Dermatology Times, Feb 1, 2003

Columns

I Missed the HIPAA Extension Deadline: Now What?

By David J. Goldberg, M.D., J.D.

Dr. Derm runs a small, efficient, single-physician dermatology practice. He is a participant in many managed care plans, accepts Medicare payments and has no interest in changing either the thrust or the way he operates his practice.

Malpractice, Patient Safety Mandate Physicians' Voices be Heard

By Bob Gatty

With the new Republican-controlled 108th Congress now in business, there is an improved chance that lawmakers will get the message about sky-rocketing cost of malpractice insurance and provide some relief.

Community Service: Are You Involved?

By Lawrence A. Schachner, M.D.

I was exceedingly impressed by a conversation I had with Dr. Adelaide Hebert at the University of Texas department of dermatology some time ago. We were discussing residency programs and she informed me that charity or community service work was a requirement for dermatology residents at her institution.

Departments

Derms Reflect on Cosmetics Impact

By Karen Nash

The image of dermatology as a medical profession has undergone a variety of changes over the decades. In the 1800s and the early part of the 20th century, dermatologists were the physicians to go to for venereal diseases, as well as diseases of the skin, so their place as a medical necessity was secure.

Exploring Earth's Mysteries

By Karen Nash

There was little in his childhood in Washington, D.C., to indicate that Haines Ely's future would take him to a career as a dermatologist/dermatopathologist, with a weekly radio talk show that deals often in metaphysics and alternative medicines. He also leads trips to visit a faith healer in Brazil.

Special Reports

Pregnancy & Prescriptions

By Paula Moyer

Denver - Perinatal exposure to oral glucocorticoids may be associated with delayed effects not seen until adolescence, such as diabetes and hypertension.

Uplifting News for Men

By Chet Scerra

San Francisco - Most recipients of botulinum toxin type A (Botox Cosmetic) injections to soften or even remove facial wrinkles are currently women. But according to University of California-San Francisco dermatologist Christopher B. Zachary, M.D., males also benefit from this therapy, and removing certain facial wrinkles and furrows may provide benefits beyond just a handsome face.

Progressive Systemic Sclerosis

By Nancy Groves

Paris - Researchers at Jefferson Medical College are developing cutting edge techniques to attack the increased biosynthesis that appears to cause accumulation of collagen characteristic of scleroderma and particularly of a subset of the disease known as progressive systemic sclerosis (PSS), Jouni Uitto, M.D., Ph.D., chair, department of dermatology and cutaneous biology, said here at the World Congress of Dermatology.

Melanoma Revision

By Lisette Hilton

New York - Researchers have identified a molecular biomarker that was shown in a study to predict survival in melanoma patients, independently of tumor thickness and other known prognostic indicators.

Not to be Ignored

By Debbie L. Sklar

Paris - Papular and pruritic dermatoses of pregnancy are usually the result of three conditions - prurigo, papular dermatitis of pregnancy (PDP), and pruritic folliculitis (PF) - Samantha Vaughan Jones, M.D., F.R.C.P., said at the World Congress of Dermatology. Depending on the symptoms and their severity, these conditions can affect the health of both the mother and her baby.

Teledermatology

By Suzette Hill

Columbia, Mo. - With fewer than 10,000 dermatologists serving a population of more than 2.9 billion people, there's no question that less-than-adequate access to dermatologic services isn't solely a women's issue.

First Line

By Barbara J. Rutledge, Ph.D.

Paris - Topical medications should often be considered as first-line therapy in the treatment of vulval diseases because they are effective, easy to use, and fast-acting, according to Annarosa Virgili, M.D.

Heed Early Signs

By John Nemec

Paris - Two macroscopically observable features, hair diameter diversity and peripilar signs, have been shown to predict later hair loss in androgenic alopecia when the patient is still in the early stages of the condition, according to Olivier de Lacharriere, M.D., Ph.D.

Scabies and Pregnancy

By Rochelle Nataloni

Springfield, Ill. - Permethrin (Elimite, Acticin, Nix) is the scabicide of choice for all ages and conditions, including pregnancy, according to Stephen P. Stone, M.D., division of dermatology, Southern Illinois University School of Medicine. "Of the commonly used treatments for scabies, the most safe and effective in pregnancy is permethrin 5 percent cream," he said.

Herpes Gestationis

By John Jesitus

Research presented here by Luis A. Diaz, M.D., establishes conclusively that herpes gestationis (HG), also known as pemphigoid gestationis, is a true organ-specific autoimmune disease unique to pregnancy.

Male Woes

By Lisette Hilton

Troy, Mich. - Looking at the penis is an important part of the dermatological exam. Dermatologists who make the effort will commonly find skin conditions related only to the penis, general skin conditions, cancer, and infections, according to Ali Moiin, M.D., a board certified dermatologist and clinical assistant professor, Wayne State University, Troy, Mich.

Common Condition

By Barbara J. Rutledge, Ph.D.

Paris - Polymorphic eruption of pregnancy (PEP), also known as pruritic urticarial papules and plaques of pregnancy (PUPPP), is the most common of all the specific dermatoses of pregnancy, with a reported incidence of approximately one in every 120 pregnancies.

Lead Story

Rosacea Relief

By Cheryl Guttman

Las Vegas - The FDA on Jan. 2 cleared Berlex Laboratories Inc. to market Finacea (azelaic acid 15 percent) gel for the treatment of rosacea.

News

Periocular Surgery and the Asian Face

By Cheryl Guttman

Chicago - The presence of a single upper lid or asymmetry between the left and right lids with regard to the height of the supratarsal crease are among the most frequent characteristics that bring Asian patients to seek periocular aesthetic surgery, Jean Carruthers, M.D., said at the annual meeting of the American Society for Dermatology Surgery.

Inching Closer

By Andrew Bowser

Patients enrolled in a phase III trial of a novel Bcl-2-directed antisense agent plus chemotherapy with dacarbazine (DTIC) are yielding remarkable responses thus far, according to Anna C. Pavlick, D.O., assistant professor of medicine, New York University School of Medicine, New York.

Physicians rant over increasing insurance rates

By Martin Kohl

Twelve percent of dermatologists responding to an American Academy of Dermatology survey said they have had difficulty getting malpractice insurance or renewing an existing policy. Sixty-nine percent have had their insurance premiums raised.

E-liminating E-mail E-mergencies

By Mark Blanchard

Tech-savvy physicians, take note: The American Medical Association, state medical boards, and several professional groups have joined forces to develop some "unified" guidelines that will help you tackle the sensitive subject of patient e-mail.

Sections

Facial Wasting

By Suzette Hill

Hermosa Beach, Calif. - New treatment options for patients with HIV-related facial lipodystrophy are proving as effective at boosting the spirits as they are at filling out the face. The distinctive outward appearance of facial wasting stigmatizes AIDS patients and contributes to heightened levels of anxiety and depression.

Liposuction Tools

By John Jesitus

Denver - Most cannula manufacturers seem to care more about doctors' well being than that of patients, Gerhard Sattler, M.D., said here at the American Academy of Cosmetic Surgery's world congress on liposuction. A board-certified dermatologic surgeon based in Darmstadt, Germany, Dr. Sattler presented an analysis of six common cannulas that addressed how they perform from a patient's perspective.

Wart Mainstay

By Fred Wilson

Ipswich, U.K. -- From a ragbag of low-quality randomized trials, the simplest and cheapest topical preparation has emerged as the safest and most effective treatment of cutaneous warts, according to Sam Gibbs, M.R.C.P.

Established Paradigm

By Cheryl Guttman

Paris - Combination immunotherapy for psoriasis is coming into the clinic. Experience is showing it can be a valuable strategy for increasing efficacy while minimizing toxicity, both acutely and potentially over the longer term, Christopher E.M. Griffiths, M.D., said at the World Congress of Dermatology.

Extra ... Extra ...

By Paul Wynn

New York - Two years ago Neil Sadick, M.D., started a newsletter to inform his patients about new procedures and research studies at his practice in New York City. One issue included stories about laser liposuction, the new botulinum toxin B molecule called Myobloc, and IPL photorejuvenation.

Alopecia Areata

By Cheryl Guttman

Paris - Topical treatment with a fragment of brain-derived neurotrophic factor (BDNF) may offer a unique new approach to the management of alopecia areata, Vladimir Botchkarev, M.D., Ph.D., said at the World Congress of Dermatology.

New Approach to Hair Removal

By Cheryl Guttman

Chicago - A system emitting both intense pulsed light (wavelength range 680 nm to 980 nm) and radiofrequency energy (1 MHz) (Aurora DS) appears to offer an effective and safe modality for hair removal in patients of all skin types, Dina Yaghmai, M.D., reported at the annual meeting of the American Society for Dermatologic Surgery.

Back to the Basics

By John Jesitus

Denver - While new surgical tools are always welcome, doctors must not forget about the old reliable ones, Pierre F. Fournier, M.D., an aesthetic plastic surgeon b based in Paris, said at the American Academy of Cosmetic Surgery's world congress on liposuction.

Hair Harvest

By Cheryl Guttman

Chicago - The beard region may serve as a useful harvesting site for hair transplantation in men who already have a severely depleted scalp donor supply, Gary S. Hitzig, M.D., said at the annual meeting of the American Society for Dermatologic Surgery.

Multi Passes

By Cheryl Guttman

Sacramento, Calif. - A multipass technique using a longer interval between pulses may offer new opportunities for therapeutic benefits when treating vascular lesions with a pulsed dye laser, Emil A. Tanghetti, M.D., said.

Slow to Change

By Robert H. Carlson

Chicago - A pilot survey in California, completed in January 2002, suggests that dermatologists prefer to stick with tried and true surgical modalities to treat numerous actinic keratoses (AK) and severe actinic dysplasia of the face, rather than using alternate treatments.

Fungal Masquerades

By Cheryl Guttman

Paris - Clinicians evaluating nail disorders must keep in mind that the spectrum of problems affecting the nail is broad and many nail problems can masquerade as others.

Stimulus, Response ... Knowledge

By Cheryl Guttman

Chicago - Digital audio/video provides a superior format for teaching dermatologic surgery, Michael R. Migden, M.D., said at the annual meeting of the American College of Mohs Micrographic Surgery & Cutaneous Oncology.

Liposuction Safety

By John Jesitus

Denver - Liposuction safety is no accident, according to Robert A. Shumway, M.D., F.A.C.S.. a La Jolla, Calif.-based cosmetic surgeon and founder of the Shumway Institute of Laser and Cosmetic Surgery.

Psoriasis Surprises

By Cheryl Guttman

Paris - A survey of patients with psoriasis has yielded some interesting findings regarding adherence to prescribed regimens and the affected individuals' desires and concerns about their disease and its treatment, Peter C. M. van de Kerkhof, M.D., Ph.D., said at the World Congress of Dermatology.

Phthalates Safe

By Chet Scerra

Washington -- Phthalates, as used in the cosmetic industry, are considered to be safe, according to an independent panel of medical and scientific experts.

Wresting Away Lip Rhytides

By Cheryl Guttman

Chicago - Perioral injection of botulinum toxin type A (Botox Cosmetic) can be a very safe and effective modality for ameliorating the appearance of vertical upper lip rhytides with an added benefit of enhancing upper lip fullness, Roberta D. Sengelmann, M.D., reported at the annual meeting of the American Society for Dermatologic Surgery.

Ms.Codit

By Inga Ellzey

Q: My doctors commonly use the following example in their dictation: "IDN back, no other suspicious lesions noted on complete general cutaneous skin exam." Would this documentation support a 99213, 99202, or 99242 level of care since six body areas are required to meet the documentation guidelines for the examination?

Creditable Cards

By Kevin C. Smith, M.D.

At a meeting in Hong Kong, I needed to transfer a Powerpoint presentation from my laptop to a different laptop being used for projection of the talks. I felt a moment of panic but was saved when one of the organizers pulled out a credit card sized device and plugged it into the PCMCIA slot on the side of my laptop.

Multiple Factors Play Role in Wide Local Excision of Primary Melanomas

By Cheryl Guttman

Paris - Tumor thickness is the primary factor determining the extent of the surgical margin when performing wide local excision of Stage I and II melanomas, but other lesional features, including diameter and location, may need to be taken into account, D©ràRatner, M.D., said at the World Congress of Dermatology.

Accutane Draws Crowd

By Thomas P. Skernivitz

Dermatologists aren't the only ones who see the virtues of Accutane (isotretinoin).

Irradiated Hope

By Jane Schwanke

Santa Monica, Calif. - With melanoma rates increasing 3 to 5 percent each year, dermatologists can glean some hope from recent study results that found Canvaxin, a therapeutic cancer vaccine, doubled survival rates for patients with advanced melanoma.

Cosmetic Conundrums

By Zoe Diana Draelos, M.D.

Q. Is vitamin E allergenic? This is an important question, since there is some confusion regarding this issue. Vitamin E can be an unstable substance prone to oxidation in the presence of light and air. It is a potent antioxidant and in the process becomes oxidized itself.

Suboptimal Treatment

By Cheryl Guttman

Paris - New options for treatment and prevention of severe drug eruptions are likely on the horizon thanks to recent advances in understanding the mechanisms of these reactions, Jean-Claude Roujeau, M.D., said at the World Congress of Dermatology.

Adverse Sequelae

By Cheryl Guttman

Chicago - Although certain problems may arise after sclerotherapy even when performed by the most skilled hands, those adverse sequelae may be minimized with proper treatment technique and appropriate postoperative management, Mitchel P. Goldman, M.D., said at the annual meeting of the American Society for Dermatologic Surgery.

Showing Muscle

By Cheryl Guttman

Chicago -- Increasing experience with fat autograft muscle injection (FAMI) demonstrates its value for producing predictable, long-lasting, three-dimensional volume augmentation, Kimberly J. Butterwick, M.D., said at the annual meeting of the American Society for Dermatologic Surgery.