Recent Developments

Cosmetic Surgery Forum Wraps Up Its Seventh Year

Covering topics from the appropriate use of permanent fillers to the role of spirituality in practice, the seventh annual Cosmetic Surgery Forum (CSF) brought together experts from multiple specialties at the Aria in Las Vegas this month. The three-day program included guidance on practice management and planning, discussion of skincare and cosmeceuticals, reviews of disease management, expert analysis of new cosmetic procedures, and ample dialogue between presenters and attendees.

“The audience is an active participant and it’s not just people on the podium who don’t want to listen to the audience,” says Joel Schlessinger, MD, CSF Founder and Program Chair. “We want lively discussion. We encourage debate.” (You can watch Dr. Schlessigner discuss the meeting at dermtube.com/video/cosmetic-surgery-forum-2015/)

Bridging the gap between core specialists, the faculty includes facial plastic and oculoplastic surgeons, along with dermatologists and features international speakers. The dynamic creates opportunity to re-think approaches to patient care. For example, dermatologist Suneel Chilukuri, MD noted that discussion of nasal aesthetics reinforced the notion that dermatologists should not place fillers in areas like the nasal tip that are cosmetically sensitive and anatomically challenging.

A robust discussion emerged about the use of permanent fillers, with injectors from outside the US noting problems with granulomas developing with placement of permanent fillers, while those in the US noted differences in formulation and availability in the States, compared to Europe and Canada.

During his keynote address, Michael Greenberg, MD offered tips on bringing spirituality—a humanistic rather than religious concept—into practice. He said it’s all about intimacy, but with a twist. “In to me see,” he said. When you look into the patient and into yourself, that’s when true connections develop, he explained. You can make money and be spiritual, Dr. Greenberg said, but your focus should be on people not possessions.

As in years past, the program included resident presenters. Check out Resident Resource Center in this issue to see the list of Top 10 presenters. Watch video updates at DermTube.com.

Review Does Not Support Monthly Lab Testing for Oral Isotretinoin Use for Acne

A review of medical literature does not support monthly laboratory testing for all patients who are using standard doses of the acne medication isotretinoin, according to an article published online by JAMA Dermatology.

Isotretinoin has been associated with several adverse effects, including teratogenicity (causing birth defects) and hyperlipidemia. Prior studies have looked at the usefulness of laboratory monitoring during isotretinoin therapy.

Joslyn S. Kirby, MD, MEd, MS, of the Penn State Milton S. Hershey Medical Center, Hershey, PA, and coauthors reviewed medical literature to estimate changes in laboratory tests during isotretinoin therapy. The authors included 26 studies (1,574 patients) in their meta-analysis, which evaluated laboratory test results for lipid levels, hepatic (liver) function and complete blood cell counts.

Results suggest that while isotretinoin was associated with a change in the average value of some laboratory tests (white blood cell count and hepatic and lipid panels), the average change across a patient group did not meet the criteria for high-risk and the proportion of patients with laboratory abnormalities was low, the authors report.

However, the authors note their study should be considered in the context of some limitations, which include that the analysis was limited by the availability of data and the completeness of reports. Authors also did not have access to information about patients or the treatment so specific laboratory changes could not be correlated with doses or dose changes.

“The findings of this study suggest that less frequent laboratory monitoring may be safe, with few missed high-risk laboratory changes, for many patents with acne who are receiving typical doses of isotretinoin. … A decrease in the frequency of laboratory monitoring for some patients could help to decrease health care spending and potential anxiety-provoking blood sampling,” the study concludes.

Modernizing Medicine Introduces Practice Management Solution

Modernizing Medicine, Inc., creator of the Electronic Medical Assistant® (EMA™), introduced a new practice management solution, modmed PM, at the company’s second annual EMA Nation Users Conference.

Building on the success Modernizing Medicine has achieved by employing specialty physicians to design and code its EMR system, the company says modmed PM was designed and built by the company’s own practice management professionals. A natural extension of EMA, modmed PM delivers an all-in-one solution for improved patient and office flows for the front desk, patient billing, practice administrators, and medical staff. With a data-centric approach to billing, modmed PM is designed to improve accounts receivable, while generating metrics-driven reports to measure financial and operational success.

Modernizing Medicine customers participated in the development of modmed PM to ensure it answered the call to be flexible, helpful, intuitive, and efficient, like EMA, according to the company. “modmed PM has solved our problems and is integrated with EMA Dermatology for a seamless patient flow from beginning to end of the visit. It is amazing how the communication amongst the staff has improved by using this all-in-one system. The layout is easy to navigate, enhancing our workflow and making everyone more efficient,” Victoria A. Cirillo-Hyland, MD, of Bryn Mawr Skin & Cancer Institute, PA, said.

Data: Acne Sufferers Lack Understanding About Potential Antibiotic Resistance Issues

Widespread and inappropriate use of antibiotics continues to be a problem in the US leading to antibiotic resistance issues. While most people understand how the overuse of antibiotics to treat viral infections contributes to this issue, according to Galderma, new data reveal that acne patients and parents of teenage acne patients significantly underestimate the risks and potential consequences associated with antibiotic use for the treatment of acne, particularly topical antibiotics (e.g., clindamycin and erythromycin).

Over the past two years, about 11.5 million prescriptions for oral antibiotics and 6.9 million prescriptions for topical antibiotics were dispensed for dermatology related issues, including acne, and in 2013, nearly two-thirds of antibiotic use in dermatology was for acne, according to Galderma. Both oral and topical antibiotics have been widely used in the treatment for acne for more than 50 years because of their ability to reduce the Propionibacterium acnes (P. acnes) and reduce inflammation, but the long-term risk of these treatment options is not registering for most acne sufferers and parents of acne sufferers.

A recent survey sponsored by Galderma Laboratories, L.P., inclusive of 809 acne sufferers (ages 17-40 years) and 210 parents of acne sufferers (child, aged 9-17 years), found that despite the risk of antibiotic resistance and potential side effects:

Sixty-four percent of survey respondents were not aware that overuse of topical antibiotics to treat acne could make them a carrier of drug-resistant bacteria.

More than 50 percent of respondents had not spoken with their doctor about the risk of antibiotic use to treat acne.

While 65 percent of survey respondents said that they make an effort to avoid antibiotics unless they are the only option, only a third of those not prescribed antibiotic-free acne treatment were aware such treatments existed.

Only 28 percent of survey respondents who were not prescribed antibiotic-free acne treatment had ever discussed antibiotic-free treatment for acne with their healthcare providers.

Study Finds Increasing Prices for Prescription Dermatology Drugs

A recent study published in JAMA Dermatology found that the price of prescription dermatologic drugs rose considerably from 2009 to 2015. In an effort to determine the changes in the prices of commonly prescribed dermatologic medications and to identify trends in price increases for different classes of drugs, researchers surveyed four national chain pharmacies about price data on commonly prescribed dermatologic drugs in 2009, 2011, 2014, and 2015. The initial survey requested information on 72 brand-name drugs, while subsequent surveys included 120 additional brand-name drugs and their generic alternatives when available. Based on frequency of prescription, diseases treated, or unusual price increases, 19 brand-name drugs surveyed in all four years were selected for final price trend analysis, which was conducted from August 1 to 15, 2015.

Of the 19 brand-name drugs analyzed, the retail prices of seven were found to have more than quadrupled during the study period. Among the 19 drugs, the mean price increase was 401 percent during survey period, with the majority of the price increases occurring after 2011. The survey found that prices of topical antineoplastic drugs had the greatest mean absolute and percentage increase ($10 926.58 [1240 percent]). Prices of drugs in the antiinfective class had the smallest mean absolute increase ($333.99); prices of psoriasis medications had the smallest mean percentage increase (180 percent), according to the study. Prices of acne and rosacea medications were found to have increased a mean of 195 percent, and prices of topical corticosteroids increased by a mean of 290 percent during the study period. The researchers also found that selected generic drugs surveyed in 2011 and 2014 also increased a mean of 279% during the three-year period. n