April 10

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IN THIS ISSUE / April 10, 2019


‘Inactive’ ingredients in pills may cause allergic reaction 
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A new study published online in Science Translational Medicine suggests that more than 90% of medications that Americans take contain an inactive ingredient that could cause an allergic reaction, like hives, difficulty breathing, or gastrointestinal symptoms. Reports of patients who have had severe allergic reactions to an inactive ingredient are not uncommon, although it is unclear how much of an ingredient triggers the reaction. About 75% of most pills are taken up by inactive ingredients, said lead author Giovanni Traverso, MD, a gastroenterologist in Boston. 

The researchers looked at inactive ingredients in more than 42,000 medications, which contained nearly 360,000 inactive ingredients. They found 38 inactive ingredients that can cause allergic reactions after ingestion. Nearly 93% of the drugs studied had at least one of these ingredients. The investigators found 45% of drugs contained lactose; 33% contained food dye; and slightly less than 1% contained peanut oil. Often, there are alternative formulations patients can use without the allergen. Dr. Traverso recommends that physicians and patients be aware of inactive ingredients in drugs. The full list can be found in a medication’s package insert or can be accessed online in the U.S. National Library of Medicine databases.

Are you a rash whisperer? Learn more about the complexities of diagnosing allergic contact dermatitis in Dermatology World.

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DW Insights and Inquiries: Is there a best approach to widespread actinic keratoses?

Widespread actinic keratoses (AKs) are problematic to both patients and physicians, not only because of their pre-cancerous nature, but because of the cosmesis and discomfort associated with them. Many years ago, during my (NL) dermatopathology fellowship at Parkland Hospital in Dallas, I did a split-faced comparative trial on medium depth peels versus 5-fluorouracil 5% cream in the treatment of severe actinic damage on the face of veterans. Both treatments cleared approximately 75% of actinic keratoses, showing equal efficacy. Patients preferred the chemical peel, as they found it more convenient, quicker to heal, and less uncomfortable. A follow-up study on this patient population showed that most patients required additional treatment to their AKs post field treatment. Keep reading!


What’s the optimal way to perform total body skin examinations?

A recent study that will be published in JAAD reviewed how physicians perform total body skin examinations (TBSE). Researchers reviewed video recordings of five dermatology faculty and five residents conducting TBSE. Exam time, physician movements, patient movements, sequence of body parts examined, and body parts missed were analyzed.  There was significant variability among providers in their efficiency and order of examination. The most time was spent examining the head (41%), followed by the legs (22%), and arms (20%). The neck had the highest frequency of being missed during a TBSE (29.5%) followed by the underarm region (13.6%)

From this analysis, the researchers identified an optimized format for conducting the TBSE. The proposed process begins with the patient sitting while the dermatologist examines the anterior face, scalp, neck, chest, flank, stomach, arms, hands, legs and feet of the patient. Then the patient stands and turns away from the examiner to have the posterior scalp, neck, back, posterior arms and legs examined.

The authors concluded that having a standardized process for performing TBSE minimizes the chance of missing a body area and could be taught to medical students, residents, and physicians. Learn more about how identifying and monitoring melanoma is a team effort in Dermatology World.

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Study shows medical spa oversight needs improvement 

Researchers explored the significant variations in oversight of medical spas in the United States and its implications for patient safety. According to results published in Dermatologic Surgery, of the 247 medical spas surveyed, 72% reported having a medical director and 6.5% claimed that the director was on site. Of medical directors listed on the spas’ websites, 41% were trained in dermatology and/or plastic surgery. In phone interviews, 79% of the medical spas verified that the medical director was board-certified, and 52% stated that the medical director was on site less than 50% of the time. Based on the information gathered, the researchers conclude that increased regulation of medical spas may be warranted to ensure patient safety.

Find out what services non-physician clinicians are allowed to perform in each state.

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Deadline to review QPP performance data April 27

The Centers for Medicare and Medicaid Services (CMS) is getting ready to publish physicians’ Quality Payment Program (QPP) performance information for public viewing. Physicians have until April 27 to review their 2017 data before it is published on Physician Compare. Physicians can review their data by logging into the QPP website.

According to a recent report released by CMS regarding clinician reporting experiences for the first year of the QPP, of the 1,057,824 clinicians eligible for MIPS, 95% participated in MIPS and avoided a negative payment adjustment. About 93% of participants earned a positive payment adjustment, 2% earned a neutral payment adjustment, and 5% received the 4% negative payment adjustment. Participation was strong among dermatologists across the country at 88.25%. About 87% of dermatologists reported dermatology-specific measures from within the dermatology specialty set. Small practices reported more than needed to avoid the penalty 

The requirements for QPP will become more stringent and the negative payment adjustment increases from year to year eventually capping off at 9%. To learn more and determine how to avoid the penalty in 2019, visit www.aad.org/macra

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