ABSTRACT
Correct coding is an important component of effective dermatology practice management. Over the past several years there have been updates to many commonly used codes within dermatology. This review highlights many of these updates, such as: the skin biopsy codes have been subdivided to reflect the different biopsy techniques. The definition of complex linear repairs has been updated and clarified. Outpatient and inpatient evaluation and management visits have new coding guidelines to determine level of care. Dermatopathology consultation codes have been updated and category III codes related to digital pathology have been created. Understanding the details and nuances of each of these categories of codes is vital to ensuring appropriate coding is performed.
Subject(s)
Clinical Coding , Dermatology , Dermatology/standards , Dermatology/methods , Humans , Skin Diseases/diagnosis , Skin Diseases/pathology , Skin Diseases/therapy , Biopsy , International Classification of DiseasesABSTRACT
BACKGROUND: Dyshidrotic eczema (DE) is a common form of eczema affecting the hands, feet, or both areas. To date, there has been little research examining demographics and cost burden associated with this disease. OBJECTIVE: This study seeks to characterize the demographics of patients affected and the direct costs of care associated with DE. METHODS: This is a retrospective analysis utilizing insurance claim information from IBM MarketScan. Pertinent data including demographic information, healthcare provider type, medications prescribed, and average cost of care were identified using the ICD 10 code L30.1 for DE for the year 2018. RESULTS: In 2018, 34 932 patients filed claims for DE, with 61% female and an average age of 37 years at first diagnosis. DE was mostly seen in employees from the service industry and the manufacturing of durable goods. The total annual direct cost was US $11 738 985. Average annual costs, however, did vary based on type of treating healthcare provider, level of care, and medications prescribed. CONCLUSIONS: Patients with DE can face an economic burden due to their disease and providers should aim to recognize this disease and its treatments to minimize healthcare costs for patients and improve quality of life.
Subject(s)
Cost of Illness , Eczema, Dyshidrotic/economics , Eczema, Dyshidrotic/epidemiology , Health Care Costs , Adolescent , Adult , Ambulatory Care Facilities/economics , Child , Child, Preschool , Direct Service Costs , Drug Costs , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Office Visits/economics , Retrospective Studies , Young AdultABSTRACT
Due to the shortage of pediatric dermatologists and the abundance of skin disorders presenting in childhood, general pediatricians shoulder the management of many pediatric dermatologic disorders and would benefit from additional dermatology-specific training. To address this educational gap, general pediatricians were enrolled in a pediatric dermatology-specific Project Extension for Community Healthcare Outcomes (ECHO) program and surveyed to assess the efficacy of the program in increasing providers' ability and confidence in managing pediatric dermatologic conditions. Providers unanimously reported increased confidence and abilities in assessment and management of pediatric dermatologic conditions. Pediatric dermatology Project ECHO demonstrated high efficacy in improving general practitioners' comfort and knowledge on dermatology-specific topics and may be used as an education model for enhancing primary care providers' knowledge and management of common disorders.
Subject(s)
Dermatology , Child , Community Health Services , Dermatology/education , Humans , Primary Health Care , Surveys and QuestionnairesABSTRACT
BACKGROUND: Syphilis is often misdiagnosed clinically, and biopsies might be required. OBJECTIVE: To determine histopathologic features that distinguish secondary syphilis from pityriasis lichenoides (PL), pityriasis rosea (PR), and early mycosis fungoides (MF). METHODS: Histopathologic features of 100 cases of syphilis, 110 cases of PL, 72 cases of PR, and 101 cases of MF were compared. RESULTS: Elongated rete ridges and interstitial inflammation favor syphilis over PL (likelihood ratios 3.44 and 2.72, respectively), but no feature reliably distinguishes between them. Secondary syphilis and PR can be distinguished by neutrophils in the stratum corneum, plasma cells, interface dermatitis with lymphocytes and vacuoles, and lymphocytes with ample cytoplasm. Plasma cells and lymphocytes with ample cytoplasm are rare in early MF and can be used as distinguishing features. CONCLUSIONS: Histopathologic features characteristic of syphilis can be seen in PL, PR, and early MF. Distinguishing syphilis from PL can be difficult histologically, and a high index of suspicion is required. Although elongation of rete and interstitial inflammation favor syphilis, plasma cells (historically considered a significant feature of syphilis) are often encountered in PL. Vacuolar interface dermatitis with a lymphocyte in every vacuole is considered characteristic of PL, but this feature appears to be more common in syphilis.
Subject(s)
Mycosis Fungoides/diagnosis , Pityriasis Lichenoides/diagnosis , Pityriasis Rosea/diagnosis , Skin Neoplasms/diagnosis , Syphilis/diagnosis , Syphilis/pathology , Diagnosis, Differential , Humans , Mycosis Fungoides/pathology , Pityriasis Lichenoides/pathology , Pityriasis Rosea/pathology , Sensitivity and Specificity , Skin Neoplasms/pathologyABSTRACT
Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia that primarily affects women of African descent. Although histopathological features of CCCA have been described, the pathophysiology of this disease remains unclear. To better understand the components of CCCA pathophysiology, we evaluated the composition of the inflammatory infiltrate, the distribution of Langerhans cells (LCs), and the relationship between fibrosis and perifollicular vessel distribution. Our data indicate that CCCA is associated with a CD4-predominant T-cell infiltrate with increased LCs extending into the lower hair follicle. Fibroplasia associated with follicular scarring displaces blood vessels away from the outer root sheath epithelium. These data indicate that CCCA is an inflammatory scarring alopecia with unique pathophysiologic features that differentiate it from other lymphocytic scarring processes.
Subject(s)
Alopecia/pathology , Cicatrix/pathology , Hair Follicle/pathology , Langerhans Cells/pathology , Black or African American/ethnology , Alopecia/physiopathology , CD4-Positive T-Lymphocytes/pathology , CD8-Positive T-Lymphocytes/pathology , Female , Fibrosis/pathology , Hair Follicle/blood supply , Humans , Retrospective StudiesABSTRACT
BACKGROUND: SOX10 immunostaining has been considered a highly sensitive and specific marker for melanoma. But there is evidence suggesting that SOX10 positive cells can be present in dermal scars. Therefore, we investigated whether non-melanocytic cell types present in chronic inflammatory processes or benign lymph nodes express SOX10. METHODS: We retrospectively selected 20 benign lymph nodes and 20 cutaneous granulomatous dermatoses. SOX10, CD68, and Melan-A immunohistochemistry was performed in all cases. RESULTS: Scattered SOX10 positivity was found in 85% of lymph nodes, specifically in subcapsular and medullary sinuses and in 85% of granulomatous dermatoses. In granulomatous dermatoses, the Melan-A stain did not label the scattered SOX10 positive cells and it was difficult to determine if CD68 was co-expressed on the SOX10 positive cells. In the lymph nodes, the SOX10 positive cells did not co-express Melan-A or CD68. CONCLUSIONS: We report SOX10 positive cells detected in granulomatous dermatoses and benign lymph nodes. In lymph nodes, SOX10 positive cells were exclusively in subcapsular and medullary sinuses. Therefore, SOX10 is an excellent stain for evaluation of metastatic melanoma with the caveat that positivity in subcapsular and medullary sinuses can be of non-melanocytic origin; the use of additional melanocytic markers is recommended in this situations.
Subject(s)
Biomarkers, Tumor/metabolism , Lymph Nodes/metabolism , Melanoma/metabolism , Neoplasm Proteins/metabolism , SOXE Transcription Factors/metabolism , Skin Diseases/metabolism , Skin Neoplasms/metabolism , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Immunohistochemistry , Lymph Nodes/pathology , Male , Melanoma/pathology , Middle Aged , Retrospective Studies , Skin Diseases/pathology , Skin Neoplasms/pathology , Staining and LabelingSubject(s)
Dermatitis, Allergic Contact , Dermatitis, Irritant , Dermatitis, Occupational , Occupational Exposure , Humans , Retrospective Studies , Dermatitis, Allergic Contact/diagnosis , Dermatitis, Allergic Contact/etiology , Dermatitis, Occupational/diagnosis , Dermatitis, Occupational/etiology , Patients , Patch TestsABSTRACT
Although allergists often evaluate rashes associated with allergic, IgE mediated etiologies, it is important to consider a wide range of differential diagnoses that includes inflammatory, infectious, and autoimmune etiologies. The case of a 58-year-old woman with a 1-year history of progressive pruritic rash that did not improve with topical creams and steroids is presented. The patient did not state any other symptoms, and a physical examination was notable for a widespread rash. After a detailed evaluation of the rash, a differential diagnosis was made, and results of a skin biopsy confirmed a specific diagnosis. Even in the context of a medical history of atopy, one must consider nonallergic causes of rash, including abnormal presentations of systemic conditions. It is important to determine the specific etiology of the rash because this will dictate treatment and prognosis and/or complications of the disease associated with the skin manifestations.
Subject(s)
Exanthema/diagnosis , Pruritus/diagnosis , Biomarkers , Biopsy , Diagnosis, Differential , Female , Hand , Humans , Immunoassay , Middle Aged , Phenotype , Symptom AssessmentABSTRACT
Linear vesicles or papules in a newborn can be a presenting sign of incontinentia pigmenti (IP). In this report, we present two cases of neonates with cutaneous manifestations of incontinentia pigmenti. In one case, mild peripheral eosinophilia was noted. No extra-cutaneous manifestations were noted otherwise in both cases after complete ophthalmological and neurological evaluations. These cases serve as a reminder for clinicians to consider IP in newborns presenting with linear vesicles or papules.
Subject(s)
Incontinentia Pigmenti/pathology , Leg Dermatoses/pathology , Female , Humans , Incontinentia Pigmenti/diagnosis , Infant, Newborn , Leg Dermatoses/diagnosisABSTRACT
BACKGROUND: Secondary syphilis has a wide spectrum of clinical and histologic manifestations. OBJECTIVE: We sought to determine the frequency of histopathological features characterizing secondary syphilis, and which are most common in specimens displaying few diagnostic findings. METHODS: In a multicenter, retrospective analysis of biopsy-proven secondary syphilis, cases were subcategorized by the number of histologic characteristics present. RESULTS: The 106 cases mostly had 5 to 7 of the features studied. Many features were scarcer in cases with 5 or fewer features, including endothelial swelling (87.7% overall vs 72.4% ≤5 features), plasma cells (69.8% vs 48.3%), and elongated rete ridges (75.5% vs 27.6%). Specimens with 5 or fewer features were more likely to be truncal (61.1% vs 34.4% overall), demonstrate rete ridge effacement (44.8% vs 19.8%), and have pityriasis rosea (33.3% vs 17.2%) or drug eruption (33.3% vs 10.9%) in the clinical differential. An interstitial inflammatory pattern was the most common characteristic of specimens with 5 or fewer features (75.9%). LIMITATIONS: This was a retrospective review. CONCLUSION: The independent value of many histologic features of syphilis may be overestimated. Combinations of endothelial swelling, interstitial inflammation, irregular acanthosis, and elongated rete ridges should raise the possibility of syphilis, along with the presence of vacuolar interface dermatitis with a lymphocyte in nearly every vacuole and lymphocytes with visible cytoplasm.
Subject(s)
Syphilis, Cutaneous/epidemiology , Syphilis, Cutaneous/pathology , Syphilis/epidemiology , Syphilis/pathology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Biopsy, Needle , Cohort Studies , Female , Humans , Immunohistochemistry , Incidence , Male , Middle Aged , Prognosis , Retrospective Studies , Risk Assessment , Severity of Illness Index , Sex Distribution , Sexually Transmitted Diseases/prevention & control , United States/epidemiology , Young AdultABSTRACT
Atypical acquired melanocytic nevi in patients with epidermolysis bullosa (EB) have been referred to as EB nevi and are considered to be a type of recurrent nevus with atypical but distinctive histopathologic findings. Herein, we describe an atypical nevus in a patient with Hailey-Hailey disease with different histopathologic findings from EB nevi because of presumably different pathogenesis. It is important to be aware that the recurrent nevi phenomenon can be seen in acantholytic conditions as well as blistering disorders, given these lesions may clinically resemble melanoma.
Subject(s)
Melanoma/pathology , Neoplasm Recurrence, Local/pathology , Nevus, Pigmented/pathology , Pemphigus, Benign Familial/pathology , Skin Neoplasms/pathology , Adult , Female , HumansSubject(s)
Carney Complex , Melanocytes , Neurilemmoma , Skin Neoplasms , Adult , Carney Complex/metabolism , Carney Complex/pathology , Humans , Male , Melanocytes/metabolism , Melanocytes/pathology , Neurilemmoma/metabolism , Neurilemmoma/pathology , Skin Neoplasms/metabolism , Skin Neoplasms/pathologyABSTRACT
On January 1, 2024, the new add-on complexity code for evaluation and management (E/M) services, G2211, went into effect. Understanding appropriate use of this code and how it can and cannot be utilized is of importance for all physicians. This article discusses the nuances of this code and gives examples of how to effectively incorporate it into practice.
Subject(s)
Clinical Coding , Humans , Dermatology , United StatesABSTRACT
The 2023 ruling by the Supreme Court of the United States (SCOTUS) on the use of race-based criteria in college admissions may have implications for the selection of individuals into the dermatology workforce. This article highlights the impact of these decisions at the undergraduate, medical school, and graduate medical education levels, as well as within the field of dermatology.
Subject(s)
Dermatology , Supreme Court Decisions , Dermatology/legislation & jurisprudence , Humans , United States , School Admission Criteria , Personnel Selection/legislation & jurisprudence , Schools, Medical/legislation & jurisprudenceABSTRACT
TLR3 is expressed in human skin and keratinocytes, and given its varied role in skin inflammation, development, and regeneration, we sought to determine the cellular response in normal human keratinocytes to TLR3 activation. We investigated this mechanism by treating primary human keratinocytes with both UVB, an endogenous and physiologic TLR3 activator, and poly(I:C), a synthetic and selective TLR3 ligand. TLR3 activation with either UVB or poly(I:C) altered keratinocyte morphology, coinciding with the key features of epithelial-to-mesenchymal transition: increased epithelial-to-mesenchymal transition gene expression, enhanced migration, and increased invasion properties. These results confirm and extend previous studies demonstrating that in addition to its classical role in the innate immune response, TLR3 signaling also regulates stem cell-like properties and developmental programs.
Subject(s)
Cell Movement , Epithelial-Mesenchymal Transition , Keratinocytes , Poly I-C , Signal Transduction , Toll-Like Receptor 3 , Humans , Toll-Like Receptor 3/metabolism , Toll-Like Receptor 3/genetics , Keratinocytes/metabolism , Epithelial-Mesenchymal Transition/genetics , Poly I-C/pharmacology , Cell Movement/genetics , Ultraviolet Rays/adverse effects , Cells, Cultured , Skin/metabolism , Skin/cytologyABSTRACT
Consultation codes can be utilized by dermatologists in both the inpatient and outpatient setting. Updates to the inpatient and outpatient consultation code families went into effect January 1, 2023. Similar to the outpatient evaluation and management (E/M) codes, level of service is now determined solely based on either time on the date of the encounter or medical decision-making. Additionally, interprofessional consultation codes are time-based codes that can be utilized when assisting in the diagnosis and/or management of a patient without face-to-face contact.