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Featured Articles

Diagnosis and Management of Primary Hyperhidrosis: Practical Guidance and Current Therapy Update

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Skin of Color Update

Featured Article

With the busy practitioner and dermatology resident in mind, we provide here a disease state primer for hyperhidrosis, a top-line review of the breadth of literature underscoring the overall burden of the disease, a practical guide to differential diagnosis, and an update on current treatment approaches, including for the most common form of the condition, primary axillary hyperhidrosis.

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A case study on the importance of early and effective management strategies for those suffering with hyperhidrosis.

Joe Gorelick MSN FNP-C, Adam Friedman MD

In the most simplistic definition, hyperhidrosis is excessive sweating. However, it is largely misunderstood, often goes undiagnosed, and continues to be inadequately managed for many patients. Approximately half of those who self-identify as having excessive sweating do not discuss their symptoms with healthcare professionals despite the severe negative impact on their quality of life; reasons for this include the misconception that hyperhidrosis is not a medical condition and that no treatments exist.

In one study, only half of patients who reported their symptoms to a healthcare professional were ultimately diagnosed with primary hyperhidrosis, which may reflect a reality of widespread underdiagnosis of the condition.1 In a survey conducted by the International Hyperhidrosis Society (IHhS), 48.9% of patients waited 10 or more years before seeking medical help for their excessive sweating.2

With the busy practitioner and dermatology resident in mind, here we provide a disease state primer for hyperhidrosis, a top-line review of the breadth of literature underscoring the overall burden of the disease, a practical guide to differential diagnosis, and an update on current treatment approaches.3, 4 In addition, a case study in primary axillary (underarm) hyperhidrosis is presented to provide a real-life perspective from the clinic on the importance of early and effective management strategies for those suffering with hyperhidrosis.

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Colloidal Oatmeal Part I: Clinical Efficacy in the Treatment of Atopic Dermatitis

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Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various…

Oral Collagen Supplementation: A Systematic Review of Dermatological Applications

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Nutrition is thought to play an important role in skin homeostasis. The use of nutraceuticals or “functional foods” in skincare along with technological innovations within the food industry has been…

Revisiting Handwashing – As It Is Absolutely Essential

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As the coronavirus pandemic continues into the second half of 2020, states across the US remain steadfast in their search to determine the safest methods of returning to normalcy. Without…

Once-Daily Polymeric Tazarotene 0.045% Lotion for Moderate-to-Severe Acne: Pooled Phase 3 Analysis by Sex

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Skin of Color Update

Featured Article

Acne is a common dermatologic condition, affecting up to 85% of adolescents and young adults.1 The prevalence of adult acne appears to be increasing in both females and males; however, there are differences in treatment needs and physiology between the sexes that should be taken into account when prescribing acne treatments.

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Data from these studies were pooled and analyzed post hoc to evaluate outcomes by sex

Leon H. Kircik MD, Linda Stein Gold MD, Kenneth Beer MD, Jerry Tan MD, Hilary Baldwin MD, Eric Guenin PharmD PHD MPH, Robert Kang MS, Jognson Varughesei

Acne is a common dermatologic condition, affecting up to 85% of adolescents and young adults.1 The prevalence of adult acne appears to be increasing in both females and males; however, there are differences in treatment needs and physiology between the sexes that should be taken into account when prescribing acne treatments. While most patients experience onset during adolescence, persistent adult acne is more common in female patients.

Additionally, females are more likely to experience recurrences of acne throughout their lives, requiring long-term maintenance treatment.3,4 In terms of skin physiology, males tend to have less epidermal water loss, higher sebum production, and a lower pH than females.5 In females, sebum production is not only lower, it also decreases with age leading to drier skin later in life.5 Along these lines, females are more likely to report dry, sensitive skin,4 which may become more apparent with age.6 These differences between female and male patients with acne could affect treatment efficacy, tolerability, or adherence.

Topical retinoids are the mainstay of acne treatment due to their comedolytic and anti-inflammatory properties.7 Several retinoids are commercially available (eg, tretinoin, adapalene, trifarotene, and tazarotene)1,8 but studies have shown that tazarotene 0.1% cream may be more effective than tretinoin 0.025% or adapalene 0.1% or 0.3% in treating acne.9-11 While the efficacy and safety of topical retinoids are well established,12,13 adverse effects such as irritation, erythema, peeling, and dryness can occur in the first weeks of treatment, especially at higher concentrations.7,12 To address these issues, a new tazarotene 0.045% lotion formulation was developed utilizing polymeric emulsion technology.14 An oil-in-water emulsion—structured by a three-dimensional mesh matrix containing tazarotene along with hydrating and moisturizing agents—allows for more uniform release and increased absorption of ingredients. This easily spreadable and easy-to-use lotion formulation also allows for a lower tazarotene concentration, and when combined with optimized delivery of active and hydrating ingredients, may improve tolerability.14

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Colloidal Oatmeal Part I: Clinical Efficacy in the Treatment of Atopic Dermatitis

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Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various…

Oral Collagen Supplementation: A Systematic Review of Dermatological Applications

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Nutrition is thought to play an important role in skin homeostasis. The use of nutraceuticals or “functional foods” in skincare along with technological innovations within the food industry has been…

Revisiting Handwashing – As It Is Absolutely Essential

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As the coronavirus pandemic continues into the second half of 2020, states across the US remain steadfast in their search to determine the safest methods of returning to normalcy. Without…

Culturally Competent Care for LGBT Patients in Dermatology Clinics

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Skin of Color Update

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We developed an anonymous, online survey to investigate dermatology practice characteristics relevant to LGBT patients.

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Culturally Competent Care for LGBT Patients in Dermatology Clinics

Alexander M. Cartron BS, Sorana Raiciulescu MS, John C. Trinidad MD MPH

Lesbian, gay, bisexual, and transgender (LGBT) patients face unique health disparities.1 Routine collection of sexual orientation and gender identity (SOGI) data can optimize patient-provider interactions.2 Gender-neutral bathrooms promote inclusivity for LGBT patients.3 There is limited data on the extent to which dermatology practices make use of such features to deliver culturally competent care to LGBT patients.

We developed an anonymous, online survey to investigate dermatology practice characteristics relevant to LGBT patients. IRB approval was obtained prior to distributing the survey via a listserv of board-certified dermatologists available on the American Academy of Dermatology’s website. Bivariate associations were explored using Monte Carlo estimation for the Fisher’s exact test and chi-square. Multivariable logistic regression was performed to evaluate the associations between provider demographic, practice variables, and likelihood of routine patient intake form use.

891 board-certified dermatologists received the survey link. 81 dermatologists completed the survey. Of providers surveyed, most were female (63%), heterosexual (80%), practiced in urban environments (53%), and in private practice settings (64%) (Table 1). Most practices reported seeing less than 5 transgender patients annually (54%), though 21% of practices reported seeing more than 10 transgender patients annually. 79% of practices surveyed reported making using of gender-neutral bathrooms. Of 71 respondents with knowledge of their intake forms, 15 (21%) reported routine collection of patient sexual orientation and 14 (20%) reported their forms asked about patients’ preferred gender pronouns, in addition to gender identity. Intake form administration did not vary significantly by provider sexual orientation (P=0.43) or practice setting (P=0.10). Of 13 dermatologists not using intake forms, 7/13 (54%) cited administrative burden, 2/13 (15%) reported intake forms were not in the scope of their practice, and 1/13 (7%) cited a lack of data for patient benefit.

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Colloidal Oatmeal Part I: Clinical Efficacy in the Treatment of Atopic Dermatitis

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Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various…

Oral Collagen Supplementation: A Systematic Review of Dermatological Applications

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Nutrition is thought to play an important role in skin homeostasis. The use of nutraceuticals or “functional foods” in skincare along with technological innovations within the food industry has been…

Revisiting Handwashing – As It Is Absolutely Essential

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As the coronavirus pandemic continues into the second half of 2020, states across the US remain steadfast in their search to determine the safest methods of returning to normalcy. Without…

Developing a Topical Adjunct to Injectable Procedures

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Dermatology News

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“In vivo testing of bruising resolution demonstrated that at day 2/3, participants using the study product (INhance Post-Injection Serum with TriHex Technology®, Alastin Skincare, Inc. Carlsbad, CA) had 73% less bruise color intensity and statistically significant improvement over the bland moisturizer. “

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Developing a Topical Adjunct to Injectable Procedures

New JDD study reveals 81% of subjects applying a topical product had less bruising at day 2/3 compared to the bland moisturizer.

Injectable procedures have come to play an enormous part in everyday  aesthetic medical practice. Whether its use is directed at volumizing with fillers, decreasing volume using enzymes, skin-tightening using multi-needle approaches, or neuromuscular blockade, the injectable route is the means of delivery in all these cases, making injectable procedures the most common aesthetic procedure performed.

As with all procedures, expected and unexpected consequences may follow including bruising, swelling, discomfort, and the possibility of infection. This paper outlines the scientific process and validation of a product designed as an adjunct to injection therapy and the scientific deep dive needed to encompass both symptomatic and adjunctive purposes. On the symptomatic side, bruising, swelling, and pain were considered, while volumetric enhancement, regeneration, and anti-microbial/biofilm effects were desired outcomes from the adjunctive perspective.

Utilizing peptides and active agents aimed at reducing excess residual iron and stimulating macrophage absorption of red blood cells, we were able to achieve efficient resolution of bruising. In addition, peptides were included to stimulate collagen, elastin, and hyaluronic acid in synergy with the injectable. Anti-inflammatory, antimicrobial, and antibiofilm agents were added to aid in the safety profile of the injectable.

In vivo testing of bruising resolution demonstrated that at day 2/3, participants using the study product (INhance Post-Injection Serum with TriHex Technology®, Alastin Skincare, Inc. Carlsbad, CA) had 73% less bruise color intensity and statistically significant improvement over the bland moisturizer. Overall, 81% of subjects applying the study topical product had less bruising at day 2/3 compared to the bland moisturizer.

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JDD Article Referenced in this Post

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Colloidal Oatmeal Part I: Clinical Efficacy in the Treatment of Atopic Dermatitis

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Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various…

Oral Collagen Supplementation: A Systematic Review of Dermatological Applications

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Nutrition is thought to play an important role in skin homeostasis. The use of nutraceuticals or “functional foods” in skincare along with technological innovations within the food industry has been…

Revisiting Handwashing – As It Is Absolutely Essential

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As the coronavirus pandemic continues into the second half of 2020, states across the US remain steadfast in their search to determine the safest methods of returning to normalcy. Without…

How to Get Rid of Dry Skin

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Dermatology News

Featured Article

Colloidal oat extracts exhibit anti-inflammatory activities, which may provide the mechanisms for observed dermatological benefits when using the colloidal oatmeal in skin protectant lotion.

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"How to Get Rid of Dry Skin"

Dry skin is a common complaint, with many dermatology patients seeking treatments for itching, irritation, and tightness. Severe dry skin can lead to cracked skin and bleeding.
While there are many topical agents to combat dry skin, including scent-free lotions, emollients, and creams, one tried-and-true remedy is making a comeback.

Insider.com‘s recent feature, “How to Get Rid of Dry Skin,” cites JDD research on oatmeal’s efficacy in combating dry, irritated skin ( “Anti-inflammatory Activities of Colloidal Oatmeal (Avena Sativa) Contribute to the Effectiveness of Oats in Treatment of Itch Associated With Dry, Irritated Skin” )

A 2015 study published in the Journal of Drugs in Dermatology showed that colloidal oatmeal (which is essentially oats that have been finely ground down) is effective at reducing skin dryness, roughness, and itchiness. This is because oatmeal helps repair the skin barrier, is anti inflammatory, and has antioxidant properties […].

Moreover, colloidal oat extracts exhibit anti-inflammatory activities, which may provide the mechanisms for observed dermatological benefits when using the colloidal oatmeal in skin protectant lotion.

Topical Applications of Oatmeal

Discover more research on oatmeal’s anti-inflammatory, anti-oxidant properties and applications in a variety of skin conditions.

JDD Article Referenced in this Post

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Colloidal Oatmeal Part I: Clinical Efficacy in the Treatment of Atopic Dermatitis

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Colloidal oatmeal has a long-standing history in the treatment of dermatologic disease. It is composed of various phytochemicals, which contribute to its wide-ranging function and clinical use. It has various…

Oral Collagen Supplementation: A Systematic Review of Dermatological Applications

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Treating the AD Patient During COVID-19

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iTunes Google Play Stitcher TuneIn Dr. Peter Lio and Dr. Adam Friedman   Atopic dermatitis is a relentless, recurring, unreasonable, often recalcitrant inflammatory skin disease that impacts millions of children…

Phototherapy for Psoriasis: A Safe and Effective Treatment Modality

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Dermatology News

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“Fewer people are doing mainstay full-body phototherapy as in the past, as biologics and other systemic therapies have proven to be safe and much more effective,” Dr. Nestor said in a recent interview with Dermatology Times.

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Phototherapy for Psoriasis: A Safe and Effective Treatment Modality

A study recently published in the JDD reveals phototherapy remains a safe and effective treatment modality for mild to moderate psoriasis vulgaris

Phototherapy remains a safe and effective treatment modality for mild to moderate psoriasis, according to Mark S. Nestor, M.D., Ph.D., in a study recently published in the Journal of Drugs in Dermatology.
Current options for treating psoriasis include systemic and topical agents: systemic treatment options may involve immune inhibitors, and/or immune modulators. For moderate to severe cases, biologic agents may be used.
Topical agents may be comprised of ointments, medicated baths, and phototherapy.

“Fewer people are doing mainstay full-body phototherapy as in the past, as biologics and other systemic therapies have proven to be safe and much more effective,” Dr. Nestor said in a recent interview with Dermatology Times.

“Additionally,” he added, “laser has largely taken over for individual and spot treatment of specific areas because you don’t have the same issue of systemic problems with burning.”

In the study, “Randomized, Investigator-Blinded Study to Compare the Efficacy and Tolerance of a 650-microsecond, 1064-nm YAG Laser to a 308-nm Excimer Laser for the Treatment of Mild to Moderate Psoriasis Vulgaris,” co-authored by Dr. Nestor, Daniel Fischer DO MS,a and David Arnold DOa eligible subjects enrolled in a randomized, investigator-blinded study.

Psoriatic plaques on one side of the body were treated with the 650-microsecond laser and plaques on the other side were treated with the 308-nm excimer laser. Study subjects received up to 15 treatments, twice weekly, or fewer if full clearance was achieved. Efficacy and tolerance were evaluated by the mPASI scores and local skin reactions, respectively.

Both devices showed efficacy in treating psoriatic plaques. Differences between the two devices were not significant for redness, thickness, scaliness, mPASI scores for arms and legs, and overall mPASI scores for the treated psoriatic plaques on each side of the body. The investigator-assessed scores for erosion/ulceration, vesicles, erythema, scaling, edema, and atrophy were low and identical for both sides of the body.

“There is potential for utilizing this therapy much more in the future, especially in areas such as the palms and soles, where excimer appears to be less effective,” Dr. Nestor said.

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November 16, 2020

Colloidal Oatmeal Part I: Clinical Efficacy in the Treatment of Atopic Dermatitis

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GW Survey Evaluates Influence of Social Media in Attracting Patients

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Dermatology News

Featured Article

“A rapidly growing number of dermatologists are advocating for the value of social media to promote their practices,” said Adam Friedman, MD, interim chair of the Department of Dermatology at the GW School of Medicine and Health Sciences and senior author on the study. “Only one other survey has been conducted on patient perception of social media. There hasn’t been enough to show us how effective social media is as a marketing tool for dermatologists.”

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GW Survey Evaluates Influence of Social Media in Attracting Patients

A survey from the George Washington University evaluated whether patients consider a dermatologist’s social media presence when looking for a doctor

WASHINGTON (May 7, 2020) – Patients often do not take social media into consideration when looking for a dermatologist, according to a survey from researchers at the George Washington University. The survey was published recently in the Journal of Drugs in Dermatology.

As of 2019, 79% of Americans have a social media presence on platforms such as Facebook, Twitter, and Instagram. Many dermatologists consider social media to be a useful tool for building their practices and recruiting patients. However, limited data exists about whether a provider’s social media presence is a driver in attracting new patients to their practice.

“A rapidly growing number of dermatologists are advocating for the value of social media to promote their practices,” said Adam Friedman, MD, interim chair of the Department of Dermatology at the GW School of Medicine and Health Sciences and senior author on the study. “Only one other survey has been conducted on patient perception of social media. There hasn’t been enough to show us how effective social media is as a marketing tool for dermatologists.”

The GW research team distributed a 10-question online survey to a diverse patient population to evaluate their perceptions of social media and what aspects of a dermatologist’s site are the most helpful. Only 25% of respondents aged 18–30 years old thought social media was extremely or very important, suggesting that leaning on social media may not be the best way to grow a practice.

The results also indicated that respondents who did utilize social media for these purposes were interested in seeing patient education, viewing patient reviews, as well as dermatologists’ experience levels rather than personal information.

“While patients overall may not rely on social media to select a dermatologist nor be interested in nonmedical content, many of our respondents did express interest in educational content written by their dermatologists on social media,” Friedman said. “Practitioners should still count social media as a tool in building their practices and engaging their current patients, however, it should be one of many methods that they rely on to recruit new patients.”

The authors say that further research needs to be done to determine whether social media is an effective educational tool for dermatologists.

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November 16, 2020

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The Influence of Dermatologists’ Use of Social Media on Attracting Patients

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JDD Multimedia

Featured Article

Emily C. Murphy BS, Kamaria Nelson MD, and Adam J. Friedman MD

In a new article, published in the May 2020 issue of the JDD,  “The Influence of Dermatologists’ Use of Social Media on Attracting Patients,” authors Emily C. Murphy BS,a,b Kamaria Nelson MD,a and Adam J. Friedman MDa examine how social media influences patients when choosing a dermatologist and the aspects of dermatologists’ sites that offer the most benefits to patients.

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"The Influence of Dermatologists’ Use of Social Media on Attracting Patients"

As of 2019, 79% of Americans have a social media profile, with the majority using platforms such as Facebook, Twitter, YouTube, and Instagram.1 Social media was originally created to connect with family and friends, but individuals now use it to self-promote, to disseminate information, and for activism.

Physicians are even more likely to use social media than the general population, with 87% having an account in 2011.2 In the medical community, social media allows for the distribution of health information and may increase healthcare access by connecting patients and physicians.3,4 Despite these benefits, there is also concern among practitioners about the misuse of social media given its lack of regulation, which may lead to inappropriate online consultations, spread of false information, and HIPAA violations.3

In a new article, published in the May 2020 issue of the JDD,  “The Influence of Dermatologists’ Use of Social Media on Attracting Patients,” authors Emily C. Murphy BS,a,b Kamaria Nelson MD,a and Adam J. Friedman MDa examine how social media influences patients when choosing a dermatologist and the aspects of dermatologists’ sites that offer the most benefits to patients.

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November 16, 2020

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Is the Coronavirus (COVID-19) Pandemic an Indication to Temporarily Modify Dermatological Management Plans?

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Dermatology News

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Dermatologist looking at skin

"Is the Coronavirus (COVID-19) Pandemic an Indication to Temporarily Modify Dermatological Management Plans?"

While the world lives under the shadow of the novel coronavirus (COVID-19) pandemic, dermatologists wonder if the current situation calls for a temporary change in the management of skin conditions.

Immunosuppressive drugs are used ubiquitously in the modern treatment of inflammatory and autoimmune skin diseases like psoriasis, bullous diseases, connective tissue diseases, and many others. Treatment of these conditions is based on the suppression of the patient’s immune system using steroids, steroid-sparing drugs, and biological agents.1
“The use of immunosuppressive to treat these conditions can amplify this effect, and it might leave the patient vulnerable to more serious complications should an infection with the novel coronavirus be established. Hence, it may be wise to restrict temporarily the use of immunosuppressive agents including systemic steroids, steroid-sparing agents, and biologics in dermatology daily practice until more evidence is avilable about their safety in the current pandemic.6 As a relates point, the International Psoriasis Council declared an urgent statement on March 11, 2020 that the physician should be alert to the potentially harmful effects of COVID-19 infection on patients with psoriasis and to immediately discontinue or postpone immunosuppressant medications for psoriasis patients diagnosed with COVID-19 disease.”

As the declaration of the novel coronavirus as a pandemic by the WHO is a trending topic nowadays, dermatologists around the world view with concern the impact of this pandemic on their daily practice.

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Universal Protocol in Mohs Micrographic Surgery: Incorporating a “Time Out” Procedure in Histopathologic Interpretation

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In 1999, the Institute of Medicine’s (IOM) first report, “To Err Is Human”, brought forth the issue of medical error in patient care.1 In this publication, the IOM recognized that mistakes or failures to prevent mistakes were mostly caused by flawed systems, processes, and conditions. It outlined a four-tiered approach to improve safety including: 1) development of leadership, research, tools, and protocols to enhance the knowledge base on safety, 2) a nationwide public mandatory reporting system and encouraging voluntary participation to identify and learn from errors, 3) oversight organizations, professional groups, health care purchasers to raise performance standards and expectations, and 4) implementation of safety systems in the healthcare organization to ensure delivery of safe practice. This was the first roadmap towards a safer health system.

The Joint Commission adopted a formal Sentinel Event Policy to assist office-based surgery practices to improve safety and learn from serious adverse events when they occur. To reduce errors, the Joint Commission implemented the use of Universal Protocol to prevent wrong-site, wrong-person, or wrong-procedure surgery.2 In dermatology, the addition of preoperative biopsy-site photography has been helpful in site identification. In a survey study of 722 Mohs surgeons, 89% reported photographs as the most useful tool to decrease risk of wrong-site surgery.3

Surgical specialties have incorporated Universal Protocol, consisting of a verification process, surgical site marking, and time out immediately prior to procedure. The time out is designed to ensure correct patient identity, correct scheduled procedure, and correct surgical site. The pre-procedure verification process and surgical site marking include the patient, nursing staff, and Mohs surgeon by confirming patient’s name and date of birth, reviewing pathology report and photographs if available, and involving the patient in site identification. We believe a time out process during interpretation of Mohs histopathology sections would minimize mapping errors that could lead to persistence or recurrence of cancer, as well as over-resection of tissue.

Often times several patients’ slides are prepared simultaneously to maximize efficiency. As a result, several sets of slides are completed at the same time for the surgeon to read. The combination of multiple patients with possibly more than one slide each further compounds the risk for error. The time out procedure should involve at least two people: Mohs surgeon, fellow, resident, histology technician, or nurse. The verbal confirmation should include patient’s name, diagnosis, stage, and section number (Table 1). The time out process should occur prior to slide being placed on the microscope and agreed upon by Mohs surgeon and second participant. The procedure must be performed before reading each slide in order to facilitate accurate map marking.

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June 16, 2020

A Must-Read: The Business of Dermatology

Edited by Drs. Jeffrey S. Dover and Kavita Mariwalla, and authored by impressive experts in the field, The Business of Dermatology offers a comprehensive guide to opening, maintaining, and sustaining…
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June 1, 2020

Controversies in Photoprotection

Adam Friedman, MD, FAAD is Professor and Interim Chair of Dermatology and serves as Residency Program Director, Director of Translational Research, and Director of the Supportive OncodermatologyProgram in the Department…
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May 18, 2020

Does This Skin Cancer Really Need Mohs?

The discussion was led by Dr. Vishal Patel and Dr. Sailesh Konda, and was moderated by Dr. William Hanke. In recognition of National Skin Cancer Month, the Journal of Drugs…