Subject(s)
Chilblains , Lupus Erythematosus, Discoid , Sarcoidosis , Chilblains/diagnosis , Chilblains/etiology , HumansABSTRACT
Vulvar aphthous ulcer, also known as acute genital ulceration or Lipschutz ulcers, is an uncommon, non-sexually acquired condition characterized by sudden onset ulcerations of the vulva in young girls and women. It is thought to represent an immunologic reaction to an infection or other source of inflammation and is commonly preceded by prodromal symptoms including fever, chills, fatigue, and malaise. During the COVID-19 pandemic, vulvar aphthous ulcer associated with COVID-19 infection has been reported. Here, we report a case of vulvar aphthous ulcer in response to COVID-19 vaccination.
Subject(s)
COVID-19 , Stomatitis, Aphthous , Vulvar Diseases , COVID-19 Vaccines , Female , Humans , Pandemics , SARS-CoV-2 , Stomatitis, Aphthous/etiology , Ulcer , Vaccination/adverse effects , Vulvar Diseases/etiologyABSTRACT
BACKGROUND: Dermatology experiences a disproportionately high burden of prior authorizations (PAs). OBJECTIVE: To examine the effect of a centralized pharmacy intervention on the PA process and the impact of PAs on patient outcomes. METHODS: A retrospective review of PAs submitted for medications before and after implementation of pharmacy intervention was conducted. RESULTS: PA was required for 8.1% of all prescriptions. PAs were most frequently submitted for topical steroids, topical antibiotics and antifungals, and topical retinoids. Most common indications included acne, psoriasis, and dermatitis. Biologic agents (55.2%) and brand-name only medications (42.8%) required PA at higher rates. Pharmacy intervention resulted in shorter time to PA submission (4 days vs 1 day, P < .001) and decision (6 days vs 1 day, P < .001) and higher approval rates (63.9% vs 80.6%, P < .001) but did not decrease the total number of PAs. Patients with approved PAs had higher likelihood of disease improvement vs those with denied PAs (71.1% vs 58.0%, P = .013). LIMITATIONS: Data were collected from a single academic institution. Patient medication compliance was not assessed. CONCLUSIONS: The current PA process may result in delays in care and a negative impact on patients. A centralized pharmacy intervention is an effective measure but does not eliminate the overall burden of PAs.
