The American Academy of Dermatology

The annual meeting of the American Academy of Dermatology was held from March 1 to 5 in Washington, D.C., and attracted more than 15,000 participants from around the world, including clinicians, academicians, allied health professionals, and others interested in dermatology. The conference highlighted recent advances in the diagnosis and management of dermatological conditions.

During one presentation, Justin P. Bandino, M.D., of the San Antonio Military Medical Center in Texas, discussed some of the most common dermatologic conditions that arise after flooding events, including skin and soft tissue infections and unusual infections such as atypical organisms, mycobacteria, and deep fungal infections.

“Climate change is real, temperatures are warming, and natural disasters, in particular flood-related disasters, are increasing,” Bandino said. “Victims exposed to disastrous floods are at high risk for a myriad of infectious and noninfectious sequelae.”

According to Bandino, dermatologists are uniquely skilled at identifying, diagnosing, and treating these sequelae, and their efforts are not only helpful during relief efforts but also in the weeks or months after a flooding disaster.

“The impact specifically entails improved ability to make a diagnosis, better awareness of atypical infections, and more appropriate treatment and therapies,” Bandino said.

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During another presentation, Roger S. Ho, M.D., of NYU Langone Health in New York City, discussed the promise of artificial intelligence (AI) for skin cancer detection.

“I discussed the current state of AI and skin cancer detection and further addressed the following questions: What are the foreseeable barriers in achieving 100 percent AI accuracy in skin cancer detection? What are the issues to consider with this type of technology? What impact and what end-target audience experience should all this have on dermatologists, the nondermatologist, and patients? What might be the best way for both dermatologists and patients to embrace this technology?” Ho explained.

According to Ho, patients need to understand that AI currently cannot detect skin cancer with 100 percent accuracy, and 100 percent accuracy may not be achievable in the foreseeable future because of a myriad of logistical, methodological, and technological barriers.

“However, the dermatological community is committed to working with different technological platforms to enhance these algorithms in order to prioritize resources for patients and streamline patient access and patient education,” Ho said. “For the dermatologic community, AI technology is not meant to be used to replace dermatologists, but AI technology, when used with guidance from a dermatologist or the dermatologic community, has the potential to transform skin cancer screening and provide more efficient and precise dermatologic care. AI technology can also facilitate triaging so that dermatologists can do what they are best at doing and help those who need dermatologic care the most.”

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Marie Leger, M.D., Ph.D., a board-certified dermatologist in New York City, discussed how tattoos are very common (about 40 percent of people born after 1980 in the United States have a tattoo) and complications are also relatively common.

“People often do not come to dermatologists with their tattoo complaints. Instead, they go back to their tattoo artist or to the emergency room,” Leger said. “Dermatologists should be seen as tattoo experts. We have the opportunity to let tattoo artists and referring primary care doctors know that we are available to help with complications.”

Leger recommends dermatologists examine patients’ tattoos carefully when skin checks are performed.

“Patients will often not point out any problems to their dermatologist, and many complications (especially sarcoidosis) can have very subtle findings, including small bumps or ulcerations within and/or around the tattoo,” Leger said. “Patients with tattoo-related sarcoidosis seem to be at high risk for systemic sarcoidosis. Keep a close eye on these patients and screen them after doing a complete review of symptoms and a physical exam as you would other cutaneous sarcoidosis patients.”

Leger also recommends that dermatologists contact the tattoo artist if they see an acute tattoo complication occurring in the first days to weeks after a patient has obtained the tattoo. These complications are often related to technique or infection.

“Infections can have multiple sources, including the tattoo inks themselves, and artists can be important partners in helping to track and prevent infections,” Leger said. “Tattoo allergies (usually presenting as itchy, raised, sometimes scaly, irritated portions of the tattoo confined to one ink color that occur weeks to months after obtaining the tattoo) only rarely have positive patch testing results. These diagnoses need to be made clinically — histopathology is variable with allergies. Allergies can be treated with topical or injected steroids, ablative fractional laser, or ‘dermatome shaving,’ a technique in which the tattoo is removed with a dermablade a few millimeters at a time until no residual ink is observed. The wound then heals via secondary intention.”

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Jeffrey Rapaport, M.D., a board-certified dermatologist in private practice in New Jersey, discussed how platelet-rich plasma (PRP) therapy is a safe addition to existing therapy for hair loss.

“The safety of PRP has remained excellent. A growing body of evidence has shown that it is an effective treatment for androgenic alopecia and other forms of hair loss. My clinical impression is that the response rate is 60 to 80 percent,” Rapaport said. “A consensus protocol has developed. This includes monthly treatments for three months and maintenance every three to six months, depending upon the response. Subdermal injection gives good results. Pain levels are a two out of 10 when a 32-gauge needle is used. No anesthesia is needed.”

According to Rapaport, PRP is a new, natural alternative for those who wish to avoid current drug therapy (and the potential side effects) for androgenic alopecia.

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AAD: Isotretinoin Exposure for Acne Not Linked to Depression Risk

FRIDAY, March 1, 2019 (HealthDay News) — For patients with acne, exposure to isotretinoin is not associated with an increased risk for being diagnosed with depression, according to a study presented at the annual meeting of the American Academy of Dermatology, held from March 1 to 5 in Washington, D.C.

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