SDPA DIGITAL Live Blog: What’s New in the Literature?
Dr. Joslyn Kirby kicked off the SDPA Digital CME conference Thursday morning with an enlightening review of the dermatology medical literature published within the last year. Dr. Kirby initiated the presentation by illustrating the dermatologic manifestations of COVID-19 with an important reminder that these cutaneous presentations are “not pathognomonic to COVID.” Additionally, she reviewed the increased rates of PPE dermatitis and hand dermatitis with the practice of medicine during COVID, underscoring that most dermatitis from PPE is a result of wear for durations longer than six hours. Further, Dr. Kirby discussed the research around the use of biologics in dermatology patients during the COVID health crisis. The research reveals it is safe to start and maintain effective biologics for our patients and there is no evidence of increased rates of severe (COVID) disease among patients on biologic medications.
Next, Dr. Kirby discussed some of the newest updates in the area of non-melanoma and melanoma skin cancers. A 2019 JAAD article explored the (T)umor staging of melanoma skin cancer with the depths of these tumors now rounded to the tenth place. Staging of these tumors is no longer based on mitoses. Of note, Dr. Kirby emphasized the presence of in-transit or satellite lesions automatically will move a melanoma into a stage 3 or higher category. Furthermore, Dr. Kirby highlighted the importance of careful inspection and biopsy of basal cell carcinomas in high-risk areas. Up to 40% of basal cell carcinomas, particularly in high-risk facial regions have been found to have two or more growth patterns. Dr. Kirby related the histology of these lesions impacts recurrence risk (and thus treatment options).
Dr. Kirby relayed the care of transgender patients by dermatology providers as a way for us to “use our tools as an art to help people live in their bodies”. She reviewed the use of neurotoxins and fillers for facial shaping in these patients— particularly in the jaw, brow, and cheekbones. Additional topics of interest in this patient population is the importance of understanding the dermatologic effects of hormone use. For example, estrogen and progesterone use can lead to xerosis, eczema, and nail thinning while testosterone can cause androgenetic alopecia.
The use of platelet-rich-plasma (PRP) as a treatment option for androgenetic alopecia (AA) and vitiligo was examined by Dr. Kirby. PRP has shown the ability to increase the number of hairs as well as the thickness of individual hairs in patients with AA. For vitiligo, PRP has been found most effective on the face, trunk, and extremities and least effective on acral regions. Additionally, PRP is effective for vitiligo when combined with fractionated CO2.
Lastly, Dr. Kirby finished her presentation with the discussion of JAK inhibitors for the treatment of atopic dermatitis in patients aged six years and up and for the treatment of alopecia areata patients.
Byline: Sarah B.W. Patton, MSHS, PA-C
Posted October 29, 2020