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On Call asked dermatologists around the country what they, or their practices are planning this year as they await a determination of what healthcare delivery will look like. Are they making any major changes, expanding or downsizing their practices?

Above and beyond its therapeutic value in cosmetic medicine, botulinum toxin can be useful in a number of medical indications and can represent an adjunct treatment option, said Philippe Humbert, M.D., Ph.D., at the 20th annual European Academy of Dermatology and Venereology Congress last October.

Accurately coding for evaluation and management (E&M) services billed to Medicare requires mastering subtleties that aren't always spelled out in coding instructions, said Allan S. Wirtzer, M.D., medical director, Mid Valley Dermatology and Cosmetic Surgery Center, Sherman Oaks, Calif., at the 2012 annual meeting of the American Academy of Dermatology.

Although ipilimumab (Yervoy, Bristol-Myers Squibb) has been a tremendous advance for patients with metastatic melanoma, only a subset of patients benefits from treatment.

The revolution in treatments for venous incompetence includes combinations of lasers and sclerosing technologies for leg veins, along with the gold standard of pulsed dye lasers for facial telangiectasias, hemangiomas and port wine stains, according to Neil Sadick, M.D.

Dr. Laser, in an attempt to lower office fees, taught his nurses to use lasers for various problems such as hair removal, facial toning and acne treatment. He sent his staff to many training courses and established rigid in-office guidelines for laser treatments. Unfortunately, a patient treated by a laser nurse now has a scar on her upper lip, and she filed a complaint against the nurse and Dr. Laser with the state board of nursing.

Physicians with the most satisfied patients aren't necessarily the ones who spend the most time with patients. Sometimes, even getting the highest-quality goods or services doesn't make up for a poor interaction.

Two experimental psoriasis drugs that target the interleukin (IL)-17 signaling pathway led to significant improvements in skin lesions for most patients over 12 weeks, separate phase 2 studies show.

Just as they do in lighter-skinned patients, new injectable and energy-based aesthetic treatments work synergistically for patients of color, according to Hema Sundaram, M.D.

The primary goal of the dermatologic laser surgeon is to deliver effective treatments without compromising patient safety. Laser and light-based technologies continue to evolve at a torrid pace, whereas the methodology by which laser surgeons assess the skin to be treated has lagged behind.

Topical combination treatments for psoriasis offer a high degree of clinical efficacy, patient safety and flexibility in designing treatment regimens, says David M. Pariser, M.D.

The approval of ingenol mebutate gel presents and easy-to-use option to treat actinic keratoses (AKs), but the flexibility in dosing of a treatment like imiquimod will ensure its place in the armamentarium of AK treatments, according to the professor and chairman of the department of dermatology, Mount Sinai School of Medicine, New York.

In my early years in dermatology, there were many distinguished and acknowledged experts whose published findings became part of the core of the discipline. When they presented their findings at medical meetings or in print, one assumed that the data was valid and accurate, and it was often translated into specific management options for our patients.

On March 22, the GOP-controlled U.S. House of Representatives voted to repeal the controversial Independent Payment Advisory Board (IPAB), established by the new healthcare law now being challenged in the U.S. Supreme Court, and intended to provide a mechanism to control increasing Medicare costs. That, of course, has been sought by large numbers of physicians groups, including the American Academy of Dermatology Association.

In coming years, the trend toward less invasive technologies will continue not only in fat removal and body sculpting treatments, but also in new modalities for delivering a variety of drugs, according to physicians who spoke at MauiDerm 2012: Advances in Cosmetic and Medical Dermatology in February.

Newly available photoacoustic devices can help dermatologists identify which pigmented lesions to biopsy, according to Darrell S. Rigel, M.D., M.S. Such devices only aid the trained specialist in the assessment of such lesions, however, and do not substitute for the professional, he says.

Several newly approved therapies have changed and are continuing to change the treatment of melanoma therapy so that it is no longer the "black sheep" of cancer therapy, according to Adil Daud, M.D.

Teledermatology just got a boost: A new study shows that "remote viewing" by skincare specialists improves the accuracy of dermatologic diagnoses in the primary care setting by almost 70 percent.

Water-resistant sunscreen with a sun protection factor of 70 or greater can help to adequately protect people against skin cancer and photodamage, even when applied sparingly, a new study suggests.

The use of Mohs micrographic surgery (MMS) to treat nonmelanoma skin cancer (NMSC) among Medicare beneficiaries doubled from 2001 through 2006, a study published in the April issue of Archives of Dermatology reports.

Basal cell carcinoma on the ear is more frequently found in men, and is significantly more likely to be aggressive, according to a study in the May issue of the Journal of the American Academy of Dermatology.

A laser approach that selectively targets the sebaceous glands may prove to be an effective future therapy for acne, said Fernanda H. Sakamoto, M.D., Ph.D., at the 2012 annual meeting of the American Society for Laser Medicine and Surgery.

A procedure known as Axilase that involves use of a fixed combination of 924 nm and 975 nm continuous wave laser energy can treat primary axillary hyperhidrosis, according to study data presented at the 2012 annual meeting of the American Society for Laser Medicine and Surgery.

The use of propranolol and pulsed dye laser (PDL) led to more rapid clearing of infantile hemangiomas than propranolol alone, according to a retrospective chart review presented at the 2012 annual meeting of the American Society for Laser Medicine and Surgery.

The cosmetic and medical aspects of onychomycosis appear to be treated effectively with 1,064 nm Nd:YAG laser therapy, said Jill Waibel, M.D., at the 2012 annual meeting of the American Society for Laser Medicine and Surgery.

An aesthetic device that delivers bipolar radiofrequency (RF) energy via microneedling appears to achieve skin tightening, lifting and volumization that can be measured objectively through the comparison of pre- and post-procedure 3-D images, said Lori Brightman, M.D., at the 2012 annual meeting of the American Society for Laser Medicine and Surgery.

Treatment with a picosecond 755 nm alexandrite laser (Cynosure) appears to be a significant advance for clearing tattoos as well as benign pigmented lesions, according to research reported at LASER 2012, the annual conference of the American Society for Laser Medicine and Surgery.

Repetitive same-day treatment with a nanosecond pulse, Q-switched laser increases tattoo ink clearance and is safe, but the magnitude of improvement does not appear to increase linearly with the number of treatments, reported Suzanne L. Kilmer, M.D., at LASER 2012, the 32nd annual meeting of the American Society for Laser Medicine and Surgery.

Finasteride, the main ingredient in Merck?s drugs Proscar, Propecia and generic equivalents, will now carry an expanded warning about lingering sexual side effects, the Associated Press reports.

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