Recent Developments

PE-Backed Ownership of Dermatology Practices Is On The Rise

Private equity (PE) firms have increased their financial stakes in dermatology practices throughout the US, but effects on care are not fully understood yet. PE-backed dermatology management groups acquired 184 dermatology practices from 2012 to 2018, with the number of acquisitions increasing over time and broadening in geographic reach, according to a cross-sectional study of five financial databases in JAMA Dermatology. These acquired practices comprised an estimated 381 dermatology clinics as of mid-2018, and the number of financing deals in which dermatology management groups raised capital increased over time, the study found. Specifically, there were nearly 12 times as many takeovers in 2017 as in 2012, and more than 700 unique dermatology clinics in the US are now owned by PE firms.

“Further research is needed to assess whether and how private equity-backed ownership influences clinical decision-making, health care expenditures, and patient outcomes,” conclude the authors, who were led by Arash Mostaghimi, MD, MPA, MPH, of Brigham and Women’s Hospital in Boston and an associate editor of JAMA Dermatology. In an editorial accompanying the new study, Drs. Joshua M. Sharfstein and Jamar Slocum, both from Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, urge extreme caution in the face of the rapid takeover of the private practice of dermatology by private equity firms.

“The more compelling case today…is that the basic approach and incentives of private equity are not aligned with health and value in dermatology,” they write. “Efforts to protect the field of dermatology and the American public from the potential adverse consequences should begin now.”

In addition to greater transparency, the editorial authors urge dermatologists to stop selling their practices to private equity firms. “Legislators should prohibit such transactions,” they write. “Exceptions should be permitted for situations in which a practice can make a strong and public case to health officials that doing so is in the public interest—based on a review of access to care for the local community, plans to maintain and improve quality of care, and anticipated costs.”

New AAD, NPF Guidelines Address Psoriasis Phototherapy image

New guidelines from the American Academy of Dermatology (AAD) and the National Psoriasis Foundation (NPF) take on psoriasis phototherapy. The 2019 guidelines of care for the management of psoriasis with phototherapy address multiple phototherapy treatment options, ranging from widely used ultraviolet modalities to the combined use of photosensitizing agents; to newer and less prevalent choices that have demonstrated promise.

The guideline also discusses recommended dosing regimen, efficacy, and adverse effects of the various phototherapy modalities, which are used as monotherapy or in combination with other psoriasis therapies to treat moderate-to-severe psoriasis in adults.

In addition to treatment recommendations in the guideline, the role of the dermatologist in monitoring and educating patients about the benefits and risks associated with phototherapy is explored.

RealSelf Releases 2019 Sun Safety Report

According to the 2019 RealSelf Sun Safety Report, only one in 10 adults in the US uses sunscreen every day, and almost half (47 percent) of Americans never wear sunscreen. Women are significantly more likely than men to wear sunscreen on a daily basis (15 percent vs. four percent).

The report also found that factors like age and location influence sunscreen use. Two-thirds (66 percent) of 18- to 34-year-olds wear sunscreen at least one day a week, compared to 49 percent of adults 35 and older. Adults who live in the midwestern US are significantly less likely than those who live in other regions of the country to wear sunscreen—only 16 percent of adults living in the Midwest wear sunscreen four or more days a week, compared to 29 percent of adults in the West, 25 percent of adults in the South, and 24 percent of adults in the Northeast.

A little more than half (53 percent) of Americans wear sunscreen at least one day a week, and among those, 93 percent apply it to the face. The second most popular body area is the neck (74 percent), followed closely by the arms (73 percent). Nearly one-third (28 percent) of US adults who wear sunscreen say they always or almost always reapply throughout the day. Men are significantly more likely than women to always or almost always reapply (34 percent vs. 25 percent of women), and adults ages 18–44 are two times more likely than adults 45 and older to reapply on most days they wear sunscreen (40 percent vs. 19 percent).

Although daily sunscreen use was found to be low, 65 percent of Americans say they always or almost always wear sunscreen if they plan to be outdoors for an extended period of time, such as while at the beach or during a sporting event. Only 57 percent of adults in the Midwest always or almost always wear sunscreen when outside for extended periods, which is significantly lower than all other regions of the country: West (68 percent), South (67 percent), and Northeast (66 percent).

Among the 47 percent of Americans who never wear sunscreen, more than half (56 percent) believe they don’t get enough sun exposure to need sunscreen. Other top reasons for not wearing sunscreen include having skin that doesn’t burn easily (25 percent) and not liking how sunscreen feels on the skin (18 percent).

Among those who do use sunscreen, the main motivations are to prevent skin cancer, prevent sunburn, and prevent the appearance of aging skin. Adults 35 and older are significantly more likely than adults under 34 to say preventing skin cancer is a main motivation for sunscreen (79 percent vs. 63 percent).

Women are significantly more likely than men to say preventing the look of aging skin is a main motivation (55 percent vs. 33 percent), and they are also more likely to be motivated by sunspot prevention (44 percent vs. 33 percent for men). More than half of men (52 percent) say preventing the look or feel of a sunburn is a main motivation, compared to only 45 percent of women.

While women are more likely to wear sunscreen daily, men are significantly more likely to have had a skin check in the past (70 percent vs. 65 percent of women) and significantly more likely to get their skin checked every year (36 percent vs. 27 percent of women). Adults who know someone with skin cancer or have been personally diagnosed with skin cancer are almost twice as likely to have annual skin checks compared to those who do not know someone with skin cancer (53 percent vs. 29 percent).

CLOSE UP with Adam Friedman, MD, FAAD

Caring for wounds—even those created via procedures—is a big part of dermatology, and there is a push toward simpler, better and evidence-based methods to address these injuries, says Adam Friedman, MD, FAAD, Professor and Interim Chair of Dermatology and Director of the Residency Program and Translational Research at the George Washington University School of Medicine & Health Sciences in Washington, DC. Dr. Friedman and colleagues recently took a closer look at the use of topical collagen powder for wound healing. He shared some pearls from the study with Practical Dermatology® magazine.

Why is this topic important to study?

Dr. Friedman: As dermatologists, forgetting even the management of acute and chronic wounds, we create a diverse group of wounds on a daily basis. Best practices with respect to how to manage and care for even a shave or punch biopsy wound has been the subject of some debate. We recently witnessed a big push to avoid the use of topical antibiotics by the American Academy of Dermatology through their collaboration with the Choosing Wisely campaign. Why stop there? Why not keep digging to determine simpler, easier, better/non-inferior ways to address the incessant injuries we create? Our investigator-initiated study is an example of this ongoing push and one of the things I love about being an academic dermatologist. Our question was simple: does collagen powder assist in wound healing and offer benefits over standard practices such as suturing? Collagen is a component of the extracellular matrix that plays an integral role in wound healing by acting as a scaffold for cellular ingrowth and deposition of new collagen. Collagen-based dressings and fractionated collagen powders have been developed for wound therapy as they are thought to replace degraded collagen and recruit inflammatory cells, fibroblasts, and keratinocytes. Collagen has low antigenicity, is a poor culture medium, promotes hemostasis, and is hydrophilic, suggesting is could be promising for wound therapy. However, fake news about collagen supplements, salves, power drinks, etc. keep coming up in the lay media with limited data from the scientific world. Especially when considering wound care, there is double the demand for new evidence-based approaches and a fact-finding mission on the potential benefit of supplemental collagen.

Please describe the research and your findings.

Dr. Friedman: This pilot study is the first to compare the utility of topical collagen powder on the rate and quality of full-thickness wound healing as compared to the gold standard, primary closure. Eight healthy volunteers received a single 4mm punch biopsy on each thigh to provide for internalized controls. One wound was managed with primary closure, while the other wound was treated with daily topical collagen powder for up to four weeks. At four weeks, wounds were re-biopsied for histopathological analysis (H&E staining, CD31 staining, and Masson trichrome). At weeks two, three and four, patients rated itch, pain, and overall preferences. Six of eight collagen-treated wounds were completely healed four weeks after initial wounding. Histologic analysis of the wounds revealed epidermal re-epithelization in both groups. More organized granulation tissue was noted in collagen-treated wounds and confirmed using Masson trichrome and CD31 staining for collagen and neoangiogenesis, respectively. Subjects reported similar itch and pain metrics between wounds. Both subjects and blinded dermatologists preferred the early cosmetic appearance of collagen-treated wounds over primarily closed wounds.

What is the next step?

Dr. Friedman: For the most part, we are disseminating this information to enable the practicing clinician to make an educated decision with respect to biopsy wound care. There are some intricacies with respect to reimbursement with collagen powder that could actually be cost saving and beneficial to both the physician and patient, not to mention undercutting the need for suture removal. It’s difficult to change practice, especially for a physician who always sutures or utilizes a barrier protectant with a pressure dressing. I think it’s worth keeping an open mind.

New Cerave Poll Reveals Confusion about Healthy, Clean Skin and How to Achieve It

Many consumers are confused about what “clean” skin really means and how best to achieve it, according to an online survey commissioned by CeraVe.

Of 2,000 US adults polled, 37 percent of respondents think their skin should feel tight after cleansing although a feeling of tightness is actually a sign of stripped moisture from the skin and often means you should be adapting your routine with products that include gentler, moisturizing ingredients. Another 33 percent associate dry skin with clean skin, which is not true. A feeling of tightness is actually a sign of stripped moisture from the skin and often means you should be adapting your routine with products that include gentler, moisturizing ingredients.

More than half of respondents (53 percent) said they are confused about which type of cleanser to use; followed by how often to cleanse (47 percent).

Despite confusion, a regular skincare routine is a necessity for healthy skin. Yet, nearly half of respondents (47 percent) admit to behaviors that are bad for their skin and one-third (35 percent) confessed to having poor skincare habits. When it comes to cleansing, 53 percent of respondents said they only use water when they wash their face, which is not an effective way to cleanse.

Moreover, people are willing to admit that there is more than confusion contributing to their skin sins:

• The top three reasons respondents say they don’t cleanse are that they’re too tired (61 percent), they forget (47 percent) and they feel it is too much of a hassle and inconvenient (33 percent).
• More than one-quarter of respondents (27 percent) say they have gone more than two weeks without washing their bedsheets and pillowcases, leaving skin susceptible to breakouts and irritation from sweat, oil and bacteria buildup.
• While many people use washcloths for cleansing, 42 percent of respondents will use the same cloth up to four times without washing it and 16 percent will even use it up to seven times; thus, adding back accumulated grime and bacteria to freshly cleansed skin
• Two-fifths of respondents (41 percent) admit that they use hot water when washing their face, which dermatologists say strips moisture from the skin and therefore, they advise using lukewarm water instead.

New Launches and Clearances from Cynosure

Hologic’s Cynosure division is rolling out the TempSure Firm handpiece and a petite mask for WarmSculpting with SculpSure® Profile treatments.

The company also announced SculpSure submental treatments are now FDA cleared for patients with a BMI up to 49—the highest BMI clearance on the market for submental treatments.

The TempSure Firm handpiece, created for use with the existing TempSure platform, uses monopolar radiofrequency energy to gently heat tissue and temporarily reduce the appearance of cellulite with unique massage heads. The new 60mm handpiece allows practitioners to treat larger areas of the body such as the abdomen, arms, buttocks and thighs at a faster rate, without surgery or downtime.

Cynosure’s new petite mask attachment to the SculpSure platform will allow practitioners to perform WarmSculpting Profile treatments of submental fat on patients with a narrow jawline.

In conjunction with these launches, Cynosure has updated its SculpSure software to include a new, optional, guided mode feature. It comprises a preset algorithm for energy titration, resulting in a controlled increase in temperature to achieve lipolysis, as well as energy setting parameters designed to guide providers into a repeatable and comfortable treatment for their patients.

Sciton Targets Veins, Skin, and Hair with Clear Suite

Sciton, Inc. is launching its Clear Suite family of products. The Clear Suite offerings make the JOULE platform customizable. Utilizing the 1064 Nd:YAG wavelength, the Clear Suite family of products, including ClearV, ClearSilk, and ClearHair, combined with BroadBand Light (BBL), allows physicians to treat veins, skin, and hair from a single platform.

The new ClearV SVI technology allows users to change the lighting color, level of brightness and beam intensity. This enhanced visibility of deeper, lower feeder veins facilitates a more complete picture and precise procedure. ClearV now also uses a single handpiece with multiple sizing options and integrated cooling for patient comfort. VascuZoom enables quick and easy spot size changes directly on the handpiece, enabling physicians to move effortlessly between 2-6 mm spot sizes. The integrated sapphire cooling plate can be adjusted to temperatures between 5 and 25°C and allows for pre, parallel and post-cooling, making the treatment more comfortable for the patient