Assessing the Impact of Prior Authorizations on Dermatology Residents.

INTRODUCTION: Prior authorizations (PAs) are administrative tasks commonly required by insurers to approve medications or therapies for patients. Dermatology practices frequently employ coordinators to focus on completing PAs, among other solutions. The degree to which this support is offered in academic centers and, importantly, how much time dermatology residents spend on PAs over educational pursuits is largely unknown. The authors sought to identify the impact of PAs on dermatology residents. METHODS: An IRB-approved (#NCR213814) 13-question survey was distributed nationwide to dermatology residents regarding the impact of PAs on aspects of clinical and scholarly activities.  Results: 150 of 1462 dermatology residents, 10.3%, responded to the survey. 70% of responding residents contribute to obtaining PAs. 58.7% indicated that their program employed a PA coordinator; though, of these, 63.6% still relied on residents for PAs. 84% indicated that for the following month they feared the burden of PAs would lead to a lapse in treatment for patients. 72.7% avoided prescribing certain medications due to PAs. 64% indicated the PA burden impedes their ability to perform scholarly activities. 80.7% indicated the PA burden contributed to burnout or decreased morale. CONCLUSION: Our data highlight that dermatology residents are negatively impacted by the burden of PAs, resulting in reduced time to study, research, and best care for their patients. Dermatology residents and patients would benefit from reducing the burden of PAs, especially on residents by reforms or regulations that reduce dermatologic PAs, or by academic institutions removing these responsibilities from residents as best as possible. Drugs Dermatol. 2024;23(6):485-488.    doi:10.36849/JDD.7617.

The Representation of Skin Tones in Google Images of Skin Cancers.

Skin self-examinations play a vital role in skin cancer detection and are often aided by online resources. Available reference photos must display the full spectrum of skin tones so patients may visualize how skin lesions can appear. This study investigated the portrayal of skin tones in skin cancer-related Google Images, discovering a significant underrepresentation of darker skin tones. J Drugs Dermatol. 2024;23(5):e132-e133.     doi:10.36849/JDD.7886e.

Skin Tone Representation on Patient-Facing Skin Cancer Education Websites.

When patients self-detect suspicious skin lesions, they often reference online photos prior to seeking medical evaluation. Online images must be available in the full spectrum of skin tones to provide accurate visualizations of disease, especially given the increased morbidity and mortality from skin cancer in patients with darker skin tones. The purpose of this study was to evaluate the representation of skin tones in photos of skin cancer on patient-facing websites. Six federally-based and organization websites were evaluated, and of the 372 total representations identified only 49 depicted darker skin tones (13.2%). This highlights the need to improve skin tone representation on patient-facing online resources. J Drugs Dermatol. 2024;23(5):e137-e138.     doi:10.36849/JDD.7905e.

Sensitive Skin: A Survey of Dermatology Resident Physicians' Perspectives and Educational Exposures.

Sensitive skin (SS) is a common patient complaint presenting to the dermatology office, but there exists a lack of consensus on defining criteria and evidence-based management approaches. Furthermore, incorporation of SS training into the dermatology residency curriculum is unknown, and therefore the authors herein sought to determine dermatology resident physicians' exposure to education about SS, perspectives on SS, and management approaches. Ninety-nine percent of residents believe that SS should be included in some capacity in their dermatology residency training. However, less than half of responding residents received education specifically about SS during their training and less than one-fourth of residents reported feeling very knowledgeable about SS diagnosis, clinical evaluation, or management. Residents who had received specific education about SS were significantly more likely to self-describe as "very knowledgeable" about all queried topics. Residents reported challenges with all aspects of SS patient care, and cited heterogenous approaches to SS patients. These data highlight a gap in residency education, as indicated by limited consensus over diagnostic and management approaches to SS.J Drugs Dermatol. 2024;23(2):85-89.   doi:10.36849/JDD.7830.

Evaluation of a Moisturizing Cream with 20% Urea for Keratosis Pilaris.

BACKGROUND: Keratosis pilaris (KP) is a benign dermatosis consisting of folliculocentric keratotic papules or pustules with surrounding erythema, often on proximal extensor surfaces of extremities. Management strategies for KP largely center on moisturization and exfoliation. Urea, a well-established ingredient in topical skincare, is a component of the natural moisturizing factors with concentration-dependent humectant, emollient, and exfoliative properties.  Given the overlap of urea’s properties and management goals of KP, a 4-week, open-label, noncomparative clinical study was conducted to evaluate a moisturizing cream formulated with 20% urea for use in KP.  Thirty participants aged 18 to 65 years with KP completed this study. After a 5-day washout period, study participants applied a 20% urea cream once daily to areas of KP for 4 weeks. At baseline, 1-week, and 4-week visits, clinical grading of skin texture, adverse event monitoring, and participant satisfaction questionnaires were conducted. After 1 week and 4 weeks of product use, the percent change in skin smoothness/texture from baseline was significant (P≤0.001). Furthermore, after 4 weeks of use, the majority of participants indicated satisfaction with the feel of their skin, as well as improved confidence and decreased embarrassment related to their skin. No significant adverse events were reported. Overall, the results of this study support that 20% urea cream is generally well tolerated and suitable for use in treating KP. J Drugs Dermatol. 2024;23(1):1274-1277.     doi:10.36849/JDD.7806.

Participant Satisfaction of a Community-based Telehealth Clinic for Atopic Dermatitis.

Atopic dermatitis (AD), a chronic, relapsing inflammatory disease that affects more than 30 million children and adults in the US, disproportionally impacts African American (AA) and Hispanic children, with a higher prevalence of severe AD in these populations than in white children.1,2 Visits to urgent care, emergency departments, and hospitalizations for AD in the United States were more common among AA and Hispanic adults, and those with lower socioeconomic status.1,3 In Washington DC, outcomes and access to care among the District's poor and underrepresented minorities lag far behind other groups. Ward 8, for example, which is 89% Black, has the District's highest per capita rate of coronavirus-related deaths - 6 for every 10,000 residents.4 These disparities have been long-lived and pervasive in all areas of medicine, including dermatology.5.

Insight Into Dermatology Providers' Perspectives on Approaches to Sensitive Skin: A Pilot Survey.

Sensitive skin (SS) is a common patient complaint; however, there are no consistent guidelines to guide dermatologists' approaches to diagnosis and management of SS. Attendees of an international dermatology conference were surveyed to gauge dermatology providers' experiences and perspectives on SS. Survey results suggest that although the definition and diagnosis of SS are ambiguous, SS is increasingly being considered as a unique condition. Patients are commonly seeking dermatologic care for SS; however, dermatologists identified challenges with diagnosis, counseling patients, selecting products or medications, and assessing clinical improvement. These data highlight both a significant demand and a current need for improved provider resources for SS. Citation: McCormick ET, Desai S, Friedman A. Insight into dermatology providers’ perspectives on/and approaches to sensitive skin: a pilot survey. J Drugs Dermatol. 2023;22(9):950-951. doi:10.36849/JDD.7450.

Fractional Laser for Prevention of Non-melanoma Skin Cancer.

CITATION: McCormick ET, Desai S, Nelson K, et al. Fractional laser for prevention of non-melanoma skin cancer. J Drugs Dermatol. 2023;22(9):953-954. doi:10.36849/JDD.NVRN0923.

Nano-encapsulated anandamide reduces inflammatory cytokines in vitro and lesion severity in a murine model of cutaneous lupus erythematosus.

Cutaneous lupus erythematosus (CLE) is a heterogeneous autoimmune skin disease which occurs independently and in conjunction with systemic lupus erythematosus. Drug development for CLE is severely lacking. Anandamide (AEA) is a primary endocannabinoid which exhibits immunomodulatory effects through mixed cannabinoid receptor agonism. We evaluated AEA as topical treatment for CLE and assessed benefits of nanoparticle encapsulation (AEA-NP) on cutaneous drug penetration, delivery and biological activity. Compared to untreated controls, AEA-NP decreased IL-6 and MCP-1 in UVB-stimulated keratinocytes (p < 0.05) in vitro. In BALB/c mice, AEA-NP displayed improved cutaneous penetration, extended release and persistence of AEA in the follicular unit extending to the base after 24 h. Utilizing the MRL-lpr lupus murine model, twice weekly treatment of lesions with topical AEA-NP for 10 weeks led to decreased clinical and histologic lesion scores compared to unencapsulated AEA and untreated controls (p < 0.05). Prophylactic application of AEA-NP to commonly involved areas on MRL-lpr mice similarly resulted in decreased clinical and histologic scores when compared to controls (p < 0.05), and reduced C3 and IBA-1 in lesional tissue (p < 0.05). The demonstrated clinical and immunomodulatory effects of treatment with AEA support its potential as therapy for CLE. This work also suggests that encapsulation of AEA improves penetration and treatment efficacy. Future studies will be conducted to assess full therapeutic potential.

EXTRA, EXTRA, Treatment Approaches for EXTRAmammary Paget Disease.

Desai S, McCormick E, Nelson K, et al. EXTRA, EXTRA, treatment approaches for EXTRAmammary Paget disease. J Drugs Dermatol. 2023;22(8):844-845. doi:10.36849/jdd.NVRN0823.

Shining a Light on Vitiligo and Associated Comorbidities: What Is the Evidence?

CITATION: Desai S, McCormick E, Sodha P, et al. Shining a light on the vitiligo and associated comorbidities: What is the evidence? J Drugs Dermatol. 2023;22(4):428-430. doi:10.36849/JDD.NVRN0423.

An Up-to-Date Approach to the Management of Seborrheic Dermatitis.

Seborrheic dermatitis (SD) is a chronic, relapsing, inflammatory dermatosis with ambiguous pathophysiology of overcolonization of Malassezia combined with predisposing factors including sebocyte activity, impaired immunity with diminished T-cell responses and activation of complements, disruption of epidermal barrier integrity and skin microbiota, and environmental influences.