to a study published online June 1 in
 
 JAMA Dermatology
 
 .




 Giovanni Pellacani, M.D., from the University of Modena and Reggio Emilia in Italy, and colleagues conducted a randomized clinical trial involving 3,165 patients enrolled from three dermatology referral centers in Italy, with a mean follow-up of 9.6 months. Patients were randomly assigned to standard therapeutic care with or without adjunctive RCM. A diagnostic analysis was included for 3,078 patients.




 The researchers found that adjunctive RCM was associated with a higher positive predictive value (18.9 versus 33.3), a lower benign-to-malignant ratio (3.7:1.0 versus 1.8:1.0), and a 43.2 percent reduction in the number needed to excise (5.3 versus 3.0) compared with standard therapeutic care alone. All 15 lesions with delayed melanoma diagnoses were thinner than 0.5 mm.




 "This randomized interventional trial assessed the applicability of adjunctive RCM for equivocal lesions suspected of melanoma in a clinical setting and proves that unnecessary excisions can be reduced by almost half, with greater accuracy of in vivo identification of benign lesions," the authors write.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2792714" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>

Adjunctive RCM associated with higher positive predictive value, lower benign-to-malignant ratio compared with standard therapeutic care alone

Can Reflectance Confocal Microscopy Reduce Unnecessary Excisions?

For pigmented skin lesions (PSLs), biopsy decisions made with electrical impedance spectroscopy (EIS) have increased sensitivity for melanomas/severely dysplastic nevi, according to a study published in the May issue of
 
 SKIN
 
 .




 Shayan Owji, from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a pilot study to examine the effect of EIS on clinical decisions for PSLs compared to traditional dermoscopy. Dermatologists, dermatology residents, and medical students completed an online survey providing their biopsy decisions for 24 PSLs: Half were presented as a clinical image with an associated dermoscopic image and half were presented as a clinical image with the corresponding EIS score.




 The researchers found that for melanomas/severely dysplastic nevi, decisions made with EIS had a mean sensitivity of 75 percent compared with 66 percent for decisions made with dermoscopy. Dermatologists biopsied with similar sensitivities when using EIS or dermoscopy (both 81 percent), while for residents and medical students, greater sensitivity in biopsies was seen when using EIS. The greatest improvement in sensitivity and specificity when using EIS versus dermoscopy was seen for respondents who reported rarely using dermoscopy.




 "Given that not all providers are trained in dermoscopy, and our finding that EIS particularly benefits those who infrequently use dermoscopy, EIS may complement dermoscopy by helping a broader range of providers make improved PSL diagnostic decisions," the authors write. "This will ultimately improve patient care and reduce the morbidity and mortality of a melanoma diagnosis."




 <a class="rm-stats-tracked" href="https://jofskin.org/index.php/skin/article/view/1568" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>

Sensitivity increased for biopsy decisions when using EIS versus dermoscopy, especially for those rarely using dermoscopy

Is Electrical Impedance Spectroscopy Beneficial for Pigmented Skin Lesions?

Many physician assistants (PAs) are employed in dermatology, with a larger annual increase seen for PAs in dermatology versus other specialties, according to a research letter published online May 4 in
 
 JAMA Dermatology
 
 .




 Justin D. Arnold, M.D., from the University of California in Irvine, and colleagues characterized the dermatology PA workforce in a cross-sectional study using deidentified longitudinal data from the National Commission on Certification of Physician Assistants from January 2013 to December 2018.




 Data were included for 98,554 certified PAs. The researchers found that in the study's final year, there were 3,938 PAs practicing in dermatology compared with 94,616 in all other fields. Compared with 3.7 percent in all other specialties, only 1.6 percent of PAs in dermatology identified as African American or Black. The rates of Hispanic ethnicity were similar for PAs in dermatology and other fields (6.0 and 6.5 percent, respectively). Compared with PAs in other specialties, PAs in dermatology mainly worked in office-based private practices (92.5 versus 37.7 percent) and more often resided in metropolitan geographic settings (94.7 versus 92.0). During the study period, dermatology added 164 to 539 PAs to the field annually, with a mean annual increase of 11.6 percent compared with a mean increase of 7.8 percent in all other specialties.




 "Although this study did not assess the reasons for the substantial increase of dermatology PAs, numerous factors, such as a potential physician shortage or the expansion of private equity-owned practices, may contribute to the accelerating use of PAs within the field," the authors write.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2791463" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>




 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2791589" target="_blank">
 </a>

Mean annual increase of 11.6 percent in number of PAs in dermatology reported compared with 7.8 percent in all other specialties

Physician Assistants Commonly Employed in Dermatology

Common occupationally related allergens include rubber accelerators, preservatives, and bisphenol A epoxy resin, and the occupations most commonly affected by occupational skin disease are service workers and machine operators, according to a study published in the April issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Joel G. DeKoven, M.D., from the University of Toronto, and colleagues analyzed the frequency of allergic reactions to a screening series of allergens among 38,614 North American patients undergoing patch testing between 2001 and 2016.




 The researchers found that 11.6 percent of the participants had occupational skin disease; 70.5 percent of those had allergic contact dermatitis. Rubber accelerators, preservatives, and bisphenol A epoxy resin were included as the most common occupationally related allergens. The most common sites of dermatitis were hands, arms, and face (75.8, 30.0, and 15.9 percent, respectively). Service workers and machine operators were the occupations most affected.




 "Important occupational allergens included rubber accelerators, bisphenol A epoxy resin, methylisothiazolinone, formaldehyde, and nickel," the authors write. "Knowledge of common occupational allergens, sources of exposure, and occupations/industries at risk is important to facilitate prevention and treatment."




 Several authors disclosed financial ties to the pharmaceutical industry.




 <a class="rm-stats-tracked" href="https://www.jaad.org/article/S0190-9622(21)00591-0/fulltext" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>

Common allergens include rubber accelerators, preservatives, bisphenol A epoxy resin; service workers, machine operators affected most often

What Are the Most Common Occupationally Related Allergens?

Debt valuation of dermatology private equity-backed groups (DPEGs) decreased prior to the COVID-19 pandemic and then decreased further during the pandemic, according to a study published online March 9 in
 
 JAMA Dermatology
 
 .




 Rohail Memon, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a cross-sectional study from Aug. 1, 2016, to Aug. 31, 2021, and examined public financial statements filed by business development corporations (BDCs) lending to DPEGs before and during the COVID-19 pandemic. Ten BDCs contained data on nine unique DPEGs; overall, there were 15 trackable DPEG debt instruments.




 The researchers found that during the study period, the amortized cost of the loans for an individual DPEG varied from $1.7 million to $100 million. For many DPEGs, the valuation of debt instruments was stable until some were discounted starting in May 2018; a significant decrease was seen prior to the COVID-19 pandemic from May to August 2019 (−1.4 percent). During the pandemic, there was another significant decrease from February to June 2020 (−9.0 percent). A modest and significant improvement in debt valuations was seen after pharmaceutical companies announced effective COVID-19 vaccine candidates in November 2020 (2.3 percent), but they remained discounted.




 "Dermatologists should be aware of the financial health of DPEGs, and the risks involved when considering selling their practice to or working for a DPEG," the authors write.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2789439" target="_blank">
 Abstract/Full Text
 </a>




 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>

Valuation of debt instruments significantly decreased from May to August 2019, followed by further decrease during COVID-19

Debt Valuation of Private Equity-Backed Dermatology Groups Down

Body dysmorphic disorder (BDD) symptoms are more prevalent for patients with dermatological conditions compared with healthy-skin controls, according to a study published online Jan. 18 in the
 
 British Journal of Dermatology
 
 .




 Christina Schut, Ph.D., from the Justus-Liebig-University Gießen in Germany, and colleagues compared the prevalence of BDD symptoms between patients with different dermatological conditions and healthy-skin controls in a cross-sectional multicenter study involving 5,487 patients with different skin diseases, recruited at 22 dermatology outpatient clinics, and 2,808 healthy-skin controls.




 The researchers found that the prevalence of BDD symptoms was five times higher for patients with dermatological conditions compared with healthy-skin controls (10.5 versus 2.1 percent). The odds of having BDD symptoms were elevated more than 11-fold for patients with hyperhidrosis, alopecia, and vitiligo compared with healthy-skin controls (adjusted odds ratio, &gt;11), while the odds were increased more than sixfold for patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo, and bullous diseases (adjusted odds ratio, &gt;6). BDD symptoms were significantly associated with younger age, female sex, higher psychological stress, and feelings of stigmatization using a logistic regression model.




 "This study demonstrated that more than 10 percent of patients with dermatological conditions experience potentially distressing symptoms of BDD," the authors write. "This highlights that doctors should keep in mind this condition and refer patients not responding to treatment to an appropriate health care service for further psychological assessment."




 <a class="rm-stats-tracked" href="https://onlinelibrary.wiley.com/doi/10.1111/bjd.21021" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>

Odds of BDD increased more than 11-fold for patients with hyperhidrosis, alopecia, and vitiligo versus healthy-skin control

Body Dysmorphic Disorder Prevalent in Patients With Skin Conditions

Six Brut and Sure aerosol antiperspirant and deodorant sprays sold in the United States and Canada have been recalled by their maker due to the presence of the chemical benzene.




 "Benzene is classified as a human carcinogen. Exposure to benzene can occur by inhalation, orally, and through the skin and it can result in cancers including leukemia and blood cancer of the bone marrow and blood disorders which can be life-threatening," stated a news release from TCP HOT Acquisition LLC dba HRB Brands. "While benzene is not an ingredient in any of the recalled products, our review showed that unexpected levels of benzene came from the propellant that sprays the product out of the can," the company said. But it added that there have been no reports of adverse events related to the recall, which is being conducted out of an "abundance of caution."




 Similar recalls have been issued for other consumer products that surprisingly contained benzene in the past six months: Pantene/Herbal Essence dry spray shampoos; Old Spice spray deodorants; and Neutrogena/Aveeno spray sunscreens.




 Five of the recalled TCP products are: Brut Classic Antiperspirant Aerosol (4 oz; UPC 00827755070085); Brut Classic Antiperspirant Aerosol (6 oz; UPC 000827755070108); Brut Classic Deodorant Aerosol (10.0 oz; UPC 00827755070047); Sure Regular Antiperspirant Aerosol (6.0 oz; UPC 00883484002025); and Sure Unscented Antiperspirant Aerosol (6.0 oz; UPC 00883484002278). A sixth recalled product was sold only in Canada: Brut Classic Deodorant Aerosol (154 g; UPC 00827755070177).




 Consumers should stop using the recalled products immediately and dispose of them appropriately, said the company, which also advised consumers to contact a health care provider if they experience any problems that may be associated with use of the recalled products. For more information or to request a refund, consumers can contact the company at 1-866-615-0976 or go to its
 <a class="rm-stats-tracked" href="https://www.brutsurerecall2022.com/en" target="_blank">
 website
 </a>
 .




 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/tcp-hot-acquisition-llc-dba-hrb-brands-issues-voluntary-nationwide-recall-sure-and-brut-aerosol" target="_blank">
 More Information
 </a>








 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>

There have been no reports of adverse events related to the recall, which is being conducted out of an 'abundance of caution'

Brut, Sure Brand Deodorants Under Recall Due to Benzene

The Ichthyosis Scoring System (ISS) is reliable for measuring global ichthyosis severity in children and adults, according to a study published online Feb. 16 in
 
 JAMA Dermatology
 
 .




 Qisi Sun, M.D., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues created and evaluated a comprehensive instrument to measure total body ichthyosis severity in adults and children. Using photographs of participants with ichthyosis, an 83-image teaching set was created. All test photographs were scored by two cohorts of dermatologists (11 dermatologists) to assess interrater and intrarater reliabilities. Creation of the ISS included participants of all ages, races, and ethnicities; raters had varying experience and areas of expertise.




 The researchers found that the intraclass correlation coefficients for total, scale, and erythema scores were greater than 0.90, greater than 0.91, and greater than 0.88, respectively, across both cohorts of 11 dermatologists. Moderate to good interrater reliabilities were exhibited by most body sites for scale and erythema. Good to excellent intrarater reliabilities were observed.




 "Scales, such as the ISS, that can reliably and accurately capture disease severity play an important role as outcomes in these studies," writes the author of an accompanying editorial. "They will enable us to differentiate what treatments provide meaningful clinical benefits for patients with ichthyoses and facilitate comparative effectiveness studies."




 Several authors disclosed financial ties to the pharmaceutical industry.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2788834" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2788837" target="_blank">
 Editorial (subscription or payment may be required)
 </a>

Moderate to good interrater reliabilities exhibited by most body sites; good to excellent intrarater reliabilities also seen

Ichthyosis Scoring System Reliable for Measuring Disease Severity

A new multimodal learning algorithm can perform multilabel classification of skin lesions, according to a study published in the February issue of
 
 Medical Image Analysis
 
 .




 Peng Tang, from the Technical University of Munich, and colleagues proposed a novel two-stage multimodal learning algorithm for multilabel classification of skin diseases. A FusionNet, which exploits and integrates the representation of clinical and dermoscopy images at the feature level, was constructed at the first stage; a Fusion Scheme 1 was used to conduct the information fusion at the decision level. To further incorporate patients' meta-data, a Fusion Scheme 2 was proposed, which integrates the multilabel predictive information from the first stage and patients' meta-data information. The final diagnosis was formed by fusion of the predictions from both stages. The algorithm was assessed on the 7-point checklist dataset for multilabel classification of skin disease.




 The researchers found that the proposed FusionM4Net first stage achieved an average accuracy of 75.7 percent for multiclassification tasks and 74.9 percent for diagnostic tasks, without using the patient's meta-data; this was more accurate than other methods. The second stage of FusionM4Net, which included patients' meta-data increased average accuracy to 77.0 percent and diagnostic accuracy to 78.5 percent.




 "Future routine clinical use of algorithms with high diagnostic accuracy might help ensure that rare diseases are also detected by less experienced physicians and it might mitigate decisions affected by stress or fatigue," a coauthor said in a statement.




 <a class="rm-stats-tracked" href="https://www.sciencedirect.com/science/article/abs/pii/S1361841521003522" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>




 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>

New algorithm uses multistage fusion process that includes clinical images, dermoscopy images, and patient meta-data

Novel Algorithm May Help Classify Skin Diseases

For moderate-to-severe plaque psoriasis, treatment with the humanized immunoglobulin G1 monoclonal antibody that specifically binds to the p19 subunit of interleukin 23, risankizumab, is superior to fumaric acid ester (FAE) treatment, according to a study published in the January issue of the
 
 British Journal of Dermatology
 
 .




 Diamant Thaçi, M.D., Ph.D., from the University of Lübeck in Germany, and colleagues compared risankizumab to FAE treatment for psoriasis in a phase III randomized trial. Participants with chronic moderate-to-severe plaque psoriasis, who were naive to and candidates for systemic therapy, were randomly assigned to subcutaneous risankizumab 150 mg at weeks 0, 4, and 16 or oral FAEs at increasing doses from 30 to 720 mg daily (60 and 60 patients, respectively).




 The researchers found that at 24 weeks, significantly more patients randomly assigned to risankizumab achieved a ≥90 percent improvement in the Psoriasis Area and Severity Index (PASI) than those randomly assigned to FAEs (83.3 and 10.0 percent, respectively). Significantly more patients randomly assigned to risankizumab achieved ≥100 percent improvement in the PASI (50.0 and 5.0 percent, respectively); ≥75 percent improvement in the PASI (98.3 and 33.3 percent, respectively); ≥50 percent improvement in the PASI (100 and 53.3 percent, respectively); and the Static Physician's Global Assessment of clear/almost clear (93.3 and 38.3 percent, respectively). The FAE group had higher rates of gastrointestinal disorders, flushing, lymphopenia, and headache.




 "These results support the superiority of risankizumab to FAEs in producing clinically meaningful improvement in the extent and severity of psoriasis over time," the authors write.




 Several authors disclosed financial ties to AbbVie, which manufactures risankizumab and funded the study.




 <a class="rm-stats-tracked" href="https://onlinelibrary.wiley.com/doi/10.1111/bjd.20481" target="_blank">
 Abstract/Full Text
 </a>
 <a class="rm-stats-tracked" href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 </a>

Significantly more patients achieved ≥90 percent improvement in PASI at week 24 with risankizumab versus FAE

How Does Risankizumab Compare to Fumaric Acid Esters for Plaque Psoriasis?

Biosimilar drugs could drive down prices for biologic drugs and generate savings of about $38.4 billion between 2021 and 2025, according to a study published online Jan. 3 in the
 
 American Journal of Managed Care
 
 .




 Andrew Mulcahy, Ph.D., from RAND Corporation in Arlington, Virginia, and colleagues projected U.S. spending on biologics during a five-year period under three scenarios: (1) a baseline scenario holding quarter 4 (Q4) of 2020 market conditions constant; (2) under main assumptions allowing for biosimilar market growth and entry; and (3) an upper-bound scenario assuming greater biosimilar uptake, more robust price competition, and quicker biosimilar entry.




 The researchers found that estimated biosimilar savings from 2021 to 2025 under their main approach were $38.4 billion, or 5.9 percent of projected spending on biologics during the same period. An estimated $26.1 billion of savings was accounted for by biologics first facing biosimilar competition from 2021 to 2025, with $12.2 billion from evolving market conditions for already-marketed biosimilars. Under the main approach, $24.6 billion of savings were from downward pressure on reference biologic prices rather than lower biosimilar prices. Under the upper-bound scenario, savings were substantially higher ($124.5 billion).




 "Biosimilars have the potential to lower spending on biologic drugs that account for a rapidly increasing share of overall U.S. prescription drug spending," Mulcahy said in a statement.




 <a class="rm-stats-tracked" href="https://www.ajmc.com/view/projected-us-savings-from-biosimilars-2021-2025" target="_blank">
 Abstract/Full Text
 </a>




 <a href="https://consumer.healthday.com/u/physiciansbriefingstaff">
 <img alt="HealthDay" src="https://assets.rbl.ms/23636171/origin.png" style="max-width: 150px;"/>
 </a>

Increased market growth of biosimilars that are similar to brand-name biologic agents has the potential to reduce spending on prescription drugs

Biosimilars Could Cut Spending for Biologic Therapy in the U.S.

For patients receiving immune checkpoint inhibitors, cutaneous immune-related adverse events (cirAEs) are associated with survival, according to a study published online Jan. 12 in
 
 JAMA Dermatology
 
 .




 Kimberly Tang, from Massachusetts General Hospital in Boston, and colleagues examined the association of developing cirAEs following treatment with anti-programmed cell death 1 or anti-programmed cell death ligand 1 therapy with patient survival in a retrospective study. Data were included for 7,008 eligible patients who developed cirAEs after treatment for malignant neoplasms of digestive organs, bronchus or lung, melanoma of skin, and the urinary tract and 7,008 matched controls.




 The researchers found that using a Benjamini-Hochberg correction with a significance level of 0.05, pruritus, drug eruption, xerosis, nonspecific rashes, and appearance of any cirAE were significantly protective of mortality (hazard ratios, 0.695, 0.755, 0.626, 0.704, and 0.778, respectively). Psoriasis and lichen planus/lichenoid dermatitis were also significant (hazard ratios, 0.703 and 0.511, respectively). Strong protective clinical effects were seen for eczematous dermatitis, vitiligo, bullous pemphigoid, and Grover disease, but they did not reach statistical significance.




 "This cohort study suggests that cirAE development is a favorable clinical indicator and warrants further investigation into its underlying immunopathogenesis, which may provide further insights into immunotherapy response," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2787886" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>

Improved survival associated with cirAEs for patients receiving anti-programmed cell death 1 or anti-programmed cell death ligand 1 therapy

Cutaneous Immune-Related AEs Linked to Survival After ICI Therapy

For patients with mild-to-severe actinic keratoses (AK) located on the extremities, trunk, and neck, nanoemulsion gel formulation containing 7.8 percent 5-aminolevulinic acid (BF-200 ALA) has superior efficacy compared with vehicle, according to a phase III study published in the December issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Martina Ulrich, M.D., from the CMB Collegium Medicum Berlin GmbH in Germany, and colleagues examined the efficacy and safety of BF-200 ALA compared to vehicle for the treatment of mild-to-severe AK located on the extremities, trunk, and neck in an intraindividual study conducted among 50 patients in six centers in Germany. Each patient received treatment with BF-200 ALA/red light photodynamic therapy (PDT) and vehicle/PDT on opposite sides, with a maximum of two PDTs.




 The researchers found that with respect to total lesion clearance rates (86.0 versus 32.9 percent) and patient complete clearance per patient's side (67.3 versus 12.2 percent), BF-200 ALA was superior to vehicle. The overall lesion recurrence rates at one year were 14.1 and 27.4 percent for BF-200 ALA and vehicle, respectively. Patient satisfaction with the cosmetic outcome was higher with BF-200 ALA/PDT than vehicle/PDT. Adverse events in association with BF-200 ALA/PDT were consistent with the known safety profile.




 "In line with our previous studies, the results demonstrated high efficacy with superiority to vehicle and confirmed good safety and tolerability and excellent cosmetic outcome," the authors write.




 Several authors disclosed financial ties to biopharmaceutical companies, including Biofrontera Bioscience GmbH, which funded the study.




 <a class="rm-stats-tracked" href="https://www.jaad.org/article/S0190-9622(21)00575-2/fulltext" target="_blank">
 Abstract/Full Text
 </a>

BF-200 ALA has high efficacy, excellent cosmetic outcome for patients with mild-to-severe actinic keratoses located on extremities, trunk, neck

Is BF-200 ALA Superior to Vehicle for Total Lesion Clearance in AK?

In CLEAR Derm consensus guidelines issued by the International Skin Imaging Collaboration Artificial Intelligence Working Group and published online Dec. 1 in
 
 JAMA Dermatology
 
 , recommendations are presented for imaging-based artificial intelligence (AI) algorithm development and assessment in dermatology.




 Roxana Daneshjou, M.D., Ph.D., from the Stanford School of Medicine in Redwood City, California, and colleagues guide developers and reviewers of dermatology AI by consolidating limited existing literature with expert opinion. Key recommendations were formulated and grouped into topics of data, technique, technical assessment, and application.




 The authors developed a checklist of items that outlined the best practices of image-based AI development and assessment. The checklist relating to data included image types, image artifacts, technical acquisition details, preprocessing procedures, synthetic images made public, adequate referencing of public images, patient-level metadata, skin tone information, potential biases, data set partitions, sample sizes, external test data, multivendor images, class distribution and balance, and images that are out of distribution. The checklist for techniques included labeling method, references to common/accepted diagnostic labels, histopathologic review for malignant neoplasms, and detailed description of the development of algorithms. Technical assessment included publicly evaluating algorithms; performance measures; benchmarking, technical comparison, and novelty; and assessment of bias. Finally, the application checklist included the use of cases and target conditions and potential impacts on the health care team and patients.




 "While we propose guidelines for clinical and peer-review evaluation of AI, these recommendations are also relevant for a regulatory framework and should be considered for any automated dermatology algorithm that may affect the wider community," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical, technology, and health care industries; one author holds several related patents.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2786912" target="_blank">
 Abstract/Full Text (subscription or payment may be required)
 </a>

Checklist for evaluation of image-based AI reports grouped into topics of data, technique, technical assessment, application

Recommendations Developed for Dermatology Artificial Intelligence

In Episode 63 of Derms and Conditions, our host, James Q. Del Rosso, DO, sits down with Adam Friedman, MD, to discuss some important topics in dermatology, including a comprehensive resource for portraying skin conditions and his research findings relating to sensitive skin.

In Episode 63 of Derms and Conditions, our host, James Q. Del Rosso, DO, sits down with Adam Friedman, MD, to discuss some important topics in dermatology, including a comprehensive resource for portraying skin conditions and his research findings relating to sensitive skin.Dr Friedman begins by describing his atlas project, created to address a gap in dermatology in the limited way textbooks and atlases portray skin conditions. The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas is a comprehensive resource that depicts dermatologic conditions across the full spectrum of skin tones to help dermatology professionals visualize the nuances in skin conditions.Next, Dr Friedman discusses his research on sensitive skin and how he puts his findings into practice with his patients. He details his global study that looked in-depth at sensitive skin and what factors trigger and exacerbate it, highlighting the importance of dermatologists having tools to assess the condition and provide management strategies. The pair also touch on guiding patients on the use of products for sensitive skin and utilizing samples.They conclude by discussing the importance of early intervention to prevent disease progression and the benefits of initiating more advanced therapies in earlier disease.Tune into this episode to hear more about what’s on Dr Adam Friedman’s mind!

Adam Friedman, MD

Derms and Conditions Podcast

What is Dr Adam Friedman Up To Now?

30 Tips in 30 Minutes

This multispeaker session is always an audience favorite; this year, the panel included medical, surgical, as well as practice management tips. Erin Boh, MD, PhD, kicked off the session with a tip on identifying cutaneous T cell lymphoma (CTCL) in clinical practice. This can be difficult because CTCL can mimic psoriasis, atopic dermatitis, and drug eruptions, but Dr Boh emphasized the importance of early recognition to increase disease-specific survival. Dr Boh also discussed the use and monitoring of methotrexate in clinical practice as well as labs for a thorough work-up of prurigo nodularis. Dr Boh concluded with tips on the work-up of pretibial myxedema, which includes thyroid function studies and biopsy, as well as the early use of biopsies in dupilumab nonresponders after 3 to 4 months of therapy to rule out CTCL.Sandra Lee, MD, discussed in-office procedural pearls, such as using a 15-blade in its wrapper for an inexpensive shave biopsy and covering cysts with a transparent film dressing prior to local anesthesia to prevent splashing. Dr Lee recommended using tumescent anesthesia for large lipoma excisions and attempting to aspirate large pilar cysts before excision as many can become liquified. Dr Lee concluded with a tip on a clinical maneuver to determine whether large lipomas are superficial or are lying underneath a muscle.The next panelist, Lawrence F. Eichenfield, MD, began with a tip on using an otoscope or flashlight to evaluate for transillumination of cysts and look for calcification in pilomatricomas. Dr Eichenfield advised documenting body surface area involvement for all moderate-to-severe inflammatory skin diseases and told the audience that one thumb size is approximately 1% of the scalp when evaluating alopecia areata. For reducing pain during procedures or injections in children, Dr Eichenfield recommended lidocaine 4% cream, listening to music, utilizing the Zimmer cooler, and a wrapping technique for immobilizing smaller children.Steven Wang, MD, continued the discussion with surgical tips for the office. Dr Wang recommended doing multiple scouting shave biopsies in a clock pattern on the periphery of large pigmented facial lesions suspected to be lentigo maligna. For nonsurgical treatment of lentigo maligna, Dr Wang gave tips on using imiquimod cream 5 times weekly for 12 weeks. Dr Wang’s next 2 tips were on the use of ferric subsulfate solution as a landmark for scalp biopsies that may need further surgical treatment and the use of heating packs to enhance aminolevulinic acid incubation prior to photodynamic therapy. Dr Wang concluded with a recommendation for weekly intralesional triamcinolone injections for keratoacanthomas on the lower extremities.G. Michael Lewitt, MD, gave the audience a few medical pearls, the first being to check a Tb spot on patients who have an indeterminate QuantiFERON Gold test. For cases of psoriasiform dermatitis with overlapping eczematous features on the hands and feet, Dr Lewitt recommended treating with a systemic JAK inhibitor for rapid improvement. When using immunosuppressive medications, Dr Lewitt reminded the audience to avoid the concomitant use of live vaccines, including the MMR, rotavirus, and varicella vaccines. To conclude, Dr Lewitt recommended sticking to a strict order when performing total body skin exams, even when patients come in with a list of things to address.David M. Pariser, MD, concluded the session with a few office efficiency and medical tips for the audience. Starting with office efficiency, Dr Pariser recommended getting a scribe for each provider and making sure they are well-trained in billing to help save time. Moving on to medical dermatology, Dr Pariser reviewed evidence for a novel targeted alkali thermolysis patch as an in-office treatment for axillary hyperhidrosis. In studies, a single 3-minute application led to reduction in excessive sweating for up to 3 months. Dr Pariser concluded with a discussion of efficacy of various field treatments for actinic keratoses and recommended occlusion of aminolevulinic acid for photodynamic therapy.&nbsp;

What’s New in SKIN

To round out the morning review of dermatology literature, Roger I. Ceilley, MD, delighted the audience with a look back at the past year for SKIN: The Journal of Cutaneous Medicine. SKIN is a peer-reviewed, open-access, online-only journal dedicated to providing free access globally to dermatologic knowledge. Readership of SKIN continues to grow, with over 68,000 reads in May 2023. Dr Ceilley highlighted important sections of SKIN, including a new Medical Educational in Dermatology section and the ever-popular SKINmages section. High-impact articles from 2023 included an expert consensus panel report on the use of gene expression profiling in melanoma management. The panel concluded that adding gene expression profiling results to AJCC classification improves prognostic assessment of patients with cutaneous melanoma. Dr Ceilley concluded with a look at the most-read articles of 2023, which included a review of makeup ingredients and their effects on acne cosmetica, a short communication about solutions for the lidocaine shortage, and an original research article on the use of ampicillin in acne vulgaris.

FC23 Welcome Reception

Join Nick Brownstone, MD, and Jennifer Bares, MD, as they interview our attendees from the Welcome Reception!

Dermatology Condition Center

Featured in Dermatology

30 Tips in 30 Minutes

Latest Dermatology Videos

What’s New in SKIN

FC23 Welcome Reception

Dermatology Episodes to Explore

What is Dr Adam Friedman Up To Now?

Dermatology News & Research

Educational Courses You Might Like on Dermatology

Difficult Dermatology Conversations: Improving Care for Diverse Patient Populations

2023 Virtual Grand Rounds Session 14: November 15, 2023 - Fall Clinical 2023- Your Questions Answered

2023 Virtual Grand Rounds Session 13: September 27, 2023 - Challenging Cases in Dermatology