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March 3, 2021

IN THIS ISSUE / March 3, 2021

The latest on the association between diet and acne

In an article published in the International Journal of Dermatology, study investigators reviewed 53 articles on the association between diet and acne published over the past 10 years. They found that acne-promoting factors include high glycemic index (GI)/glycemic load (GL) foods, dairy products, high-fat foods, and chocolate. Foods that seem to protect against acne include fatty acids as well as fruit and vegetable intake.

Many studies have confirmed that consumption of a large amount of high GI/GL is a major factor in the promotion and exacerbation of acne. Hyperglycemia and hyperinsulinemia resulting from eating high GI/GL foods increase insulin-like growth factor 1, which in turn promotes keratinocyte hyperproliferation and an androgenic increase that contributes to acne.

The acnegenic property of milk may be tied primarily to its content in hormonal components or other bioactive molecules like steroids or growth factor stimulating hormones rather than to its content in fat compounds (e.g., skim milk is consistently associated with acne). While milk has a low GI, the hormonal components increase glycemic and insulinemic levels mimicking the effects of high GI/GL foods as well as other biomolecular processes. Read more about how certain food types can promote or protect against acne.

Can diet affect dermatologic health? Experts weigh in on the evidence in DermWorld.

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Dr. Warren Heymann photo
DermWorld Insights and Inquiries: Time to reassess messing around with steroids and psoriasis

You don't tug on Superman’s cape
You don't spit into the wind
You don't pull the mask off that old Lone Ranger
And you don’t mess around with Jim

If the late Jim Croce was a dermatologist, he would have added the lyric that “you don’t give systemic steroids to psoriatic patients” because of the risk of inducing a pustular flare upon steroid withdrawal. Dermatology residents get indoctrinated with this dogma from day one — is it a myth?

The prevalence of psoriasis is estimated at 3.2% of adults, with an increasing incidence in children. Appropriate treatment of psoriasis is based on disease severity in the context of comorbidities and concomitant medications. (1) Even if systemic steroids are not used for psoriasis per se, their use may be indicated for co-existing maladies ranging from inflammatory bowel disease to poison ivy. Are we putting our psoriatic patients at risk by prescribing systemic steroids in these circumstances? Keep reading!

Is intralesional 5-FU effective for nonmelanoma skin cancer?

A systematic review of 125 articles was performed to assess the efficacy of intralesional fluorouracil (IL 5-FU) in the treatment of nonmelanoma skin cancer (NMSC). The authors found no significant difference between the clearance rate of squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) after IL 5-FU therapy (87% vs. 91%, respectively); however, the clearance rate of both SCC and BCC was significantly greater than that of keratoacanthoma (KA) (74.5%). The study authors concluded that IL 5-FU achieved higher clearance rate in SCC and BCC groups than in the KA group.

How can functionality assessments help determine appropriate treatment for NMSCs in elderly patients? Find out in DermWorld.

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Topical CBD for skin conditions: The known and unknown

A recent review published in Clinical, Cosmetic, and Investigational Dermatology explores the current literature on the potential therapeutic effects of cannabidiol (CBD) in specific skin conditions, including atopic dermatitis, psoriasis, pruritus, and other inflammatory conditions. Most of the published clinical evidence has focused on the effects of CBD and other cannabinoids when consumed, inhaled, or injected as opposed to topically applied, the authors noted.

[CBD: Potential or placebo? Read about the potential applications and concerns regarding the use of cannabinoids in dermatology in DermWorld.]

Researchers theorize that CBD may be beneficial for skin disorders associated with free radical formation and inflammation due to the anti-inflammatory, antioxidant, and anti-apoptotic properties associated with HMOX1. Additionally, topical administration of CBD in preclinical and clinical studies may target inflammation and help reduce pain associated with certain conditions.

Other potential applications being researched include wound healing and hair growth. While the therapeutic potential is evident, more robust studies are needed to validate the efficacy of topical CBD.

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2021 AAD election: View ballot book, prepare to cast vote

Voting in the Academy’s 2021 election opens March 20 and closes April 3. Members will receive a personalized online voting link via email that will take them directly to the Academy’s voting site where the ballot book can be viewed and votes cast. The voting access code can be used when you log in to https://vote.escvote.com/aad along with your AAD member ID number to cast your vote. Learn more about the AAD election.

Members who wish to receive a PDF of the 2021 AAD election ballot book by email may request it at candidates@aad.org.

Members who wish to vote by mail may print their online secure voting ballot beginning March 20. All ballots must be received by April 3 at 11:59 p.m. (ET).

CMS announces automatic exemption for MIPS 2020 performance period, extended deadline for COVID relief

In response to the ongoing COVID-19 public health emergency, CMS recently announced that it will apply an automatic extreme and uncontrollable circumstance (EUC) policy for all eligible clinicians for the MIPS 2020 performance year. Additionally, CMS will be extending the deadline for the EUC application for those reporting as a group that may still want to apply. Get guidance on next steps in the Academy's MIPS Resource Center.

When is repayment due for the CMS advance payment program?

As part of the CARES Act, CMS expanded its accelerated and advance payment program. Under the new law, repayment is now delayed until one year after payment was issued. After that first year ends, Medicare Administrative Contractors will automatically recoup 25% of Medicare payments otherwise owed to the practice for 11 months. At the end of the 11-month period, recoupment will increase to 50% for another six months. Learn more about Medicare relief payments.