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Study: Azole Antifungals Induce Resistance in Dermatophytes

Just as clinicians make strides against bacterial resistance, there’s a new emerging concern. Data presented at the AAD Meeting in San Francisco suggest that azoles have high potential for inducing resistance in dermatophytes, with prevalence having been reported as high as 19 percent in certain areas worldwide. This resistance affects not only superficial fungal infections but also systemic disease, eventually causing human infections. In contrast, the investigators noted that the potential of allylamines (terbinafine or naftifine) to potentiate resistance is very low. The primary mode of action of allylamines is the inhibition of squalene epoxidase, leading to accumulation of the ergosterol precursor squalene, which is known to be toxic to the fungal cells and explains the allylamine mechanism of cidality.

CMS Releases Final Rule for Medicare Advantage Plans

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) released its final rule for 2016 Medicare Advantage (MA) plans. The American Academy of Dermatology Association (AADA) urged CMS to ensure network directories are accurate and up-to-date. CMS heeded that call and is mandating plans to maintain accurate directories and identify a process to help patients who have been denied access to contracted providers. As part of the final rule, CMS will initiate a three-pronged approach, including direct monitoring, developing a new audit protocol, as well as compliance and/or enforcement actions. Medicare Advantage plans whose network adequacy is not met because of failure to have a sufficient number of providers open and accepting new patients may also be subject to such actions.

By the Numbers: 9.3 Million

The amount of publicly traded securities the American Board of Dermatology (ABD) reportedly has invested. In the latest edition of Derm Insider, Dr. Jeanine Downie noted that the ABD, which has proposed new Maintenance of Certification standards, should answer to physicians on how it uses the funds. “They’re stockpiling too much of our money and they, quite frankly, need to answer to us,” Dr. Downie noted. “I think they’ve lost their path and lost their way, because they’re supposed to be all about patient safety and improving patient care. Instead they’re stockpiling our money for something that’s not proving positive outcomes.” Go to to watch the episode.

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Controversies in Vitamin D

“I really have to educate my patients that the spectrum that leads to vitamin D production in skin is the exact same spectrum that causes DNA damage and leads to skin cancer. You really can’t tease those out. There is no safe amount of sun that you can get.”

—Maryam Asgari, MD

As part of DermTube’s Daily Coverage of the Annual Meeting of the American Academy of Dermatology in San Francisco, host Joel Cohen, MD discussed controversies related to vitamin D with Maryam Asgari, MD. In particular, Dr. Asgari addressed vitamin D deficiency as well as the implications of vitamin D supplementation. To see the full interview, visit

Discharging the Problem Patient

Sometimes problem patients need to be let go. In the January/February edition of Modern Aesthetics® magazine, Michael J. Sacopulos, JD offers strategies for letting go of “problem” patients. For example:

The difficult patient is an inevitability in aesthetic practice. Don’t wait until you become fed up with a patient to take action. Know the applicable laws and have the tools you need in place so that you can address any challenges as soon as they arise.

Have your attorney draft a standard patient discharge letter at the same time as all your other standard office forms and form letters. It should be brief (four to six sentences) and clear. You do not want to run afoul of abandonment laws, and there is some jurisdictional variability in the requirements for patient discharge; your lawyer can advise on these. In general, discharging physicians are required to provide emergency care to the patient for 30 days and to provide the patient access to his/her records.

Once you’ve made the decision to discharge a patient and provided the discharge notice, do not back down. Reversing the decision once a patient has received a discharge notice is a bad precedent. The standard office policy must be to not revisit or reconsider any discharge decision. Advise staff of this, and instruct them to use the policy as the standard response for the patient who may call to argue about a letter: “As a matter of policy, the practice cannot reconsider these decisions.”

If the patient engages you, the surgeon, be firm. Advise the patient that you don’t believe you can meet his/her needs. Use their dissatisfaction with you to your advantage: “I realize you are not happy with me and my staff, why don’t you see if another surgeon can better meet your needs?” n

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