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 is a board-certified Physician Assistant in Dermatology since 2003 in Chicago, Illinois, and an Editorial Advisory Board member of 

. She has served as president of the Society of Dermatology Physician Assistants (SDPA) and the Illinois Society of Dermatology Physician Assistants (ISDPA).

Articles

Adopting diversity management is not just a choice but a pressing need in the evolving health care landscape.

Embracing Diversity and Cultural Competence

A new report delves into the case of a 35-year-old man with ARPC and why dupilumab was utilized for treatment.

Case Report: Efficacy of Dupilumab for Acquired Reactive Perforating Collagenosis Associated with Atopic Dermatitis

James Song, MD, shares a comprehensive guide to what is new, what is now, and what is next in AD treatment.

The Cutaneous Connection: Navigating Systemic Therapies in Atopic Dermatitis

With the latest advancements in dermatology, there is a great range of treatments available to address the various types of acne scarring.   

Addressing Acne Scarring Concerns Among Patients

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Renee Dowling is a billing and coding consultant with VEI Consulting in Indianapolis, Indianapolis. Send your diagnosis coding questions to medec@mjhlifesciences.com

Getting denied for injection administration can be common. How to make sure you get paid.

 How to get paid for injection administrations

The providers in our clinic want to start billing e-visits. Can they bill for all the communication between the provider and patient through our online portal?

How to Correctly Document and Bill for Patient E-visits

Insight about what to document for these visits.

Coding Office Visits: The 99211 Checklist

Hyperhidrosis is not rare. According to the 

, approximately 385 million people worldwide live with hyperhidrosis.

In fact, they note that the amount of people living with chronic, excessive sweating is even higher than the amount of people living with other dermatologic conditions like psoriasis.

Just how common is hyperhidrosis in real-world comparisons?

The prevalence of hyperhidrosis is much higher in younger populations than in the general population, with 8.8% of individuals between the ages of 18 to 39 years old living with the condition. 

When comparing these statistics to everyday, common occurrences like hair color, the number of people with hyperhidrosis is greater than the 1% of individuals with natural red hair and 2% of individuals with natural blond hair. 

Despite how common hyperhidrosis is, it is estimated that 27% of those with the condition never receive a diagnosis.

 wants to hear from you. What percentage of the global population is estimated to have hyperhidrosis?

 to share your hyperhidrosis insights or research.

Albert. Fact check: Hyperhidrosis - International Hyperhidrosis Society: Official site. Home - International Hyperhidrosis Society. October 24, 1970. Accessed November 16, 2023. 

https://www.sweathelp.org/home/news-blog/542-fact-check-hyperhidrosis.html

Click here to answer this week's poll for Hyperhidrosis Awareness Month.

News 

Polls 

POLL: What Percent of the Global Population is Estimated to Have Hyperhidrosis?

Combination therapy (eg, topical agents + procedures)

Lilit Garibyan, MD, PhD, and Sara Moradi Tuchayi, MD, MPH, of 

, topical agents such as kojic acid, cysteamine, and rucinol should be avoided among patients who are pregnant. 

Share your recommended melasma treatment pearls or additional methods not mentioned above with us by emailing 

Click here to answer this week's melasma poll. 

clinical

POLL: What Treatment Approach Do You Find Most Successful for Improving Melasma?

Amber Blair, PA-C, Shares Innovative Insights as SDPA President-Elect

, president-elect of the Society of Dermatology Physician Assistants (SDPA). They emphasize the significance of innovation, mentorship, and lifelong learning as dermatology physician assistants.

 My name is Renata block, I’m a dermatology physician assistant, and I am here on behalf of

 at the SDPA Summer Conference in San Diego. I have the pleasure to be sitting and interviewing the amazing Amber Blair. She is the incoming president that is going to be taking effect July 1. Thank you for joining us and congratulations!

 Thank you for having me, Renata. It's so good to be here; very excited for what's coming ahead. I could not be happier than to sit down with you for a few minutes and chat about the future.

 I want to let everybody know that you have some exciting things coming down the pipeline. What does it mean to you to be the next president of the Society of Dermatology Physician Assistants, and what is your goal?

 I could talk for a really long time about all of those things, but to try and condense it, it could not be a bigger honor for me to sit here right now having this conversation. To be a part of this organization, to be thought of as a leader in this organization - it's wild to me. When I started as a derm PA, I thought I stumbled into this Mecca. The coolest specialty that could ever be, and I fell in love with it instantly. As soon as I got my feet under meand I figured out what I was doing, I wanted to give back somehow. I started working with a nonprofit in the state of Florida, that was myhome state, and loved it, and that somehow matriculated into SDPA. I didn't have a path to become president of the organization by any stretch of the imagination. I just loved what I was doing and wanted to be involved. The fact that I'm here right now, and I turn around and I look back at my path, it's wild to me. I don't do that very often. I normally have a goal, and that's where I go, and I'mvery organized and methodical. But this just sort of organically happened over the years, and I'm just so honored to have wound up in this place. I can't even put it into words.

 I remember when you were with Florida. You've done so much for that organization, and it's such a large organization as an affiliate of the SDPA. When you start with the SDPA, it's like you don't know where your path is going to go, but you almost find yourself. You find yourself and you find your passion. Let me just tell you that you being president, it's just a natural finish for you as a leader, and I couldn't think of a better person to represent us. I'm very excited for what you can bring to all dermatology PAs around the nation. The other thing is, you're right. Dermatology is a very, very specialized organization, or special organization to PAs, and being the largest society in the nation, you are just going to take it to the next level. I can't wait to see what you're going to do. What is the 1 thing you want to accomplish? What's the 1thing that you feel is the most important for Amber to disseminate the message to all our members?

 I strongly feel that we are not only amazing in our organization here in the United States, San Diego at this particular moment, but I think that SDPA should be driving innovation for dermatology PAs worldwide. We're going to take a step. We're going to be an internationally recognized organization within the next 12 months, and I’m really excited about that.

 I just got tingles just thinking about that because I think that is something that you can do, and I cannot wait for that to come to fruition.

 At our last board meeting, I made that statement. I didn't plan it, and it just kind of happened, and it was so true. The more I think about it retrospectively the SDPA is the extended family I didn't know that I needed, and it has become such an integral part of who I am. I can't imagine my life before it or without it. The people that I've met along the way have just been incredible and the opportunities that I've had to meet these amazing PAs across the country; I can't put into words how passionate I am about a lot of these things.

 I couldn't agree with you more that was very well said, and that's how I felt as part of the leadership community. It just becomes a part of your life that you can't live without. You look forward to it, and you look forward to seeing your family members. It may not be a holiday, but to us, it's the summer conference. It's leadership. It's the fall conference. It's getting together on those monthly calls and behind the scenes of all of this, and making it happen. It wouldn't happen withoutall these leaders and this core group of people. We need more people like that. We need more innovative ideas, and we need people to feel empowered that they could be the next presidentsitting in this chair.

 Stepping out of the elevator the day before the conference, and just watching the clings go on the walls and the exhibit hall being built. I get chills every single time, it's so cool, and watching the look on the eyes of the learners that are here. The derm PAs across the country, and the excitement that they bring, the vibe. It's hard to really understand unless you're here and you can see it, feel it; it’s really amazing.

Yeah, it's a very powerful vibe. The speakers – every single speaker I’m thinking, “it can't get any better.” And it does.We've already done the best, but it always gets better. We're always upping the ante and really having people walking out going, “Wow, that was incredible.” And I can't wait for the next one this year.

 I'm thankful to have had the opportunity to bring my son with me, who's 17, and the love of my life.

 Yes! For as much time as we spend right on volunteering for the organization and the hours, to have them see what I do at nighttime. What it looks like. It's really cool to watch that. I love it.

 I mean, he's a 17-year-old boy, so he wouldn't articulate that exactly.

 But you know what? It's in him. It's going to come out and he's going to be like, “Wow, that's my mother on stage representing 5000 members.”

My hope is, if nothing else, that people look at myself, the organization, what we're putting on, the education we're providing, and understand a little bit about what it's like to be a PA. To be in dermatology, to be in medicine, to be a lifelong learner. To be proud of what you're doing.

 I don’t know but I’ll tell you what—he's never displayed any interest in medicine. He's very engineer-minded. But last year, he was an honors anatomy and physiology, and he got to dissect a couple of things, and he was super excited.

There you go. It all starts right there. That's a future PA and future president of the SDPA.

Well, he's got a great mentor. Thank you for joining us, this has been such an honor and pleasure, and I am so proud of you. I have known you for the longest time, and we've grown together as leaders. This is kind of the cherry on top of the ice cream, and I think you're going to just knock it out of the park. Congratulations.

 Thank you so much. I appreciate it. It's the biggest honor that I could ever imagine being bestowed upon me as a PA in dermatology.

 It doesn't escape me that there's only a handful of people that have had the opportunity, and I couldn't be more thankful.

: My final question to you is: there's been a lot of advancements in medical and esthetic dermatology. What is the one thing that excites you most? And the second part of that question is: Are you involved in any research that is part of that advancement?

 I love that question. I am very fortunate right now in my clinic to work with a dermatologist who's fantastic, Gilly Munavalli, MD, MHS. We have a clinical research department in our office, which I haven't previously been exposed to, and it's been an interesting addition to my learning experience. I've been sub-investigator for clinical trials more on the aesthetic space and the general dermatology or medical side of it, we do a little bit of both. My clinic is very heavy in cosmetics and device driven areas. I still hold a huge amount of what I do as medical dermatology, but having the opportunity to be involved in research has been really great. We always have a fellow with us. The learning that's associated with that has been a fun addition to what I’ve had experience within the past. I've always worked for Mohs surgeons. This is now the third Mohs surgeon that I've worked with over my career path. I love the surgical side. I love the skin cancer side. I like problems that I can fix, I guess, so to speak, right disease states. I love psoriasis. I very much enjoy acne, especially in teenagers. I find it very gratifying to be able to take a young child or a teenage child that struggles, from a psychological and physical standpoint, through acne, and help them overcome that. Give them confidence. See that change in them. I love that.

 I know when they come in, it's like they're looking down, and 2 or 3 months later their head is much higher and they're sitting up straight. That confidence just spills over in the clinic.

 And they're so grateful. They can’t necessarily figure out how to say that. But you see it in their posture. You see it in their faces. I love that.

 That’s what it's all about. Now research, you said you do a lot of aesthetics. What is the 1 thing that you love about research?

I like being on the cutting edge of it. I love writing about things prior to them being FDA approved or public knowledge and understanding behind the scenes. What happens and reporting that, having that insight.

 That is exciting. Seeing how it's going to impact like you have that crystal ball of, “Wow, this is really going to impact these patients with this disease.” It doesn't feel any better than that.

And I think as a PA being involved in clinical trials is really important.

So, principal investigator? Is that coming down the pipeline?

I've been sub-investigator for a couple of different clinical trials, and I need a little more time in my life to be principal.

Absolutely. It's definitely in her future. Thank you, and I hope to share that future in the future!

[Transcript has been edited for clarity.]

Renata Block, MMS, PA-C, and Amber Blair, MMS, PA-C, discuss the gratification of helping patients and the excitement of being on the cutting edge of research. 

Public interest in benzoyl peroxide (BPO) experienced a substantial decline following Valisure LLC's March 2024 petition to the US Food and Drug Administration (FDA) requesting a recall of BPO products, according to 

The paper also found that based on relative search volume (RSV) data, BPO wash demonstrated variable patterns of interest, while Inova maintained stable interest, and PanOxyl experienced a significant decrease in RSV interest.

Valisure published its Citizen's Petition to the FDA following the testing of 66 BPO acne products, reporting that some products contained up to 12 times the FDA-allowed benzene limit. Affected products included Proactiv 2.5% BPO cream, Up & Up 2.5% BPO cream, and more.

Experts also published a research letter, Benzoyl Peroxide Drug Products Form Benzene, in 

, outlining the detection of benzene in BPO products during stability testing at temperatures mimicking body (37°C), shelf-life (50°C), and transportation (70°C) conditions.

In order to analyze the interest patterns of BPO surrounding this news, researchers Tan et al, utilized Google Trends data to conduct a query to collect RSV data. They then compared RSV data from March and April 2024 to the March-April time period of the previous years 2020, 2021, 2022, and 2023. 

RSV, scaled from 0 to 100, indicated a significant decline in interest post-petition across multiple BPO-related search terms from March to April 2024 compared to preceding years (2020-2023). 

BPO also showed a marked decrease in RSV from 86.19 in 2023 to 22.06 in 2024 (p < 0.001), consistent with a downward trend observed in earlier years. Conversely, BPO wash exhibited variable patterns but also experienced a decline in 2024 compared to 2023 (p = 0.015). 

Statistical analyses highlighted consistent decreases in RSV for BPO products overall from 2023 to 2024 (p < 0.001), indicating waning public interest following the petition. 

Specific products, such as Inova, maintained stable search volumes, while PanOxyl saw a significant RSV decrease in 2024 (p < 0.001).

Researchers identified several limitations. These included the lack of BPO-related search terms specific to RSV data and the absence of RSV data corresponding to particular BPO-related search terms, such as brand names of BPO-containing products, within the 2020 to 2024 period. Additionally, the study noted that Google Trends analysis does not provide access to RSV data from alternative search engines and cannot segment data by subpopulations, offering insights solely at the population level.

Moving forward, they noted the need for more comprehensive datasets.

"Our examination of Google Trends data post-Valisure's FDA petition in March 2024 highlights nuanced shifts in public interest regarding BPO products, providing insights into consumer perceptions amidst safety concerns and the interplay between these concerns and consumer behavior," according to Tan et al. 

In the future, they recommended that dermatology clinicians and health care providers adapt communication and treatment strategies based on changing perceptions and patient safety concerns.

Tan IJ, Sanabria B, Dhillon J, Rao B. Public interest in benzoyl peroxide: A Google Trends analysis. 

Valisure citizen petition on benzene in benzoyl peroxide drug products. Valisure. March 5, 2024. Accessed June 26, 2024. 

https://assets-global.website-files.com/6215052733f8bb8fea016220/65e8560962ed23f744902a7b_Valisure%20Citizen%20Petition%20on%20Benzene%20in%20Benzoyl%20Peroxide%20Drug%20Products.pdf

Kucera K, Zenzola N, Hudspeth A, et al. Benzoyl peroxide drug products form benzene. 

Recent research has shed light on public interest of BPO utilizing relative search volume data.

Benzoyl Peroxide Interest Plummets Post-Petition: RSV Drops from 86.19 to 22.06 in 2024, Reflecting Sustained Downward Trend

Ruth is a 45-year-old woman presenting with severe pruritus, erythematous rash, and lichenification across her legs, arms, and abdomen. She has a history of allergic rhinitis and asthma since childhood but no prior history of atopic dermatitis (AD). Ruth recently experienced work-related stress due to a promotion.

Upon further questioning, you learn that Ruth has disturbed sleep due to intense pruritis, hindering ability to be fully present in daily activities. Additionally, she mentions that she has noticed the symptoms and rash are worse when highly stressed, which is common with increased work demands. Ruth has tried multiple over the counter emollients and moderate-potency corticosteroids. Although she was diligent in their application, the rash persisted and she experienced rebound flares when tapering their use. She also mentioned that she was on a topical calcineurin inhibitor for a few months and noticed some improvement.

Ask follow up questions to determine whether stress is short-term, long-term, and/or spurred by a traumatic event

Try a different treatment option, such as dupilumab or tralokinumab

How do you approach a case that may be exacerbated by stress? We would love to hear from you. Email 

The case of a 45-year-old woman with AD challenges clinicians on how to consider stress as an exacerbating factor in a treatment-resistant case.

DermIQ 

Evaluating Stress Levels in AD Treatment Plans

will be in Scottsdale, Arizona for the 2024 Fall Clinical Dermatology Conference for PAs and NPs from May 31 to June 2, 2024. There are dozens of great sessions, poster presentations, and clinical insights from leading dermatology investigators, physicians, and practitioners to look forward to. We would love to know which sessions and topics you are most interested in, whether you are also attending in person or are counting on 

Pathogenesis and management of psoriasis, atopic dermatitis, and acne vulgaris

Up-to-date information on safe and effective use of biologic agents

Enhanced knowledge of skin cancer prevention, diagnosis, and management in my practice

Incorporating new techniques and uses of dermal fillers and neurotoxins

Will you be in Scottsdale? We would love to hear from you! Email 

Whether you are attending in-person or looking to Dermatology Times coverage, let us know which topics interest you most.

Renee Dowling

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