14-Gauge Coaxial Bone Needle Leads to Superior Results When Injecting Calcinosis Cutis.

Calcinosis cutis can occur idiopathically or be associated with injury, metabolic disease, and different rheumatologic diseases such as scleroderma and dermatomyositis. Calcinosis cutis is often treatment-resistant and leads to decreased quality of life and pain. Medical therapies, such as bisphosphonates, warfarin, tetracyclines, calcium channel blockers, colchicine, laser therapy and surgery, lithotripsy, and even stem cell transplantation have been used with varying success.

14-Gauge Coaxial Bone Needle Leads to Superior Results When Injecting Calcinosis Cutis.

Calcinosis cutis can occur idiopathically or be associated with injury, metabolic disease, and different rheumatologic diseases such as scleroderma and dermatomyositis.

Well-Being and Professional Fulfillment in Mohs Surgeons: An Explanatory Sequential Mixed-Method Design Study.

Background: There are limited data evaluating specific themes of well-being and professional fulfillment in Mohs surgeons.

Objective: To identify factors that drive occupational distress and those that promote well-being and professional fulfillment among Mohs surgeons.

Methods: This is an explanatory sequential mixed-method study, using semistructured individual interviews.

Cohort study assessing the predictive value of a research year vs additional degree in dermatology.

Taking a gap year to obtain an additional degree or for research is becoming increasingly popular among medical students pursuing dermatology to bolster residency application competitiveness. The purpose of this study was to determine whether doing so influences future academic achievement and career trajectory. A list of dermatologists who achieved board certification in 2010 was obtained from the American Board of Dermatology.

Burnout and resiliency in Mohs surgeons: A survey study.

Background: Physician burnout is a response to chronic work stress characterized by emotional exhaustion, depersonalization, and reduced sense of personal accomplishment. Resiliency is the ability to respond to chronic stress in a healthy and adaptive manner. No prior studies have specifically examined the prevalence of burnout and resilience in Mohs surgeons.

Chronic blistering rash on hands.

The location of the patient's lesions and multiple risk factors suggested that an uncommon disorder was at work.

Optimizing the total-body skin exam: An observational cohort study.

Background: Total-body skin examinations (TBSEs) are commonly performed in clinical practice. There is limited research on best practices for performing a TBSE.

Objective: To optimize the TBSE.

Bundled payment for actinic keratosis management: Pilot evaluation of developed models.

Background: There is an opportunity to explore alternate payment models in dermatology.

Objective: To pilot 2 bundled payment models for actinic keratosis (AK) management.

Methods: A prospective cohort study was conducted during September 2013-June 2016.

Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and Alternative Payment Models in dermatology.

With the introduction of the Medicare Access and Children's Health Insurance Program Reauthorization Act, clinicians who are not eligible for an exemption must choose to participate in 1 of 2 new reimbursement models: the Merit-based Incentive Payment System or Alternative Payment Models (APMs). Although most dermatologists are expected to default into the Merit-based Incentive Payment System, some may have an interest in exploring APMs, which have associated financial incentives. However, for dermatologists interested in the APM pathway, there are currently no options other than joining a qualifying Accountable Care Organization, which make up only a small subset of Accountable Care Organizations overall.

Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and the Merit-based Incentive Payment System.

As the implementation of the Medicare Access and Children's Health Insurance Program Reauthorization Act begins, many dermatologists who provide Medicare Part B services will be subject to the reporting requirements of the Merit-based Incentive Payment System (MIPS). Clinicians subject to MIPS will receive a composite score based on performance across 4 categories: quality, advancing care information, improvement activities, and cost. Depending on their overall MIPS score, clinicians will be eligible for a positive or negative payment adjustment.

Variation in the Cost of Managing Actinic Keratosis.

Importance: Actinic keratosis (AK), a skin growth induced by ultraviolet light exposure, requires chronic management because a small proportion can progress into squamous cell skin cancer. Spending for AK management was more than $1 billion in 2004. Investigating geographic variation in AK spending presents an opportunity to decrease waste or recoup excess spending.

Standardized laboratory monitoring with use of isotretinoin in acne.

Background: Laboratory monitoring for adverse effects to isotretinoin occurs with variability. Standardization of laboratory monitoring practices represents an opportunity to improve quality of care.

Objective: We sought to develop an evidence-based approach to laboratory monitoring of patients receiving isotretinoin therapy for acne.

Bundled Payment Models for Actinic Keratosis Management.

Importance: Recent legislation encourages alternative payment models, such as bundled payments. There are no clear recommendations on bundled payment design, and research on bundled payments for dermatologic care is limited.

Objective: To investigate several methods to develop bundled payment models for actinic keratosis (AK) management and the likely effect on the cost of AK management.

Individualizing patient education for greater patient satisfaction.

The benefits of educational intervention on health outcomes has been widely discussed, but the most educational methods have not been addressed. We sought to assess preferred modes of education during an outpatient dermatology visit (ie, verbal instruction [VI], written instruction [WI], demonstration [DM], Internet resources [IR]). We secondarily looked at patient satisfaction with the educational methods used.

A case of inflammatory nonscarring alopecia associated with the tyrosine kinase inhibitor nilotinib.

Importance: Nilotinib, a recently approved multitargeted tyrosine kinase inhibitor targeting the BCR-Abl translocation involved in chronic myelogenous leukemia, reportedly produces alopecia according to the package insert, but clinical and histologic descriptions of the alopecia are lacking.

Observations: A 33-year-old woman with chronic myelogenous leukemia developed widespread alopecia involving scalp and body hair within weeks after starting nilotinib therapy. Biopsies revealed perifollicular lymphocytic inflammation and evidence of follicular injury but normal hair density, consistent with a nonscarring alopecia.