Enhance your ability to diagnose, manage, and treat with the most current treatment options

Identify patients who may benefit from new approaches to difficult to manage diseases

Apply best practices for enhancing patient communication and shared decision-making techniques

Decipher clinical trial data and guidelines and how to apply them to every day practice

2024 Virtual Grand Rounds Session 7: May 8, 2024 - 60 Tips in 60 Minutes

Recognize the clinical presentation of GPP and how to diagnose it

Be familiar with the current GPP treatment options such as the IL-36 pathway 

Discuss the implications of alternatives to oral antibiotics and hormonal therapies for moderate acne vulgaris 

Assess whether patients with moderate Acne Vulgaris can benefit from weekly isotretinoin therapy 

2024 Virtual Grand Rounds Session 5: April 3, 2024 -E-Journal Club Edition: What's New in SKIN, The Journal of Cutaneous Medicine

Discuss current management advancement in dermatology from rashes through tumors 

Compare strategies to manage dermatologic conditions from laser treatment through systemic therapies

Identify appropriate treatment options for dermatologic conditions based on patient and disease characteristics 

Recognize the nuances of managing dermatologic conditions in skin of color 

Underline strategies to optimize management in patients with dermatologic conditions

Illustrate strategies to manage dermatologic conditions effectively in clinical practice

2024 Virtual Grand Rounds Session 3: March 20, 2024 - Highlights from the San Diego Academy Meeting - Our Most Important Learnings

Discuss the treatment of psoriasis and related disorders with evolving therapies

Recognize the various therapies available for acne and their role in clinical practice

Translate the role of therapies for eczema in clinical practice

Describe the modalities for diagnosing and managing skin cancer

Identify optimal patients for the use of fillers and botulinum

Describe strategies to prepare and administer fillers and botulinum

2024 Virtual Grand Rounds Session 1: January 31, 2024 - WCH24 Your Questions Answered

Identify common dermatoses presentations in patients with skin of color (SOC)

Describe how to assess patients with diverse cultural backgrounds, SOC, and sexual orientation

Review treatment options for common dermatoses seen in diverse patient populations

Employ strategies to effectively communicate with patients with diverse cultural backgrounds, SOC, and sexual orientation

Difficult Dermatology Conversations: Improving Care for Diverse Patient Populations 

Identify optimal patients for the use of fillers and botulinum 

2023 Virtual Grand Rounds Session 14: November 15, 2023 - Fall Clinical 2023- Your Questions Answered

Recognize that IL-4 and IL-13 are signature cytokines of type 2 inflammatory response

Understand that Type 2 inflammatory response involves mast cells, eosinophils, and basophils 

Recognize the common signs and symptoms of Staph Scalded Skin Syndrome

Understand treatment of Staph Scalded Skin Syndrome

Recognize the rare benign vascular disorder of Achenbach Syndrome

Understand the differential diagnosis and workup of Achenbach Syndrome

2023 Virtual Grand Rounds Session 13: September 27, 2023 - Challenging Cases in Dermatology

Dermatology

FRIDAY, March 8, 2024 (HealthDay News) -- There are notable concerns relating to the use of currently available artificial intelligence (AI) dermatology mobile applications (apps), according to a study published online March 7 in JAMA Dermatology to coincide with the annual meeting of the American Academy of Dermatology, held from March 8 to 10 in San Diego.Shannon Wongvibulsin, M.D., Ph.D., from the David Geffen School of Medicine at the University of California in Los Angeles, and colleagues conducted a scoping review to identify and characterize current English-language AI dermatology mobile apps available for download.&nbsp;A total of 909 apps were identified initially; after removal of duplicates, 391 apps remained. A further 350 apps were excluded on subsequent review, yielding 41 apps available for detailed analysis. The researchers identified several concerning aspects relating to AI apps in dermatology. None of the apps were approved by the U.S. Food and Drug Administration; disclaimers for lack of regulatory approval were included in only two apps. The apps lacked supporting evidence, input from clinicians and/or dermatologists, and transparency in terms of development of algorithms, data usage, and user privacy.&nbsp;"The use of these apps has risks associated with a lack of consistent validation and transparent user communication," the authors write. "These findings are important to increase awareness of the current limitations and the need to further develop methods for creation of AI dermatology apps with effective regulation, validation, and standardized evaluation criteria."&nbsp;One author disclosed ties to the pharmaceutical and dermatology industries and has a related patent pending.&nbsp;<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2815800">Abstract/Full Text</a>&nbsp;<a target="_blank" rel="noopener noreferrer" href="https://www.aad.org/member/meetings-education/am24">More Information</a>

None of the apps are approved by the FDA; only two include disclaimers for lack of regulatory approval

AAD: Concerns Noted Relating to Use of AI Dermatology Apps

WEDNESDAY, March 6, 2024 (HealthDay News) -- Challenges relating to artificial intelligence (AI) in dermatology and its application to skin of color (SOC) are partly due to underrepresentation of SOC in datasets, according to research published online March 6 in the International Journal of Dermatology.Rebecca Fliorent, from the Rowan-Virtua School of Osteopathic Medicine in Stratford, New Jersey, and colleagues analyzed recent literature to assess current AI programs in use for dermatologic purposes to identify challenges with application of this technology to SOC. Literature from the last 10 years through October 2023 was analyzed.The researchers note that challenges relating to AI and its application to SOC come from the underrepresentation of SOC in datasets, as well as issues with quality and standardization of images. Current AI programs are worse at identifying lesions in SOC because of these issues. Furthermore, only 30 percent of the programs identified in the literature reported on their use in dermatology, specifically in SOC. For an accurate depiction of darker skin tone images in datasets, significant development of these applications is needed."Although the mentioned AI programs do not constitute a comprehensive list, many of these programs show promise in supporting clinical decision-making; however, they require modification to become reliable diagnostic aids for SOC patients," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/ijd.17076">Abstract/Full Text (subscription or payment may be required)</a>

Challenges in AI and its application to SOC stem from underrepresentation of SOC in datasets, issues with quality, standardization of images

Skin of Color Underrepresented in AI Programs in Dermatology

WEDNESDAY, Nov. 15, 2023 -- Religion should be integrated into existing cultural humility training in order to better address the unique needs of Muslim dermatology patients, according to a study published online Nov. 15 in JAMA Dermatology.Ghida El-Banna, M.D., from the Stanford University School of Medicine in Redwood City, California, and colleagues explored the perceptions of Muslim patients of their dermatology care in a qualitative mixed-methods study composed of surveys and semistructured interviews. Twenty-one patients participated in the study: five men and 16 women, including 10 who wore hijab.According to the researchers, the survey results demonstrated variation of the impact of Islamic practices on dermatology care. Based on interviews, dermatology care was not perceived as a priority by Muslim patients, and they expressed interest in community events highlighting general dermatology education. Stigmatization of their skin disease and cosmetic care was experienced. The Muslim patient-dermatologist relationship and disclosure of the need for accommodations was hindered by prior experiences with Islamophobia and colorism. Participants described instances of bias and poor cultural humility from dermatologists. Religious and cultural needs pertinent to their care, including clinician gender concordance, adjustment of medication timing while fasting, and halal medication ingredients, were unique to Muslim participants."Clinical and educational interventions to address gaps in the care of Muslim patients in dermatology are needed," the authors write. "Future research should focus on the epidemiology of skin disease in Muslim subpopulations and Muslim patients' health-seeking behaviors."

Incorporation of religion into cultural humility training recommended, as well as dermatology education at community events

How Can Dermatology Care Be Improved for Muslim Patients?

THURSDAY, Nov. 2, 2023 (HealthDay News) -- Skin diseases can cause a psychosocial burden and feelings of stigmatization, according to a study published online Oct. 8 in the Journal of the European Academy of Dermatology and Venereology.Paolo Gisondi, M.D., from the University of Verona in Italy, and colleagues evaluated the burden of the most common dermatological diseases in adult patients across Europe in terms of quality of life, work life, and stigmatization. The analysis included survey responses from 19,915 individuals.The researchers found that quality of life was particularly impaired in people with hidradenitis suppurativa and sexually transmitted diseases. A modest to extremely large effect on quality of life was seen in roughly half of participants with acne, alopecia, or chronic urticaria and about 40 percent of those with atopic dermatitis, skin cancers, or psoriasis. Overall, 88.1 percent of participants considered their skin disease as embarrassing slightly more in their personal life than in their work life (83 percent). Furthermore, roughly half of the respondents reported sleeping difficulty, feeling tired, and impact of the disease on taking care of themselves. Roughly one in seven (14.5 percent) believed they have been rejected by others because of the skin disease, and 19.2 percent believe they have been looked at with disgust. Across diseases, anxiety and depression were frequently reported."Our study highlights the psychosocial burden experienced by people with skin diseases, and the need to address their impact on quality of life and stigmatization in the context of patient management," the authors write.

Effect seen on patients' daily and work life

Skin Diseases Pose a Psychosocial Burden

WEDNESDAY, June 14, 2023 -- In 2021, more than 70 percent of populated zip codes with dermatologists had fewer than four dermatologists per 100,000 people, according to a brief article published in the May issue of SKIN.Christopher N. Nguyen, M.D., from Northside Hospital Gwinnett in Lawrenceville, Georgia, and colleagues retrieved the distribution of dermatologists in three-digit zip code areas using membership data from the 2021 American Academy of Dermatology database.The researchers found that 71.6 percent of the 712 populated zip codes with dermatologists had less than four dermatologists per 100,000 people compared with 72.3 percent in 2016 (compound annual growth rate, –0.19 percent). There was a significant difference observed in the dermatologist density of the 100 most versus least populated areas (median, 4.5 versus 1.6 dermatologists per 100,000)."Consistent with 2016, over 70 percent of areas do not meet that target density and nearly 60 percent have less than three per 100,000. These results may indicate that initiatives aimed at redistribution of dermatologists have not made a major difference," the authors write. "This complex issue likely needs a multifaceted solution with continual effort and thought from leaders in the field."

71.6 percent of 712 populated zip codes with dermatologists have fewer than four dermatologists per 100,000

Maldistribution of Dermatologists Persisted in 2021

Diversity gaps persist in the dermatology workforce pipeline, according to a study published online Nov. 16 in
 
 JAMA Dermatology
 
 .




 Yi Gao, M.D., from the University of Minnesota in Minneapolis, and colleagues conducted a secondary analysis of a repeated cross-sectional study involving 58,077 graduating allopathic medical students to examine their demographic characteristics and intended career goals.




 Of the graduating students, 49.0 percent were female, 14.5 percent were from racial and ethnic groups underrepresented in medicine (URM), and 6.3 percent were sexual minority (SM) students. The researchers found that the likelihood of identifying as URM or SM was lower for female students pursuing dermatology versus other specialties (11.6 versus 17.2 percent and 1.9 versus 5.7 percent, respectively). Students pursuing dermatology versus other specialties had reduced odds of intending to care for underserved populations, practice in underserved areas, and practice public health (adjusted odds ratios, 0.40, 0.40, and 0.44, respectively), but they had increased odds of intending to pursue research in their careers (adjusted odds ratio, 1.76). Female, URM, and SM identities were independently associated with increased odds of caring for underserved populations and practicing public health among students pursuing dermatology.




 "Addressing health inequities and improving care for underserved patients is the responsibility of all dermatologists, and efforts are needed to increase diversity and interest in careers focused on underserved care among trainees in the dermatology workforce pipeline," the authors write.




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Students pursuing dermatology have lower odds of intending to care for underserved populations, practice in underserved areas

Diversity Gaps Persist in Dermatology Workforce Pipeline

Significantly more adults with dermatomyositis receiving intravenous immune globulin (IVIG) versus placebo have a response of at least minimal improvement, according to a study published in the Oct. 6 issue of the
 
 New England Journal of Medicine
 
 .




 Rohit Aggarwal, M.D., from the University of Pittsburgh School of Medicine, and colleagues conducted a randomized, placebo-controlled trial involving patients with active dermatomyositis who were randomly assigned to receive either IVIG or placebo (47 and 48 patients, respectively) every four weeks for 16 weeks. Patients receiving placebo and those without confirmed clinical deterioration while receiving IVIG could enter a 24-week open-label extension phase. The primary end point was a response, defined as a Total Improvement Score (TIS) of at least 20 at week 16, indicating at least minimal improvement, and no confirmed deterioration.




 The researchers found that 79 and 44 percent of patients in the IVIG and placebo groups, respectively, had a TIS of at least 20 at 16 weeks. With respect to the secondary end points, including at least moderate improvement and major improvement, the results were generally in the same direction, except for the change in creatine kinase level, which did not differ meaningfully between the two groups. There were 282 treatment-related adverse events in the IVIG group over 40 weeks. Nine serious events that could be considered related to IVIG occurred.




 "Larger and longer trials to determine the long-term effects and risks of IVIG in patients with dermatomyositis are warranted," the authors write.




 The study was funded by Octapharma Pharmazeutika.




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More adults receiving IVIG versus placebo had Total Improvement Score of at least 20 at 16 weeks

IV Immune Globulin Bests Placebo for Dermatomyositis

The U.S. Food and Drug Administration on Tuesday issued warning letters to three companies, including Amazon, for selling unapproved products for removing moles and skin tags.




 No over-the-counter medications have FDA approval for that purpose, and the Food, Drug, and Cosmetic Act prohibits interstate sale of unapproved drugs and cosmetics.




 "It is the FDA's duty to protect public health from harmful products not approved for the U.S. marketplace," Donald Ashley, director of the compliance office in the FDA Center for Drug Evaluation and Research, said in a statement. "This includes where online retailers like Amazon are involved in the interstate sale of unapproved drug products. We will continue to work diligently to ensure that online retailers do not sell products that violate federal law."




 Besides Amazon, the FDA issued warning letters to Ariella Naturals and Justified Laboratories. The agency emphasized that it has not examined the mole and skin tag removal products sold by these companies for safety, effectiveness, or quality.




 The warning letters put the companies on notice that failure to address the violations cited by the FDA may result in legal action, including seizure. Once they receive the warning letter, the companies have 15 days to inform the agency of any corrective measures they have taken.




 The FDA said Tuesday that it will continue to use all the tools available to protect public health and remove fraudulent or unproven drug products from the American market. The warning letters were just the first step.




 <a class="rm-stats-tracked" href="https://www.fda.gov/news-events/press-announcements/fda-issues-warning-letters-three-companies-selling-unapproved-new-drugs-mole-and-skin-tag-removal" target="_blank">
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No over-the-counter medications have FDA approval for the removal of moles and skin tags

FDA Warns Amazon, Other Vendors About Sale of Skin Tag Removal Products

Edgewell Personal Care Co. has recalled three batches of its Banana Boat Hair &amp; Scalp Sunscreen Spray SPF 30 because trace levels of benzene were found in some samples during an internal review. Though this sunscreen product is not meant to contain benzene, it may have come from the propellant that sprays the product out of the can.




 The
 <a class="rm-stats-tracked" href="https://edgewell.com/pages/edgewell-personal-care-issues-voluntary-nationwide-recall-of-banana-boat-hair-scalp-sunscreen-due-to-the-presence-of-benzene" target="_blank">
 recall
 </a>
 is voluntary, and the U.S. Food and Drug Administration is aware of it, the company said. Specific batches are affected by the recall, which does not apply to other batches of the product. No other Banana Boat products are part of the recall. The products are packaged in aerosol cans and were distributed throughout the United States to retailers and online. Retailers have been alerted to the recall.




 Banana Boat said it will reimburse consumers who have purchased a recalled product. Consumers can determine whether their cans of sunscreen have been recalled by looking for the lot codes on the bottom of the can and comparing them to the recalled
 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/edgewell-personal-care-issues-voluntary-nationwide-recall-banana-boat-hair-scalp-sunscreen-due" target="_blank">
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 Edgewell said it has not received any reports of adverse events and noted that benzene is in the environment and humans are exposed to it regularly from multiple sources.




 Information is also available online at
 <a class="rm-stats-tracked" href="https://www.bananaboat.com/" target="_blank">
 www.bananaboat.com
 </a>
 . Consumers should contact their physician or health care provider if they have any questions or concerns or have experienced any problems related to using these aerosol sunscreen products.




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Company says it has not received any reports of adverse events

Banana Boat Sunscreen Recalled Due to Benzene

The chronic inflammatory skin condition, lichen sclerosus (LS), which primarily affects the anogenital area in women, is associated with depression and anxiety, according to a research letter published online June 15 in JAMA Dermatology.

 Ryan Fan, from the Yale School of Medicine in New Haven, Connecticut, and colleagues conducted a nested, matched, case-control study involving U.S. women aged 18 years or older to examine the association of LS with depression and anxiety. Using nearest-neighbor propensity score matching with replacement, each case patient was matched to four controls based on age, sex, and race and ethnicity. Data were included for 765 women with LS (mean age, 66.2 years) and 3,060 matched controls.

 The researchers found that compared with controls, women with LS were significantly more likely to have a diagnosis of depression (42.5 versus 24.4 percent) or anxiety (42.6 versus 22.6 percent). LS remained significantly associated with depression and anxiety in a multivariable analysis (odds ratios, 2.16 and 2.50, respectively).

 "Health professionals treating patients with LS should recognize the increased risk of depression and anxiety, consider mental health screening, and refer patients with LS to mental health professionals when appropriate," the authors write.

 <a href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2793096" class="rm-stats-tracked" target="_blank">Abstract/Full Text (subscription or payment may be required)</a>

Lichen sclerosus remained significantly associated with depression and anxiety in multivariable analyses

Lichen Sclerosus Linked to Depression, Anxiety in Adult Women

Adjunctive use of reflectance confocal microscopy (RCM) for suspect lesions reduces unnecessary excisions in a real-life setting, according to a study published online June 1 in
 
 JAMA Dermatology
 
 .




 Giovanni Pellacani, M.D., from the University of Modena and Reggio Emilia in Italy, and colleagues conducted a randomized clinical trial involving 3,165 patients enrolled from three dermatology referral centers in Italy, with a mean follow-up of 9.6 months. Patients were randomly assigned to standard therapeutic care with or without adjunctive RCM. A diagnostic analysis was included for 3,078 patients.




 The researchers found that adjunctive RCM was associated with a higher positive predictive value (18.9 versus 33.3), a lower benign-to-malignant ratio (3.7:1.0 versus 1.8:1.0), and a 43.2 percent reduction in the number needed to excise (5.3 versus 3.0) compared with standard therapeutic care alone. All 15 lesions with delayed melanoma diagnoses were thinner than 0.5 mm.




 "This randomized interventional trial assessed the applicability of adjunctive RCM for equivocal lesions suspected of melanoma in a clinical setting and proves that unnecessary excisions can be reduced by almost half, with greater accuracy of in vivo identification of benign lesions," the authors write.




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Adjunctive RCM associated with higher positive predictive value, lower benign-to-malignant ratio compared with standard therapeutic care alone

Can Reflectance Confocal Microscopy Reduce Unnecessary Excisions?

For pigmented skin lesions (PSLs), biopsy decisions made with electrical impedance spectroscopy (EIS) have increased sensitivity for melanomas/severely dysplastic nevi, according to a study published in the May issue of
 
 SKIN
 
 .




 Shayan Owji, from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a pilot study to examine the effect of EIS on clinical decisions for PSLs compared to traditional dermoscopy. Dermatologists, dermatology residents, and medical students completed an online survey providing their biopsy decisions for 24 PSLs: Half were presented as a clinical image with an associated dermoscopic image and half were presented as a clinical image with the corresponding EIS score.




 The researchers found that for melanomas/severely dysplastic nevi, decisions made with EIS had a mean sensitivity of 75 percent compared with 66 percent for decisions made with dermoscopy. Dermatologists biopsied with similar sensitivities when using EIS or dermoscopy (both 81 percent), while for residents and medical students, greater sensitivity in biopsies was seen when using EIS. The greatest improvement in sensitivity and specificity when using EIS versus dermoscopy was seen for respondents who reported rarely using dermoscopy.




 "Given that not all providers are trained in dermoscopy, and our finding that EIS particularly benefits those who infrequently use dermoscopy, EIS may complement dermoscopy by helping a broader range of providers make improved PSL diagnostic decisions," the authors write. "This will ultimately improve patient care and reduce the morbidity and mortality of a melanoma diagnosis."




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Sensitivity increased for biopsy decisions when using EIS versus dermoscopy, especially for those rarely using dermoscopy

Is Electrical Impedance Spectroscopy Beneficial for Pigmented Skin Lesions?

Many physician assistants (PAs) are employed in dermatology, with a larger annual increase seen for PAs in dermatology versus other specialties, according to a research letter published online May 4 in
 
 JAMA Dermatology
 
 .




 Justin D. Arnold, M.D., from the University of California in Irvine, and colleagues characterized the dermatology PA workforce in a cross-sectional study using deidentified longitudinal data from the National Commission on Certification of Physician Assistants from January 2013 to December 2018.




 Data were included for 98,554 certified PAs. The researchers found that in the study's final year, there were 3,938 PAs practicing in dermatology compared with 94,616 in all other fields. Compared with 3.7 percent in all other specialties, only 1.6 percent of PAs in dermatology identified as African American or Black. The rates of Hispanic ethnicity were similar for PAs in dermatology and other fields (6.0 and 6.5 percent, respectively). Compared with PAs in other specialties, PAs in dermatology mainly worked in office-based private practices (92.5 versus 37.7 percent) and more often resided in metropolitan geographic settings (94.7 versus 92.0). During the study period, dermatology added 164 to 539 PAs to the field annually, with a mean annual increase of 11.6 percent compared with a mean increase of 7.8 percent in all other specialties.




 "Although this study did not assess the reasons for the substantial increase of dermatology PAs, numerous factors, such as a potential physician shortage or the expansion of private equity-owned practices, may contribute to the accelerating use of PAs within the field," the authors write.




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Mean annual increase of 11.6 percent in number of PAs in dermatology reported compared with 7.8 percent in all other specialties

Physician Assistants Commonly Employed in Dermatology

Common occupationally related allergens include rubber accelerators, preservatives, and bisphenol A epoxy resin, and the occupations most commonly affected by occupational skin disease are service workers and machine operators, according to a study published in the April issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Joel G. DeKoven, M.D., from the University of Toronto, and colleagues analyzed the frequency of allergic reactions to a screening series of allergens among 38,614 North American patients undergoing patch testing between 2001 and 2016.




 The researchers found that 11.6 percent of the participants had occupational skin disease; 70.5 percent of those had allergic contact dermatitis. Rubber accelerators, preservatives, and bisphenol A epoxy resin were included as the most common occupationally related allergens. The most common sites of dermatitis were hands, arms, and face (75.8, 30.0, and 15.9 percent, respectively). Service workers and machine operators were the occupations most affected.




 "Important occupational allergens included rubber accelerators, bisphenol A epoxy resin, methylisothiazolinone, formaldehyde, and nickel," the authors write. "Knowledge of common occupational allergens, sources of exposure, and occupations/industries at risk is important to facilitate prevention and treatment."




 Several authors disclosed financial ties to the pharmaceutical industry.




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Common allergens include rubber accelerators, preservatives, bisphenol A epoxy resin; service workers, machine operators affected most often

What Are the Most Common Occupationally Related Allergens?

Debt valuation of dermatology private equity-backed groups (DPEGs) decreased prior to the COVID-19 pandemic and then decreased further during the pandemic, according to a study published online March 9 in
 
 JAMA Dermatology
 
 .




 Rohail Memon, from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a cross-sectional study from Aug. 1, 2016, to Aug. 31, 2021, and examined public financial statements filed by business development corporations (BDCs) lending to DPEGs before and during the COVID-19 pandemic. Ten BDCs contained data on nine unique DPEGs; overall, there were 15 trackable DPEG debt instruments.




 The researchers found that during the study period, the amortized cost of the loans for an individual DPEG varied from $1.7 million to $100 million. For many DPEGs, the valuation of debt instruments was stable until some were discounted starting in May 2018; a significant decrease was seen prior to the COVID-19 pandemic from May to August 2019 (−1.4 percent). During the pandemic, there was another significant decrease from February to June 2020 (−9.0 percent). A modest and significant improvement in debt valuations was seen after pharmaceutical companies announced effective COVID-19 vaccine candidates in November 2020 (2.3 percent), but they remained discounted.




 "Dermatologists should be aware of the financial health of DPEGs, and the risks involved when considering selling their practice to or working for a DPEG," the authors write.




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Valuation of debt instruments significantly decreased from May to August 2019, followed by further decrease during COVID-19

Debt Valuation of Private Equity-Backed Dermatology Groups Down

Body dysmorphic disorder (BDD) symptoms are more prevalent for patients with dermatological conditions compared with healthy-skin controls, according to a study published online Jan. 18 in the
 
 British Journal of Dermatology
 
 .




 Christina Schut, Ph.D., from the Justus-Liebig-University Gießen in Germany, and colleagues compared the prevalence of BDD symptoms between patients with different dermatological conditions and healthy-skin controls in a cross-sectional multicenter study involving 5,487 patients with different skin diseases, recruited at 22 dermatology outpatient clinics, and 2,808 healthy-skin controls.




 The researchers found that the prevalence of BDD symptoms was five times higher for patients with dermatological conditions compared with healthy-skin controls (10.5 versus 2.1 percent). The odds of having BDD symptoms were elevated more than 11-fold for patients with hyperhidrosis, alopecia, and vitiligo compared with healthy-skin controls (adjusted odds ratio, &gt;11), while the odds were increased more than sixfold for patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo, and bullous diseases (adjusted odds ratio, &gt;6). BDD symptoms were significantly associated with younger age, female sex, higher psychological stress, and feelings of stigmatization using a logistic regression model.




 "This study demonstrated that more than 10 percent of patients with dermatological conditions experience potentially distressing symptoms of BDD," the authors write. "This highlights that doctors should keep in mind this condition and refer patients not responding to treatment to an appropriate health care service for further psychological assessment."




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Odds of BDD increased more than 11-fold for patients with hyperhidrosis, alopecia, and vitiligo versus healthy-skin control

Body Dysmorphic Disorder Prevalent in Patients With Skin Conditions

Six Brut and Sure aerosol antiperspirant and deodorant sprays sold in the United States and Canada have been recalled by their maker due to the presence of the chemical benzene.




 "Benzene is classified as a human carcinogen. Exposure to benzene can occur by inhalation, orally, and through the skin and it can result in cancers including leukemia and blood cancer of the bone marrow and blood disorders which can be life-threatening," stated a news release from TCP HOT Acquisition LLC dba HRB Brands. "While benzene is not an ingredient in any of the recalled products, our review showed that unexpected levels of benzene came from the propellant that sprays the product out of the can," the company said. But it added that there have been no reports of adverse events related to the recall, which is being conducted out of an "abundance of caution."




 Similar recalls have been issued for other consumer products that surprisingly contained benzene in the past six months: Pantene/Herbal Essence dry spray shampoos; Old Spice spray deodorants; and Neutrogena/Aveeno spray sunscreens.




 Five of the recalled TCP products are: Brut Classic Antiperspirant Aerosol (4 oz; UPC 00827755070085); Brut Classic Antiperspirant Aerosol (6 oz; UPC 000827755070108); Brut Classic Deodorant Aerosol (10.0 oz; UPC 00827755070047); Sure Regular Antiperspirant Aerosol (6.0 oz; UPC 00883484002025); and Sure Unscented Antiperspirant Aerosol (6.0 oz; UPC 00883484002278). A sixth recalled product was sold only in Canada: Brut Classic Deodorant Aerosol (154 g; UPC 00827755070177).




 Consumers should stop using the recalled products immediately and dispose of them appropriately, said the company, which also advised consumers to contact a health care provider if they experience any problems that may be associated with use of the recalled products. For more information or to request a refund, consumers can contact the company at 1-866-615-0976 or go to its
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 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/tcp-hot-acquisition-llc-dba-hrb-brands-issues-voluntary-nationwide-recall-sure-and-brut-aerosol" target="_blank">
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There have been no reports of adverse events related to the recall, which is being conducted out of an 'abundance of caution'

Brut, Sure Brand Deodorants Under Recall Due to Benzene

The Ichthyosis Scoring System (ISS) is reliable for measuring global ichthyosis severity in children and adults, according to a study published online Feb. 16 in
 
 JAMA Dermatology
 
 .




 Qisi Sun, M.D., from the Yale University School of Medicine in New Haven, Connecticut, and colleagues created and evaluated a comprehensive instrument to measure total body ichthyosis severity in adults and children. Using photographs of participants with ichthyosis, an 83-image teaching set was created. All test photographs were scored by two cohorts of dermatologists (11 dermatologists) to assess interrater and intrarater reliabilities. Creation of the ISS included participants of all ages, races, and ethnicities; raters had varying experience and areas of expertise.




 The researchers found that the intraclass correlation coefficients for total, scale, and erythema scores were greater than 0.90, greater than 0.91, and greater than 0.88, respectively, across both cohorts of 11 dermatologists. Moderate to good interrater reliabilities were exhibited by most body sites for scale and erythema. Good to excellent intrarater reliabilities were observed.




 "Scales, such as the ISS, that can reliably and accurately capture disease severity play an important role as outcomes in these studies," writes the author of an accompanying editorial. "They will enable us to differentiate what treatments provide meaningful clinical benefits for patients with ichthyoses and facilitate comparative effectiveness studies."




 Several authors disclosed financial ties to the pharmaceutical industry.




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Moderate to good interrater reliabilities exhibited by most body sites; good to excellent intrarater reliabilities also seen

Ichthyosis Scoring System Reliable for Measuring Disease Severity

A new multimodal learning algorithm can perform multilabel classification of skin lesions, according to a study published in the February issue of
 
 Medical Image Analysis
 
 .




 Peng Tang, from the Technical University of Munich, and colleagues proposed a novel two-stage multimodal learning algorithm for multilabel classification of skin diseases. A FusionNet, which exploits and integrates the representation of clinical and dermoscopy images at the feature level, was constructed at the first stage; a Fusion Scheme 1 was used to conduct the information fusion at the decision level. To further incorporate patients' meta-data, a Fusion Scheme 2 was proposed, which integrates the multilabel predictive information from the first stage and patients' meta-data information. The final diagnosis was formed by fusion of the predictions from both stages. The algorithm was assessed on the 7-point checklist dataset for multilabel classification of skin disease.




 The researchers found that the proposed FusionM4Net first stage achieved an average accuracy of 75.7 percent for multiclassification tasks and 74.9 percent for diagnostic tasks, without using the patient's meta-data; this was more accurate than other methods. The second stage of FusionM4Net, which included patients' meta-data increased average accuracy to 77.0 percent and diagnostic accuracy to 78.5 percent.




 "Future routine clinical use of algorithms with high diagnostic accuracy might help ensure that rare diseases are also detected by less experienced physicians and it might mitigate decisions affected by stress or fatigue," a coauthor said in a statement.




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New algorithm uses multistage fusion process that includes clinical images, dermoscopy images, and patient meta-data

Novel Algorithm May Help Classify Skin Diseases

For moderate-to-severe plaque psoriasis, treatment with the humanized immunoglobulin G1 monoclonal antibody that specifically binds to the p19 subunit of interleukin 23, risankizumab, is superior to fumaric acid ester (FAE) treatment, according to a study published in the January issue of the
 
 British Journal of Dermatology
 
 .




 Diamant Thaçi, M.D., Ph.D., from the University of Lübeck in Germany, and colleagues compared risankizumab to FAE treatment for psoriasis in a phase III randomized trial. Participants with chronic moderate-to-severe plaque psoriasis, who were naive to and candidates for systemic therapy, were randomly assigned to subcutaneous risankizumab 150 mg at weeks 0, 4, and 16 or oral FAEs at increasing doses from 30 to 720 mg daily (60 and 60 patients, respectively).




 The researchers found that at 24 weeks, significantly more patients randomly assigned to risankizumab achieved a ≥90 percent improvement in the Psoriasis Area and Severity Index (PASI) than those randomly assigned to FAEs (83.3 and 10.0 percent, respectively). Significantly more patients randomly assigned to risankizumab achieved ≥100 percent improvement in the PASI (50.0 and 5.0 percent, respectively); ≥75 percent improvement in the PASI (98.3 and 33.3 percent, respectively); ≥50 percent improvement in the PASI (100 and 53.3 percent, respectively); and the Static Physician's Global Assessment of clear/almost clear (93.3 and 38.3 percent, respectively). The FAE group had higher rates of gastrointestinal disorders, flushing, lymphopenia, and headache.




 "These results support the superiority of risankizumab to FAEs in producing clinically meaningful improvement in the extent and severity of psoriasis over time," the authors write.




 Several authors disclosed financial ties to AbbVie, which manufactures risankizumab and funded the study.




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Significantly more patients achieved ≥90 percent improvement in PASI at week 24 with risankizumab versus FAE

How Does Risankizumab Compare to Fumaric Acid Esters for Plaque Psoriasis?

Biosimilar drugs could drive down prices for biologic drugs and generate savings of about $38.4 billion between 2021 and 2025, according to a study published online Jan. 3 in the
 
 American Journal of Managed Care
 
 .




 Andrew Mulcahy, Ph.D., from RAND Corporation in Arlington, Virginia, and colleagues projected U.S. spending on biologics during a five-year period under three scenarios: (1) a baseline scenario holding quarter 4 (Q4) of 2020 market conditions constant; (2) under main assumptions allowing for biosimilar market growth and entry; and (3) an upper-bound scenario assuming greater biosimilar uptake, more robust price competition, and quicker biosimilar entry.




 The researchers found that estimated biosimilar savings from 2021 to 2025 under their main approach were $38.4 billion, or 5.9 percent of projected spending on biologics during the same period. An estimated $26.1 billion of savings was accounted for by biologics first facing biosimilar competition from 2021 to 2025, with $12.2 billion from evolving market conditions for already-marketed biosimilars. Under the main approach, $24.6 billion of savings were from downward pressure on reference biologic prices rather than lower biosimilar prices. Under the upper-bound scenario, savings were substantially higher ($124.5 billion).




 "Biosimilars have the potential to lower spending on biologic drugs that account for a rapidly increasing share of overall U.S. prescription drug spending," Mulcahy said in a statement.




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Increased market growth of biosimilars that are similar to brand-name biologic agents has the potential to reduce spending on prescription drugs

Biosimilars Could Cut Spending for Biologic Therapy in the U.S.

For patients receiving immune checkpoint inhibitors, cutaneous immune-related adverse events (cirAEs) are associated with survival, according to a study published online Jan. 12 in
 
 JAMA Dermatology
 
 .




 Kimberly Tang, from Massachusetts General Hospital in Boston, and colleagues examined the association of developing cirAEs following treatment with anti-programmed cell death 1 or anti-programmed cell death ligand 1 therapy with patient survival in a retrospective study. Data were included for 7,008 eligible patients who developed cirAEs after treatment for malignant neoplasms of digestive organs, bronchus or lung, melanoma of skin, and the urinary tract and 7,008 matched controls.




 The researchers found that using a Benjamini-Hochberg correction with a significance level of 0.05, pruritus, drug eruption, xerosis, nonspecific rashes, and appearance of any cirAE were significantly protective of mortality (hazard ratios, 0.695, 0.755, 0.626, 0.704, and 0.778, respectively). Psoriasis and lichen planus/lichenoid dermatitis were also significant (hazard ratios, 0.703 and 0.511, respectively). Strong protective clinical effects were seen for eczematous dermatitis, vitiligo, bullous pemphigoid, and Grover disease, but they did not reach statistical significance.




 "This cohort study suggests that cirAE development is a favorable clinical indicator and warrants further investigation into its underlying immunopathogenesis, which may provide further insights into immunotherapy response," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical industry.




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Improved survival associated with cirAEs for patients receiving anti-programmed cell death 1 or anti-programmed cell death ligand 1 therapy

Cutaneous Immune-Related AEs Linked to Survival After ICI Therapy

For patients with mild-to-severe actinic keratoses (AK) located on the extremities, trunk, and neck, nanoemulsion gel formulation containing 7.8 percent 5-aminolevulinic acid (BF-200 ALA) has superior efficacy compared with vehicle, according to a phase III study published in the December issue of the
 
 Journal of the American Academy of Dermatology
 
 .




 Martina Ulrich, M.D., from the CMB Collegium Medicum Berlin GmbH in Germany, and colleagues examined the efficacy and safety of BF-200 ALA compared to vehicle for the treatment of mild-to-severe AK located on the extremities, trunk, and neck in an intraindividual study conducted among 50 patients in six centers in Germany. Each patient received treatment with BF-200 ALA/red light photodynamic therapy (PDT) and vehicle/PDT on opposite sides, with a maximum of two PDTs.




 The researchers found that with respect to total lesion clearance rates (86.0 versus 32.9 percent) and patient complete clearance per patient's side (67.3 versus 12.2 percent), BF-200 ALA was superior to vehicle. The overall lesion recurrence rates at one year were 14.1 and 27.4 percent for BF-200 ALA and vehicle, respectively. Patient satisfaction with the cosmetic outcome was higher with BF-200 ALA/PDT than vehicle/PDT. Adverse events in association with BF-200 ALA/PDT were consistent with the known safety profile.




 "In line with our previous studies, the results demonstrated high efficacy with superiority to vehicle and confirmed good safety and tolerability and excellent cosmetic outcome," the authors write.




 Several authors disclosed financial ties to biopharmaceutical companies, including Biofrontera Bioscience GmbH, which funded the study.




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BF-200 ALA has high efficacy, excellent cosmetic outcome for patients with mild-to-severe actinic keratoses located on extremities, trunk, neck

Is BF-200 ALA Superior to Vehicle for Total Lesion Clearance in AK?

In CLEAR Derm consensus guidelines issued by the International Skin Imaging Collaboration Artificial Intelligence Working Group and published online Dec. 1 in
 
 JAMA Dermatology
 
 , recommendations are presented for imaging-based artificial intelligence (AI) algorithm development and assessment in dermatology.




 Roxana Daneshjou, M.D., Ph.D., from the Stanford School of Medicine in Redwood City, California, and colleagues guide developers and reviewers of dermatology AI by consolidating limited existing literature with expert opinion. Key recommendations were formulated and grouped into topics of data, technique, technical assessment, and application.




 The authors developed a checklist of items that outlined the best practices of image-based AI development and assessment. The checklist relating to data included image types, image artifacts, technical acquisition details, preprocessing procedures, synthetic images made public, adequate referencing of public images, patient-level metadata, skin tone information, potential biases, data set partitions, sample sizes, external test data, multivendor images, class distribution and balance, and images that are out of distribution. The checklist for techniques included labeling method, references to common/accepted diagnostic labels, histopathologic review for malignant neoplasms, and detailed description of the development of algorithms. Technical assessment included publicly evaluating algorithms; performance measures; benchmarking, technical comparison, and novelty; and assessment of bias. Finally, the application checklist included the use of cases and target conditions and potential impacts on the health care team and patients.




 "While we propose guidelines for clinical and peer-review evaluation of AI, these recommendations are also relevant for a regulatory framework and should be considered for any automated dermatology algorithm that may affect the wider community," the authors write.




 Several authors disclosed financial ties to the biopharmaceutical, technology, and health care industries; one author holds several related patents.




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Checklist for evaluation of image-based AI reports grouped into topics of data, technique, technical assessment, application

Recommendations Developed for Dermatology Artificial Intelligence

In episode 24 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, sits down with Sandra Lee, MD, aka Dr Pimple Popper.&nbsp;

In episode 24 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, sits down with Sandra Lee, MD, aka Dr Pimple Popper.&nbsp;The episode focuses on the state of the art concerning social media and dermatology and how resident dermatologists can create and improve their social media presence. Dr Lee discusses how to build a successful social media presence, including tips on the best kind of content to post and how to make the content compelling for your audience.&nbsp;Dr Lee and Dr Brownstone then focus on the issue of misinformation on social media within dermatology and skin care and how to address this problem. Dr Lee also discusses how to address and prevent criticism or counterattacks on social media and gives her thoughts on engaging in social media didactics during residency.&nbsp;The episode ends with Dr Lee giving clinical tips on how to perform tumescent anesthesia for resection of large skin lesions in clinic and advice on learning new procedures after graduating residency.&nbsp;You can’t miss hearing from one of the biggest stars in dermatology!&nbsp;Cutaneous Miscellaneous Board Booster!In this new feature, we’ll put your knowledge to the test with high-yield board review questions written by dermatology residents and fellows and sourced from key resources like Bolognia’s Dermatology, Andrews’ Dermatology, and Alikhan’s Review of Dermatology. These quiz questions will test your skills on the board review topic that’s discussed in each episode. Click <a href=" https://www.research.net/r/FNJY3YM?Email=[Email_value]" target="_blank" rel="noopener noreferrer">here</a><a href="" target="_blank" rel="noopener noreferrer"> </a>to begin.

Sandra Lee, MD

Cutaneous Miscellaneous Podcast

Dermatology Social Media: The State of the Art with Dr Sandra Lee

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews Cory Rubin, MD, dermatologist and owner of the Michigan Dermatology Institute, about the business side of running a practice, with specific focus on the buy-and-bill model.

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews Cory Rubin, MD, dermatologist and owner of the Michigan Dermatology Institute, about the business side of running a practice, with specific focus on the buy-and-bill model.&nbsp;Dr Rubin shares some of the challenges he has faced and explains the value of buy-and-bill for dermatologists, particularly in complex cases where medications may not be easily accessible through traditional pharmacies. They cover suitable medications, such as biologics for psoriasis, cutaneous T-cell lymphoma, and other conditions, as well as the financial benefits, clinical advantages, and patient convenience associated with in-office administration.&nbsp;The conversation dives into the practical aspects of implementing buy-and-bill. They explore the importance of understanding insurance processes, obtaining prior authorizations, and tracking patient outcomes. The pair emphasize the need to start small, gradually expanding buy-and-bill capabilities while ensuring proper documentation and reimbursement.&nbsp;Dr Rubin offers rich practical advice and reiterates the importance of mentorship and seeking assistance from experts in billing and reimbursement. He also extends an invitation for further consultation via email and expresses his willingness to support colleagues in navigating the complexities of practice management. This episode is a valuable listen for dermatologists looking to optimize their practice operations and enhance patient care through buy-and-bill.

Cory Rubin, MD

Derms and Conditions Podcast

Prescribed Success: Navigating Buy-and-Bill Strategies in Dermatology Practice

In episode 23 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, speaks with Terrence A. Cronin Jr, MD, FAAD, and President of the American Academy of Dermatology for 2023-2024 term.

In episode 23 of Cutaneous Miscellaneous, our host, Nicholas Brownstone, MD, speaks with Terrence A. Cronin Jr, MD, FAAD, and President of the American Academy of Dermatology for 2023-2024 term.The episode focuses on policy issues affecting dermatology residents now and in the future. Dr Cronin specifically discusses the Medicare physician pay cuts, misinformation on social media, scope-of-practice creep, and truth in advertising. Dr Brownstone asks Dr Cronin what dermatology residents and dermatologists can do to help fix these frustrating issues within our field.Dr Cronin also gives some highlights of his term as AAD president and discusses what he enjoyed most while serving as the leader of the largest dermatology organization in the world.If you care about the field of dermatology and where it’s headed, you can’t miss this episode! See the links below to get involved today. We need your help!<a target="_blank" rel="noopener noreferrer" href="https://www.aad.org/member/advocacy/priorities/medicare-physician-payment/medicare-payment-reform-webinar">Join the AAD</a> for an update on advocacy regarding Medicare physician payment cuts on February 20 at 7 PM CT.Urge Congress to stop Medicare physician payment cuts.&nbsp;Use the AAD’s <a target="_blank" rel="noopener noreferrer" href="https://takeaction.aad.org/takeaction/alertid/2456/">easy-to-use tool</a> to send a letter to your representatives in less than 1 minute! <o:p></o:p>

Terrence A. Cronin Jr, MD, FAAD

Shaping the Future: Insights from the AAD President on Dermatology’s Critical Issues

In Episode 63 of Derms and Conditions, our host, James Q. Del Rosso, DO, sits down with Adam Friedman, MD, to discuss some important topics in dermatology, including a comprehensive resource for portraying skin conditions and his research findings relating to sensitive skin.

In Episode 63 of Derms and Conditions, our host, James Q. Del Rosso, DO, sits down with Adam Friedman, MD, to discuss some important topics in dermatology, including a comprehensive resource for portraying skin conditions and his research findings relating to sensitive skin.Dr Friedman begins by describing his atlas project, created to address a gap in dermatology in the limited way textbooks and atlases portray skin conditions. The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas is a comprehensive resource that depicts dermatologic conditions across the full spectrum of skin tones to help dermatology professionals visualize the nuances in skin conditions.Next, Dr Friedman discusses his research on sensitive skin and how he puts his findings into practice with his patients. He details his global study that looked in-depth at sensitive skin and what factors trigger and exacerbate it, highlighting the importance of dermatologists having tools to assess the condition and provide management strategies. The pair also touch on guiding patients on the use of products for sensitive skin and utilizing samples.They conclude by discussing the importance of early intervention to prevent disease progression and the benefits of initiating more advanced therapies in earlier disease.Tune into this episode to hear more about what’s on Dr Adam Friedman’s mind!

Adam Friedman, MD

What is Dr Adam Friedman Up To Now?

Dermbusters: Emmy Graber, MD, MBA

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with acne and rosacea expert Emmy Graber, MD, MBA, about some common misperceptions they often hear from their patients.&nbsp;Dr Graber shares some tips on counseling patients on 2 topics: how diet impacts acne and advising patients on isotretinoin to wait 6 to 12 months before getting cosmetic procedures.&nbsp;Myth 1: Fried and fatty foods cause acne.&nbsp;Dr Graber addresses the widespread belief among patients that fried and fatty foods can induce acne. She acknowledges the challenges of studying diet’s impact on acne but shares a few tips on counseling patients based on published data.&nbsp;Tips for counseling your patients:&nbsp;<ul><li>Explain to patients that while some studies suggest a correlation between high-glycemic foods and acne for some individuals, the association is not universal&nbsp;</li><li>Emphasize the role of dairy products, particularly skim milk products, in exacerbating acne for some patients&nbsp;</li><li>For patients who can identify specific dietary triggers, give them the option of avoiding that food&nbsp;</li><li>Emphasize the uniqueness of individual responses to dietary triggers rather than making blanket statements&nbsp;</li></ul>Myth 2: Patients must wait at least 6 months following the use of isotretinoin before having any cosmetic or surgical procedures.&nbsp;Dr Brownstone and Dr Graber then discuss advising patients on isotretinoin on the often-recommended waiting period before undergoing any cosmetic or surgical procedures. Dr Graber challenges the traditional notion of waiting 6 to 12 months, relating a few discussion points to share with patients.&nbsp;Tips for counseling your patients:&nbsp;<ul><li>Cite a systematic review of over 32 studies and 1400 procedures1 that found no evidence supporting the need for a prolonged delay for cosmetic procedures following isotretinoin use&nbsp;</li><li>Advise patients that procedures like visible light lasers, hair removal, superficial chemical peels, and fractional and ablative lasers are safe while on isotretinoin&nbsp;</li><li>Counsel patients to follow the waiting period and delay more intense procedures like nonfractional lasers, deep dermabrasions, and deep chemical peels until there is more data available to support the safety of such procedures while on isotretinoin&nbsp;</li><li>Mention potential benefits of pulsed dye laser treatments for acne for patients concurrently on isotretinoin, noting not only safety but potentially improved outcomes&nbsp;</li></ul>Tune in to the episode to hear the full details on Dr Graber’s informed approach to counseling patients that embraces evidence-based practices to optimize care.&nbsp;Reference&nbsp;<ol><li>Spring LK, Krakowski AC, Alam M, et al. Isotretinoin and timing of procedural interventions: a systematic review with consensus recommendations. JAMA Dermatol. 2017;153(8):802-809. doi:10.1001/jamadermatol.2017.2077</li></ol>

Interview with Andrew Alexis, MD, MPH

In this episode of Under Your Skin, host Nicholas Brownstone, MD, chats with guest Andrew Alexis, MD, MPH, about the public perception of dermatology, therapeutic gaps for challenging pigmentary conditions, and balancing aesthetics and medical dermatology in the clinic.&nbsp;<h5>The incomplete public perception of dermatology&nbsp;</h5>They begin by discussing the public perception of dermatology, noting that the general public may not fully grasp the extent of dermatologists' contributions.&nbsp;Dr Alexis highlights the diversity of the specialty and its profound impact on individuals' lives. He emphasizes that dermatology encompasses a wide spectrum of care, ranging from aesthetics to inflammatory conditions, infectious diseases, and diagnosing internal diseases through cutaneous manifestations, noting the myriad ways in which dermatologists positively influence patients' well-being.&nbsp;<h5>Therapeutic gaps for pigmentary disorders&nbsp;</h5>Transitioning to therapeutic considerations, Dr Alexis acknowledges the remarkable recent advancements in dermatology. However, he underscores the persistent need for better therapies, particularly for pigmentary conditions such as lichen planus pigmentosus and erythema dyschromicum perstans, or ashy dermatosis. These challenging conditions pose treatment difficulties due to limited therapeutic options, and Dr Alexis expresses hope for future breakthroughs in identifying new targets and developing effective therapies to address these unmet needs.&nbsp;<h5>The intersection of aesthetics and medical dermatology&nbsp;</h5>Shifting focus to aesthetic dermatology, Dr Alexis provides insights into the evolving landscape of his practice. He shares that approximately 40% of his time is dedicated to performing aesthetic procedures, such as lasers, peels, and injectables, and that he anticipates a continued increase in the demand for aesthetic services over time. Many of Dr Alexis' aesthetics patients initially sought medical dermatology care but later returned for aesthetic procedures to address additional concerns. This trend underscores the intersection between medical and aesthetic dermatology and highlights the expanding role of dermatologists in meeting patients' diverse needs.

Interview with Sandra Lee, MD

In this episode of Under Your Skin, host Nicholas Brownstone, MD, gets to know renowned dermatologist and social media sensation Sandra Lee, MD, known by her fans as Dr Pimple Popper. Delving beyond dermatology, the duo explores alternative career paths, relaxation techniques after a hectic day in the clinic, and the best part of Dr Pimple Popper's unique role.&nbsp;<h5>Exploring alternative career paths&nbsp;</h5>When considering alternative career choices beyond dermatology, Dr Lee shares 2 possibilities. Firstly, she entertains the notion of a professional potato chip tester, drawn to the allure of indulging in salty snacks. Secondly, she contemplates a career in marketing, relishing the opportunity to exercise creativity and conceptualize innovative ideas.&nbsp;<h5>Finding balance in a busy profession&nbsp;</h5>Reflecting on methods to unwind post-clinic, Dr Lee details the significance of finding balance amidst the demands of professional and personal life. For Dr Lee, that means quality time with her family and cats; she also emphasizes the importance of finding time for self-care during a busy schedule.&nbsp;<h5>A fulfilling benefit of social media stardom&nbsp;</h5>Dr Lee finds fulfillment in her interactions with her young fans. She recounts instances of children visiting her office for birthday celebrations or casual encounters, inspired by the prospect of pursuing dermatology as a future vocation. Dr Lee finds profound gratification in fostering their interest in dermatology, underscoring the enduring impact of her role on future practitioners.

Dermbusters: Katherine Glaser, MD

In this episode of Dermbusters, host Nicholas Brownstone, MD, sits down with Katherine Glaser, MD, a dermatologic surgeon specializing in Mohs surgery, about some common misperceptions heard from both colleagues and patients.&nbsp;Dr Glaser shares some insights on 2 frequently misunderstood topics: the use of lidocaine with epinephrine in the fingers and toes and the role of sunscreen in vitamin D absorption.&nbsp;Myth 1: Dermatologists should not use lidocaine with epinephrine in the fingers and toes.&nbsp;Contrary to a commonly held belief among dermatologists, Dr. Glaser emphasizes that there is robust data supporting the safe use of lidocaine with epinephrine in the fingers and toes. Despite concerns about vascular ischemia and resulting necrosis, studies from both dermatology and plastic surgery literature demonstrate the safety of lidocaine with epinephrine.&nbsp;Tips for advising colleagues:&nbsp;<ul><li>Share the existing data and research findings that support the safe use of lidocaine with epinephrine in the fingers and toes&nbsp;</li><li>Highlight the lack of reported cases of ischemia with traditional lidocaine with epinephrine and contrast it with cases involving other substances, high concentrations of epinephrine, and improper tourniquet use&nbsp;</li><li>Emphasize the importance of adhering to safe injection practices, proper dosage, and avoiding direct arterial injection to mitigate any potential risks&nbsp;</li></ul>Myth 2: Sunscreen should not be used because it prevents absorption of vitamin D.&nbsp;Next, Dr Glaser addresses a common myth that dermatologists often hear from their patients: that they shouldn’t use sunscreen because it prevents them from absorbing an adequate amount of vitamin D. While sunscreen does block the UVB rays that aid in vitamin D synthesis, the AAD advises against UV exposure solely for the purpose of absorbing vitamin D.&nbsp;Tips for counseling your patients:&nbsp;<ul><li>Explain that while sunscreen may affect vitamin D absorption, it's not a reason to skip it&nbsp;</li><li>Highlight alternative sources of vitamin D, such as diet and supplements&nbsp;</li><li>Encourage wearing sunscreen consistently and correctly&nbsp;</li><li>Stress the importance of protecting the skin from harmful UV rays to prevent skin damage and reduce the risk of skin cancer</li></ul>

Interview with James Q. Del Rosso, DO

In this episode of Under Your Skin, host Nicholas Brownstone, MD, chats with James Q. Del Rosso, DO, who shares anecdotes and insights from his dermatology career on rare diseases, the benefits of being a dermatologist, and the outlook on treatments for challenging conditions.&nbsp;<h5>Encounters with a rare disease&nbsp;</h5>Dr Del Rosso recounts an anecdote from his internship when he encountered a patient with a rare disease he had never seen before—cytophagic histiocytic panniculitis (CHP). Despite its rarity, Dr Del Rosso encountered CHP again the following year, where, as a first-year resident, he was able to surprise a leading dermatologist by correctly diagnosing this rare condition.&nbsp;<h5>The dermatologist’s advantage&nbsp;</h5>Dr Del Rosso highlights the autonomy and diversity the field offers. Dermatologists have the flexibility to cater to patients of all ages and can choose to specialize in various areas such as cosmetic, medical, or surgical dermatology. This autonomy extends to their practice setting and scheduling, allowing for a fulfilling and adaptable career.&nbsp;<h5>Advancing care for challenging conditions&nbsp;</h5>Discussing areas where better medications are needed, Dr Del Rosso reflects on past challenges with conditions like hidradenitis suppurativa, vitiligo, and alopecia areata, where treatment options were limited. However, he expresses optimism about recent advancements in medication development, particularly in JAK inhibitors and monoclonal antibodies. He emphasizes the significant strides being made, providing much-needed additions to the dermatologist’s toolbox when treating patients with these challenging conditions

Interview with Doris Day, MD, FAAD

In this episode of Under Your Skin, host Nicholas Brownstone, MD gets to know Doris Day, MD, FAAD, a dermatologist specializing in laser, cosmetic, surgical, and aesthetic dermatology. Dr Day offers tips on guiding conversation with difficult patients, gives her thoughts on an emerging trend in dermatology, and shares her approach to a healthy work-life balance.&nbsp;<h5>Understanding the demanding patient and guiding the conversation&nbsp;</h5>Dr Day approaches interactions with demanding patients with empathy and understanding. Rather than viewing them as difficult, she recognizes their need to be heard and understood. By empathizing with their anxieties, expectations, and budget constraints, she transforms demanding patients into supportive allies.&nbsp;She also believes in transparent communication and education. Instead of persuading patients into treatments, she informs them about their options and recommends a holistic approach. Starting conversations with compliments helps ease tension and facilitates open dialogue. By striking a balance between meeting patients where they are and being honest about what can be achieved, Dr Day guides conversations with these patients effectively. Sometimes, she acknowledges when she might not be the right fit for a patient, prioritizing ethical practice over profit.&nbsp;<h5>A trend towards dermatology’s expanding scope&nbsp;</h5>When discussing emerging trends in dermatology, Dr Day says she looks forward to the expanding scope of the field. She emphasizes the importance of recognizing the value of appearance, noting that while many common dermatologic conditions are not life-threatening, they still profoundly impact a patient’s overall well-being and self-confidence.&nbsp;As the population gains a better understanding of general health, Dr Day foresees a future where dermatologists play a crucial role in enhancing healthspan through a holistic approach that integrates skin care, lifestyle modifications, and preventive healthcare.&nbsp;<h5>Avoiding burnout with an integrated approach to life&nbsp;</h5>To avoid burnout, Dr Day advocates for an integrated approach to life. Balancing her professional commitments with personal interests, such as family, allows her to find fulfillment. She advises against setting goalposts that must be achieved before pursuing the next goal and instead suggests a more balanced approach to the work-life relationship.&nbsp;She emphasizes the need to compartmentalize stress and prioritize self-care. By consciously separating work-related concerns from personal life, Dr Day maintains emotional well-being and prevents burnout.

Interview with Lisa Swanson, MD

In this installment of Under Your Skin, host Nicholas Brownstone, MD, sits down with Lisa Swanson, MD, to hear her commentary on what she loves most about being a dermatologist, her tips on dealing with demanding patients, and what conditions we still need better treatments for in dermatology.&nbsp;<h5>A passion for dermatology&nbsp;</h5>Dr Swanson's journey into dermatology is deeply rooted in childhood experiences growing up with her urologist father. She was exposed to the medical world early through manually organizing and filing her father's research articles and was impacted by his perspectives on medical practice, which became a driving force in her decision to become a doctor.&nbsp;Dr Swanson sees herself practicing in the "golden age of dermatology," driven by the profound impact dermatologists can have on improving patients' lives.&nbsp;<h5>Dealing with demanding patients&nbsp;</h5>Addressing the challenge of demanding patients, Dr Swanson emphasizes 2 crucial elements: listening and accessibility.&nbsp;As a pediatric dermatologist, she makes sure to allocate ample time for appointments with potentially demanding parents. This ensures that she’s able to listen thoroughly to their concerns without these extended encounters impacting her ability to stay on schedule in clinic.&nbsp;Regarding accessibility, Dr Swanson encourages email communication with her more demanding patients, establishing a connection that helps diffuse tension by offering them an easy way to ask questions.&nbsp;Drs Brownstone and Swanson acknowledge that doctors may be hesitant to share contact information in this way for fear that patients will abuse it; however, they both agree that patients are usually reassured simply by having access to this valuable outlet and thus rarely overuse it.&nbsp;<h5>Improving the treatment landscape for challenging conditions&nbsp;</h5>Dr Swanson identifies 3 conditions in need of better treatment options in dermatology. Hidradenitis suppurativa presents challenges for many patients despite existing treatments, though she anticipates more solutions in the coming years.&nbsp;She also feels alopecia areata and vitiligo need improved medication options. However, both appear to be on the cusp of a treatment revolution, particularly with the promising developments in JAK inhibitors.

Use of OTC Products in Your Practice

Joslyn Kirby, MD, walked us through how to manage patient expectations and social perceptions when “prescribing” over-the-counter products in practice. She started with evidence-based treatments for itch, specifically the use of second-generation antihistamines for chronic spontaneous urticaria. While hydroxyzine and lorazepam require prescriptions prior to procedures, diphenhydramine can be kept in the office and used 30 minutes prior at 25-mg to 50-mg dosages for anxiety. She also gave us the recipe for orange juice mixed with 10 x 50 mg naltrexone tablets, which can be dosed in 1-tsp (5-mL) quantities for various pruritus-inducing dermatoses, though patients should be counseled on vivid dreams and headaches. &nbsp; Dr Kirby had even more hacks for our patients as she presented a study from JAAD that demonstrated that salicylic acid improves the penetration of topical steroids. N-acetyl cysteine functions as a glutamate modulator and antioxidant but has demonstrated efficacy for treatment of picking disorders at 600 mg to 2400 mg daily. If picking becomes pimples, an alternative to antibiotics is zinc gluconate at 90 mg daily for more conservative patients with acne. Pimple patches are also remarkable at keeping hands away from these lesions. Her last pearls are to try out adapalene for acanthosis nigricans, which has more evidence than calcipotriol, and don’t forget to recommend compression stockings, which can be layered at lower strengths for ease of application.&nbsp;

The Newest in Dermatology: Acne, Atopic Dermatitis, Actinic Keratoses, Psoriasis, Skin Cancer, and More

A much-anticipated session with Drs Del Rosso, Lebwohl, and Zeichner reviewed the hottest new trends and therapeutics for multiple common dermatoses. Starting with acne, results from a clinical trial with the triple-combination gel with clindamycin, adapalene, and benzoyl peroxide were shown, touting a dramatic reduction in inflammatory and noninflammatory lesions by week 4. &nbsp;For psoriasis, 3-year safety data has been published on bimekizumab, noting 18.5 events per 100 person years in the first year on the IL-17A and F inhibitor. Spesolimab has been shown to decrease flares in generalized pustular psoriasis with those who were started on high-dose spesolimab with a GPPGA score of 0 or 1 remaining flare-free for 48 weeks after week 4 of dosing. Deucravacitinib also has long-term efficacy data from clinical trials, with patients who achieved a PASI75 and PASI90 generally maintaining response for 3 years.&nbsp; The speakers moved on to discuss updates in atopic dermatitis including delgocitinib cream for chronic hand eczema, which tripled those obtaining IGA treatment success by week 8 when compared to placebo. For standard atopic dermatitis, response to abrocitinib may be predicted by week 4, and, for those who don’t achieve an EASI-50 reduction by this time point, dose-escalation to 200 mg should be considered. Tapinarof 1% cream has significant efficacy in children 2 years and up all the way to adults in atopic dermatitis. In a review of novel medications for a few other conditions, the efficacy of roflumilast foam for seborrheic dermatitis, which allowed 79% to obtain IGA success by week 8 compared to 48% using vehicle alone, was covered, along with the improvements of eyelash and eyebrow growth in patients with severe alopecia areata on baricitinib. Deuruxolitinib is another JAK inhibitor undergoing clinical trials for this condition. For chronic spontaneous urticaria, dupilumab improves itch and omalizumab improves sleep.&nbsp; Other advances in dermatology that were covered in this presentation centered around the improvements in gene expression tests. This may lead to advances in difficult-to-diagnose conditions like mycosis fungoides. The 2-GEP assay has a negative predictive value of 99.7%, indicating it can be used to rule out melanoma. &nbsp;

Interview with Muneeb Shah, DO

In this episode of Under Your Skin, host Nicholas Brownstone, MD, chats with Muneeb Shah, DO, to explore some valuable advice for residents, effective time management techniques, and strategies for advertising your practice.&nbsp;<h5>What advice would you give someone just beginning residency?&nbsp;</h5>Dr Shah begins by reflecting on his residency experience, likening it to "drinking from a fire hose" due to the overwhelming influx of information. His key advice to residents is to seize this period as a valuable learning opportunity. He emphasizes the importance of asking questions and seeking insights not only on clinical matters but also on aspects like billing and operations. He encourages residents to attend conferences, network, and absorb as much knowledge as possible, as the intensity of post-residency responsibilities may leave little room for catching up on missed learning opportunities.&nbsp;<h5>What are your most useful time management techniques?&nbsp;</h5>Acknowledging his own journey to improve time management, Dr Shah underscores the significance of building a supportive team. Delegating tasks that may not be the best use of one's time to qualified team members, whether an office manager or medical assistant, allows for more efficient and strategic use of time. Additionally, he advocates for creating systems within the office to streamline patient interactions, suggesting the implementation of codes to prompt assistance when spending excessive time with a patient. Dr Shah's insights highlight the long-term benefits of optimizing team dynamics and establishing efficient office protocols.&nbsp;<h5>How do you advertise your practice?&nbsp;</h5>Dr Shah acknowledges the benefit having a large social media following has in attracting patients; however, he notes that patients discovered through social media tend to be more complex. They often seek him out after other dermatologists were unable to solve difficult-to-treat issues and have higher expectations.&nbsp;He also notes that despite having a large social media following, targeting a specific geographic area remains a challenge. Considering that, Dr Shah does not dismiss traditional advertising methods like door-to-door marketing and business card distribution to local family physicians and businesses, noting that he has seen significant success with these tactics.

Dermbusters: Anthony Rossi, MD

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with Anthony Rossi, MD, about some common misperceptions they often hear from their patients.&nbsp;Dr Rossi shares some suggestions on how to counsel patients on 3 significant topics: a misconception surrounding higher-percentage medications, the proper use of facial cleansers, and the necessity of wearing sunscreen during the winter months.&nbsp;<h5>Myth 1: Higher-percentage ingredients mean a medication is more efficacious.&nbsp;</h5>Dr Rossi begins by addressing the prevalent belief that higher percentages of ingredients in medications indicate greater efficacy. Contrary to this notion, he emphasizes that the right amount, rather than the highest percentage, is the key to achieving optimal results.&nbsp;Patients are advised to focus on key or active ingredients, striking a balance between not being the first or last listed in a formulation. Striving for a middle ground ensures effectiveness without causing unnecessary irritation.&nbsp;Tips for counseling your patients:&nbsp;<ul><li>Advise them to look at their product’s ingredient list. The active ingredient should neither be the first nor the last listed. Being the first suggests it's the highest percentage, while being the last indicates it's the lowest. Suggest they aim to find a product with the active ingredient listed somewhere in the middle.&nbsp;</li><li>Caution them that certain ingredients, such as vitamin C, can actually be irritating in higher concentrations.&nbsp;&nbsp;</li></ul><h5>Myth 2: You must wash your face for 60 seconds for maximum effectiveness.&nbsp;</h5>Dr Rossi supports this popular notion that washing the face for at least 60 seconds maximizes impact, with one important caveat: water alone is not an effective cleanser.&nbsp;He emphasizes the importance of a good cleanser and advises patients to focus on contact time; he recommends keeping cleanser on the face for at least 60 seconds to allow the active ingredient to work.&nbsp;Tips for counseling your patients:&nbsp;<ul><li>Advise patients not to wash with water alone, especially if they wear makeup or live in an urban environment and are exposed to daily pollution.&nbsp;</li><li>Suggest they apply their cleanser, let it become sudsy, then brush their teeth before washing it off. This ensures the cleanser is making contact with their skin for at least one minute.&nbsp;&nbsp;</li></ul><h5>Myth 3: Sunscreen isn’t necessary in the winter.&nbsp;</h5>Next, Dr Rossi addresses a myth that dermatologists hear often: sunscreen isn’t necessary in the winter or on cloudy days. Dr Rossi underscores that significant amounts of both UVA and UVB rays can still reach the skin even in the winter months and that sun protection is still important.&nbsp;Tips for counseling your patients:&nbsp;<ul><li>Show them images from the New England Journal of Medicine article “Unilateral Dermatoheliosis” by Gordon et al, which showcases photoaging on one side of a truck driver’s face and serves as an impactful visual aid that UVA can be transmitted through window glass.</li><li>Explain that the light reflection from snow can amplify sun exposure when engaging in outdoor winter activities.&nbsp;</li><li>Advise them to look for a sunscreen that offers both an SPF of 30 or higher and UVA protection.&nbsp;</li></ul>

Interview with Terrance A. Cronin Jr, MD

In this episode of Under Your Skin, host Dr Nicholas Brownstone is joined by Dr Terrence A. Cronin Jr, the president of the American Academy of Dermatology for the 2023-2024 term, to discuss the impact of social media on dermatology, strategies to avoid burnout, and one of the most pressing challenges facing dermatologists today—physician reimbursement.&nbsp;<h5>Social media's influence on dermatology&nbsp;</h5>One significant topic discussed in the episode is the influence of social media on the field of dermatology. Dr Cronin expresses concern about individuals presenting themselves as skin experts without the necessary background or education, spreading misinformation through platforms like TikTok and Instagram. To counter this, the American Academy of Dermatology (AAD) has initiated the "Your Dermatologist Knows" program, which features ambassadors who actively address public concerns on AAD social media sites with scientifically studied and professional responses. The goal is to combat misinformation and ensure accurate information reaches the public.&nbsp;Additionally, Dr Cronin cautions dermatologists who engage with social media regarding maintaining their professional standing, noting that involvement in social media may be perceived as unprofessional or lead to the inadvertent sharing of information that could be used against dermatologists in their professional future.&nbsp;<h5>Combating burnout in dermatology&nbsp;</h5>Dr Cronin emphasizes the importance of dermatologists finding outlets beyond their daily work to prevent burnout. Given that dermatologists are visual learners who excel at recognizing patterns, he suggests engaging in activities slightly outside the norm. His recommendations include exploring artistic outlets such as music or creative writing. These activities can serve to stretch creativity and reengage the part of the brain worn down by day-to-day work.&nbsp;<h5>The biggest challenge facing dermatology today&nbsp;</h5>The central issue highlighted in the episode is the broader challenge facing dermatology and the medical profession in general. Dr Cronin points out that physicians, including dermatologists, are grappling with inflation and physician reimbursement cuts imposed by the government. Physicians are notably the only group within the medical-industrial complex not receiving an inflationary update from the federal government. As inflation rises, hospitals, nursing homes, and inpatient and outpatient facilities receive increased payments, creating a financial gap that physicians struggle to bridge.&nbsp;The episode concludes with a call to action, urging physicians and patients alike to reach out to their congressmen and advocate for change. AAD members can visit <a target="_blank" rel="noopener noreferrer" href="https://takeaction.aad.org/">https://takeaction.aad.org/</a> to easily contact their congressmen and can also advocate on social media with the hashtag #fixmedicarenow to add their voices to this vital call for action.

Get Involved with Camp Discovery 

In this special edition of Topical Conversations, Charlie Dunn, MD, provides an overview of the American Academy of Dermatology’s (AAD) Camp Discovery and how you can get involved with this uniquely valuable experience for pediatric patients.&nbsp;<a target="_blank" rel="noopener noreferrer" href="https://www.aad.org/public/public-health/camp-discovery/support-camp">Applications are open until April 2, 2024</a>, representing a chance to make a lasting impact on the lives of children with chronic skin conditions.&nbsp;What is Camp Discovery?&nbsp;Established in 1993 by the AAD, this multisite, weeklong program offers children living with chronic skin conditions a unique summer camp experience. Provided at no cost to families, Camp Discovery welcomes pediatric patients with conditions including eczema, psoriasis, vitiligo, alopecia, epidermolysis bullosa, ichthyosis, and more.&nbsp;An invaluable experience for children with chronic skin conditions&nbsp;Studies have demonstrated that after participating in Camp Discovery, children with chronic skin conditions have a better understanding of their condition, improved symptom control, better social functioning, and higher overall quality of life.&nbsp;Benefits for the clinician&nbsp;The benefits of Camp Discovery extend beyond the campers; medical volunteers also experience a substantial positive impact by participating. One study demonstrated that 97% of medical volunteers encountered skin conditions at Camp Discovery they had not previously seen, and 93% report it as one of the best rotations they’ve undertaken.&nbsp;Engaging in this program opens doors to networking opportunities, establishes lifelong mentor-mentee relationships, enhances knowledge of complex diseases, and fosters multidisciplinary communication.&nbsp;Importantly, this opportunity is not exclusively for pediatric specialists; volunteers include both adult and pediatric dermatologists who span medical, cosmetic, and surgical dermatology.&nbsp;How to get involved&nbsp;<ol><li><a target="_blank" rel="noopener noreferrer" href="https://www.aad.org/public/public-health/camp-discovery/support-camp">Be a volunteer</a>: Sign up to be a medical volunteer and contribute your expertise to this life-changing experience.&nbsp;</li><li><a target="_blank" rel="noopener noreferrer" href="https://assets.ctfassets.net/1ny4yoiyrqia/4dZtocRVr0c4e6KgGF902i/555ea543e7baf10e3c26dd1136d4eff7/camper-referral-form.pdf">Refer your patients</a>: Encourage your patients to apply and witness the transformative impact of Camp Discovery on their lives.&nbsp;</li><li>Change a life: By participating, you have the power to make a positive difference in the lives of children.</li></ol>

What's New in JAMA Derm

April Armstrong, MD filled this jam-packed session with treatments and techniques to use in difficult dermatoses. She started by detailing a multi-sectioned retrograde injection of certolizumab (total 60mg in 0.3mL) every 4 weeks for 3 months for refractory lupus pernio, and then moved on to another resistant disease, palmoplantar pustulosis. Guselkumab, risankizumab, and brodalumab are all approved for palmoplantar pustulosis internationally, though topical steroids remain the most commonly prescribed treatment in a review of almost 200 patients. In a case report, tocilizumab, an IL-6 receptor inhibitor, was used for corticosteroid-refractory immune checkpoint inhibitor-induced generalized morphea. Botulinum toxin A was used to treat primary palmar hyperhidrosis but effectively cleared concomitant yellow nail syndrome in another case report.&nbsp; Another few case reports showed promising results of JAK-inhibitors for novel indications. Netherton syndrome, a rare autosomal recessive skin disease characterized by hair shaft defects and ichthyosis, was treated successfully with abrocitinib, while a patient with epidermolysis bullosa acquisita who failed high dose prednisolone and methotrexate was treated successfully with tofacitinib, allowing him to taper prednisolone to 5mg at 20 months. Severe lupus miliaris disseminatus, a facial granulomatous skin disease, that was unresponsive to oral doxycycline and topical ivermectin, responded to topical ruxolitinib 1.5% cream.&nbsp; Moving on to more common clinical syndromes, Dr. Armstrong detailed a needle-free injection technique of 5-flurouracil for verruca vulgaris which involves paring with a scalpel without reaching bleeding point and then using a spring loaded mixture of 5-FU and lidocaine into each wart. Two treatments led to complete resolution without hyperpigmentation. She also covered the hot topic of venous thromboembolism in atopic dermatitis patients on JAK-inhibitors. In a meta-analysis of 466,993 patients of patients with AD, 3 of 5722 (0.05%) on JAK inhibitors experienced VTE compared with 1 of 3065 (0.03%) receiving placebo or dupilumab, indicating no increased risk of VTE in AD patients.&nbsp;

Clinical and Therapeutic Pearls in Medical Dermatology

This is always a favorite multispeaker session that provides useful pearls on a wide range of dermatologic diagnoses and therapeutics. Boni Elewski, MD kicked off this session by discussing a popular option for alopecia, minoxidil, which in a combined review of 17 studies and over 630 patients showed efficacy in androgenic alopecia, telogen effluvium, lichen planoilaris/frontal fibrosing alopecia, alopecia areata, and chemotherapy induced hair loss. A larger review (n=1404) of adverse events with low-dose minoxidil highlighted hypertrichosis and effects related to the drugs impact on blood pressure like light-headedness, tachycardia, and fluid retention (all &lt;2%), the latter of which Dr. Elewski recommended could be ameliorated with the addition of spironolactone. Rarely, the drug has been linked to generalized anasarca including pericardial and pleural effusion.&nbsp; The next pearls focused on treatment of actinic keratoses and the efficacy of PDT, imiquimod, 5-FU, and other treatments. Dr. Pariser delved into the reasons behind different reported reduction rates between trials including patient adherence, the addition of curettage before PDT, and the grades of AKs studied. Other PDT pearls to enhance efficacy are to use heat, “thermal PDT”, prior to treatment and occlusion on the extremities. He also covered a novel phase 3 trial that used PDT for superficial BCC successfully. Giving answer to an pertinent clinical question, Dawn Merritt, DO presented data from a prospective multicenter study examining patch test results before and during dupilumab treatment (n=36); results were 83% congruent with 3.6% turning negative i.e. patch tests maintain reproducibility. She also covered chronic urticaria and reported that omalizumab can be uptitrated to 600mg or dosed every 2 weeks for uncontrolled patients. For patients with 6-9 months without attacks, she recommended decreasing dosage by 150mg monthly until the patient is on 150mg monthly at which point the interval can be widened to 6 weeks before stopping entirely. After discontinuation, if the patient does flare, luckily there is a strong recapture rate at normal dosing levels.&nbsp; For the clinician, tips for practice were to use a scribe both to minimize charting time and maximize patient volume, and to try placing steri-strips parallel to incisions to help brace external sutures in thin and friable tissue. Though research on biotin supplements is conflicting, many patients take these vitamins, sometimes in high doses which can impact various laboratory results. Dr. Elewski explained that high doses of biotin can lead to the misdiagnosis of hyperthyroidism by impacting streptavidin-biotin based immunoassays and cause both falsely low and high troponin levels, depending on the test used. Patients should halt supplements at least 72 hours prior to scheduled testing when possible.&nbsp;Dr. Nguyen covered a few unique treatment indications including dupilumab for bullous pemphigoid at standard AD dosing, apremilast for generalized granuloma annulare, and topical ruxolitinib for connective tissue diseases like CLE and dermatomyositis. He also proposed a few atypical medication formulations such as topical cyclosporine, 100mg capsules of which can be compounded with 100% vitamin E oil, for PG which improved both ulcers and patient symptoms in 6 of 7 patients in a case series. Another case series he presented treated toxic erythema of chemotherapy and radiation dermatitis with very high doses of vitamin D (50,000-100,000IU).&nbsp;

60 Tips in 60 Minutes - Day 3:  Acne, Psoriasis, Eczema, Urticaria, Skin Cancer and Office Management 

For the final round of 60 tips in 60 minutes, inflammatory skin diseases, rare infectious diseases, and with a few general life pearls were delivered. Mark Lebwohl, MD reviewed a few highly recalcitrant disease treatments including penicillin to decrease recurrence of cellulitis and timolol gel for chronic venous leg ulcers. Timolol ophthalmic solution (0.5%) applied topically can also be used for hypergranulation seen in hidradenitis suppurativa, Dr. Kirby told us. Other tips in the management of HS include utilizing the HS foundation website which has prior authorization templates for a variety of systemic drugs and laser hair removal.&nbsp; Dr. Stein Gold covered two RCTs for topical atopic dermatitis medications: roflumilast and tapinarof. She also reviewed promising long-term results from the 1726nm laser for acne in 104 subjects followed for 12 months. Lesion clearance and IGA were improved at the 12 month mark post treatment even compared to 3 months after completion of the regimen. A few new infectious etiologies were brought to our attention by Dr. Tomecki, including Orf virus, a pox virus, which leads to contagious ecthyma contracted from sheep, goats, oxen, and reindeer, as well as talaromycosis, a soil-dwelling fungus.&nbsp; Our hair loss pearls in this session were delivered by Dr. Leavitt who covered dutasteride in depth. He started by reviewing a series of patients with frontal fibrosing alopecia (n=224) who were followed for at least 12 months while on dutasteride or another systemic therapy, such as hydroxychloroquine, doxycycline, and isotretinoin. Those on dutasteride had higher stabilization rates than the other groups, around 60% in all scalp regions. Dutasteride for androgenic alopecia was also deemed superior to finasteride and minoxidil, but he recommended combination therapy for maximal benefit. Dr. Siegel gave us a helpful clinical pearl to scrape rather than clip nails for a KOH prep. Leaving us with a few real life warnings, he recommended backing up our documents and photos often and taking steps, like ultra-wideband technologies in tags and cards, to prevent us from losing our electronic devices for those of us who seem to misplace things all too often.

What's New in the Medicine Chest? Acne, Rosacea, Actinic Keratoses, Psoriasis, Urticaria and Other Common Dermatoses

Dr. Del Rosso led an engaging and data-driven session on new therapeutics and updated guidelines, though he did remind us that while new medications are constantly in development, many tried-and-true formulations remain the anchored in treatment algorithms. The art of medicine is determining when dupilumab, for example, remains an excellent choice, where topical corticosteroids fit into a regimen, and which patient needs something more nuanced. He started his presentation by reviewing topical medications for itchy and inflammatory conditions, such as topical ruxolitinib which shows significant impact on patient report of itch in AD in even 2 days. Topical tapinarof, an acrylic hydrocarbon receptor modulator, works by regulating Th2 cell differentiation as well as reducing resident memory T-cell generation. In 2023, an 8 week RCT in &gt;= 2 year olds showed significant impact on IGA, EASI, and Itch scores in AD though follicular events are a pertinent side effect that can be minimized by avoiding normal skin and applying a thin layer of the ointment. Further, as a steroid sparing agent, tapinarof’s usage in intertriginous psoriasis in a phase 4 trial showing iPGA of 0 at week 12 in 65% of patients is particularly vital. Topical PDE4 inhibitors, which interrupt the inflammatory cAMP pathway, are another steroid-sparing agent, and roflumilast has shown efficacy in seborrheic dermatitis, psoriasis, and atopic dermatitis. A long-term open label extension study using roflumilast 0.15% twice weekly maintained efficacy in about 50% of patients, defined as an IGA of 0 or 1, with AD. For psoriasis, the cream at 0.3% achieved PASI 75 in 40.3% and a PASI-HD-75 in almost 60%, a more precise assessment of severity when BSA&lt;10%. Roflumilast 0.3% foam was also used effectively for skin and scalp seborrheic dermatitis. No relation to diarrhea has been seen with the topical formulations. Systemic players are nemolizumab, the IL-31 inhibitor, which interrupts the itch cycle at the immune and nervous system level, lebrikizumab, the IL-13 inhibitor that is a promising new injection for atopic dermatitis, and bimekizumab, the IL-17A and IL-17F inhibitor that shows dramatic clinical efficacy rapidly in plaque psoriasis, with 90% of patients achieving PASI 90 by week 16. While medications for inflammatory conditions can lessen symptoms and signs, many patients, after achieving control, wonder if treatment can be stopped and remain in remission. Dr. Del Rosso addressed this question starting with dupilumab, which has data to support prolonging dosing to every 4 weeks if atopic dermatitis is well controlled. However, new systemic medications may be able to target memory T cells which perpetuate eczema flares in atopic, but normal appearing, skin. Rocatinlimab, the OX-40 inhibitor, is one of these potentially disease-modifying drugs, as the OX40 pathway promotes differentiation of activated effector T cells into memory cells. Amlitelimab, the OX-40L inhibitor, is another such medication currently under study with 40% and 60% of patients achieving an EASI 75 at Week 16 and Week 24 respectively. These pathways may not be as rapid as JAK inhibitors, but more data is required to assess if they can truly lead to a period of disease-free remission after dosing.&nbsp;

60 Tips in 60 Minutes - Day 1: Acne, Psoriasis, Eczema, Urticaria, Skin Cancer and Office Management

Our first full day in Hawaii commenced with this favorite multispeaker session covering clinical pearls, novel treatments, and medication side effects. Clay Cockerell, MD, educated us on dermatoses with atypical histologic findings such as photodermatitis with minimal inflammatory infiltrate or a subepidermal blistering disorder in older patients with DIF-negative and cell poor findings often in relation to NSAID usage. He also detailed the shift to grade dysplastic nevi as low- or high-grade, the latter requiring excision and reevaluation.&nbsp;On all things hair loss, Dr Leavitt reviewed trichoscopy findings of androgenetic alopecia, lichen planopilaris, and CCCA. He recommended trialing minoxidil for at least 6 months for multiple subtypes of alopecia. One small trial (n=89) did not show significant impact on blood pressure. Joslyn Kirby, MD, recommended trialing adapalene 0.1% for acanthosis nigricans and gave us an easy tip for picking patients, including children with atopic dermatitis and adults with acne: hydrocolloid patches. N-acetyl cysteine, though it can cause GI upset, can also be used for picking patients dosed at 600 mg to 2400 mg daily. Dr Green gave us some tips on prescribing antibiotics for acne, including adding a probiotic after dosing, preferably the liquid formulations, and to minimize treatment to 3 months. Spironolactone may also be a viable antibiotic-sparing treatment even for nonhormonal acne.&nbsp;Dr Lebwohl showed us 2 multicenter RCTs using cantharidin in molluscum contagiosum with superior clearance response in the head/neck and groin regions. He also covered a review of laboratory tests in chronic urticaria and angioedema, which very rarely impact management. All doses of omalizumab significantly improved itch severity score in patients with antihistamine-refractory chronic urticaria and spontaneous urticaria, and the risk of anaphylaxis with this medication is estimated to be 0.2% from reports of about 57000 patients. For those with uremic pruritus or notalgia paresthetica, a new medication, difelikefalin, has dramatically impacted itch scores as soon as one week in multiple RCTs and may be useful in patients with refractory itch in atopic dermatitis.

60 Tips in 60 Minutes - Day 2: Acne, Psoriasis, Eczema, Urticaria, Skin Cancer and Office Management

While blood work is often unnecessary to diagnose most alopecia subtypes, Dr. Leavitt did explore the association between vitamin D deficiency and insufficiency in CCCA which could be an easy target for supplementation if studies examine the impact on this progressive disease course. Linda F. Stein Gold, MD went through some clinical pearls on atopic dermatitis, reporting that patients often can complain of itch even after skin lesions resolve and that failing one biologic doesn’t necessarily preclude success with another. &nbsp;Shifting to skin and soft tissue infections, Dr. Tomecki recommended against antibiotics unless in a high-risk patient, severe or system, or otherwise complicated, preferring incision and drainage as first-line treatment. Further, compression stockings may prevent recurrent cellulitis.Some new medications covered in this section were sonidegib, a hedgehog pathway inhibitor, for advanced basal cell carcinoma, nemolizumab for prurigo nodularis, and dupilumab for chronic pruritus of unknown origin all presented by Dr. Lebwohl. Aphthous stomatitis was effectively treated with vitamin B12 and apremilast in two RCTs. Dr. Green also gave us some surgical tips like using intradermal sutures for closures on the back to improve closures and when, why, and how to document appropriate undermining.

Interview with Joslyn R. Sciacca Kirby, MD, MEd, MS

In this episode of Under Your Skin, host Dr Nicholas Brownstone engages in a conversation with Dr Jocelyn Kirby to explore strategies for avoiding burnout, time management techniques in clinic, and advice for dermatology residents.&nbsp;<h5>How do you avoid burnout?&nbsp;</h5>One key insight from Dr Kirby is the significance of staying connected to the purpose behind her work—the patients. By seeing patients as individuals rather than just by appointment times or medical conditions, she finds a deeper sense of fulfillment. Taking the time to understand her patients on a personal level becomes a meaningful antidote to burnout.&nbsp;<h5>What is your favorite time management technique in clinic?&nbsp;</h5>When discussing time management techniques in the clinic, Dr Kirby acknowledges the inevitability of occasionally falling behind schedule. Despite this, she stresses the importance of being present in the moment with each patient. By focusing entirely on the individual she is currently counseling, she avoids distractions related to previous or upcoming appointments, ensuring that each patient receives her full attention and care.&nbsp;<h5>If you could go back in time to your first day as a dermatology resident, what advice would you give yourself?&nbsp;</h5>Reflecting on her own journey as a dermatology resident, Dr Kirby recognizes the prevalence of imposter syndrome among her peers. She <a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(19)32901-9/fulltext">collaborated on a project</a> with a colleague, Dr Paul Riegen, and discovered that around 90% of dermatology residents experience imposter syndrome, a phenomenon that often extends beyond residency. Her advice to her younger self is to recognize her worth, acknowledge the hard work that brought her to where she is, and trust in the respect and support of her colleagues. This self-assurance, she believes, is key to sustained success in the field.

30 Tips in 30 Minutes

You. Hello, everybody. Dr. Sandra Lee, aka Dr. Pimple Popper. I am here at fall Clinical 2023 in Las Vegas, and here are my five quick tips. One quick tip, and it's really easy and quick and inexpensive, is to actually take your scalpel blade when you, when you're taking a butt, when you're doing a biopsy, take your scalpel blade and wrap the foil wrapper around the end of it so it fashions off a little scalpel handle, and that makes it very quick. You don't have to sterilize that handle, and that makes it very inexpensive to do a shave biopsy. Number two, if you have a cyst that you are afraid it's going to spray back at you, you want to actually cover it with some transparent film, like a little transparent bandage, so that you can inject into that area and it won't squirt at you. If you have a large lipoma that you need to anesthetize safely, you want to use tumescent formula and tumescent infiltration. Number four, I deal with some pretty large pylor cysts on the scalp, and oftentimes when they're that big, they become liquefied. So my best advice is to actually aspirate some of it first so you don't make a mess. My fifth tip is, how do you know whether a lipoma is under the muscle? Well, I try to ask my patients to do this particular maneuver. If it is on their back, for example, I ask them to flex the muscles that are under that area. If they flex that muscle and the lipoma gets very firm, there's a good chance that it's under the muscle and lipoma that I can remove. There are my five tips.

This multispeaker session is always an audience favorite; this year, the panel included medical, surgical, as well as practice management tips. Erin Boh, MD, PhD, kicked off the session with a tip on identifying cutaneous T cell lymphoma (CTCL) in clinical practice. This can be difficult because CTCL can mimic psoriasis, atopic dermatitis, and drug eruptions, but Dr Boh emphasized the importance of early recognition to increase disease-specific survival. Dr Boh also discussed the use and monitoring of methotrexate in clinical practice as well as labs for a thorough work-up of prurigo nodularis. Dr Boh concluded with tips on the work-up of pretibial myxedema, which includes thyroid function studies and biopsy, as well as the early use of biopsies in dupilumab nonresponders after 3 to 4 months of therapy to rule out CTCL.Sandra Lee, MD, discussed in-office procedural pearls, such as using a 15-blade in its wrapper for an inexpensive shave biopsy and covering cysts with a transparent film dressing prior to local anesthesia to prevent splashing. Dr Lee recommended using tumescent anesthesia for large lipoma excisions and attempting to aspirate large pilar cysts before excision as many can become liquified. Dr Lee concluded with a tip on a clinical maneuver to determine whether large lipomas are superficial or are lying underneath a muscle.The next panelist, Lawrence F. Eichenfield, MD, began with a tip on using an otoscope or flashlight to evaluate for transillumination of cysts and look for calcification in pilomatricomas. Dr Eichenfield advised documenting body surface area involvement for all moderate-to-severe inflammatory skin diseases and told the audience that one thumb size is approximately 1% of the scalp when evaluating alopecia areata. For reducing pain during procedures or injections in children, Dr Eichenfield recommended lidocaine 4% cream, listening to music, utilizing the Zimmer cooler, and a wrapping technique for immobilizing smaller children.Steven Wang, MD, continued the discussion with surgical tips for the office. Dr Wang recommended doing multiple scouting shave biopsies in a clock pattern on the periphery of large pigmented facial lesions suspected to be lentigo maligna. For nonsurgical treatment of lentigo maligna, Dr Wang gave tips on using imiquimod cream 5 times weekly for 12 weeks. Dr Wang’s next 2 tips were on the use of ferric subsulfate solution as a landmark for scalp biopsies that may need further surgical treatment and the use of heating packs to enhance aminolevulinic acid incubation prior to photodynamic therapy. Dr Wang concluded with a recommendation for weekly intralesional triamcinolone injections for keratoacanthomas on the lower extremities.G. Michael Lewitt, MD, gave the audience a few medical pearls, the first being to check a Tb spot on patients who have an indeterminate QuantiFERON Gold test. For cases of psoriasiform dermatitis with overlapping eczematous features on the hands and feet, Dr Lewitt recommended treating with a systemic JAK inhibitor for rapid improvement. When using immunosuppressive medications, Dr Lewitt reminded the audience to avoid the concomitant use of live vaccines, including the MMR, rotavirus, and varicella vaccines. To conclude, Dr Lewitt recommended sticking to a strict order when performing total body skin exams, even when patients come in with a list of things to address.David M. Pariser, MD, concluded the session with a few office efficiency and medical tips for the audience. Starting with office efficiency, Dr Pariser recommended getting a scribe for each provider and making sure they are well-trained in billing to help save time. Moving on to medical dermatology, Dr Pariser reviewed evidence for a novel targeted alkali thermolysis patch as an in-office treatment for axillary hyperhidrosis. In studies, a single 3-minute application led to reduction in excessive sweating for up to 3 months. Dr Pariser concluded with a discussion of efficacy of various field treatments for actinic keratoses and recommended occlusion of aminolevulinic acid for photodynamic therapy.&nbsp;

What’s New in SKIN

Hello. I'm Dr. Roger Seeley, clinical professor of dermatology at the University of Iowa and co editor of the Journal of Skin. I'm excited to be able to present some information at our meeting about this journal. It's a free online journal that authors are able to retain their copyright, and it's free access in the district emanates information about dermatology across the world online. We've also added several new sections to our journal. We've added a skin images, which is an exciting collection of images with descriptions that goes with each issue. And I'd encourage you to submit images and description of some of these to the journal. J o skin and it's online easy to access. We've also added some other members to our board, resident member and fellow members. We have a new component where you can get a win a prize if you answer some of the questions over the previous issues of the journal. So it's an exciting journal. It's growing. We had 40,000 reads last month and almost a million reads already in the five years that the journal has been present. Thank you and enjoy the Journal of Skin.

To round out the morning review of dermatology literature, Roger I. Ceilley, MD, delighted the audience with a look back at the past year for SKIN: The Journal of Cutaneous Medicine. SKIN is a peer-reviewed, open-access, online-only journal dedicated to providing free access globally to dermatologic knowledge. Readership of SKIN continues to grow, with over 68,000 reads in May 2023. Dr Ceilley highlighted important sections of SKIN, including a new Medical Educational in Dermatology section and the ever-popular SKINmages section. High-impact articles from 2023 included an expert consensus panel report on the use of gene expression profiling in melanoma management. The panel concluded that adding gene expression profiling results to AJCC classification improves prognostic assessment of patients with cutaneous melanoma. Dr Ceilley concluded with a look at the most-read articles of 2023, which included a review of makeup ingredients and their effects on acne cosmetica, a short communication about solutions for the lidocaine shortage, and an original research article on the use of ampicillin in acne vulgaris.

FC23 Welcome Reception

Roll. My name is Dr. Nick Brownstone. I'm here with. Hey, I'm Dr. Jennifer bars, and we're at the fall clinical 2023 opening reception at the fabulous Wood Hotel and casino in Las Vegas, Nevada. Let's go talk some attendees and find out what they're hoping to learn and why they're excited to be here. Bright Light city gonna set my soul gonna set my soul on fire got a whole lot of money that's ready to burn soul get those stakes up higher there's a thousand pretty women waiting out there they're all living the devil may care and I'm just a devil with love Beaver, Las Vegas. So what's your favorite way to lose money in Vegas? I mean, of course, blackjack. Shopping. Shopping. What's your favorite way to lose money in Las Vegas? Shopping. Shopping. Shopping. Go to all the clubs, drinks. What are you most excited to learn about? Just learn about the different avenues in dermatology and also being an influencer and learning about speaking and public speaking and sharing information in dermatology. Can you give me fall clinical in one word? Networking. Unbelievable. A lot of fun. Great ambiance. Exciting. Jam packed. Super fun. Oh, impactful. What's your favorite show on the Strip? So I definitely like shin Lim at the Mirage. He's good. And Matt Franco at the link. You know, I'm an old school guy. I gotta go with Lionel Richie. Oh, gosh, I haven't been to a show in forever. I'd probably choose a Cirque du Soleil show. What about shows on the Strip? What's your favorite one? We're going to the spirits tomorrow night. What's your favorite show in Las Vegas? Ooh, favorite show. That's a tough one. David Blaine, the magic show. Favorite show we're going to you, too. Tomorrow night. Anything. Cirque du Soleil. I'm going to go right now with Adele. So Dr. Del Rosso is known for his extensive guitar collection. How many guitars do you think he has in his collection? 62. How many guitars does Dr. Del Rosso have in his collection? I have seen a picture. If I had to guess, I would say 30. 30. 513. How many guitars do you think he has in his collection? I'm a new guitarist myself, so I would love to see that, but I'm going to go with 50. Let's do 350. 1218. 42. How many guitars do you think he has in his collection? Oh, no, I did see this before, and I forgot. 50. How many guitars do you have in your guitar collection? Viva Las Vegas. Viva Las Vegas. So right now I have 126.

Join Nick Brownstone, MD, and Jennifer Bares, MD, as they interview our attendees from the Welcome Reception!

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