PracticalDermatology

Telemedicine Slashes Dermatology Consult Time from 84 Days to 5 Hours

When patients’ primary care doctors were able to photograph areas of concern and share them with dermatologists, the response time for a consultation dropped from almost 84 days to under five hours, finds a new study from researchers in the Perelman School of Medicine at the University of Pennsylvania and Independence Blue Cross.

Moreover, the study did not show any undue increases in utilization or cost that might be prohibitive to making the practice widespread. The findings were published in Telemedicine and e-Health.

“Telemedicine offers the opportunity to accelerate health care access by getting around infrastructure barriers: namely, heavily booked dermatology practices,” says the study’s senior author, Jules Lipoff, MD, an assistant professor of Clinical Dermatology. “Our study provides evidence that more patients can be cared for with the same amount of resources we’re using now.”

Although this study’s data comes from before the emergence of COVID-19, telemedicine measures like these have taken on a particular importance since the outbreak because of its ability to accommodate social distancing.

“The COVID-19 pandemic has illustrated just how important it is to ensure patients have the ability to access the care, education and support they need virtually,” adds co-author Aaron Smith-McLallen, director of Health Informatics and Advanced Analytics at Independence Blue Cross. “We see a future where more and more of our members will be using digital tools to complement in-person care, and we are working with our provider partners to make that a reality.”

Dr. Lipoff, Mr. Smith-McLallen, and their fellow researchers, including lead author Neha Jariwala, MD, a resident in Dermatology, designed the study to implement a shared digital photography service (also known as “Store-and-Forward”) between providers. Previously, similar models had been tested in smaller patient groups—including in the inpatient setting as part of the Penn Medicine Center for Health Care Innovation’s accelerator program in 2013. In this larger study, five primary care practices trained their clinicians to take the photos received over a secure application to a rotation of eight dermatologists for consults. This workflow was used instead of the usual process of referring patients to the next available in-person dermatology appointment.

In the study’s process, once the dermatologists reviewed the pictures of the concerning areas, s/he then responded to the primary care physician with clinical recommendations, which included a triage determination of whether an in-person visit with a dermatologist was needed. Of note, the study’s dermatologists provided these consultations within the course of their regular clinical duties without needing additional dedicated time to the effort.

Overall, 167 patients took part in the study, with a retrospective control group of 1,962 patients for comparison who had followed the traditional consultation system of seeing their primary care doctor, receiving a referral, and then scheduling an in-person appointment with a dermatologist.

In addition to the dramatic reduction in time to consultation, the study also suggested that the difference in total medical costs did not significantly differ between the telemedicine patients and those in the non-telemedicine arm of the study. Moreover, there was not a significant increase in consults when telemedicine was used compared to the previous process.

The study was conducted from June 2016 until May 2017, well before the COVID-19-related expansion of telemedicine, which was due, in large part, to the relaxation of rules for care reimbursement, traditionally the highest barrier for widespread telemedicine use. However, those changes have been mostly related to video calls with health care providers.

“Video-based telemedicine has been extremely helpful amid the social distancing precautions brought about by the COVID-19 outbreak,” Dr. Lipoff explains. “But we also need to look toward how we can expand other forms that may be more efficient in delivering care, such as ‘Store-and-Forward’ and hybrid models, since we’ve shown how effective they can be.”

It is unclear whether many of the changes in telemedicine brought about from the COVID-19 expansion will become permanent. But the researchers hope their study can serve as proof of the viability of photo-based telemedicine for dermatology—and other specialties, too.

This study was co-funded by Independence Blue Cross and an Innovation Grant from the Penn Medicine Center for Health Care Innovation.

CLOSE UP with Linda Stein Gold, MD

Arcutis Biotherapeutics, a Phase 3 biotech developing topical therapies for common skin diseases, recently released positive top line data from a Phase 2b clinical trial evaluating ARQ-154 (topical roflumilast foam) for scalp psoriasis.

Linda Stein Gold, MD, Director of Dermatology Clinical Research at Henry Ford Health System in Detroit, spoke to Practical Dermatology® magazine about the results.

Why is this topic important to study?

Linda Stein Gold, MD: The scalp is a commonly affected area of involvement in psoriasis. Scalp psoriasis patients suffer from the cosmetic appearance of red, flaky skin and the discomfort of persistent itching. It presents a difficult challenge for treatment as the drug must be delivered under the hair, and the vehicle can leave the hair appearing dirty. Novel non-steroidal treatments are needed, particularly ones like topical roflumilast foam.

Describe the research and your findings.

Dr. Stein Gold: The trial compared roflumilast 0.3% topical foam, applied once daily for eight weeks, to a matching vehicle foam in 304 adult and adolescent patients. Subjects who used roflumilast achieved a statistically significant rate of success of 59.1 percent in getting the scalp to clear or almost clear, compared to a rate of 11.4 percent in those who used vehicle. Results were seen as early as two weeks.

There was also a significant improvement in scalp itch. The drug was well tolerated, and treatment-related adverse events and discontinuations were similar to vehicle.

What are the next steps?

Dr. Stein Gold: Roflumilast 0.3% foam should go on to Phase 3 trials looking at efficacy and safety in the scalp and body in larger clinical trials. Longevity or duration of results is the name of the game as available neuromodulators seek to distinguish themselves from the coming competition.

ASDS: On-demand PREP Course for New MDS Subspecialty Certification Examination

To help board certified dermatologists prepare for the American Board of Dermatology’s (ABD) first ever Micrographic Dermatologic Surgery (MDS) Subspecialty Certification Examination next fall, the American Society for Dermatologic Surgery (ASDS) is offering the MDS Exam Review Course virtually, on-demand through ASDS Learn.

Co-directors Kishwer S. Nehal, MD, and Rajiv I. Nijhawan, MD put together a comprehensive review of dermatologic surgery fundamentals and key knowledge in high-yield content areas outlined by the ABD Study Guide. For more information about the exam, practice pathway and eligibility requirements, visit abderm.org.

“The course is an excellent review for surgeons of all levels including fellows and residents, even if he/she does not plan to take the exam,” says Dr. Nijhawan in a news release. “It is a very comprehensive review of all the content areas that may be tested in the upcoming exam.”

The course, exclusive to ASDS members, costs $199 and registrants will have access until October 4, 2021.

In Review: VCS Virtual Format Hailed as a Success

After a decade and a half of bringing topline aesthetic education to Las Vegas, VCS went virtual this fall.

“While it wasn’t live—it was virtual—I knew it was absolutely fantastic,” says meeting co-chair and Modern Aesthetics® magazine co-chief medical editor Steven Dayan, MD. “We had over 72 hours of content. Rich material. We covered everything from head to toe, from skin to bone. It was all there.”

In addition to cadaver labs and practice management sessions, the program included master classes.

Several attendees commented on the clinical benefit of the program. “I enjoyed learning about all of the up-and-coming treatments that aren’t quite out in the market yet,” observed one attendee. “It helps me prepare for some new things that our practice might want to provide in the future.”

“The speakers were all extremely informative and engaged in the topics,” noted another attendee. “I appreciated that lectures were given and that there was a discussion panel amongst the presenters. This was different from most conferences and added a level of communication and education that I had not experienced in the past.”

“If you did not see it, go to VegasCosmeticSurgery.info,” Dr. Dayan urges. “There, you can still watch it till the end of the year. Over 35 CME credits are available to you.”

Research Identifies Long-Term Benefits of Incorporating Ceramides into Baby Skincare

Using ceramide-infused products on baby skin may have long-term benefits lasting into adulthood, according to a newly published study in the Journal of Drugs in Dermatology.

The study analyzed the role of ceramides in the vernix caseosa. Since the vernix caseosa is removed after birth, it becomes critical that those ceramides continue to be restored to support a baby’s skin barrier.

Coral Springs, FL-based pediatric dermatologist and dermatologic surgeon Latanya Benjamin, MD is one of seven experts on a panel of dermatologists who developed statements on the role that moisturizers with ceramides play on a baby’s skin health. Therapeutic skincare brand CeraVe is partnering with Dr. Benjamin to educate on how to care for baby skin and why she recommends the CeraVe line of ceramide-infused baby products for her patients.

“Baby skin is different than adult skin, and a key characteristic of baby skin is its delicacy while developing, which results in more susceptibility to dryness and common conditions like eczema,” says Dr. Benjamin in a news release. “While ceramides are naturally found in baby skin beginning in the third trimester of pregnancy, they should play a pivotal role in a baby’s daily care routine, as utilizing products with ceramides from birth, like those in the CeraVe Baby line, can help replenish the protective barrier and restore hydration as the skin matures.”

Merz Aesthetics Seeks Entries for Innovation Forum

Merz Aesthetics is launching its first-ever Innovation Forum and is seeking the most creative and inventive medical aesthetics abstracts from the next generation of researchers and healthcare professionals.

The author of the winning abstract will have the opportunity to present his or her work on the main stage at the Merz Aesthetics Expert Summit (MEXS), scheduled for Fall 2021 in Vienna.

Entries will be accepted through January 31, 2021, online at innovationforum.merz.com.