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DermatologyTimesCLINICAL INSIGHTS THAT EXPAND EXPERTISE AND ADVANCE PRACTICE
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DermatologyTimesCLINICAL INSIGHTS THAT EXPAND EXPERTISE AND ADVANCE PRACTICE
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ONCOLOGY
New cSCC guidelines
COSMETIC
Neuromodulators and combination therapies
COLUMNS
Dermatology’s identity crisis
READ MORE
READ MORE
BUSINESS
Curbing drug costs
DermatologyTimesCLINICAL INSIGHTS THAT EXPAND EXPERTISE AND ADVANCE PRACTICE Volume 39, Number 8 | August 2018
Pediatric AD treatment gaps
CLINICAL
PSYCHOLOGICAL DISTRESSEmotional burden of skin conditions may be rooted in physiology
Make ‘patient-centered’ work in practiceWHITNEY J. PALMER | Staff Correspondent
Advances in Pediatric Atopic Dermatitis
All physicians are vulnerable to mal-practice claims.
W h i le c l a i m s don’t always lead
to court cases, they can lead to stress, says Stephen E. Wolverton, M.D., a dermatologist with Indi-ana University Health in Bloom-ington, Ind. He has served as an expert witness for medicolegal cases since 1993.
Dr. Wolverton has had personal experience with malpractice lawsuits. He’s been sued twice, but both cases were dropped before settlement or before going to court. One case was brought by a
patient who experienced an adverse event after con-suming excessive doses of prednisone for bullous pemphigoid. The second was brought by a patient who sought a second-opinion from Dr. Wolverton about the safety of the long-term use of meth-otrexate for plaque psoria-sis. The patient sued both the primary physician and Dr. Wolverton for adverse events he experienced with long-term methotrexate use.
Although malpractice suits can cause a great deal of stress, dermatologists are actually sued less
DermatologyTimesCLINICAL INSIGHTS THAT EXPAND EXPERTISE AND ADVANCE PRACTICE Volume 39, Number 09 | September 2018
MALPRACTICE CONTINUES ON PAGE 92�
Malpractice stress
LISETTE HILTON | Staff Correspondent
Helping a dermatopathologist diagnose neoplasms and infections of the foot requires requires taking adequate samples and including clinical photographs, physicians reported at DERMfoot 2018. (Photo courtesy of Clay J. Cockerell, M.D.)
FULL STORY ON PAGE 60�
Biopsies for foot infections
M O R E I N T H I S I S S U E
Columns 15Innovation Introducing a new column on turning ideas into practice.
Clinical 28Treating alopecia areataDietary supplements for hair loss?
Oncology 60Nail biopsiesEvaluation considerations.
Cosmetic 76Thermage FLXDr. Vic Narurkar reviews evidence for this aesthetic procedure.
Business 84Procedures by NPs, medical assistantsMore procedures, more standardization.
RISE OF FFAINGRID TORJESEN | Staff Correspondent
FFA CONTINUES ON PAGE 55�
Put the risk of a malpractice lawsuit into perspective
Frontal fi brosing alopecia, which was fi rst reported 30 years ago, is a condi-tion that is increasing in epidemic proportions,
said Jerry Shapiro, M.D., in a pre-sentation at the 2018 AAD Sum-mer Meeting.
Frontal fi brosing alopecia is a patterned variant of lichen planopilaris and predominantly aff ects postmenopausal women. However, around 20% of cases occur in premen-opausal women and the condition sometimes occurs in men (1-2% of cases), said Dr. Shapiro who is director of disorders of hair and scalp, New York University School of Medicine.
The condition typically occurs on the fronto-temporal region of the scalp, but upper periauric-ular and occipital localization (hair loss behind the ears) are also common, and in some cases the band of alopecia stretches around the head
Trends found among patients experiencing hair loss
completely (circumferential fi brosing alopecia). “The band of alopecia is often readily dis-
tinguishable from the sun damaged skin of the forehead,” Dr. Shapiro said.
Loss of the eyebrows is a common and help-ful diagnostic feature aff ecting 50% to 95% of individuals with frontal fi brosing alopecia, he
added. “It can either precede or follow the onset of scalp hair loss.” “Lonely hairs” are also frequently evident in the band of hair loss, he said.
The dist inct ion between frontal fi bro-sing alopecia and lichen planopilaris is primarily
clinical, as the histologic fi ndings for both condi-tions are essentially identical, although perifol-licular infl ammation tends to be less intense in
TABLE OF THE
MONTH:
MINIMIZE
LIABILITY
RISK PAGE 107
25%
of Dr. Shapiro’s practice consists of treating frontal fi brosing alopecia.
Dr. Shapiro
Dr. Wolverton
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Topical rapamycin improves facial skin lesions in tuberous sclerosis complexSep 12, 2018
Topical rapamycin improves facial skin lesions in tuberous sclerosis complexSep 12, 2018
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by Alireza Firooz, M.D. of the Center for Research and Training in Skin Disease and Leprosy at Teh-ran University of Medical Sciences in Iran.
“The studies show that the skin parameters of hydration, transepidermal water loss, sebum, microcirculation, pigmentation, and thickness are generally higher in men but skin pH is higher in women,” she and her colleagues wrote.
Developing a deeper understanding of the skin in this way could be used in developing facial products and cosmetic treatments that are truly sex-specifi c.
“The knowledge of sex-linked cutaneous diff erences might help in study planning and the
development of female- versus male-specifi c prod-ucts for more appropriate dermatological treat-ments or cosmetic interventions,” the authors wrote.
There are established sex diff erences in anat-omy (see “Optimize injections in men,” page 40),
Clinicians working for Catholic health-care organizations are generally barred from prescribing contracep-tives for birth control, but where does
the clinician stand when a woman requests a pre-scription for an oral contraceptive pill for acne?
The Catholic Church views contraception as separating sex from the purpose of procreation within a marriage and therefore does not approve of contraceptive methods. Catholic health insti-tutions in the United States are explicitly prohib-ited from promoting or condoning contraceptive practices under the Ethical and Religious Direc-
tives for Catholic Health Care Services,1 estab-lished by the United States Conference of Cath-olic Bishops that sets rules for Catholic-affi liated health care organizations in the United States.
The treatment of acne is a well known non-con-traceptive benefi t of birth control pills, so female patients may attend Catholic health institutions asking for a prescription for birth control pills as a treatment for acne, when they may really want the prescription to prevent pregnancy. The patient may even go so far as to state that she wants the prescription primarily for contraception and to
Oral contraceptives for acne
INGRID TORJESEN | Staff Correspondent
Male-female skin differences drive Tx choices
AMY REYES | Managing Editor
MALE-FEMALE CONTINUES ON PAGE 36�
Should men and women be treated with the same facial products in the same way? A literature review by an international group of physicians shows that the phys-
iological skin parameters of hydration, transepi-dermal water loss, sebum, microcirculation, pig-mentation and thickness diff er among men and women, suggesting that treatment choices should diff er as well.
“Understanding the phys-iological, chemical, and bio-physical characteristics of the skin helps us develop a proper approach for the management of skin diseases,” wrote the authors of a review that focuses on sex diff er-ences of skin. The review appears in the Septem-ber issue of the International Journal of Wom-en’s Dermatology.
The review, which included 57 studies, was led
Distinctions
Ethical dilemmas for physicians in Catholic healthcare organizations
CONTRACEPTIVES CONTINUES ON PAGE 30�
Neurotoxins and dermal fi llers are more commonnly used in male patients today, but men don’t often achieve the same results as women.SEE THE STORY ON PAGE 40�
MALE PATIENTS
Columns 5Differential DiagnosisA framework for making informed medical decisions.
Clinical 24Sexual HistorySexual orientation and sexual behavior not the same.
Cosmetic 38Vaginal Rejuvenation Experts address what you should know.
Oncology 52Breast Exams/Skin ChecksEducation at mammogram impacts skin cancer awareness.
Business 74Off-Label RulesProposed laws may expand rules.
DermatologyTimesCLINICAL INSIGHTS THAT EXPAND EXPERTISE AND ADVANCE PRACTICE Volume 39, Number 10 | October 2018
GENDER-BASED considerations
SEE
FEMALE SKIN
PROPERTIES
STUDYPG. 36
HOW MEN & WOMEN ARE DIFFERENT: In this month’s table, we highlight skin differences between men & women. PAGE 90�
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� Although men are increasingly seeking fi llers, many are not
achieving treatment goals.Photo courtesy of Merz North America.
ES25941_DT1018_cv1.pgs 09.26.2018 02:38 UBM blackyellowmagentacyan
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Dermatology................................................. 12,383
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PSYCHOLOGICAL DISTRESS
LISETTE HILTON | Staff Correspondent
Two months ago in Hong Kong, a
23-year-old woman was reportedly
so tormented by chronic eczema that
she killed her parents, then herself
in an act that brought attention to the stress of
living with a life-long skin condition.
This is not the first case in which the psycho-
logical distress of living with a skin disorder has
led to suicide, but it is not the norm.
Anxiety and depression are far more com-
mon, shows a study of psoriasis patients pub-
lished online in July in the British Journal of
Dermatology.
Of 59,961 patients with psoriasis, researchers
from the University of Manchester in the United
Kingdom found a lower suicide risk in people
with psoriasis as compared to a control group
of 876,919 patients without psoriasis. However,
the psoriasis group had a higher prevalence for
Emotional burden of skin conditions may be rooted in physiology
DISTRESS CONTINUES ON PAGE 28�
Make ‘patient-centered’
For Elizabeth Kiracofe,
M.D., the patient-cen-
tered care focus started
with retinoid cream.
“When I opened my practice
and started seeing patients, many
of them said they had stopped using topical ret-
inoids because they were allergic,” she said. “I
discovered they really meant they were develop-
ing retinoid dermatitis from the medicine, and
they needed more guidance on how to use the
creams.”
That’s when the board-certified dermatolo-
gist with Illinois Dermatology Institute in Chi-
cago began designing her practice around giving
WHITNEY J. PALMER | Staff Correspondentwork in practice
PATIENT-CENTERED CONTINUES ON PAGE 33�
While important gaps in diagnosing,
treating and managaging atopic
dermatitis still exist, pipeline therapies
show promise. Experimental research
also taking place to address the skin
microbiota, which may one day lead
to a cure. FULL STORY ON PAGE 16�
DermatologyTimes
CLINICAL INSIGHTS THAT EXPAND EXPERTISE AND ADVANCE PRACTICE
Clinical 16
Pediatric atopic dermatitis
Gaps in treatment; drug advances
Cosmetic 40
On the horizon
New neuromodulator approvals
Oncology 50
cSCC Guidelines
Tx recommendations reinforce
standard of care
Business 56
Managed care
pharmacy survey
Insight into curbing drug costs
patients not only the best dermatology care pos-
sible, specifically with acne, but also providing
education about their conditions and the med-
ications used for management.
Ensuring your patients know what you’re doing
and why is critical to protocol adherence regard-
less of what condition you’re treating, she said.
“If you don’t give them an understanding of
why the program you’ve created together makes
sense specifically for them, they’re not going to
do it,” Dr. Kiracofe said. “The main trouble hap-
pens when patients receive plans that don’t match
their lifestyle. They just can’t do it.”
But, while this patient-centered focus works
well for the individuals you treat, what does it
mean for your practice?
Volume 39, Number 8 | August 2018
having a history of alcohol misuse, bipolar dis-
order, depression, anxiety disorders, self-harm,
and having psychotropic drug prescriptions.
The risk of suicide was found to be lower in
psoriasis patients who were older than 40 years
old. For patients younger than 40 years, the risk
of suicide was not any better or worse than the
control group, but there was a slight increase in
self harm.
For some patients, a skin con-
dition can become so unbearable,
they request euthanasia as in the
case of a patient treated by Michael
J. Cork, M.B., Ph.D., of the Uni-
versity of Sheffield in the United Kingdom.
Dr. Cork treats some of the most severe cases of
atopic dermatitis in the U.K. In 2016, he treated
a young woman with atopic dermatitis who was
so severely depressed, she requested euthana-
sia. Prior to seeing Dr. Cork she was treated with
Dr. Cork
Dr. Kiracofe
Advances
in Pediatric Atopic
Dermatitis
COMMUNICATION: Patient-centered care requires individualized tactics. PAGE 78
Table OF THE MONTH
M O R E I N T H I S I S S U E
Derm
atologyTim
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Aug
ust 2018 V
olum
e 39 No. 8 C
linical in
sights th
at expand expertise and advance p
ractice
Derm
atologyT
imes.com
by Alireza Firooz, M.D. of the Center for Research
and Training in Skin Disease and Leprosy at Teh-
ran University of Medical Sciences in Iran.
“The studies show that the skin parameters
of hydration, transepidermal water loss, sebum,
microcirculation, pigmentation, and thickness
are generally higher in men but skin pH is higher
in women,” she and her colleagues wrote.
Developing a deeper understanding of the
skin in this way could be used in developing
facial products and cosmetic treatments that
are truly sex-specifi c.“The knowledge of sex-linked cutaneous
diff erences might help in study planning and the
development of female- versus male-specifi c prod-
ucts for more appropriate dermatological treat-
ments or cosmetic interventions,” the authors wrote.
There are established sex diff erences in anat-
omy (see “Optimize injections in men,” page 40),
Clinicians working for Catholic health-
care organizations are generally
barred from prescribing contracep-
tives for birth control, but where does
the clinician stand when a woman requests a pre-
scription for an oral contraceptive pill for acne?
The Catholic Church views contraception as
separating sex from the purpose of procreation
within a marriage and therefore does not approve
of contraceptive methods. Catholic health insti-
tutions in the United States are explicitly prohib-
ited from promoting or condoning contraceptive
practices under the Ethical and Religious Direc-
tives for Catholic Health Care Services,1 estab-
lished by the United States Conference of Cath-
olic Bishops that sets rules for Catholic-affi liated
health care organizations in the United States.
The treatment of acne is a well known non-con-
traceptive benefi t of birth control pills, so female
patients may attend Catholic health institutions
asking for a prescription for birth control pills as a
treatment for acne, when they may really want the
prescription to prevent pregnancy. The patient
may even go so far as to state that she wants the
prescription primarily for contraception and to
Oral contraceptives for acneINGRID TORJESEN | Staff Correspondent
Male-female skin differences drive Tx choices
AMY REYES | Managing Editor
MALE-FEMALE CONTINUES ON PAGE 36�
Should men and women be treated with
the same facial products in the same way?
A literature review by an international
group of physicians shows that the phys-
iological skin parameters of hydration, transepi-
dermal water loss, sebum, microcirculation, pig-
mentation and thickness diff er among men and
women, suggesting that treatment
choices should diff er as well.“Understanding the phys-
iological, chemical, and bio-physical characteristics of the
skin helps us develop a proper approach for the management of
skin diseases,” wrote the authors of a review that focuses on sex diff er-
ences of skin. The review appears in the Septem-
ber issue of the International Journal of Wom-
en’s Dermatology.The review, which included 57 studies, was led
Distinctions
Ethical dilemmas for physicians
in Catholic healthcare organizations
CONTRACEPTIVES CONTINUES ON PAGE 30�
Neurotoxins and dermal fi llers
are more commonnly used in
male patients today, but men
don’t often achieve the same
results as women.SEE THE STORY ON PAGE 40�
MALE PATIENTS
Columns 5Differential DiagnosisA framework for making informed
medical decisions. Clinical 24Sexual HistorySexual orientation and sexual
behavior not the same. Cosmetic 38Vaginal Rejuvenation
Experts address what you should know.
Oncology 52Breast Exams/Skin Checks
Education at mammogram
impacts skin cancer awareness. Business 74Off-Label RulesProposed laws may expand rules.
DermatologyTimes
CLINICAL INSIGHTS THAT EXPAND EXPERTISE AND ADVANCE PRACTICE
Volume 39, Number 10 | October 2018
GENDER-BASED considerations
SEE FEMALE SKIN PROPERTIES
STUDYPG. 36
HOW MEN & WOMEN ARE DIFFERENT: In this month’s table, we highlight skin differences between men & women. PAGE 90�
DermatologyT
imes
Octo
ber 2
018 V
olu
me 3
9 N
o. 1
0 Clin
ical in
sights th
at e
xpand e
xp
ertise
and a
dvance p
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Derm
ato
log
yT
imes.c
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� Although men are increasingly seeking fi llers, many are not
achieving treatment goals.Photo courtesy of Merz North America.
ES25941_DT1018_cv1.pgs 09.26.2018 02:38 UBM
blackyellowmagentacyan
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DermatologyTimes.comLast revised: 05/15/2019
*Editorial features subject to change.
JANUARY ISSUE FEBRUARY ISSUE MARCH ISSUE
APRIL ISSUE MAY ISSUE JUNE ISSUE (ACNE SUPPLEMENT)
production and editorial calendar 2019
» Ad close: December 06 » Materials due: December 12 » Inserts due: December 18
» Ad close: January 07 » Materials due: January 11 » Inserts due: January 18
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» Ad close: March 07 » Materials due: March 13 » Inserts due: March 19
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Editorial features*: Dermatology as Big BusinessManaging Your Business in the Digital Age Does “patient-centered” work in practice? New to market Physician Profile
Bonus Distribution: • Maui Derm For Dermatologists Meeting, January 26-30,
Kihei, Hawaii • American Academy of Cosmetic Surgery (AACS) Annual
Meeting , January 31 - February 2, Orlando, FL • American Academy of Dermatology (AAD) Annual
Meeting, March 1-5, Washington, DC
Editorial features*: Back to Basics/What’s old May be New Again/A Retrospective Review of Dermatology (coin-cides with Hall of Fame) New to market Physician Profile
Bonus Distribution: • American Academy of Dermatology (AAD) Annual
Meeting, March 1-5, Washington, DC
Editorial features*: FDA Device Regulations • Evaluating and choosing among options, • Microneedling the new laser? New to market Physician Profile
Bonus Distribution: • American Society for Laser Medicine and Surgery
Conference (ASLMS), March 27-31, Denver, CO
Editorial features*: Nail fungus: Distinguishing among dermatophytosis New to market Physician Profile
Bonus Distribution: • Tennessee Society For Laser Medicine And Surgery
(TSLMS) Symposium for Cosmetic Advances and Laser Education (SCALE), May 9-11, Nashville, TN
Editorial features*: Practical Understanding of Dermatopathology Pipeline products New to market Physician Profile
Bonus Distribution: • American Society for Aesthetic Plastic Surgery (ASAPS),
May 16-19, New Orleans, LA • Vegas Cosmetic Surgery Forum (VCS), June 5-9, Las
Vegas, NV
Editorial features*: Perspectives on Payers — The impact of the regulatory landscape on dermatology New to market Physician Profile
Supplement: Acne Pipeline products
Bonus Distribution: • Maui Derm NP+PA Summer 2019, June 19-22, Colorado
Springs, Colorado • The Aesthetic Show 2019 (TAS), July TBD, TBD
DermatologyTimes.comLast revised: 05/15/2019
*Editorial features subject to change.
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» Ad close: October 08 » Materials due: October 15 » Inserts due: October 21
» Ad close: November 05 » Materials due: November 11 » Inserts due: November 15
Editorial features*: Cutaneous warts: Emerging procedural and prescription New to market Physician Profile
Bonus Distribution: • The Aesthetic Show 2019 (TAS), July TBD, TBD • DERM Foundation NPPA, TBD, TBD • American Academy of Dermatology (AAD) Summer Meeting,
July 25-28, New York, NY • ADM, TBD, TBD
Editorial features*: Psoriatic arthritis patient management strategies • The role of the dermatologist New to market Physician Profile
Supplement: Psoriasis Patient perspective and quality of life concerns
Bonus Distribution: • AES, TBD, TBD
Editorial features*: New frontiers in the treatment of melasma and vitiligo New to market Physician Profile
Bonus Distribution: • American Society of Plastic Surgeons (ASPS) Plastic
Surgery Meeting 2019, September 20-24, San Diego, CA • Maui Derm NP+PA Fall 2019, TBD, TBD • Fall Clinical Dermatology Conference for PAs & NPs, May 31
- June 2, Scottsdale, AZ
Editorial features*: Challenges and new strategies for managing pruritis • Therapeutic approaches in kids New to market Physician Profile
Bonus Distribution: • American Society for Dermatologic Surgery Annual Meeting,
October 24-27, Chicago, IL • The Aesthetic Academy (TAA), TBD, TBD
Editorial features*: Skincare Trends – What’s New in Skin Science and Technology New to market Physician Profile
Bonus distribution: • Cosmetic Surgery Forum (CSF), TBD, TBD
Editorial features*: 2019 Workforce Trends New to market Physician Profile
production and editorial calendar 2019
DermatologyTimes.comLast revised: 05/15/2019
DermatologyTimesCLINICAL INSIGHTS THAT EXPAND EXPERTISE AND ADVANCE PRACTICE
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