Winter 2010 Journal of Dermatology for Physician Assistants

Volume 4 number 1 WINTER 2010

SDPA News and Current Affairs

dermatology pa news and notes

clinical dermatology

surgical dermatology

cosmetic dermatology

Professional development

Official Journal of the Society of Dermatology Physician Assistants

Vol.4, No. 1 WINTER 2010

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RETIN-A MICRO® (tretinoin gel) microsphere, 0.04% and 0.1% are indicated for topical application in the treatment of acne vulgaris.

Important Safety Information: RETIN-A MICRO (tretinoin gel) microsphere, 0.04% and 0.1% is contraindicated in individuals with a history of sensitivity reactions to any of its components. The skin of certain individuals may become excessively dry, red, swollen or blistered. If warranted, these individuals should temporarily reduce the amount or frequency of application, or discontinue use temporarily or altogether. Patients should be encouraged to minimize exposure to sunlight, including sunlamps, and to use a sunscreen with a SPF of 15 or higher and protective clothing.

The most common adverse reactions to RETIN-A MICRO 0.04% and 0.1% were limited to mild or moderate irritation of the skin. 1.3% of patients using RETIN-A MICRO 0.04% and 6% of patients using RETIN-A MICRO 0.1% discontinued due to irritation. RETIN-A MICRO 0.04% and 0.1% showed a visible reduction in total mean lesion count in as little as 2 weeks with full benefits seen after 7 weeks.

Please see brief summary of prescribing information on the next page. *Reported at the end of the 12-week P.U.M.P. Study. † Data based on a consumer preference study designed to evaluate preference of Pump versus tube delivery. 104 male and female acne sufferers between the ages of 13 and 36 completed the study.3 References: 1. RETIN-A MICRO 0.04%/0.1% [prescribing information]. Los Angeles, Calif: Ortho Dermatologics; May 2006. 2. Eichenfield LF, Nighland M, Rossi AB, et al; PUMP Study Group. Phase 4 study to assess tretinoin pump for the treatment of facial acne. J Drugs Dermatol. 2008;7(12):1129-1136. 3. Data on file, Ortho Dermatologics. 4. Embil K, Nacht S. The Microsponge ® Delivery System (MDS): a topical delivery system with reduced irritancy incorporating multiple triggering mechanisms for the release of actives. J Microencapsul.

1996;13(5):575-588.

RETIN-A MICRO ® is a brand of Ortho Dermatologics division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. © Ortho Dermatologics division of Ortho-McNeil-Janssen Pharmaceuticals, Inc. 2009 09DD0217 10/09 Printed in the USA

FOR TOPICAL USE ONLY. NOT FOR OPHTHALMIC, ORAL, OR INTRAVAGINAL USE. Brief Summary Retin-A Micro® (tretinoin gel) microsphere, 0.1% and 0.04% is a formulation containing 0.1% or 0.04%, by weight, tretinoin for topical treatment of acne vulgaris. This formulation uses patented methyl methacrylate/glycol dimethacrylate crosspolymer porous microspheres (MICROSPONGE® System) to enable inclusion of the active ingredient, tretinoin, in an aqueous gel.

IMPORTANT NOTE: This information is a BRIEF SUMMARY of the complete prescribing information provided with the product and therefore should not be used as the basis for prescribing the product. This summary has been prepared by deleting information from the complete prescribing information such as certain text, tables, and references.

The physician should be thoroughly familiar with the complete prescribing information before prescribing the product.

INDICATIONS AND USAGE: Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04%, is indicated for topical application in the treatment of acne vulgaris. The safety and efficacy of the use of this product in the treatment of other disorders have not been established.

CONTRAINDICATIONS: This drug is contraindicated in individuals with a history of sensitivity reactions to any of its components. It should be discontinued if hypersensitivity to any of its ingredients is noted.

PRECAUTIONS: General: • The skin of certain individuals may become excessively dry, red, swollen, or blistered. If the degree of irritation warrants, patients should be directed to temporarily reduce the amount or frequency of application of the medication, discontinue use temporarily, or discontinue use all together. Efficacy at reduced frequencies of application has not been established.

If a reaction suggesting sensitivity occurs, use of the medication should be discontinued.

Excessive skin dryness may also be experienced; if so, use of an appropriate emollient during the day may be helpful.

• Unprotected exposure to sunlight, including sunlamps, should be minimized during the use of Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04%, and patients with sunburn should be advised not to use the product until fully recovered because of heightened susceptibility to sunlight as a result of the use of tretinoin. Patients who may be required to have considerable sun exposure due to occupation and those with inherent sensitivity to the sun should exercise particular caution. Use of sunscreen products (SPF 15) and protective clothing over treated areas are recommended when exposure cannot be avoided.

• Weather extremes, such as wind or cold, also may be irritating to patients under treatment with tretinoin.

• Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04%, should be kept away from the eyes, the mouth, paranasal creases of the nose, and mucous membranes.

• Tretinoin has been reported to cause severe irritation on eczematous skin and should be used with utmost caution in patients with this condition.

Information for Patients: A Patient Information Leaflet has been prepared and is included with each package of Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04%.

Drug Interactions: Concomitant topical medication, medicated or abrasive soaps and cleansers, products that have a strong drying effect, products with high concentrations of alcohol, astringents, or spices should be used with caution because of possible interaction with tretinoin. Avoid contact with the peel of limes. Particular caution should be exercised with the concomitant use of topical over-the-counter acne preparations containing benzoyl peroxide, sulfur, resorcinol, or salicylic acid with Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04%. It also is advisable to allow the effects of such preparations to subside before use of Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04%, is begun.

Carcinogenesis, Mutagenesis, Impairment of Fertility: In a 91-week dermal study in which CD-1 mice were administered 0.017% and 0.035% formulations of tretinoin, cutaneous squamous cell carcinomas and papillomas in the treatment area were observed in some female mice. These concentrations are near the tretinoin concentration of these clinical formulations (0.04% and 0.1%). A dose-related incidence of liver tumors in male mice was observed at those same doses. The maximum systemic doses associated with the administered 0.017% and 0.035% formulations are 0.5 and 1.0 mg/kg/day, respectively. These doses are two and four times the maximum human systemic dose applied topically, when normalized for total body surface area. The biological significance of these findings is not clear because they occurred at doses that exceeded the dermal maximally tolerated dose (MTD) of tretinoin and because they were within the background natural occurrence rate for these tumors in this strain of mice. There was no evidence of carcinogenic potential when 0.025 mg/kg/day of tretinoin was administered topically to mice (0.1 times the maximum human systemic dose, normalized for total body surface area). For purposes of comparisons of the animal exposure to systemic human exposure, the maximum human systemic dose applied topically is defined as 1 gram of Retin-A Micro (tretinoin gel) microsphere, 0.1% applied daily to a 50 kg person (0.02 mg tretinoin/kg body weight).

Dermal carcinogenicity testing has not been performed with Retin-A Micro (tretinoin gel) microsphere, 0.04% or 0.1%.

Studies in hairless albino mice suggest that concurrent exposure to tretinoin may enhance the tumorigenic potential of carcinogenic doses of UVB and UVA light from a solar simulator. This effect has been confirmed in a later study in pigmented mice, and dark pigmentation did not overcome the enhancement of photocarcinogenesis by 0.05% tretinoin. Although the significance of these studies to humans is not clear, patients should minimize exposure to sunlight or artificial ultraviolet irradiation sources.

The mutagenic potential of tretinoin was evaluated in the Ames assay and in the in vivo mouse micronucleus assay, both of which were negative.

The components of the microspheres have shown potential for genetic toxicity and teratogenesis.

EGDMA, a component of the excipient acrylates copolymer, was positive for induction of structural chromosomal aberrations in the in vitro chromosomal aberration assay in mammalian cells in the absence of metabolic activation, and negative for genetic toxicity in the Ames assay, the HGPRT forward mutation assay, and the mouse micronucleus assay.

In dermal Segment I fertility studies of another tretinoin formulation in rats, slight (not statistically significant) decreases in sperm count and motility were seen at 0.5 mg/kg/day (4 times the maximum human systemic dose applied topically, and normalized for total body surface area), and slight (not statistically significant) increases in the number and percent of nonviable embryos in females treated with 0.25 mg/kg/day (2 times the maximum human systemic dose applied topically and normalized for total body surface area) and above were observed. In oral Segment I and Segment III studies in rats with tretinoin, decreased survival of neonates and growth retardation were observed at doses in excess of 2 mg/kg/day (17 times the human topical dose normalized for total body surface area).

Dermal fertility and perinatal development studies with Retin-A Micro (tretinoin gel) microsphere, 0.1% or 0.04%, have not been performed in any species.

Pregnancy: Teratogenic Effects: Pregnancy Category C. In a study of pregnant rats treated with topical application of Retin-A Micro (tretinoin gel) microsphere, 0.1%, at doses of 0.5 to 1 mg/kg/day on gestation days 6-15 (4 to 8 times the maximum human systemic dose of tretinoin normalized for total body surface area after topical administration of Retin-A Micro (tretinoin gel) microsphere, 0.1%) some alterations were seen in vertebrae and ribs of offspring. In another study, pregnant

New Zealand white rabbits were treated with Retin-A Micro (tretinoin gel) microsphere, 0.1%, at doses of 0.2, 0.5, and 1.0 mg/kg/day, administered topically for 24 hours a day while wearing Elizabethan collars to prevent ingestion of the drug. There appeared to be increased incidences of certain alterations, including domed head and hydrocephaly, typical of retinoid-induced fetal malformations in this species, at 0.5 and 1.0 mg/kg/day. Similar malformations were not observed at 0.2 mg/kg/day, 3 times the maximum human systemic dose of tretinoin after topical administration of Retin-A Micro (tretinoin gel) microsphere, 0.1%, normalized for total body surface area. In a repeat study of the highest topical dose (1.0 mg/kg/day) in pregnant rabbits, these effects were not seen, but a few alterations that may be associated with tretinoin exposure were seen. Other pregnant rabbits exposed topically for six hours to 0.5 or 0.1 mg/ kg/day tretinoin while restrained in stocks to prevent ingestion, did not show any teratogenic effects at doses up to 17 times (1.0 mg/kg/day) the maximum human systemic dose after topical administration of Retin-A Micro (tretinoin gel) microsphere, 0.1%, adjusted for total body surface area, but fetal resorptions were increased at 0.5 mg/kg. In addition, topical tretinoin in non Retin-A Micro (tretinoin gel) microsphere formulations was not teratogenic in rats and rabbits when given in doses of 42 and 27 times the maximum human systemic dose after topical administration of Retin-A Micro (tretinoin gel) microsphere, 0.1%, normalized for total body surface area, respectively, (assuming a 50 kg adult applied a daily dose of 1.0 g of 0.1% gel topically).

At these topical doses, however, delayed ossification of several bones occurred in rabbits. In rats, a dose-dependent increase of supernumerary ribs was observed.

Oral tretinoin has been shown to be teratogenic in rats, mice, rabbits, hamsters, and subhuman primates. Tretinoin was teratogenic in Wistar rats when given orally or topically in doses greater than 1 mg/kg/day (8 times the maximum human systemic dose normalized for total body surface area). However, variations in teratogenic doses among various strains of rats have been reported. In the cynomolgus monkey, which metabolically is more similar to humans than other species in its handling of tretinoin, fetal malformations were reported for doses of 10 mg/kg/day or greater, but none were observed at 5 mg/kg/day (83 times the maximum human systemic dose normalized for total body surface area), although increased skeletal variations were observed at all doses. Dose-related increases in embryolethality and abortion also were reported. Similar results have also been reported in pigtail macaques.

Topical tretinoin in animal teratogenicity tests has generated equivocal results. There is evidence for teratogenicity (shortened or kinked tail) of topical tretinoin in Wistar rats at doses greater than 1 mg/kg/day (8 times the maximum human systemic dose normalized for total body surface area). Anomalies (humerus: short 13%, bent 6%, os parietal incompletely ossified 14%) have also been reported when 10 mg/kg/day was topically applied. Supernumerary ribs have been a consistent finding in rats when dams were treated topically or orally with retinoids.

There are no adequate and well-controlled studies in pregnant women. Retin-A Micro should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

With widespread use of any drug, a small number of birth defect reports associated temporally with the administration of the drug would be expected by chance alone. Thirty human cases of temporally associated congenital malformations have been reported during two decades of clinical use of Retin-A. Although no definite pattern of teratogenicity and no causal association has been established from these cases, five of the reports describe the rare birth defect category holoprosencephaly (defects associated with incomplete midline development of the forebrain). The significance of these spontaneous reports in terms of risk to the fetus is not known.

Non-Teratogenic Effects: Topical tretinoin has been shown to be fetotoxic in rabbits when administered 0.5 mg/kg/day (8 times the maximum human systemic dose applied topically and normalized for total body surface area), resulting in fetal resorptions and variations in ossification. Oral tretinoin has been shown to be fetotoxic, resulting in skeletal variations and increased intrauterine death in rats when administered 2.5 mg/kg/day (21 times the maximum human systemic dose applied topically and normalized for total body surface area).

There are, however no adequate and well-controlled studies in pregnant women.

Animal Toxicity Studies: In male mice treated topically with Retin-A Micro (tretinoin gel) microsphere 0.1%, at 0.5, 2.0, or 5.0 mg/kg/day tretinoin (2, 8, or 21 times the maximum human systemic dose after topical administration of Retin-A Micro (tretinoin gel) microsphere, 0.1%, normalized for total body surface area) for 90 days, a reduction in testicular weight, but with no pathological changes were observed at the two highest doses. Similarly, in female mice there was a reduction in ovarian weights, but without any underlying pathological changes, at 5.0 mg/kg/day (21 times the maximum human dose). In this study there was a dose-related increase in the plasma concentration of tretinoin 4 hours after the first dose. A separate toxicokinetic study in mice indicates that systemic exposure is greater after topical application to unrestrained animals than to restrained animals, suggesting that the systemic toxicity observed is probably related to ingestion. Male and female dogs treated with Retin-A Micro (tretinoin gel) microsphere, 0.1%, at 0.2, 0.5, or 1.0 mg/kg/day tretinoin (5, 12, or 25 times the maximum human systemic dose after topical administration of Retin-A Micro (tretinoin gel) microsphere, 0.1%, normalized for total body surface area, respectively) for 90 days showed no evidence of reduced testicular or ovarian weights or pathological changes.

Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Retin-A Micro (tretinoin gel) microsphere, 0.1% or 0.04%, is administered to a nursing woman.

Pediatric Use: Safety and effectiveness in children below the age of 12 have not been established.

Geriatric Use: Safety and effectiveness in a geriatric population have not been established.

Clinical studies of Retin-A Micro did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.

ADVERSE REACTIONS: The skin of certain sensitive individuals may become excessively red, edematous, blistered, or crusted. If these effects occur, the medication should either be discontinued until the integrity of the skin is restored, or the medication should be adjusted to a level the patient can tolerate.

However, efficacy has not been established for lower dosing frequencies.

True contact allergy to topical tretinoin is rarely encountered. Temporary hyper- or hypopigmentation has been reported with repeated application of tretinoin. Some individuals have been reported to have heightened susceptibility to sunlight while under treatment with tretinoin.

OVERDOSAGE: Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04%, is intended for topical use only. If medication is applied excessively, no more rapid or better results will be obtained and marked redness, peeling, or discomfort may occur. Oral ingestion of large amounts of the drug may lead to the same side effects as those associated with excessive oral intake of Vitamin A. Rx only.

Patent Nos.: 4,690,825; 5,145,675 & 5,955,109

Distributed by: OrthoNeutrogena DIVISION OF ORTHO-MCNEIL PHARMACEUTICAL, INC. Los Angeles, CA 90045 © OMP 2006 06DD0123 7/06 RETIN-A MICRO® is a registered trademark of Ortho-McNeil Pharmaceutical, Inc. MICROSPONGE® is a registered trademark of Cardinal Health, Inc., Dublin, OH.

Publishing Staff

EDITORIAL BOARD

Travis Hayden, MPAS, PA-C, Editor in chief Joe R. Monroe, MPAS, PA-C Patricia Ferrer, MPAS, PA-C Gordon Day, R.Ph., PA-C Nancy Primo, MPAS, PA-C Lauren Zajac, MHS, PA-C Michelle DiBaise, MPAS, PA-C P. Eugene Jones, Ph.D., PA-C Kristine Kucera, DHS, MPAS, PA-C Alan Menter, MD

DEPARTMENT EDITORS

Clinical Department Editor Susan E. King-Barry, MPAS, PA-C Drugs in Dermatology Editor Stephen Wolverton, MD Surgical Department Editor Christy Kerr, MPAS, PA-C Cosmetic Department Editor Nancy Primo, MPAS, PA-C Prof Dev Department Editor Abby Jacobson, MS, PA-C

SDPA Board of Directors

PrESiDEnT Kristine Kucera, DHS, MPAS, PA-C PrESiDEnT-ElECT Abby Jacobson, MS, PA-C iMMEDiATE PAST PrESiDEnT Bethany Grubb, MPAS, PA-C ViCE PrESiDEnT CaSondra Soto, PA-C SECrETAry / TrEASurEr Sharon Swartz, PA-C DirECTors AT lArGE Mark Hyde, MMS, PA-C Lauren R. Zajac, MHS, PA-C John Notabartolo, PA-C Casey Croes, PA-C

Society of Dermatology Physician Assistants, Inc P.O. Box 701461 San Antonio, Texas 78270 1-800-380-3992 SDPA@dermpa.org www.dermpa.org

Publisher Travis Hayden, MPAS, PA-C Managing Editor Jennifer M. Hayden, M.Ed Copy Editor Douglas Morris Art Director Angela Simiele Website Design Terry Scanlon Website Editor Amy Archambault

SALES Office

Physician Assistant Communications, LLC P.O. Box 416, Manlius NY 13104-0416 Phone (315) 663-4147 PAC@pacommunications.org www.pacommunications.org editorial missioN: The JDPA is the official clinical journal of the Society of Dermatology Physician Assistants. The mission of the JDPA is to improve dermatological patient care by publishing the most innovative, timely, practiceproven educational information available for the physician assistant profession.

PUBLISHED CONTENT IN THE JDPA: Statements and opinions expressed in the articles and communications herein are those of the authors and not necessarily those of the Publisher or the Society of Dermatology Physician Assistants (SDPA). The Publisher and the SDPA disclaim any responsibility or liability for such material, including but not limited to any losses or other damage incurred by readers in reliance on such content. Neither Publisher nor SDPA verify any claims or other information appearing in any of the advertisements contained in the publication and cannot take responsibility for any losses or other damage incurred by readers in reliance on thereon. Neither Publisher nor SDPA guarantees, warrants, or endorses any product or service advertised in this publication, nor do they guaranty any claim made by the manufacturer of such product or service.

This Issue: of JDPA includes articles that have been reviewed and approved for Category I (Preapproved) CME credit by the American Academy of Physician Assistants. Approval is valid for 1 year from the issue date, and participants may submit the self-assessment at any time during that period.

Category I CME articles included in JDPA are planned and developed in accordance with AAPA’s CME Standards for Journal Articles and for Commercial Support of Journal Articles.

Since its inception, the JDPA has utilized eco-friendly printing practices. The JDPA is printed on paper obtained from sustainable forests that meet strict environmental standards. Soy-based inks that have a low environmental impact are used during printing of the journal and the journal is printed using 100% renewable energy. SDPA members, please join us in our efforts and opt to receive the JDPA in digital format.

JDPA/Journal of Dermatology for Physician Assistants (ISSN 1938-9574) is published quarterly (4 issues per volume, one volume per year) by Physician Assistant Communications, LLC, P.O. Box 416, Manlius NY 13104-0416. Volume 4, Number 1, Winter 2010. One year subscription rates: $40 in the United States and Possessions. Single copies (prepaid only): $10 in the United States (Include $6.50 per order plus $2 per additional copy for US postage and handling).

TM Periodicals postage rate paid at New York, NY 10001 and additional mailing offices. Š 2010 Physician Assistant Communications, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including by photocopy, recording, or information storage and retrieval system, without permission in writing from the publisher.

Postmaster: Send address changes to Society of Dermatology Physician Assistants, Inc. P.O. Box 701461, San Antonio, Texas 78270; 1-800-380-3992.

THIS ISSUE IS SPONSORED BY

Journal of Dermatology for Physician Assistants

Editor’s Message

Words of Wisdom Journal of Dermatology for Physician Assistants

The Official Journal of the SDPA

Stay Connected…

I

am fortunate to have found a great source of inspiration within my local community. Over the course of my career, Father Kevin has provided me with much practical advice and wisdom that I have been able to apply in my role as a healthcare provider. One of his messages in particular has resonated with me. In describing how he responds to the many compliments he receives regarding his church, Father Kevin is quick to say, “If you think this church is great, just wait until you meet the people inside.” I have found myself reflecting on these words as they clearly remind me of our own SDPA. While the SDPA is an impressive group by all standards and is continuously recognized by its peers as being a wellorganized and innovative society, these accomplishments are a direct result of the many amazing individual members who contribute to the SDPA. SDPA members, both past and present, have dedicated their time, energy, and talents to the continued development of our society. The vision and fortitude of a small group of people who were passionate about dermatology laid the groundwork for our organization. Without their pioneering efforts, our society would not be the impressive organization that it is today.

The sixteen hundred plus members of the SDPA continue to build upon this foundation and advance our society. There are numerous ways in which our members are positively impacting the reputation and growth of the SDPA. Across the nation our members are hard at work volunteering in their local communities and abroad, teaching and preceptoring PA students, building and participating in state affiliate chapters, networking and sharing information with each other through the SDPA’s online resources, writing and editing articles for the JDPA, organizing and attending SDPA conferences, and dialoguing with leaders of the AAD and the AAPA to continue to advance the legislative goals of our society… just to name a few.

The SDPA continues to progress because of our members’ commitment to the success of our organization. I am extremely proud to be a part of this amazing society and sincerely thank all SDPA members who have shared with us their great gifts of time and talent. When I receive a compliment regarding the SDPA, I recall Father Kevin’s words of wisdom and say with pride, “If you think the SDPA is great, just wait until you meet the members.” J

Did you know the SDPA is on Facebook and Twitter?

Join fellow SDPA members and Stay informed, updated, and connected at all times.

Travis Hayden Editor in chief

Vol.4, No. 1 WINTER 2010

table of contents

16

SDPA Members Only Content A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Quality of Life for Patients with Psoriasis: More Than Skin Deep

By Petrina Bamber, MSBS, PA and Karen Graham, MPAS, PA-C

CME

10 Derm PA News & Notes – part one • Dermatology Market Watch • SDPA Putting Technology to Work

16 Clinical Dermatology

• CME Article – Quality of Life for Patients with Psoriasis: More Than Skin Deep • Drugs in Dermatology – Minocycline-Induced Cutaneous Dyspigmentation • Dermatology Case Report – Scleroderma

Departments

04 Editorial Board 05 Editor’s Message 09 SDPA News & Current Affairs 13 SDPA Membership Changes for 2010 14 First Foundations 20 From The Patient’s Perspective 23 Dermatoscopy 26 Clinical Snapshots 33 Cosmetic Pearls 39 Notes from your Office Manager 40 Outside & Inside the 9 to 5 44 “Derm Quotes” 45 The Difference We Make 47 Professional Opportunities and Development

31 Surgical Dermatology

• Surgical Wisdom – Ten Steps to a Seamless Excision

32 Cosmetic Dermatology

• American Academy of Dermatology to Phase Out AAD SEAL OF RECOGNITION® Program

35 Professional Development

• The History of the SDPA • Dermatology Billing & Coding – 2010 Updates

43 Derm PA News & Notes – part two • From the Desk of…

• Supervising Physician Corner

Go Green – Read Online As part of the “Going Green” initiative, the JDPA is now available as an electronic only option to interested SDPA members. To start receiving your copy of the JDPA in digital format please visit the SDPA website and update your membership profile.

Journal of Dermatology for Physician Assistants

Vol.4, No. 1 WINTER 2010

Journal of Dermatology for Physician Assistants

Calendar

FROM THE SPDA News & Current Affairs

of events

2010 MARCH 68th AAD Annual Academy Meeting March 5-9, 2010 Miami, FL june SDPA 1st Summer Dermatology Conference June 10-13, 2010 Chicago, IL AUGUST AAD Summer Academy Meeting August 4 - 8, 2010 Chicago, IL NOVEMBER SDPA 8th Annual Fall Conference November 10-13, 2010 Gaylord Texan Resort Grapevine, TX Calendar of Events Submissions Send information to: Editor@jdpa.org

Turning Over a New Green Leaf

T

he Society of Dermatology Physician Assistants’ “Going Green” initiative was officially kicked off at our Fall Conference in Scottsdale, Arizona. The Board of Directors wanted to join the fight to help keep our environment healthy. With that goal in mind, we felt that the simplest way to begin was to decrease the amount of paper that we use as an organization. After doing some research, it was enlightening to discover how much paper is actually used and/or wasted in the United States.

As we all may know, carbon dioxide is a major source of global warming. Trees are efficient at withdrawing carbon dioxide from the atmosphere and play an important role in keeping atmospheric levels to a minimum. According to the Daily Green, half of the Earth’s forests have been cleared with over 42% of the harvested wood used to make paper. Not only are our forests being destroyed, the paper industry is the fourth largest contributor to greenhouse gas emissions in the United States and paper accounts for 25% of landfill waste.

In the next few months, you will be asked to join us in this endeavor. The Journal of Dermatology for Physician Assistants (JDPA) and the SDPA Newsletter will be providing an option that will allow you to opt out of receiving these in printed form and opt in to receiving them only as electronic versions. Also, during the upcoming elections, electronic voting will be available and we encourage you to use this type of ballot. Those of you who wish can still receive the printed formats of the JDPA, Newsletter, and election ballots.

Please help the SDPA to reduce our carbon footprint but more importantly take the time to examine how you can help our environment on a personal level. Think twice before you print that next email, try to utilize reusable drinking containers, and take the time to recycle. If you have any ideas on how the SDPA can further contribute to our “Going Green” initiative, please forward them to any of the SDPA Board of Directors or Committee Chairs.

Kristine Kucera, DHS, MPAS, PA-C President Society of Dermatology Physician Assistants

Vol.4, No. 1 WINTER 2010

9

Dermatology PA news & notes

Dermatology Market Watch New Glytone Anti-Aging Day Cream A day cream with time released, high concentrations of Vitamin E, Red Tea and Glycolic Acid to synergistically deliver powerful antioxidant protection and anti-aging benefits.

Benefits: Helps to protect against environmental, photo and free radical damage.

Works to reduce visible signs of premature aging.

Contains: 6% Glycolic Acid, Pierre Fabre’s patented Delta Tocopheryl Glucoside (with the most technologically advanced form of time released Vitamin E), Red Tea Extract (Rooibos, a powerful antioxidant), and Hyaluronic Acid.

Direction for use: Optimal for normal or oily skin.

Apply daily, morning and evening. For additional antioxidant protection, use in conjunction with the Glytone Anti-Aging Facial Serum and Anti-Aging Eye Cream.

New Glytone Anti-Aging Facial Serum A layering serum with time released, high concentrations of stabilized Vitamin C and Vitamin E combined with Red Tea to deliver powerful antioxidant protection and anti-aging benefits.

Benefits: Helps to protect against environmental, photo and free radical damage. Works to reduce visible signs of premature aging. Improves collagen synthesis Contains: Tetrahexyldecyl Ascorbate (the most technologically advanced form of time released Vitamin C), Pierre Fabre’s patented Delta Tocopheryl Glucoside (with the most technologically advanced form of time released Vitamin E), Red Tea Extract (Rooibos, a powerful antioxidant).

Direction for use: Optimal for normal or oily skin.

Apply a few drops to face and neck in the morning. For additional antioxidant protection, use in conjunction 10 Journal of Dermatology for Physician Assistants

with the Glytone Anti-Aging Day Cream and AntiAging Eye Cream.

New Glytone Anti-Aging Eye Cream A unique, synergistic combination of Glycolic Acid, Caffeine, Licorice Extract and Red Tea target the key problems of the delicate eye area, while delivering powerful anti-aging benefits.

Benefits: Works to de-puff, brighten and tighten the eye area. Helps protect against environmental damage. Helps reduce visible signs of premature aging.

Contains: Glycolic Acid, Red Tea Extract (Rooibos, a powerful antioxidant), Caffeine, Licorice Extract.

Direction for use: Pat a small amount under eye area and over brow bone until fully absorbed. Use morning and night.

StelaraTM (Ustekinumab) Receives FDA Approval for Treatment of Moderate to Severe Plaque Psoriasis with Four-Times-a-Year Maintenance Dosing The U.S. Food and Drug Administration (FDA) has approved Stelaratm (ustekinumab) for the treatment of adult patients 18 years or older with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy. The efficacy and safety of Stelara were evaluated in one of the largest clinical development programs for a biologic medication in the treatment of psoriasis.

Stelara is a first-in-class human monoclonal antibody that selectively targets the cytokines interleukin-12 (IL-12) and interleukin-23 (IL-23), naturally occurring proteins that are believed to play a role in the development of psoriasis.

Stelara is a subcutaneous injection given at weeks 0 and 4, followed by every-12-week dosing. The recommended starting dose of STELARA is 45mg for patients weighing 220lbs (100kg) or less, and 90mg for patients weighing more than 220lbs.

Expectations

Reformulated

A tretinoin re-invented for success • Delivered within a unique aqueous gel with a smart combination of ingredients that are known to moisturize and hydrate skin* • Efficacy you can expect only from a tretinoin1 • Low irritation profile1

Important Safety Information: • The most common adverse reactions were mild to moderate irritation of the skin and occurred during the first few weeks of treatment with ATRALIN® Gel. • To prevent aggravating the skin, protect it from sun, tanning lights, extreme wind or cold, and harsh skincare products.

• Use of sunscreen products of at least SPF 15 and protective clothing over treated areas is recommended when exposure cannot be avoided.

• Please see next page for Brief Summary of Prescribing Information. *The contribution to efficacy of individual components has not been evaluated.

www.atralingel.com Reference: 1. Data on file. CORIA Laboratories.

ATRALIN and CORIA are registered trademarks of CORIA Laboratories. ©2008 CORIA Laboratories ATR–10011–0908

Vol.4, No. 1 WINTER 2010 11

BRIEF SUMMARY

(see package insert for full prescribing information)

For topical use only INDICATIONS AND USAGE Atralin Gel is a retinoid indicated for topical treatment of acne vulgaris.

Important Limitations of Use The safety and efficacy of the use of this product in the treatment of any other disorders have not been evaluated.

CONTRAINDICATIONS None WARNINGS AND PRECAUTIONS Skin Irritation The skin of certain individuals may become dry, red, or exfoliated while using Atralin Gel. If the degree of irritation warrants, patients should be directed to temporarily reduce the amount or frequency of application of the medication, discontinue use temporarily, or discontinue use altogether. Efficacy at reduced frequencies of application has not been established. If a reaction suggesting sensitivity occurs, use of the medication should be discontinued. Mild to moderate skin dryness may also be experienced; if so, use of an appropriate moisturizer during the day may be helpful.

Tretinoin has been reported to cause severe irritation on eczematous or sunburned skin and should be used with caution in patients with these conditions.

Topical over-the-counter acne preparations, concomitant topical medication, medicated cleansers, topical products with alcohol or astringents, when used with Atralin Gel, should be used with caution [see Drug Interactions (7)].

Ultraviolet Light and Environmental Exposure Unprotected exposure to sunlight, including sunlamps, should be minimized during the use of Atralin Gel. Patients who normally experience high levels of sun exposure, and those with inherent sensitivity to sun, should be warned to exercise caution. Use of sunscreen products of at least SPF 15 and protective clothing over treated areas is recommended when exposure cannot be avoided.

Weather extremes, such as wind or cold, also may be irritating to patients under treatment with tretinoin.

Fish Allergies Atralin Gel contains soluble fish proteins and should be used with caution in patients with known sensitivity or allergy to fish. Patients who develop pruritus or urticaria should contact their health care provider.

ADVERSE REACTIONS Clinical Studies Experience Because clinical trials are conducted under prescribed conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

In two randomized, controlled trials, 674 subjects received treatment for up to 12 weeks with Atralin Gel [see Clinical Studies (14)]. In these studies, 50% of the subjects who were treated with Atralin Gel reported one or more adverse reactions; 30% of the subjects reported treatment-related adverse reactions. In the vehicle group, 29% of the 487 randomized subjects reported at least one adverse reaction;

5% of the subjects reported events that were treatment-related. There were no serious, treatment-related adverse reactions reported by subjects in any of the treatment groups.

Selected adverse reactions that occurred in at least 1% of subjects in the two studies combined, are shown in Table 1 (below). Most skin-related adverse reactions first appear during the first two weeks of treatment with Atralin Gel, and the incidence rate for skin-related reactions peaks around the second and third week of treatment.

In some subjects the skin-related adverse reactions persist throughout the treatment period.

Table 1. Number of Subjects with Selected Adverse Reactions (Occurring in At Least 1% of Subjects) Event

Atralin Gel (n = 674)

Vehicle Gel (n = 487)

Dry Skin

109 (16%)

8 (2%)

78 (12%)

7 (1%)

53 (8%)

8 (2%)

Erythema

47 (7%)

1 (<1%)

Pruritus

11 (2%)

3 (1%)

Pain of Skin

7 (1%)

0 (0%)

Sunburn

7 (1%)

3 (1%)

Peeling/Scaling/ Flaking Skin Skin Burning Sensation

DRUG INTERACTIONS When treating with Atralin Gel, caution should be exercised with the use of concomitant topical medication, medicated or abrasive soaps and cleansers, products that have a strong drying effect, and products with high concentrations of alcohol, astringents, spices, or lime. Particular caution should be exercised with the concomitant use of topical over-the-counter acne preparations containing benzoyl peroxide, sulfur, resorcinol, or salicylic acid. Allow the effects of such preparations to subside before use of Atralin Gel is begun.

USE IN SPECIFIC POPULATIONS Pregnancy Pregnancy Category C. There are no wellcontrolled trials in pregnant women treated with Atralin Gel. Atralin Gel should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Atralin Gel at doses of 0.1, 0.3 and 1 g/kg/day was tested for maternal and developmental toxicity in pregnant Sprague-Dawley rats by dermal application. The dose of 1 g/kg/day was approximately 4 times the clinical dose assuming 100% absorption and based on body surface area comparison. Possible tretinoin-associated teratogenic effects (craniofacial abnormalities [hydrocephaly], asymmetrical thyroids, variations in ossification, and increased supernumerary ribs) were noted in the fetuses of Atralin Gel treated animals. These findings were not observed in control animals. Other maternal and reproductive parameters in the Atralin Gel treated animals were not different from control. For purposes of comparison of the animal exposure to human exposure, the clinical dose is defined as 2 g of Atralin Gel applied daily to a 50-kg person.

Oral tretinoin has been shown to be teratogenic in rats, mice, rabbits, hamsters and nonhuman primates. Tretinoin was teratogenic in Wistar rats when given orally in doses greater than 1 mg/kg/day (approximately 8 times the clinical dose based on body surface area comparison).

In the cynomolgus monkey, fetal malformations were reported for doses of 10 mg/kg/day, but none were observed at 5 mg/kg/day (approximately 80 times the clinical dose

12 Journal of Dermatology for Physician Assistants

based on body surface area comparison), although increased skeletal variations were observed at all doses. Dose-related increases in embryolethality and abortion also were reported.

Similar results have also been reported in pigtail macaques.

Topical tretinoin in a different formulation has generated equivocal results in animal teratogenicity tests. There is evidence for teratogenicity (shortened or kinked tail) of topical tretinoin in Wistar rats at doses greater than 1 mg/kg/day (approximately 8 times the clinical dose assuming 100% absorption and based on body surface area comparison). Anomalies (humerus: short 13%, bent 6%, os parietal incompletely ossified 14%) have also been reported when 10 mg/kg/day (approximately 160 times the clinical dose assuming 100% absorption and based on body surface area comparison) was topically applied.

Supernumerary ribs have been a consistent finding in rats when dams were treated topically or orally with retinoids.

With widespread use of any drug, a small number of birth defect reports associated temporally with the administration of the drug would be expected by chance alone. Cases of temporally associated congenital malformations have been reported with use of other topical tretinoin products. The significance of these spontaneous reports in terms of risk to the fetus is not known.

Nonteratogenic effects on fetuses: Oral tretinoin has been shown to be fetotoxic in rats when administered in doses 20 times the clinical dose based on a body surface area comparison. Topical tretinoin has been shown to be fetotoxic in rabbits when administered in doses 8 times the clinical dose based on a body surface area comparison.

Nursing Mothers It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Atralin Gel is administered to a nursing woman.

Pediatric Use Safety and effectiveness in children below the age of 10 have not been established.

A total of 381 pediatric subjects (aged 10 to 16 years), treated with Atralin Gel were enrolled into the two clinical studies. Across these two studies, comparable safety and efficacy were observed between pediatric and adult subjects.

Geriatric Use Safety and effectiveness in a geriatric population have not been established. Clinical studies of Atralin Gel did not include any subjects over age 65 to determine whether they respond differently than younger subjects.

Marketed by:

CORIA Laboratories, a division of Valeant Pharmaceuticals North America, Aliso Viejo, CA 92656 Manufactured by: DPT LABORATORIES, LTD. San Antonio, Texas 78215 Patent No.: 5,670,547 Revised: 11/2009 137623-1109

SDPA Putting Technology to Work

By Casey Croes, PA-C SDPA Director At Large

D

If you are interested in joining Facebook, go to www.facebook.com to sign up. Once you become a member of Facebook, you can find the SDPA page by simply typing “SDPA” in the search box. Once there, you can elect to join the group.

If you are interested in joining Twitter, go to www.twitter.com to sign up. Both SDPA and Dermcast.tv can be followed on Twitter. Simply type “dermPA” on the “Find People” page and the SDPA logo will appear. To follow Dermcast.tv, type “dermcast” and you will see the Dermcast.tv logo.

Please join us! J

SDPA Membership Changes for 2010 The beginning month for the SDPA membership year has been officially changed from January to April. Those members who have already renewed for 2010 will enjoy a few extra months for free.

The SDPA is “Going Green” and, in order to be friendlier to the environment, our members will now receive electronic SDPA membership cards (members will have the option to print their own cards from the electronic link provided at the completion of the membership application).

This year there are two new questions that have been added to the end of our membership application. The SDPA is compiling a list of members who are willing to preceptor PA students and/or who are willing to allow individuals interested in dermatology to shadow them. The SDPA is also looking for members who are interested in becoming involved within the leadership of the SDPA. We did not become one of the largest specialty PA organizations by sitting on the sidelines.

Consider getting involved with the SDPA today! J Vol.4, No. 1 WINTER 2010 13

Dermatology PA news & notes

o you tweet? Do you use Facebook to catch up with friends far and wide? Do you know that the SDPA is on both Twitter and Facebook?

As an organization, we are responding to the needs of our members for frequent communication by using technology that is both green and cost-effective. More and more health care providers are finding that social media can both educate a large audience and can serve to keep members of their respective societies informed.

Social media can help our organization to quickly respond to hot topics such as proposed legislation that affects our entire profession or technological advances. Two recent topics of interest that have been discussed on Facebook are dermatology PA education (dermatology PA residency programs versus on-thejob training) and the small but growing number of minority dermatology PAs practicing in aesthetic medicine. The SDPA believes that social media offers an opportunity to reach new members and to generate interest in our profession. For example, there have been many requests to shadow dermatology PAs as students consider working in our chosen field. We expect continued growth in the number of members in the SDPA group on Facebook and in those following both the SDPA and Dermcast.tv on Twitter. We intend to continue using these tools to reach members as well as potential dermatology PAs.

First Foundations First Year Development Guide

By Emily Massey, PA-C

SDPA Members Only Content

Dermatology PA news & notes

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

14 Journal of Dermatology for Physician Assistants

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Vol.4, No. 1 WINTER 2010 15

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Clinical Dermatology

Quality of Life for Patients with Psoriasis: More Than Skin Deep

By Petrina Bamber, MSBS, PA and Karen Graham, MPAS, PA-C

SDPA Members Only Content A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

CME

This program has been reviewed and is approved for a maximum of .5 hours of AAPA Category I CME credit by the Physician Assistant Review Panel.

Approval is valid for 1 year from the issue date of JANUARY 2010. Participants may submit the self-assessment exam at any time during that period.

This program was planned in accordance with AAPAâ&#x20AC;&#x2122;s CME Standards for Enduring Material Programs and for Commercial Support of Enduring Material Programs.

SDPA members may access the posttest at www.jdpa.org

Learning Objectives: 1) Recognize the effect of psoriasis on quality of life, psychological health, self-image, and personal relationships 2) Identify patients at increased risk for impaired quality of life from psoriasis.

3) Describe the impact of psoriasis on personal finances and the national economy.

4) Recognize the limitations of current research on quality of life in psoriasis.

16 Journal of Dermatology for Physician Assistants

Quality of Life for Patients with Psoriasis: More Than Skin Deep SDPA Members Only Content

CLINICAL Dermatology

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Vol.4, No. 1 WINTER 2010 17

Quality of Life for Patients with Psoriasis: More Than Skin Deep SDPA Members Only Content

CLINICAL Dermatology

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

18 Journal of Dermatology for Physician Assistants

Quality of Life for Patients with Psoriasis: More Than Skin Deep SDPA Members Only Content

CLINICAL Dermatology

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Journal of Dermatology for Physician Assistants

The Official Journal of the SDPA

Write for the JDPA

Are you a PA who may be...

• Interested in writing?

• Have a paper you wish to get published?

Contact us at: Editor@jdpa.org Vol.4, No. 1 WINTER 2010 19

From The Patient’s Perspective My Roller Coaster Ride with Pemphigus

CLINICAL Dermatology

By Miki Pangburn My pemphigus symptoms began in February.

I awoke to find a mouthful of painful ulcers and swishing warm salt water made it worse. My primary care physician (PCP) said I had a yeast infection and he prescribed an oral rinse. Weeks later I was still eating Jell-O and mashed potatoes. My provider suggested that we let it run its course, but still continue to use the oral rinse along with a tapered dose of prednisone. Around May, he said it was a ‘viral/ fungal’ infection. I thought that he meant that fungus, as in mold and mildew, was in my mouth. The ulcers in my mouth never completely healed. They would diminish but were replaced with torn skin. It felt as if I had corncob pieces floating around in my mouth. My gums were inflamed and raw, and brushing my teeth hurt so badly that I wanted to squeal like a pig in mud!

Eight months later there was still no solution in sight. My hair was beginning to thin and fall out and other areas of my scalp were becoming very tender. I had developed what appeared to be a horn (nickel sized and sort of squishy) growing out of my scalp. My mother always said I was a ‘bambino di diavolo’ (devil child). In a brief moment I could almost hear her voice saying that from the other side; I was losing it! My PCP said this was a cyst and poured what felt like an acid on it. He insisted that I use this treatment for about a week until it cleared up. My toes would curl with the painful treatments and I decided that I was not going to do it. I would rather walk barefoot across hot coals.

Almost a year into this ordeal, the cuticles on both my hands and feet had erupted with tiny blisters that were red, swollen, itchy, and oozing. I had to change bandages daily, even at work (I should have purchased stock in Johnson & Johnson). My PCP continued to pursue the ‘viral/fungal’ infection by prescribing yet another course of tapered prednisone. All this time, my mouth and scalp had not completely healed and now my hands and feet were erupting. When bathing, it was like having a mixture of shards of glass and hot lava beating against my skin.

A year and three months into my ordeal, during yet another visit to my PCP, I had ‘roid rage’ (those of

you who have taken steroids may know what I mean).

While taking prednisone I experienced maddening mood swings that could slip out at any time. During this visit I said some very choice words to him and he finally agreed to do a biopsy of the putrid ooze. This initial biopsy unfortunately came back as ‘undetermined.’ The following month, a small pea sized blister developed on my calf overnight and had become the size of a bottle cap by lunchtime. I felt as though I had bubble wrap growing out of my leg. My PCP immediately sent me to a dermatologist who did a biopsy of the blister.

Almost a year and a half into trying to figure out what was happening to me, the dermatologist calmly stated that I have pemphigus vulgaris, an autoimmune disease characterized by large blisters on the skin and mucous membranes that are often accompanied by itching or burning sensations. To me, pemphigus vulgaris sounded like ‘supercalifragilisticexpialidocious.’ An image of Mary Poppins with her umbrella came into my head. It did not roll off my tongue, and words are supposed to do that. I carried a piece of paper around for about a week until I could actually pronounce the diagnosis.

Prednisone and Dapsone were the recommended course of treatment. I had gained about 100 pounds while taking prednisone over the last year and a half and the dermatologist wanted me to take more at even higher doses. Physically I looked like a moon-faced bloated whale and I cried a lot. I had also experienced dizziness, nausea, double vision, swelling, steroid induced glaucoma, and mood swings. My PCP had put me on medications to counterbalance the side effects of the prednisone, which helped a little. I kept questioning my doctor about this disease and the course of treatment and then I was told that the office was no longer accepting my insurance.

It was the beginning of my second year dealing with this condition when I started seeing a new dermatologist.

I did not like this provider from the beginning. He would stand at such a distance from me and would not touch me, acting as though what I had was contagious.

It would be wonderful if providers who are not familiar

“I have had to give up my ‘normal’ life, but it hasn’t stopped me from getting a new one.”

20 Journal of Dermatology for Physician Assistants

...continued on page 23

For moderate to severe plaque psoriasis

A champion, trial after trial Powerfully effective for consistent results t PG QBUJFOUT XFSF DMFBS PS BMNPTU DMFBS JO 1IBTF *** USJBMT / 1 t &GmDBDZ SFTVMUT DPOmSNFE JO UIF MBSHFTU DPNNVOJUZ CBTFE USJBM PG JUT LJOE O 2 t PG $-0#&9® DMPCFUBTPM QSPQJPOBUF

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www.psoriasispro.com Vol.4, No. 1 WINTER 2010 21

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22 Journal of Dermatology for Physician Assistants

...continued from page 20

with a condition would either research the disease or help the patient find another provider who could help them!

I conducted an Internet search and found the International Pemphigus & Pemphigoid Foundation (IPPF) at www.pemphigus.org. I was finally able to connect with a community of pemphigus patients through an email discussion group. There were others out there like me going through what I was. This was the beginning of a new life for me. Talking with people within the IPPF was a lifesaver. They understood the importance of me needing to ask questions and share my experiences with them. My coworkers were so concerned that I had AIDS that they went to the human resource manager of the company and requested to be moved away from me. At work I was dealing with people putting latex gloves on my desk along with Lysol, coworkers whispering, and being excluded in meetings. I did have a few rages, but locked myself in my office during these outbursts.

Fortunately through the IPPF I was referred to Dr. Grant Anhalt at Johns Hopkins in Baltimore, MD. Dr. Anhalt is an expert in pemphigus and a member of the IPPF Medical Advisory Board. My husband drove me to see Dr. Anhalt. I had a legal pad filled with questions both front and back. Dr. Anhalt spent almost two hours with me. He spoke in medical terminology that gave me the ‘deer in headlights’ stare. Realizing this, he began to draw me pictures. Pictures! I can do pictures, my brain understands those! I love this man! Ok, but I did not like all the answers. He recommended high doses of prednisone and cellcept to get my pemphigus under

control. I felt as though I was preparing to be on another prednisone roller coaster ride.

So this was my life now. My body was physically exhausted, I was in pain and limp, and I felt like I was a marionette puppet. During another visit Dr. Anhalt examined me and said that I was having an allergic reaction to cellcept (which I had been taking now for three years) and that I was only the second person he ever knew of to have a crippling reaction to it. Lucky me! The next course of treatment involved imuran and prednisone. For about a year, it felt as if all my body wanted to do was sleep.

I am now more informed and aware of my condition than ever before. I now understand that if you have an autoimmune condition there is a chance that you can develop other autoimmune conditions. When I go to a new provider, I tell them during my first visit about my pemphigus history and cycles of flare-ups. If I am uncomfortable with the response or lack thereof, I will search for another provider. I have had to give up my ‘normal’ life, but it hasn’t stopped me from getting a new one. I have learned to listen to my body and, more importantly, my team of providers listens to it as well.

I have stayed involved with the IPPF because they are my family, my spine, my venting place. I have lost some prednisone weight and I have learned to live like a bloated whale. I now have the attitude that I am me, take it or leave it. I usually run on four hours of sleep.

Pain often wakes me up, but instead of popping more pills I go grocery shopping, clean, read, or do whatever I can. I have grandchildren now and enjoy them as

Journal of Dermatology for Physician Assistants

Dermatoscopy Q A

The Official Journal of the SDPA

Q: What is it?

&

“I awoke this morning with devout thanksgiving for my friends, the old and the new.”

Ralph Waldo Emerson Happy New Year from the JDPA! We extend our most sincere “thank you” to all who have shared their time and talent with our publication and to all of our readers.

We greatly value these existing relationships and look forward to enhancing them and developing new ones in the new year ahead.

Sincerely, The JDPA Staff

Answer on page 24 Vol.4, No. 1 WINTER 2010 23

CLINICAL Dermatology

From The Patient’s Perspective

From The Patient’s Perspective

CLINICAL Dermatology

much as possible. I enjoy making pictures with them out of the clouds in the sky. When they pick me flowers (dandelions), I put them in a vase on my table and when they leave I throw them out because they make me sneeze. I have a tight group of close friends outside the IPPF who truly understand me. They don’t call attention to me when I have full-blown conversations with myself, they just chime in with their two cents. My husband and I have been married now for twenty-eight years and he has been through it all with me. This is my life and despite all of it, I would not change a thing. J

&

Dermatoscopy Q A

A: Unna’s nevus (a congenital nevus of one type) and viral wart

Miki Pangburn lives in York, PA and has lived with pemphigus vulgaris for ten years. She is happily married and has two children and two wonderful grandchildren. Her pemphigus flares about three times a year and is currently treated with imuran and prednisone. She enjoys reading, cooking, sewing, and riding a Harley when she is feeling well. Miki worked until 2004 and then was placed on disability because of her pemphigus and complications relating to it. Regarding her life with pemphigus, Miki says, “I have good days, bad days, some in between and need to nap. I laugh at myself, at stupid stuff, and laugh even harder when people think I’m crazy. I have fun with me.”

Take Home points for derm pas:

By Steven K. Shama, MD, MPH l It was over a year of suffering before our patient

was referred to a dermatology practice. We need to educate general medical practitioners that we are available to diagnose and treat disorders of the skin, hair, nails, and most mucous membranes. We need to encourage them to call us if they have a question. Perhaps if this were the standard, our patient would have been referred soon after her first oral symptoms.

l The example of the second dermatology

provider standing at a distance and “would not touch me” should remind us all of the importance and power of touch. Physical touch is only one way of touching. One can “touch” a patient with the words we use and also with eye contact, to name two.

l When we see and treat patients with difficult

diseases we need to make sure that we personally have the expertise. If we do not, a referral is imperative. Ironically, it was the support group of pemphigus patients who actually gave our patient the name of the dermatology specialist Dr. Anhalt. What patients need when they have a serious skin disease is a support group who is “my family, my spine, my venting place.” How often can patients use those qualities to describe us?

I wish it were more often.

24 Journal of Dermatology for Physician Assistants

SDPA Members Only Content A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Drugs in Dermatology Minocycline-Induced Cutaneous Dyspigmentation

By Michael Brown, RPh, MHS, PA-C Edited by Stephen Wolverton, MD

SDPA Members Only Content

CLINICAL Dermatology

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Michael Brown, RPh, MHS, PA-C is a graduate of the Physician Assistant Program at Quinnipiac University in Hamden, CT. He is a Fellow member of the Society of Dermatology Physician Assistants.

He has been working in dermatology for 8 years, with previous practice experience in internal and emergency medicine. He currently practices in Amherst, MA where he works with Dr. Richard Wyatt. He has indicated no relationships to disclose relating to the content of this article.

Vol.4, No. 1 WINTER 2010 25

Clinical snapshots Leonine Facies

By Susan E. King-Barry, MPAS, PA-C JDPA Clinical Department Editor

SDPA Members Only Content

CLINICAL Dermatology

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Susan E. King-Barry, MPAS, PA-C has practiced dermatology for 13 years and is currently an Assistant Professor in the Physician Assistant Department at Western Michigan University, in Kalamazoo, Michigan.

26 Journal of Dermatology for Physician Assistants

Dermatology Case Report Scleroderma

By Loree A. Easley, PA-C and James E. Turner, MD, PhD

SDPA Members Only Content

CLINICAL Dermatology

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Vol.4, No. 1 WINTER 2010 27

SDPA Members Only Content

CLINICAL Dermatology

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Loree A. Easley, PA-C is a recent graduate from Harding University and works in dermatology with James E. Turner, MD, PhD at Mid-South Dermatology and Skin Cancer Center in Bartlett, TN. She has no relationships to disclose relating to the content of this article.

28 Journal of Dermatology for Physician Assistants

When comedonal acne is your primary concern…

PRESCRIBE DIFFERIN® GEL, 0.3%

POWERFUL EFFICACY

HIGH PATIENT SATISFACTION

From baseline to week 12, lesion reduction (total, noninflammatory, and inflammatory) was similar to tazarotene gel, 0.1%1*

86% of patients on adapalene gel, 0.3% were satisfied or very satisfied vs 69% on tazarotene gel, 0.1%1* Local tolerability scores comparable to tretinoin gel microsphere, 0.04%2†

*A phase 3b, 12-week, noninferiority, multicenter, investigator-blinded, controlled clinical study of patients 12 to 35 years of age with acne vulgaris (N=172). At the end of 12 weeks, neither product was found to be inferior.

160 patients participated in the satisfaction survey.

A single-center, randomized, investigator/evaluator-blinded, bilateral (split-face) comparison of healthy subjects ≥18 years of age (N=30). Subjects received Differin® Gel, 0.3% on one half of the face and tretinoin gel microsphere, 0.04% on the other half for 22 days.

†

Of the patients who experienced cutaneous irritation (erythema, scaling, dryness, and/or stinging/burning) during the clinical trial, the majority of cases were mild to moderate in severity, occurred early in treatment, and decreased thereafter. Adverse events that occurred in greater than 1% of the subjects included dry skin (14.0%), skin discomfort (5.8%), pruritus (1.9%), desquamation (1.6%), and sunburn (1.2%).

Pregnancy Category C.

Please see brief summary of Prescribing Information on adjacent page.

www.differin.com

Vol.4, No. 1 WINTER 2010 29

DIFFERIN® (adapalene) Gel, 0.3% BRIEF SUMMARY

Rx only

For topical use only. Not for ophthalmic, oral or intravaginal use.

INDICATIONS AND USAGE: DIFFERIN® Gel, 0.3% is indicated for the topical treatment of acne vulgaris in patients 12 years of age and older.

CONTRAINDICATIONS: DIFFERIN® Gel, 0.3% should not be administered to individuals who are hypersensitive to adapalene or any of the components in the gel vehicle.

PRECAUTIONS: General: Certain cutaneous signs and symptoms of treatment such as erythema, scaling, dryness, and stinging/burning may be experienced with use of DIFFERIN® Gel, 0.3%. These are most likely to occur during the first four weeks of treatment, are mostly mild to moderate in intensity, and usually lessen with continued use of the medication. Depending upon the severity of these side effects, patients should be instructed to either use a moisturizer, reduce the frequency of application of DIFFERIN® Gel, 0.3% or discontinue use.

If a reaction suggesting sensitivity or chemical irritation occurs, use of the medication should be discontinued.

Exposure to sunlight, including sunlamps, should be minimized during use of adapalene. Patients who normally experience high levels of sun exposure, and those with inherent sensitivity to sun, should be warned to exercise caution. Use of sunscreen products and protective clothing over treated areas is recommended when exposure cannot be avoided. Weather extremes, such as wind or cold, also may be irritating to patients under treatment with adapalene.

Avoid contact with the eyes, lips, angles of the nose, and mucous membranes. The product should not be applied to cuts, abrasions, eczematous or sunburned skin. As with other retinoids, use of “waxing” as a depilatory method should be avoided on skin treated with adapalene.

Information for Patients: Patients using DIFFERIN® Gel, 0.3%, should receive the following information and instructions: 1. This medication is to be used only as directed by the physician.

2. It is for external use only.

3. Avoid contact with the eyes, lips, angles of the nose, and mucous membranes.

4. Cleanse affected area with a mild or soapless cleanser before applying this medication.

5. Moisturizers may be used if necessary; however, products containing alpha hydroxy or glycolic acids should be avoided.

6. Exposure of the eye to this medication may result in reactions such as swelling, conjunctivitis, and eye irritation.

7. This medication should not be applied to cuts, abrasions, eczematous, or sunburned skin.

8. Wax epilation should not be performed on treated skin due to the potential for skin erosions.

9. During the early weeks of therapy, an apparent exacerbation of acne may occur. This may be due to the action of the medication on previously unseen lesions and should not be considered a reason to discontinue therapy.

Drug Interactions: As DIFFERIN® Gel, 0.3% has the potential to induce local irritation in some patients, concomitant use of other potentially irritating topical products (medicated or abrasive soaps and cleansers, soaps and cosmetics that have a strong drying effect, and products with high concentrations of alcohol, astringents, spices, or lime) should be approached with caution. Particular caution should be exercised in using preparations containing sulfur, resorcinol, or salicylic acid in combination with DIFFERIN® Gel, 0.3%. If these preparations have been used, it is advisable not to start therapy with DIFFERIN® Gel, 0.3%, until the effects of such preparations have subsided.

Carcinogenesis, Mutagenesis, Impairment of Fertility: Carcinogenicity studies with adapalene have been conducted in mice at topical doses of 0.4, 1.3, and 4.0 mg/kg/day, and in rats at oral doses of 0.15, 0.5, and 1.5 mg/kg/day. These doses are up to 3 times (mice) and 2 times (rats) in terms of mg/m²/day the potential exposure at the maximum recommended human dose (MRHD), assumed to be 2.5 grams DIFFERIN® Gel, 0.3%. In the oral study, increased incidence of benign and malignant pheochromocytomas in the adrenal medullas of male rats was observed.

No photocarcinogenicity studies were conducted. Animal studies have shown an increased risk of skin neoplasms with the use of pharmacologically similar drugs (e.g., retinoids) when exposed to UV irradiation in the laboratory or to sunlight. Although the significance of these studies to human use is not clear, patients should be advised to avoid or minimize exposure to either sunlight or artificial UV irradiation sources.

Adapalene did not exhibit mutagenic or genotoxic effects in vitro (Ames test, Chinese hamster ovary cell assay, mouse lymphoma TK assay) and in vivo (mouse micronucleus test).

Reproductive function and fertility studies were conducted in rats administered oral doses of adapalene in amounts up to 20 mg/kg/day (up to 26 times the MRHD based on mg/m² comparisons). No effects of adapalene were found on the reproductive performance or fertility of the F0 males or females. There were also no detectable effects on the growth, development and subsequent reproductive function of the F1 offspring.

Pregnancy: Teratogenic effects. Pregnancy Category C. Retinoids may cause fetal harm, when administered to pregnant women. Adapalene has been shown to be teratogenic in rats and rabbits when administered orally (see Animal Data below). There are no adequate and well-controlled studies in pregnant women. DIFFERIN® Gel, 0.3% should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. The safety and efficacy of DIFFERIN® Gel, 0.3% in pregnancy has not been established.

1. Human Data In clinical trials involving DIFFERIN® Gel, 0.3% in the treatment of acne vulgaris, women of child-bearing potential initiated treatment only after having had a negative pregnancy test and used effective birth control measures during therapy. However, 6 women treated with DIFFERIN® Gel, 0.3% became pregnant. One patient elected to terminate the pregnancy, two patients delivered healthy babies by normal delivery, two patients delivered prematurely and the babies remained in intensive care until reaching a healthy state and one patient was lost to follow-up.

2. Animal Data • No teratogenic effects were seen in rats at oral doses of 0.15 to 5.0 mg/kg/day adapalene representing up to 6 times the maximum recommended human dose (MRHD) based on mg/m² comparisons. Adapalene has been shown to be teratogenic in rats and rabbits when administered orally at doses 25 mg/kg representing 32 and 65 times, respectively, the MRHD based on mg/m² comparisons. Findings included cleft palate, microphthalmia, encephalocele and skeletal abnormalities in the rat and umbilical hernia, exophthalmos and kidney and skeletal abnormalities in the rabbit.

• Cutaneous teratology studies in rats and rabbits at doses of 0.6, 2.0, and 6.0 mg/kg/day exhibited no fetotoxicity and only minimal increases in supernumerary ribs in both species and delayed ossification in rabbits.

Systemic exposure (AUC0-24h) to adapalene 0.3% gel at topical doses of 6.0 mg/kg/day in rats and rabbits represented 5.7 and 28.7 times, respectively, the exposure in acne patients treated with adapalene 0.3% gel applied to the face, chest and back (2 grams applied to 1000 cm2 of acne involved skin).

Nursing Mothers: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when DIFFERIN® Gel, 0.3% is administered to a nursing woman.

Pediatric Use: Safety and effectiveness in pediatric patients below the age of 12 have not been established.

Geriatric Use: Clinical studies of DIFFERIN® Gel, 0.3% did not include subjects 65 years of age and older to determine whether they respond differently than younger subjects. Safety and effectiveness in geriatric patients age 65 and above have not been established.

30 Journal of Dermatology for Physician Assistants

ADVERSE REACTIONS: In the multi-center, controlled clinical trial, signs and symptoms of local cutaneous irritation were monitored in 258 acne patients who used DIFFERIN® Gel, 0.3% once daily for 12 weeks. Of the patients who experienced cutaneous irritation (erythema, scaling, dryness, and/or burning/stinging), the majority of cases were mild to moderate in severity, occurred early in treatment and decreased thereafter. The incidence of local cutaneous irritation with DIFFERIN® Gel, 0.3% from the controlled clinical study is provided in the following table: Table 2: Physician assessed local cutaneous irritation with DIFFERIN® Gel Incidence of Local Cutaneous Irritation with DIFFERIN® Gel, 0.3% from Controlled Clinical Study (N=253*) Maximum Severity Scores Higher Than Baseline Erythema Scaling Dryness Burning/Stinging

Mild 66 (26.1%) 110 (43.5%) 113 (44.7%) 72 (28.5%)

Moderate 33 (13.0%) 47 (18.6%) 43 (17.0%) 36 (14.2%)

Severe 1 (0.4%) 3 (1.2%) 2 (0.8%) 9 (3.6%)

* Total number of subjects with local cutaneous data for at least one post-Baseline evaluation.

Table 3: Patient reported local cutaneous adverse events with DIFFERIN® Gel DIFFERIN® (adapalene) Gel, 0.3% Related* Adverse Events Dry Skin Skin Discomfort Desquamation

Vehicle Gel

N=258

N=134

57 (22.1%) 36 (14%) 15 (5.8%) 4 (1.6%)

6 (4.5%) 2 (1.5%) 0 (0.0%) 0 (0.0%)

* Selected adverse events defined by investigator as Possibly, Probably or Definitely Related Related adverse events from the controlled clinical trial that occurred in greater than 1% of patients who used DIFFERIN® Gel, 0.3% once daily included: dry skin (14.0%), skin discomfort (5.8%), pruritus (1.9%), desquamation (1.6%), and sunburn (1.2%). The following selected adverse events occurred in less than 1% of patients: acne flare, contact dermatitis, eyelid edema, conjunctivitis, erythema, pruritus, skin discoloration, rash, and eczema.

In a one-year, open-label safety study of 551 patients with acne who received DIFFERIN® Gel, 0.3%, the pattern of adverse events was similar to the 12-week controlled study.

OVERDOSAGE: DIFFERIN® Gel, 0.3% is intended for topical use only. If the medication is applied excessively, no more rapid or better results will be obtained and marked redness, scaling, or skin discomfort may occur. Chronic ingestion of the drug may lead to the same side effects as those associated with excessive oral intake of vitamin A. Marketed by: GALDERMA LABORATORIES, L.P. Fort Worth, Texas 76177 USA Manufactured by: DPT Laboratories, Ltd. San Antonio, Texas 78215 USA GALDERMA is a registered trademark.

Revised: June 2007 325089-0607

Reference: 1. Thiboutot D, Pariser DM, Egan N, et al; Adapalene Study Group. Adapalene gel 0.3% for the treatment of acne vulgaris: a multicenter, randomized, double-blind, controlled, phase III trial. J Am Acad Dermatol. 2006;54:242-250.

Marketed by: GALDERMA LABORATORIES, L.P. References: 1. Thiboutot D, Arsonnaud S, Soto P. Efficacy and tolerability of adapalene 0.3% gel Fort Worth, Texas 76177 USA compared to tazarotene 0.1% gel in the treatment of acne vulgaris. J Drugs Dermatol. 2008;7 Manufactured by: (6)(suppl):S3-S10.

2.

Data on file. Galderma Laboratories, L.P. A 3-week, single-center, randomized, DPT Laboratories, Ltd. investigator/evaluator-blinded, San Antonio, Texas 78215 USA bilateral (split-face) comparison, clinical study of adults 18 years of age GALDERMA is ahealthy registered and older with skintrademark.

(N=30).

Revised: June 2007 325089-0607 Differin andisGalderma aretrademark. registered trademarks.

Galderma a registered ©2007 Galderma Laboratories, L.P. ©2010 Galderma Laboratories, L.P. Galderma Laboratories, L.P. Galderma Laboratories, L.P. 14501 N. Freeway 14501 N. Freeway Fort Worth, TX 76177 Fort Worth, TX 76177 DIFF-061 Printed01/10 www.differin.com DIF-888 in USA 11/07

SURGICAL Dermatology

SURGICAL wisdom Ten Steps to a Seamless Excision

Step 8 Fine Tune With Top Layer Sutures

By Michael Fraykor, PA-C and Michael Todd, MD

SDPA Members Only Content A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Michael Fraykor, PA-C, is a graduate of the Touro College Physician Assistant program in Long Island, NY. He is a member of the SDPA, AAPA, and VAPA. Currently, he is employed at the Skin Cancer Center of Northern Virginia where he assists with Mohs surgeries, screens patients, and performs excisions. He has no outside relationships with industry to disclose.

For most physician assistants working in the field of dermatology, excisions are an everyday occurrence. Excisions can occasionally be challenging and intimidating due to size, location, and a patientâ&#x20AC;&#x2122;s expectations. Since I work strictly for a Mohs surgeon, performing excisions and suturing have become second nature to me. I have put together the 10 key points that I have learned that help ensure good excisions as well as good cosmetic results. Hopefully, this 10 part series will provide you with the tools needed for a seamless excision.

Vol.4, No. 1 WINTER 2010 31

COSMETIC deRMATOLOGY

American Academy of Dermatology to Phase Out AAD SEAL OF RECOGNITION速 Program SDPA Members Only Content A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

32 Journal of Dermatology for Physician Assistants

Cosmetic pearls Fractional Laser Post-Treatment Care

By Risha Bellomo, MPAS, PA-C

SDPA Members Only Content

cosmetic Dermatology

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Risha Bellomo, MPAS, PA-C has practiced dermatology for 9 years.

She currently works at Advanced Dermatology & Cosmetic Surgery in Orlando, Florida and has been their Director of PA/NP Cosmetic Training for the last 3 years. She has indicated no relationships to disclose relating to the content of this article.

Vol.4, No. 1 WINTER 2010 33

The Society of Dermatology Physician Assistants Summer

Dermatology Conference CHICAGO

Register Now

at www.dermpa.org

Marriott Downtown, Chicago, Illinois June 10 â&#x20AC;&#x201C; 13, 2010

CHICAGO PLANNED TOPICS TO INCLUDE:

(Topics may change without prior notice) s (AIR $ISORDERS s $ERMATOSES OF 0REGNANCY s "ASIC )MMUNOLOGY s .ON )NVASIVE 4REATMENT FOR 0RECANCEROUS AND #ANCEROUS ,ESIONS s 2EVIEW OF THE 3URGICAL !PPROACH TO .ON -ELANOMA 3KIN #ANCER s $ERMATOPATHOLOGY AND #LINICAL #ORRELATION s 3ECOND ,INE 4HERAPIES FOR %CZEMAOUS ,ESIONS s #ONTACT $ERMATITIS s $ERMOSCOPY s $RUG %RUPTIONS

34 Journal of Dermatology for Physician Assistants

s 0ATHOPHYSIOLOGY OF 7OUND #ARE s #ONTACT 3TOMITIS s (OW TO 'ET THE -OST /UT OF #ODING s #ERTIlCATION 2EVIEW !LL 4HOSE 4HINGS )NSIDE THE 3KIN 9OU -IGHT (AVE &ORGOTTEN %DUCATIONAL SESSIONS WILL BE CONDUCTED BY AN OUTSTANDING FACULTY OF DERMATOLOGY THOUGHT LEADERS 4HIS PROGRAM IS NOT YET APPROVED FOR #-% CREDIT #ONFERENCE ORGANIZERS PLAN FOR HOURS OF #ATEGORY ) #-% #REDIT TO BE AVAILABLE 1UESTIONS Call 800-380-3992.

Professional development

The History of the SDPA

By Patricia Ferrer, MPAS, PA-C

SDPA Members Only Content A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Patricia Ferrer, MPAS, PA-C graduated from the University of Texas Medical Branch in 1998 and obtained her Masters Degree from the University of Nebraska in 2003 (SDPA scholarship). She is an Associate member of the SDPA and Fellow member of the AAPA. She has been working in dermatology for nine years and is currently on sabbatical. She has no outside relationships with industry to disclose.

Vol.4, No. 1 WINTER 2010 35

SDPA Members Only Content

professional development

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

36 Journal of Dermatology for Physician Assistants

SDPA Members Only Content

professional development

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

4"7& 5)& %"5&

SDPA_GrapevineTX Con_AD.indd 1

1/2/10 2010 5:55:58 PM Vol.4, No. 1 WINTER 37

Dermatology Billing & Coding 2010 Updates

By Inga Ellzey, MPA, RHIA, CDC

SDPA Members Only Content

professional development

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

38 Journal of Dermatology for Physician Assistants

SDPA Members Only Content

Ms. Ellzey, President/CEO of the Inga Ellzey Practice Group, Inc., in Casselberry, FL, is an expert on dermatology coding, documentation and reimbursement. She has more than 35 years of experience in the field of dermatology and is the CEO and founder of two nationwide dermatology billing services. You can reach her at the following number: (800) 318-3271, or email her at: inga@iepg.com.

Notes from your Office Manager Risk Management Tips SDPA Members Only Content A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Vol.4, No. 1 WINTER 2010 39

professional development

A complimentary subscription to the JDPA is provided to the members of the SDPA. Please visit www.dermpa.org today to join the SDPA and gain full access to the valuable content of the JDPA.

Outside & Inside the 9 to 5...

professional development

We have decided to expand our traditional “Outside the 9 to 5” section, which highlights the amazing things PAs are doing outside of their normal workday. We are now including “Inside the 9 to 5,” which will highlight to our readers some of the unique and interesting things dermatology PAs are doing during their normal workday.

Our first interview is with Mark Hyde who has been a PA for the past five years. Mark initially worked in family practice and has been practicing dermatology for over three years. He is currently working at the University of Utah on the Cutaneous Oncology Team at the Huntsman Cancer Institute, a National Comprehensive Cancer Network (NCCN) institution that focuses on treatment and research. He works with a Mohs surgeon and treats melanoma and non-melanoma skin cancers as well as cutaneous T-cell lymphoma.

and help them through an emotional and scary time.

I have become very close to many of my patients and though I mourn the losses, I never regret our closeness.

People may be surprised to know…

‘Mohs’ Micrographic Surgery was named after Dr. Frederic Mohs who discovered and developed the procedure at the University of Wisconsin Medical Center in the 1940s.

What my patients (or staff) may tell you about me… I am sarcastic and enjoy playing practical jokes. I am still a kid at heart.

What does your typical day involve?

My favorite bit of advice for my patients Three days each week are spent in Mohs (or derm PAs) is… You can never consult surgery. I assist in the Mohs process and a Mohs surgeon too soon in the process of spend a good portion of my time repairing the subsequent wounds. I also get one Mark Hyde, MMS, PA-C skin cancer, but you can definitely consult them too late. academic day each week to work on our team’s research goals as well as personal research What is the greatest challenge of working in your projects. I also get one day each week to screen highposition? My position requires some administrative risk patients for skin cancer. duties and I am required to be a liaison between multiple providers and patients. It is an exciting Why or how did you get into your position? I had challenge. a good procedural background in family practice and had done research during PA school. These If I only knew then what I know now… I wouldn’t qualifications along with the University of Utah being change a thing. my undergraduate Alma Mater made this job ideal The position I work in needs more… Space. The for me. biggest limitation I face is having enough rooms and How is your position unique compared to working staff to see our patients. in general dermatology? Working in a NCCN institute Who is your greatest source of inspiration? gives me an opportunity to see the ‘zebras’ (strange, My patients who have fought or are fighting a unique, or challenging cases). In addition to treating frustrating battle with a great attitude. the run of the mill basal cell carcinoma, I see a relatively What are you currently reading? I just finished Mary large population of transplant patients, basal cell nevus Shelley’s Frankenstein. This is a great book for anyone syndrome patients, cutaneous T-cell lymphoma, and interested in surgery, anatomy, or science. difficult recurrent or advanced cancers. I also act as a triage PA for many of the patients with melanoma What is currently your favorite interview on Dermcast. being referred to our team. tv? Of course, it is my interview with Samantha Guild from Aim at Melanoma.

What about your position is the most interesting?

Our current research focuses are on lentigo maligna, What is your greatest accomplishment to date? methods of tissue processing, and tumor influence on A happy marriage and four great little kids. dermal lymphatics. I have recently finished a survey of Describe your ideal/dream day… Three or four Mohs surgeons that will be the first data to detail how challenging surgeries followed by an hour or two of PAs are used in this subspecialty. The research aspect writing time before going home to be attacked by of my career is extremely interesting to me. the kids. J Rewarding? It is most rewarding to be able to spend adequate time with a newly diagnosed cancer patient 40 Journal of Dermatology for Physician Assistants

1

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*myfinaceaskinsavvy.com – a website for patient support and education Finacea is indicated for topical treatment of inflammatory papules and pustules of mild to moderate rosacea. Although some reduction of erythema which was present in patients with papules and pustules of rosacea occurred in clinical studies, efficacy for treatment of erythema in rosacea in the absence of papules and pustules has not been evaluated.

Finacea is for dermatologic use only, and not for ophthalmic, oral, or intravaginal use. Finacea is contraindicated in individuals with a history of hypersensitivity to propylene glycol or any other component of the formulation. In clinical trials, sensations of burning/stinging/tingling occurred in 29% of patients, and itching in 11%, regardless of the relationship to therapy. Postmarketing safety—Skin: facial burning and irritation; Eyes: iridocyclitis on accidental exposure to the eye. There have been isolated reports of hypopigmentation after use of azelaic acid. Since azelaic acid has not been well studied in patients with dark complexion, these patients should be monitored for early signs of hypopigmentation.

Please see brief summary of full Prescribing Information on following page.

References: 1. Draelos ZD, Kayne AL. Implications of azelaic acid’s multiple mechanisms of action: therapeutic versatility. Poster presented at: 66th Annual Meeting of the American Academy of Dermatology; February 1-5, 2008, San Antonio, TX. 2. Thiboutot D, Thieroff-Ekerdt R, Graupe K. Efficacy and safety of azelaic acid (15%) gel as a new treatment for papulopustular rosacea: results from two vehicle-controlled, randomized phase III studies. J Am Acad Dermatol. 2003;48(6):836-845. FINACEA was only studied in clinical trials for 12 weeks. 3. Elewski BE, Fleischer AB, Pariser DM. A comparison of 15% azelaic acid gel and 0.75% metronidazole gel in the topical treatment of papulopustular rosacea: results of a randomized trial. Arch Dermatol.

2003;139:1444-1450. 4. Thiboutot DM, Fleischer AB, Del Rosso JQ, Rich P. A multicenter study of topical azelaic acid 15% gel in combination with oral doxycycline as initial therapy and azelaic acid 15% gel as maintenance monotherapy. J Drugs Dermatol. 2009;8(7):639-648. ©2009 Intendis, Inc. All rights reserved.

09-JA-004

Vol.4, No. 1 WINTER 2010 October 41 2009

BRIEF SUMMARY

Nursing Mothers:

For Dermatologic Use Onlyâ&#x20AC;&#x201C;Not for Ophthalmic, Oral, or Intravaginal Use Rx only CONTRAINDICATIONS FINACEAÂŽ Gel, 15%, is contraindicated in individuals with a history of hypersensitivity to propylene glycol or any other component of the formulation.

Equilibrium dialysis was used to assess human milk partitioning in vitro. At an azelaic acid CONCENTRATION OF ÂŤG M, THE MILK PLASMA DISTRIBUTION COEFFICIENT WAS AND THE MILK BUFFER DISTRIBUTION WAS INDICATING THAT PASSAGE OF DRUG INTO MATERNAL MILK MAY OCCUR 3INCE LESS THAN OF A TOPICALLY APPLIED DOSE OF AZELAIC ACID CREAM

IS SYSTEMICALLY ABSORBED

the uptake of azelaic acid into maternal milk is not expected to cause a significant change FROM BASELINE AZELAIC ACID LEVELS IN THE MILK (OWEVER CAUTION SHOULD BE EXERCISED WHEN FINACEAÂŽ Gel, 15%, is administered to a nursing mother.

WARNINGS FINACEAÂŽ Gel, 15%, is for dermatologic use only, and not for ophthalmic, oral, or intravaginal use.

There have been isolated reports of hypopigmentation after use of azelaic acid. Since azelaic acid has not been well studied in patients with dark complexion, these patients should be monitored for early signs of hypopigmentation.

PRECAUTIONS General: Contact with the eyes should be avoided. If sensitivity or severe irritation develops with the use ÂŽ of FINACEA Gel, 15%, treatment should be discontinued and appropriate therapy instituted. The safety and efficacy of FINACEAÂŽ Gel, 15%, has not been studied beyond 12 weeks.

Information for Patients: Patients using FINACEAÂŽ Gel, 15%, should receive the following information and instructions: s &).!#%!ÂŽ Gel, 15%, is to be used only as directed by the physician. s &).!#%!ÂŽ Gel, 15%, is for external use only. It is not to be used orally, intravaginally, or for the eyes. s #LEANSE AFFECTED AREA S WITH A VERY MILD SOAP OR A SOAPLESS CLEANSING LOTION AND PAT DRY WITH a soft towel before applying FINACEAÂŽ Gel, 15%. Avoid alcoholic cleansers, tinctures, and astringents, abrasives, and peeling agents. s !VOID CONTACT OF &).!#%!ÂŽ Gel, 15%, with the mouth, eyes and other mucous membranes. If it does come in contact with the eyes, wash the eyes with large amounts of water and consult a physician if eye irritation persists. s 4HE HANDS SHOULD BE WASHED FOLLOWING APPLICATION OF &).!#%!ÂŽ Gel, 15%. s #OSMETICS MAY BE APPLIED AFTER &).!#%!ÂŽ Gel, 15%, has dried. s 3KIN IRRITATION E G PRURITUS BURNING OR STINGING MAY OCCUR DURING USE OF &).!#%!ÂŽ Gel, 15%, usually during the first few weeks of treatment. If irritation is excessive or persists, use of FINACEAÂŽ Gel, 15%, should be discontinued, and patients should consult their physician 3EE !$6%23% 2%!#4)/.3 s !VOID ANY FOODS AND BEVERAGES THAT MIGHT PROVOKE ERYTHEMA FLUSHING AND BLUSHING INCLUDING SPICY FOOD ALCOHOLIC BEVERAGES AND THERMALLY HOT DRINKS INCLUDING HOT COFFEE AND TEA s 0ATIENTS SHOULD REPORT ABNORMAL CHANGES IN SKIN COLOR TO THEIR PHYSICIAN s !VOID THE USE OF OCCLUSIVE DRESSINGS OR WRAPPINGS Drug Interactions: There have been no formal studies of the interaction of FINACEAÂŽ Gel, 15%, with other drugs.

Carcinogenesis, Mutagenesis, Impairment of Fertility: Long-term animal studies have not been performed to evaluate the carcinogenic potential of FINACEAÂŽ Gel, 15%. Azelaic acid was not mutagenic or clastogenic in a battery of in vitro !MES ASSAY ('024 IN 6 CELLS [#HINESE HAMSTER LUNG CELLS] AND CHROMOSOMAL ABERRATION ASSAY IN HUMAN LYMPHOCYTES AND in vivo DOMINANT LETHAL ASSAY IN MICE AND MOUSE MICRONUCLEUS ASSAY GENOTOXICITY TESTS

Pediatric Use: Safety and effectiveness of FINACEAÂŽ Gel, 15%, in pediatric patients have not been established.

Geriatric: Clinical studies of FINACEAÂŽ 'EL

DID NOT INCLUDE SUFFICIENT NUMBERS OF SUBJECTS AGED and over to determine whether they respond differently from younger subjects.

ADVERSE REACTIONS /VERALL TREATMENT RELATED ADVERSE EVENTS INCLUDING BURNING STINGING TINGLING DRYNESS TIGHTNESS SCALING ITCHING AND ERYTHEMA IRRITATION REDNESS WERE FOR FINACEAÂŽ 'EL

AND FOR THE ACTIVE COMPARATOR GEL AT WEEKS In two vehicle controlled, and one active controlled U.S. clinical studies, treatment safety was monitored IN PATIENTS WHO USED TWICE DAILY &).!#%!ÂŽ 'EL

FOR WEEKS . OR FOR WEEKS .

OR THE GEL VEHICLE . FOR WEEKS Table 3. Cutaneous Adverse Events Occurring in ĂŚ1% of Subjects in the Rosacea Trials by Treatment Group and Maximum Intensity* FINACEA ÂŽ 'EL

.

6EHICLE .

Mild N

Moderate N

Severe N

Mild N

Moderate N

Severe N

"URNING STINGING TINGLING

0RURITUS

3CALING DRY SKIN XEROSIS

%RYTHEMA IRRITATION

Contact DERMATITIS

%DEMA

!CNE

*3UBJECTS MAY HAVE CUTANEOUS ADVERSE EVENT THUS THE SUM OF THE FREQUENCIES OF PREFERRED TERMS MAY exceed the number of subjects with at least 1 cutaneous adverse event.

Pregnancy: Teratogenic Effects: Pregnancy Category B

FINACEAÂŽ Gel, 15%, and its vehicle caused irritant reactions at the application site in human dermal safety studies. FINACEAÂŽ Gel, 15%, caused significantly more irritation than its vehicle in a cumulative irritation study. Some improvement in irritation was demonstrated over the course of the clinical studies, but this improvement might be attributed to subject dropouts.

No phototoxicity or photoallergenicity were reported in human dermal safety studies.

There are no adequate and well-controlled studies of topically administered azelaic acid in pregnant women. The experience with FINACEAÂŽ Gel, 15%, when used by pregnant women is too limited to permit assessment of the safety of its use during pregnancy.

In patients using azelaic acid formulations, the following additional adverse experiences have been reported rarely: worsening of asthma, vitiligo depigmentation, small depigmented spots, hypertrichosis, REDDENING SIGNS OF KERATOSIS PILARIS AND EXACERBATION OF RECURRENT HERPES LABIALIS

/RAL ADMINISTRATION OF AZELAIC ACID AT DOSE LEVELS UP TO MG KG DAY TIMES THE MAXIMUM RECOMMENDED HUMAN DOSE BASED ON BODY SURFACE AREA DID NOT AFFECT FERTILITY OR REPRODUCTIVE performance in male or female rats.

$ERMAL EMBRYOFETAL DEVELOPMENTAL TOXICOLOGY STUDIES HAVE NOT BEEN PERFORMED WITH AZELAIC ACID

GEL /RAL EMBRYOFETAL DEVELOPMENTAL STUDIES WERE CONDUCTED WITH AZELAIC ACID IN RATS

rabbits, and cynomolgus monkeys. Azelaic acid was administered during the period of organogeneisis in all three animal species. Embryotoxicity was observed in rats, rabbits, and monkeys at oral doses of azelaic acid that generated some maternal toxicity. Embryotoxicity was observed in rats given MG KG DAY TIMES THE MAXIMUM RECOMMENDED HUMAN DOSE BASED ON BODY SURFACE AREA

RABBITS GIVEN OR MG KG DAY OR TIMES THE MAXIMUM RECOMMENDED HUMAN DOSE BASED ON BODY SURFACE AREA AND CYNOMOLGUS MONKEYS GIVEN MG KG DAY TIMES THE MAXIMUM RECOMMENDED HUMAN DOSE BASED ON BODY SURFACE AREA AZELAIC ACID .O TERATOGENIC effects were observed in the oral embryofetal developmental studies conducted in rats, rabbits, and cynomolgus monkeys.

An oral peri- and postnatal developmental study was conducted in rats. Azelaic acid was administered from gestational day 15 through day 21 postpartum up to a dose level of MG KG DAY %MBRYOTOXICITY WAS OBSERVED IN RATS AT AN ORAL DOSE THAT GENERATED SOME MATERNAL TOXICITY MG KG DAY TIMES THE MAXIMUM RECOMMENDED HUMAN DOSE BASED ON BODY SURFACE AREA )N ADDITION SLIGHT DISTURBANCES IN THE POSTNATAL DEVELOPMENT OF FETUSES WAS NOTED IN RATS AT ORAL DOSES THAT GENERATED SOME MATERNAL TOXICITY AND MG KG DAY AND TIMES THE MAXIMUM RECOMMENDED HUMAN DOSE BASED ON BODY SURFACE AREA .O EFFECTS ON SEXUAL maturation of the fetuses were noted in this study. Because animal reproduction studies are not always predictive of human response, this drug should be used only if clearly needed during pregnancy.

42 Journal of Dermatology for Physician Assistants

0OST MARKETING SAFETYn3KIN FACIAL BURNING AND IRRITATION %YES IRIDOCYCLITIS ON ACCIDENTAL EXPOSURE WITH FINACEAÂŽ 'EL

TO THE EYE SEE PRECAUTIONS OVERDOSAGE FINACEAÂŽ Gel, 15%, is intended for cutaneous use only. If pronounced local irritation occurs, patients should be directed to discontinue use and appropriate therapy should be instituted 3EE PRECAUTIONS $ECEMBER $ISTRIBUTED UNDER LICENSE U.S. Patent No 4,713,394 Manufactured by Intendis Manufacturing S.p.A., Segrate, Milan, Italy $ISTRIBUTED BY 0INE "ROOK .*

FINACEA is a registered trademark of Intendis, Inc. #ERA6E IS A REGISTERED TRADEMARK OF #/2)! ,ABORATORIES ,TD ÂĽ )NTENDIS )NC !LL RIGHTS RESERVED *! &EBRUARY

Dermatology PA news & notes

From the Desk of...

Jane Mast, MPAS, PA-C

Education and the Dermatology Physician Assistant Four Things I Wish I Knew Before I Took My First Job Dermatology is an exciting and rewarding field in which to practice. It is a field that is extremely unique among the medical specialties because of its visual nature. As more opportunities become available for physician assistants, it is important to look at how new dermatology PAs and PAs with an interest in dermatology are educated. When I look back seven years to my start as a dermatology PA, I am amazed at how my clinical skills have matured and evolved. Four things come to mind when I think about the education of new and upcoming dermatology PAs.

1. The first job you take is often the most important journey Your first job in dermatology is often where you get most of your education. It is this first job where the nature of your supervising physician is extremely important. Find a supervising physician who is more concerned about training and teaching you dermatology than about how much money you will be bringing into the practice. A good supervising physician will bring you in on interesting cases and will encourage you to attend conferences and CME events. Dermatology is not just protocols that can be learned; it is a visual art to differentiate between a melanoma, an ink-spot lentigo, or a blue nevus. I think of it as a “Where’s Waldo” of sorts (for those of you not familiar with the Where’s Waldo series it involves looking at a picture full of detail in hopes of spotting Waldo, a small thin man with glasses wearing a red and white-striped shirt). Many times our jobs entail looking at a variety of benign growths to spot a malignancy. Once you are properly trained Jane Mast, MPAS, PA-C is a graduate of the University of Florida Physician Assistant Program and has practiced dermatology for seven years at Space Coast Dermatology in Merritt Island, Florida.

you will be much more valuable to your patients and your practice both medically and financially. I have seen too many PAs eager to get into the field of dermatology who accept positions with nonexistent supervision and/or training and where the emphasis is on how many patients you see and not on the quality of care that you provide. Do not accept these positions. Keep searching for a supervising physician who is willing to make a commitment to your continued education.

2. Don’t underestimate your abilities, but don’t be over confident When I hear of new dermatology PAs who are seeing patients every five minutes during their third week on the job, I have to wonder about the quality of care that they are providing. It takes time to become proficient in dermatology. Any experienced dermatology PA will tell you that what they knew when they started practicing versus what they know now is significantly different. Take the time to ask when you don’t know something and educate yourself when a new condition presents itself. Remember to always remain a little bit humbled by the fact that not everything presents itself like the pictures in textbooks. Textbook pictures can only go so far in educating providers in dermatology. Often it is far more valuable to see a condition up close and therefore be able to appreciate all of the details that are not seen in a picture. Although most of us see the most common dermatology conditions on a daily basis, always look out for the uncommon conditions as well.

3. There is more than one way to skin a cat Every provider does things a little bit differently. Sometimes it amazes me how differently dermatologists can treat the exact same condition.

The important point to remember is that there are many different ways to do things in dermatology and that sometimes many different approaches work.

Vol.4, No. 1 WINTER 2010 43

Be adaptable to change and remain open to new therapies. When all else fails, do research into novel ideas and don’t be afraid to try something from the past. Some of the best remedies I have seen are compounded at the pharmacy and were given to me by the founder of our practice who passed away a couple of years ago after practicing dermatology for thirty years.

4. Education in dermatology is continuous

DERmatology pa news & notes

You will continue learning your entire career in dermatology. The knowledge base for this specialty is vast and it is our job to continue investing in our education so that we can provide the best care and the most up-to-date treatment options to our patients. The wonderful thing about the SDPA is its commitment to providing the best in dermatological

“

education. There are plenty of opportunities available to advance our skills: Annual SDPA Conferences, dermatology journals including the JDPA, the Distance Learning Initiative (DLI), and Dermcast.

TV. Take advantage of these opportunities provided by the SDPA. Attend Annual SDPA Conferences.

Take the time to read the major dermatology journals and consider writing for a publication. Participate in the DLI and Dermcast.TV. We need to strive to keep learning all that we can on a daily basis.

Educating PAs new to dermatology and PAs interested in dermatology is an issue important to us all. The reputation of dermatology PAs as a profession can be made or broken by these new and upcoming PAs. We should encourage these colleagues by mentoring them and guiding them to the available resources that they need to become even better PAs. Our future as dermatology PAs depends on it. J

”

Derm Quotes

“If just one person contacts their legislator, that really represents hundreds of people…”

Samantha Guild of the Aim at Melanoma Foundation - www.aimatmelanoma.org Speaking about the 2009 Howard County, Maryland ban on indoor tanning for minors.

Dermcast.tv – December 7th, 2009

“We’ve focused our agenda on removing barriers to physician-PA practice.”

Stephen H. Hanson, MPA, PA-C, AAPA President Speaking about the AAPA’s position regarding healthcare reform.

Dermcast.tv – January 18th, 2010

?

“It’s a matter of educating the physicians about who we are and what we do.”

Search the Dermcast.tv ‘People’ section (clue - it was said in 2009) and tell us the full name of the PA who said this quote.

DERM QUOTES CONTEST - SDPA members with the correct answer (full name of the quoted PA) will be entered into a drawing to win one SDPA Conference registration fee, compliments of the JDPA. The drawing will take place at this year’s inaugural SDPA Summer Dermatology Conference in Chicago; the winning member does not need to be present to claim prize. Answers must be entered onto a fully completed JDPA Reader Survey along with your SDPA member number by June 9th, 2010.

Please visit www.jdpa.org/survey to submit your answer. Limit one entry per member. Winning SDPA member can choose the SDPA Conference of his/her choice to apply the complimentary SDPA Conference registration fee (valid for 1 year from date of drawing). Best of Luck!

44 Journal of Dermatology for Physician Assistants

The Difference We Make:

Celebrating Our 11th Year Riding For Camp Discovery!

We have completed our 11th annual 100 mile bike Waldman’s office manager did her traditional 55 miles ride to raise funds for Camp Discovery. One of our training and Dr. Jones’ parents finished their planned ride of sessions consisted of a 5-hour workout completing 75 miles, over 20 miles. It was a cool day and we didn’t have any and I am not getting any younger. Our motto is, ”Pedal opportunities to shed our many layers of clothing, but until you feel it… then pedal even more!” we finished the ride nonetheless. We all felt really good about finishing. The path was great As you already may know, and the scenery was absolutely Camp Discovery is organized beautiful. The sun was out and by the American Academy the only breeze was what our of Dermatology, and is a bikes produced as we averaged wonderful cause. Contributions close to 14.5 miles per hour. We help to defray the cost so that stopped a few times to refresh more children will have the with a large selection of food opportunity to attend the and drink. Finishing felt great but camp. The camp is a place knowing that we actually did it felt where children with severe skin even greater. We have raised close diseases can have fun, be with to $35,000 so far and we expect other children who have similar more donations to come in over conditions, and at the same time the next few months. For all of receive medical supervision.

From left to right: Debbie Jones and her husband you who wanted to ride but didn’t Some children are in wheelchairs George Jones, Richard Waldman MD, David Jones make it and to those who did ride, and some will have considerably MD, and Steve Shama MD (all 3 are dermatologists) I thank you from the bottom of my shortened life spans. All of the heart. We all have opportunities children need our love. to do something very wonderful for the children of Camp Last year’s event was our greatest fundraising success.

Discovery. To see the smiles on the children’s faces as However, the weather wasn’t cooperative at all. It rained the they are able to play with other children without the selfentire weekend so we had to postpone the ride until the conscious feelings of being “different,” is evidence enough following weekend, which turned out to be beautiful. As as to why we should provide our support and caring. This usual, we were all in great shape for our 8 hour, 100 mile bike ride continues to touch my heart and I will continue bike ride, finishing about 4 o’clock in the afternoon. We to do it for these children and for those who support the were all a bit tired, but our mission was accomplished! We camp. I hope that there will be even more bike rides in the successfully finished 100 miles and raised over $42,000. future to raise additional funds so that more children can Since we began the bike ride 10 years ago, our office (with experience the camp and know that they are not alone. the loving support of family, friends, and patients) has My wish is that more dermatology practices around raised more funds for Camp Discovery than any private the country would offer to their patients this opportunity dermatology office or any dermatology society in the of giving to the Camp. Offices could organize a bike ride, United States! a run, a walk, a golf tournament, a tennis tournament, or Once again, this year’s ride took place on the Cape some creative event to which people could contribute. I Cod Rail Trail on Saturday, September 26, 2009. Three of truly believe that if many of our offices were to do this, we us including Dr. David Jones, Dr. Richard Waldman, and could quickly have a generous endowment that would myself completed the 100 mile ride. Linda Karppinen, Dr. keep the Camp going for years to come. Now that would be a wonderful accomplishment - a wonderful dream come Dr. Steve Shama has been practicing general dermatology for 30 years true, a true gift for these amazing children. J in Boston, Massachusetts. Dr. Shama has been a professional speaker for 20 of those years and enjoys speaking on many topics, some of which include: “Dealing With Difficult People and Looking Forward To It!” and “Rediscovering The Joys of Medicine and of Life.” He gives these talks at medical meetings and for the general public throughout the country. He also travels to private offices to present his workshops and talks. You can reach Dr. Shama at www.steveshama.com.

Steven K. Shama, MD, MPH

Vol.4, No. 1 WINTER 2010 45

DERmatology pa news & notes

By Steven K. Shama, MD, MPH

Supervising Physician CORNER Supporting The Dermatology Foundation

By Kent Aftergut, MD

DERmatology pa news & notes

W

e are blessed as dermatologic providers to be a part of a specialty that is both rewarding and intellectually stimulating. Studies have shown that dermatologists have one of the highest job satisfaction rates of any medical specialty. I have worked with several dermatology physician assistants over the years and have seen that dermatology can provide a gratifying and financially rewarding career for them as well. I believe that doctors and physician assistants have some responsibility to give back to our specialty.

One way is through supporting the Dermatology Foundation (DF).

The DF is a nonprofit charitable organization whose mission is to provide research support that helps develop and retain tomorrow’s teachers and researchers in the field of dermatology. The DF’s purpose is critical to the future of dermatology because it enables new generations of talented, research-focused dermatologists to have the support they need to stay on the academic and research career path. The Foundation provides the best and brightest investigators with hard to find research funding that helps bridge the gap between residency/fellowship and independent funding.

With early research support from the DF, tomorrow’s educators and leaders are able to conduct quality research that later enables them to compete successfully for federal funding.

Researchers’ success in obtaining federal grants is crucial to their ability to develop new therapies and concepts about skin disease, to train others for the future, and therefore to advance the specialty.

Having worked my entire career with PAs, I have come to appreciate the importance of them in my practice and in dermatology as a whole. Studies show that the use of dermatology PAs is on the rise and that trend does not appear to be changing anytime soon.

The increasing use of PAs in dermatology has not been without controversy. Some dermatologists question if PAs are really committed to our field?

The argument is often made amongst those who don’t support the use of dermatology PAs; they 46 Journal of Dermatology for Physician Assistants

claim that after being trained, PAs will just head down the street and work for a family practice office or the corner medispa. What better way for PAs to show their commitment to dermatology than by unselfishly supporting dermatologic research?

The DF created the Leaders Society to recognize those who have generously committed $1,500 per year. Benefits of membership in the Leaders Society include:

• Recognition plaque suitable for office display.

• Listing in an annual recognition roster sent to all AAD and DF members.

• Invitation to the Leaders Society reception at the AAD Annual Meeting.

• Complimentary subscription to a widely respected quarterly publication, Dermatology Focus.

• The opportunity to network with today’s and tomorrow’s leaders at DF sponsored events.

• Recognition ribbons given at AAD Annual Meeting and other major dermatology meetings.

• Most gratifying of all, the satisfaction of

knowing you have made a difference for yourself, your colleagues, and patients everywhere who seek excellence in medical and surgical dermatologic care.

For those interested in joining the Dermatology Foundation’s Leaders Society, please email Joe Flint (jflint@dermatologyfoundation.org) at the Dermatology Foundation for details. J Kent Aftergut, MD is a board certified dermatologist and a native Texan. He is currently a Clinical Instructor of Dermatology at the University of Texas Southwestern Department of Dermatology. He also currently serves as president of the Dallas Dermatologic Society and serves as a Dermatology Foundation Leaders Society State Chair for Texas.

Professional Opportunities and Development

Advertiser INDE X OrthoDermatologics â&#x20AC;&#x201C; Retin-A Micro... Pages 2, 3 Ranbaxy â&#x20AC;&#x201C; Kenalog Spray...................Pages 7, 8 Coria â&#x20AC;&#x201C; Atralin............................... Pages 11, 12 Galderma â&#x20AC;&#x201C; Clobex Spray.................Pages 21, 22 Galderma â&#x20AC;&#x201C; Differin 0.3.................Pages 29, 30 Intendis â&#x20AC;&#x201C; Finacea..........................Pages 41, 42 Graceway â&#x20AC;&#x201C; Aldara................................Page 48 For more information on advertising opportunities in the JDPA, please log on to www.jdpa.org

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2010

Patient @ Doctor Meeting

New Wave Dermatology April 15-18 2010 â&#x20AC;˘ Rosen Shingle Creek â&#x20AC;˘ Orlando Florida Conference sponsored by FSDPA Offering 28 hours of category I CME. Optional workshops on Lasers, Botox, Suturing, and Fillers.

Featured speakers Matt Leavitt, DO, Neil Fenske, MD, James Spencer, MD, Francisco Kerdel, MD, and Lisa Cohen, MD.

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Save the Date

To register, please visit www.fsdpa.org.

Deadline for early bird registration is March 11, 2010.

For hotel reservations, please call the Rosen Shingle Creek at 866-996-6338. Ask for the FSDPA room rate of $164 (single/double plus tax).

Vol.4, No. 1 WINTER 2010 47 fsdpa_ann10_japaad.indd 1

12/13/09 12:16 PM

Š2010 Graceway Pharmaceuticals, LLC, Bristol, TN

www.aldara.com

48 Journal of Dermatology for Physician Assistants

www.gracewaypharma.com

ALD120910