John Jesitus

National report - Certification for procedural dermatology, now under consideration by the American Board of Medical Specialties (ABMS), could result in preferential treatment by insurance companies for Mohs surgeons who have earned such certificates, some dermatologists worry.

Key coding concerns for 2008 include Medicare's elimination of the Mohs surgery exemption to the multiple-procedure reduction rule, and the continuing impact of the PQRI, an expert says.

A very low energy plasma skin regeneration protocol appears effective in treating facial photodamage, including pigmentary alterations, rhytids and textural changes, says an expert.

Common myths of cosmetic dermatology include the assumptions that one will never make mistakes, that malpractice insurance automatically covers cosmetic tools and treatments, and that the Internet is an easy place to do business, an expert says.

The complex relationship between stress and the skin can likely be influenced by the placebo effect resulting from many psychological interventions, an expert says.

The elimination of the Mohs surgery exemption to Medicare's multiple-surgery reduction rule will mean that Mohs surgeons who perform multiple in-office surgeries in one day will earn less for secondary procedures than they cost, sources say.

National report - Prompted by dermatologists' concern over the safety of a recently approved permanent dermal filler, the FDA has formed a team to study postmarket experience with all newer dermal fillers, focusing mainly on the permanent variety.

Washington - One year after iPLEDGE's inception, dermatologists applaud the program's elimination of a 23-day lockout period for male and nonchildbearing female patients who fail to fill isotretinoin prescriptions on time.

National report - Although pharmaceutical giant Merck has suspended its lobbying campaign to make its newly approved vaccine Gardasil mandatory for young girls, many dermatologists firmly believe inoculation should be compulsory - for several reasons.

Most OCD sufferers are not properly diagnosed for well over 10 years, and only one in five patients is under treatment.

Washington - Family physicians correlate well with dermatologists in diagnosis and treatment of many common skin lesions, a recent study says.

National report - The Food and Drug Administration's approval process can seem mysterious to most physicians, who lack the time to study the process, experts say.

National report - While any doctor can learn to inject needles into the skin, the difficult part of performing facial procedures is assessing the aesthetics of a situation, Ellen C. Gendler, M.D., says.

National report - The Food and Drug Administration's role is a necessary one, dermatologists say, but regulatory red tape can slow the introduction of new drugs into the marketplace, and post-marketing restrictions can hamper efforts to deliver effective medications to patients.

National report - With everyone from ENTs to ER doctors now offering cosmetic procedures, experts worry that dermatologists who focus too heavily on this market will suffer when competition slashes prices.

Kohala Coast, Kona Island, Hawaii - A basic understanding of dermatopathology can improve many dermatologists' biopsy techniques and diagnostic skills, an expert says.

Although dermatologists are very familiar with PXE, they're likely to see only a handful of cases during their careers.

International report - The International Society of Teledermatology (ISTD), based in Graz, Austria, seeks to establish worldwide access to teledermatology services, particularly as a tool for reaching underserved and often remote patient populations, one of its cofounders says.

Patients commonly follow the advice of cosmetic-counter salespersons, TV advertisements, aestheticians and friends rather than seeking a dermatologist's recommendations.

National report - While dermatology's visual nature makes it ideal for image-rich electronic applications - from teledermatology to training for residents - few dermatologists have embraced comprehensive systems such as electronic medical records (EMRs), sources say. But they predict this will change with the healthcare industry's growing emphasis on efficiency and accountability.

But when it comes to 17000 and Mohs codes, used almost exclusively by dermatologists, Dr. Pariser says, "We have no one with whom to form alliances. We're stuck out on our own."

Kohala Coast, Kona Island, Hawaii - Key issues in photoprotection research include standardizing the measurement of UVA protection from sunscreens, maximizing photostability of UV filters and sorting out the ongoing vitamin D/sunscreen debate, an expert says.

Dallas - Although competing modalities have stolen some of cryotherapy's thunder, technical advances under development could one day restore cryotherapy's luster, an expert says.

National report - When dealing with topical treatments, dermal fillers and botulinum toxin, an expert advises sticking to products backed by rigorous science and minimizing patients' risks wherever possible.

Most patients who get Botox treatments tend to like them and continue requesting them.

While many BDD screening tools exist, sources advise selecting an approach that best fits one's practice and personality. The following list summarizes a few:

National report - While it is difficult to pin down precise data regarding body dysmorphic disorder (BDD), sources tell Dermatology Times it's more common than many dermatologists think.

Las Vegas - Safe, effective laser treatments for ethnic patients require lower energy settings, longer pulses and longer wavelengths than one would typically use for Caucasian patients, as well as greater attention to cooling techniques, an expert says.

National report - Silicone gel breast implants represent a welcome option for informed patients, most sources say.

Brussels, Belgium - A year after receiving a partial face transplant, Frenchwoman Isabelle Dinoire has recovered to an "incredible" degree, one of her surgeons tells Dermatology Times. However, he says long-term risks - including graft rejection and the possible development of cancer as a result of her heavy immunosuppressive drug regimen - persist.