July 17

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IN THIS ISSUE / July 17, 2019


Isotretinoin, depression, and suicide: What’s the connection?

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According to an analysis published in JAMA Dermatology, from 1997 to 2017, nearly 18,000 cases of depression, anxiety, and emotional lability linked to isotretinoin use were reported to the U.S. Food and Drug Administration. Those in the 10- to 19-year-old age group accounted for the larger proportion of suicides — more than individuals in their 20s or 30s (58% vs. 37% vs. 4%). This suggests that teenagers may be “particularly vulnerable to psychiatric adverse events while taking isotretinoin,” or that they are prescribed the medication more frequently, noted the study authors. The majority of individuals to die from suicide were men (79%), which is consistent with national statistics.

However, the suicide rate among those taking isotretinoin may be lower than in the general population. In 2009 and 2010, respectively, 8.4 and 5.6 suicides occurred for every 100,000 individuals taking isotretinoin, which was lower than national rates from the same time period (11.8 and 12.1 per 100,000). The study’s lead author noted that a risk of increased suicidal ideation in patients with acne has been reported in prior studies, irrespective of treatment method. View the Academy’s Position Statement on Isotretinoin.

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DW Insights and Inquiries: Should dermatologists be anti-antihistamine for atopic dermatitis?

hsu-sylvia-95px.jpgAtopic dermatitis (AD) is characterized by pruritus that results in eczema induced by scratching. Histamine-1 receptor blockers are routinely used to treat the pruritus of AD, although histamine does not seem to play a role in AD through the histamine-1 receptor. He et al reported that there were 990,000 annual visits for AD between 2003 and 2012. Antihistamines were prescribed for AD in a significant proportion of visits across physician specialties (16-44%); dermatologists prescribed antihistamines at 22% of all AD visits. Dermatologists and pediatricians primarily used sedating antihistamines (58-70%), whereas the majority of family/general practitioners, internists, and other specialists prescribed nonsedating antihistamines for AD (55-100%). 

Although AAD guidelines allow for the intermittent use of sedating antihistamines to help sleep in AD patients, there is no evidence that shows sedating antihistamines have any significant benefit. A Cochrane review concluded that there is no evidence to support the use of oral antihistamines, both sedating and nonsedating, for the treatment of AD-associated pruritus. Keep reading!


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2018 MIPS performance feedback, final score, and targeted review now available

If you submitted 2018 MIPS data, you can now view your performance feedback and MIPS final score. Your 2020 payment adjustment will be based on this score. View frequently asked questions about performance feedback. If you believe an error has been made in the 2020 MIPS payment adjustment factor calculation, a targeted review can be requested until Sept. 30, 2019. Targeted review decisions are final and not eligible for further review. Learn more about how to request a targeted review.

To access your 2018 performance feedback, final score, and request a review, log in to the Quality Payment Program website.

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Natural skin care regimen vs. synthetic regimen for managing rosacea

A natural skin care regimen was more effective than a synthetic regimen when used as concomitant therapy to metronidazole in managing rosacea, according to a study published in the Journal of Drugs in Dermatology.

All study participants, who had moderate-to-severe facial rosacea, were treated with 0.75% metronidazole gel twice a day for six weeks. After this phase, the participants were randomly assigned to receive either the natural regimen or the synthetic regimen as add-on therapy. Both therapies were used in conjunction with the metronidazole gel. The natural regimen consisted of a cleanser (natural oils, beeswax, and witch hazel) and night creams (natural oils, glycerin, and botanical anti-inflammatories). The synthetic regimen consisted of a cleanser (cetyl alcohol and sodium lauryl sulfate) and a moisturizer (glycerin and polyisobutene). 

After four weeks, participants with the natural regimen showed significant improvement in a global assessment of rosacea. Study investigators found that participants’ overall skin appearance was clinically and statistically improved from baseline by 32% in those using the natural care regimen and by 12% in those using the control regimen. Both skin care regimens were well tolerated.

Learn more about the implications of rosacea’s new classification system and treatment updates in Dermatology World.

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Two more speakers confirmed for 2019 AADA Legislative Conference 

The AADA has confirmed Reps. Josh Gottheimer (D-N.J.) and Tom Reed (R-N.Y.), co-chairs of the Problem Solvers Caucus, to speak at the 2019 AADA Legislative Conference during lunch on Monday, Sept. 9. The Problem Solvers Caucus was established in 2017 and seeks to create bi-partisan cooperation on key policy issues. Learn more and register!