Fall 2017 Skin Lines

FALL 2017 President’s message By: Rosalie Elenitsas, MD

Annual Meeting Update.............2 Silent Auction Update.................3 Residents Compete in Second Annual Mole Bowl.......................4 New App for Prescribing Corticosteroid Creams................7 Residency Program Corner.......8 40 Under 40 Top Physician.......9 Practice Management Tips.....10 Dermatologist of the Year Award................................... 11 Factoid.......................................... 12 Legislative Update..................... 13

It has been an honor to serve as the president of the Pennsylvania Academy of Dermatology and Dermatologic Surgery, one of the strongest state dermatology societies in the United States.

Our society has been active for 50 years, and we celebrated our golden anniversary at this year’s annual meeting in Hershey, Pennsylvania. I would like to thank doctors Lorraine Rosamilia and Laura Ferris for organizing an outstanding scientific program. Special thanks go to Dr. Harry Nevus (Dr. Justin Vujevich) for directing the Mole Bowl and Dr. Nino Benedetto for directing the cosmetic session. Kudos goes to Dr. Joslyn Kirby for arranging our inaugural silent auction to raise money for our PAD Public Health Education Fund and sun safety essay contest. This successful event will help us continue our endeavors in educating the youth of Pennsylvania about the dangers of sun exposure. If you were unable to join us for the silent auction, you can contribute to the public health education fund when you pay your annual dues. Any amount is appreciated! We owe a great gratitude to our executive staff Jen, Kim, Jill, and Melanie who made everything run very smoothly at our sweet Hershey meeting. Thank you everyone!

Pennsylvania physicians continue to face new challenges in practicing medicine. This year, many dermatologists were confronted with reimbursement cuts on visits using the -25 modifier. This issue affects many physicians, not just dermatologists; the problem is now being seen throughout the country. The Pennsylvania Academy of Dermatology has been working closely with the Pennsylvania Medical Society and the American Academy of Dermatology on this issue; the AMA is now also involved. If you are not members of these larger societies, now is the time to start or renew your membership. Working in conjunction with the larger organizations helps us advocate for issues affecting physicians.

As 2017 comes to a close, I would like to wish you and your families a safe and healthy holiday season. The Pennsylvania Academy of Dermatology CONTINUED ON PAGE 15

50th PAD Annual Meeting Update By: Lorraine L. Rosamilia, MD The 50th PAD Annual Meeting at the Hotel Hershey was a well attended and energetic cohort!

The 50th PAD Annual Meeting was held in October at The Hotel Hershey.

Dr. Warren Heymann kicked off the meeting with sage pearls in recent literature and on the enigmatic Epstein Barr virus, and Dr. Julie Harper provided expert commentary on acne management, particularly spironolactone and isotretinoin controversies and side effects. Our prestigious named lectures this year were given by Dr. Marta vanBeek, who reviewed surgical cases in the context of patient preference for the Duhring Memorial Lecture; she also provided much-needed review on the current economic and political state of healthcare in the US. Dr. Douglas Kress then enlightened us on new therapies in atopic dermatitis for the Pennsylvania Professor/ Crumay Memorial Lecture in addition to a review of psoriasis, particularly in children. Dr. Joseph Sobanko summarized his current research on medical outcomes/success, specifically in the setting of dermatologic surgery, and Dr. Matthew Zirwas provided spirited discussion on contact dermatitis and on common products used in unique treatment settings.

Wise instruction was also provided by Dr. William James on new diagnostic

2

considerations in dermatology and on travel dermatoses.

The special programs this year were quite extensive, including a socioeconomic session, lively yet sobering in its discussion on physician audits, coding/billing, and upcoming legislation. The resident symposium showcased impressive cases and research by our Pennsylvania and New Jersey residents; the winners of the oral and poster competitions were Dr. John Barbieri from the University of Pennsylvania and Dr. Amrit Khalsa from Penn State/Hershey respectively. The residents also participated in teams for the second annual Resident Mole Bowl competition, moderated by Dr. Harry Nevus, adorned unforgettably in sequins (see the corollary article and photo in this newsletter); the University of Pittsburgh team triumphed again. Additionally, a special cosmetic session, moderated by Dr. Anthony Benedetto with live patient demonstrations, was presented by Drs. Nazanin Saedi, Christine Cabell, and Joseph Sobanko.

The Saturday dinner event included a Beatles tribute band, commemorating the year 1967, 50 years ago for our 50th annual meeting. Participants bid on incredible items in a silent auction benefitting skin health education in schools across Pennsylvania, frolicked in the photo booth, and danced the night away to Beatles hits. In addition,

Dr. Christen Mowad was awarded the prestigious ‘Dermatologist of the Year’ honor at this event.

We look forward to next year’s meeting on September 15-17, 2018, at a new venue, Kalahari Resort and Convention Center in the Poconos where there is something for everyone: a water park for families, gourmet restaurants, a world-class spa, beautiful meeting space, and much more! Mark your calendars! https://www.kalahariresorts.com/ pennsylvania

2018 Venue Highlight

About the Author Dr. Lorraine Rosamilia practices dermatology at Geisinger Scenery Park State College. She currently serves as the Vice President of the PAD.

Inaugural Silent Auction Update

FALL 2017

By: Joslyn Kirby, MD This was our most successful Silent Auction ever! It was

also our first silent auction!

Thank you to all our donors, many of whom are Board Members and faculty from the host site, Penn State Hershey. With their support, the Silent Auction featured 24 items, ranging from golf outings, to vacations, to vintage wines, and raised $5,090 for the PAD’s Public Health Education Fund!

sun protection through education and outreach programs. Thank you to everyone who donated, bid, and purchased items.

We are planning to hold the Silent Auction again at the next annual meeting and hope we can count on your support! Tell us what you want to bid on — Email us at info@ padermatology.org with suggestions on items you’d love to see, bid on, and win next year.

This was our most successful Silent Auction ever! And we hope to say the same thing next year!

About the Author Dr. Joslyn Kirby is an Associate Professor of Dermatology at Penn State Hershey Medical Center.

She serves as chair of the PAD’s Skin Cancer Screening Committee.

Your Donations Are Needed!

Which item had the biggest bidding war?

The Yeti cooler — it must have been the modeling done on the first day…

Which items were hand-made? The basket from Dr. Elenitsas — which featured a cozy blanket made by a real Grandma (Dr E’s Mom)!

Which item raised the most for the Fund? The Steelers football tickets — thanks Renee Mathur!

The proceeds from the Silent Auction ($5,090!) benefit the PAD’s Public Health Education Fund, which supports increased community awareness of

The PAD Public Health Education Fund which supports the annual Sun Shade Essay Contest is in need of funds. The PAD Health Education Fund was established to support grants and educational outreach regarding skin and sun safety. Your donation is tax-deductible.

Go to the Foundation’s online giving page to make your gift to PAD...

Click the “Designating my gift” drop down menu and choose “PAD Public Health Education Fund” to donate to this fund. The Foundation will acknowledge your tax-deductible gift.

3

Residents Compete in Second Annual PAD Mole Bowl Competition By: Geoffrey Lim, MD

Once again, the Mole Bowl tested the participants’ knowledge across a broad field.

Ladies and gentlemen, Dr. Harry Nevus just got harrier!

Returning in unforgettable fashion— literally, with chest AND leg hair replacing his AC/DC t-shirt and black-and-white zebra pants from the year before—Dr. Nevus hosted the second annual PAD Mole Bowl Competition on Saturday,

4

October 21st. In a Dr. Jekyll/Mr. Hydelike metamorphosis, Dr. Justin Vujevich, former PAD president and current board member, disappeared as Dr. Nevus made his grand procession into the Hotel Hershey conference room. Anxiously awaiting his presence were the residents of the defending champions, The Skincredibles (University of Pittsburgh), and those of the contenders, Team Moderately Atypical (Lehigh Valley), Poke-Mole-Go (University of Pennsylvania), the House

of Dragons (Drexel), and the Sweetest Team on Earth (take a wild guess!).

Once again, the Mole Bowl tested the participants’ knowledge across a broad field. Questions included visual diagnosis (both clinical and histopathologic) of cutaneous neoplasms, rate of upstaging of melanoma in situ1, kodachrome identification of Staphylococcal Scalded Skin Syndrome (judging by their reaction, Drexel team members were perhaps the only residents to answer

FALL 2017 correctly, while others blamed poor image quality…), cutaneous markers for cranial dysraphism2, histopathologic findings of chronic cutaneous lupus erythematosus3, poor prognostic indicators in alopecia areata4, and pharmacology. This year’s bonus question, while not centered around celebrity trivia, was both perplexing and alarming: what is the estimated incidence of invasive melanoma in the United States in 2017? The answer: 87,110 cases!

Pressure was on as Dr. Nevus dramatically read off each of the 15 questions. The teams had 10 seconds to write their responses before the announcement, “pencils down!”. Then, members of the audience had their opportunity to submit responses via text messaging. The results of the live polling stream were illustrated as a bar chart, which oscillated like an equalizer with the beat of suspenseful music from the popular HBO TV series, Game of Thrones.

Though touted as a much easier exam, this year’s competition was clearly more difficult than expected (especially for UPenn and Penn State, the former having only one resident participant and the latter experiencing an in-exam casualty after being peppered with on-call pages). With a narrow margin of 12 of 15 questions answered correctly, the winners, The Skincredibles, successfully defended their title and will return the highly coveted trophy back to the University Pittsburgh. There, it will be proudly displayed until the next annual PAD Mole Bowl Competition.

About the Author Dr. Geoff Lim is the Chief Resident, PGY4 at the University of Pittsburgh Medical Center, Department of Dermatology. Dr. Lim is also part of the winning Skincredibles team.

REFERENCES: 1. According to a study by Karimipour et al.

(2005) out of the University of Michigan, the rate of upstaging following complete excision of residual melanomas was 21%.

Of these, 10% became candidates for sentinel lymph node biopsy. Therefore, when performing a biopsy of an atypical pigmented lesion, it is imperative to biopsy the entire pigmented lesion.

2. The “hair collar sign” is a pediatric cutaneous finding consisting of a ring of long, dark, coars hair surrounding a midline scalp nodule. This sign should alert the physician to the possibility of ectopic neural tissue in the scalp and/ or underlying central nervous system malformations.

3. Both chronic cutaneous lupus erythematosus (CCLE) and lichen

planopilaris (LPP) exhibit lymphocytic scarring hair loss. To differentiate these entities histopathologically, note that CCLE exhibits perifollicular and interfollicular interface change, superficial and deep perivascular and perieccrine inflammation, and moderate dermal mucin.

Interfollicular interface change, dermal mucin, perieccrine and deep perivascular inflammation are not features seen in LPP. 4. The following have been reported as being associated with a poor prognosis in patients with alopecia areata: severe disease such as alopecia totalis or alopecia universalis, onset in childhood, ophiasis pattern, history of atopy, nail involvement (pitting, trachyonychia, etc.), family history of alopecia areata, and duration of hair loss greater than 1 year.

Notably, history of thyroid disease is not associated with poor prognosis in patients with alopecia areata.

The PAD again thanks its resident participants, audience members, conference coordinators, and especially host Dr. Justin Vujevich for continuing this fun, educational, and interactive event.

5

The Pennsylvania Medical Society supports legislation that reforms prior authorization in Pennsylvania, and needs your help to identify patients who have experienced prior authorization delays.

• Please share the information below with your patients.

• Visit www.pamedsoc.org/PriorAuth to learn about the legislation and how physicians can contribute.

Frustrated With Insurance Delays Standing Between You and Your Health?

Was your physician-approved treatment plan/medication delayed by an insurance company’s prior authorization process? This outdated process jeopardizes medical practices’ ability to provide you with timely care.

You can help reform this process by supporting current state legislation.

Visit www.pamedsoc.org/ShareYourStory or call the Pennsylvania Medical Society at (855) 726-3348 to share your story and communicate with your local legislators.

The project is supported by the Pennsylvania Medical Society and our physician-led medical specialty partners.

777 East Park Drive • PO Box 8820 • Harrisburg, PA 17105-8820 • KnowledgeCenter@pamedsoc.org • www.pamedsoc.org 17/568 MagAd

6

FALL 2017

New App Brings Simplicity and Accuracy to Prescribing Corticosteroid Creams When technology improves quality of care while simplifying a clinician’s life, it’s a beautiful thing.

That’s why the Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD) is so excited to tell you about the new, interactive CorticoCream Calculator App. Developed with input by dermatologists and family medicine physicians, the CorticoCream Calculator App was created to help non-Dermatologists prescribe more accurate and appropriate topical corticosteroids. It’s easy to use, and it works quickly and efficiently, allowing primary care physicians (PCPs) to spend more time with their patients.

Moreover, PCPs and other clinicians can now prescribe topical corticosteroids with greater confidence, knowing this evidencebased app will allow them to provide more accurate treatment for their patients.

The CorticoCream Calculator App makes sure that the prescription is right the first time, reducing the likelihood of “corticosteroid failure”.

How easy is it? Simply select the patient age, and affected area or areas, enter the frequency and duration of the treatment, and the app will suggest specific corticosteroid potencies, sizes and amounts. It will also suggest

certain formulations, such as gel or solution for the scalp.

See for yourself by downloading it now at www.CorticoCreamApp. com. If you find it to be useful, please spread the word and provide clinicians with a better way to prescribe with confidence.

The app was made possible by a grant received by the Pennsylvania Academy of Dermatology, with support from clinicians and researchers from Penn State Health. It’s one more example of the many ways we promote high quality, accessible dermatological care for all individuals. And make life better for the people we serve.

The Pennsylvania Academy of Dermatology and Dermatological Surgery would like to recognize Josyln Kirby, MD for her efforts on this project.

7

Residency program corner

University of Pittsburgh Department of Dermatology By: Geoffrey Lim, MD The University of Pittsburgh has one of the largest dermatology residency programs in the nation, with six residents per class, totaling 18 residents each year. Within the Department of Dermatology, the residents have exposure to more

8

than 20 clinical teaching faculty members across six diverse clinical sites, including the Veterans Affairs Hospital. The residency is based at the University of Pittsburgh Medical Center Presbyterian Hospital Campus, which houses many of the subspecialty clinics that provide residents with a wide variety of dermatologic experience.

Here, the educational focus is to train physicians and future leaders in the field of dermatology within an

enthusiastic and nurturing teaching environment.

Clinically, our department continues to grow, increasing access to services that include general dermatology, complex medical dermatology, pediatric dermatology, inpatient adult and pediatric consultation services, dermatologic surgery, cutaneous oncology, cosmetic dermatology, dermatopathology, and teledermatology. Residents also participate in a variety of

FALL 2017 multidisciplinary clinics dedicated to caring for patients with challenging diseases, including cutaneous lymphoma, melanoma, psoriasis, immunobullous diseases, hair and nail diseases, and complicated wounds.

Clinical training is divided into monthly rotations split among six diverse sites, with resident continuity clinics held weekly.

The education curriculum at the University of Pittsburgh includes weekly half-day didactic sessions that include clinical, basic science, and career-building lectures, with over 70% of lecture hours given by members of the faculty year-round.

First-year residents participate in their own focused weekly dermatopathology conference, studying a new topic each week.

Upper level residents attend onceweekly general dermatopathology teaching sessions. Monthly clinical, surgical, and basic science journal clubs are co-lead by clinical and basic science faculty to facilitate in-depth discussion of research topics and their impact on patient care. As the only dermatology residency program in western Pennsylvania, the University of Pittsburgh is constantly engaged with its local and regional communities.

Together with the Pittsburgh Academy of Dermatology, it hosts regular educational events including monthly Grand Rounds with live patient participation and lectures from national leaders in dermatology.

Residents routinely take on research projects that span a broad range of investigative endeavors, ranging from clinical trials to translational and basic science research. Simultaneously, the Department’s research program also leads numerous exciting and competitively-funded initiatives in melanoma immunotherapy, cutaneous

T-cell lymphoma immunotherapy, HIV immunotherapy, and vaccine development for biodefense.

Personally, it has been my distinct honor and privilege to call the University of Pittsburgh my home for the last three years. It remains a leading center for academic dermatology, continuing to embark on new initiatives designed to provide excellence in clinical care, education, and research. I could not be prouder of my co-residents and mentors for each making their own unique thumbprint on the field of dermatology.

Moreover, our program is supported by the Pittsburgh and Pennsylvania Academies of Dermatology, which foster professional advancement and continued engagement in their respective local, regional, and state enterprises. As my co-residents and I complete our residency training and enter in to the greater dermatologic community, we will always remain grateful for the many opportunities our training has provided us. I look forward to giving back to those institutions that supported me during this pivotal phase of my career, and I encourage my coresidents to do the same.

About the Author Dr. Geoff Lim is the Chief Resident, PGY4 at the University of Pittsburgh Medical Center, Department of Dermatology. Dr. Lim is also a resident member of the PAD Board of Directors.

PAD Board Member Recognized as 40 Under 40 Top Physician

Lorraine Rosamilia, MD, was recognized by the Pennsylvania Medical Society as one of Pennsylvania’s Top Physicians Under 40. Dr. Rosamilia was recently honored by Geisinger Health System for ranking in the top 10 percent in patient experience nationally at the health system’s annual Top Patient Experience Clinicians Awards Dinner. In 2018, she will serve as president of the Pennsylvania Academy of Dermatology and Dermatologic Surgery.

Congratulations to Dr. Rosamilia on this well-deserved recognition.

9

PRACTICE MANAGEMENT TIPS

Reducing Pathology Specimen Errors By: Scott Lim, DO In our fast paced medical practices, errors can be made in how we process our tissue specimens unless we have well-rehearsed routines.

These routines may be broken with new or changing staff, staff who are performing new routines, and visiting medical students, interns, and residents who, despite their good intent, change our routines.

Inconsistency leads to errors. Errors result in lost time, lost money, or misplaced specimens. Here are some tips that have worked for me over the years: •

10

Photograph everything biopsied, especially when using EMR where you “dot” the anatomical location. This helps with recall of lesional morphology and anatomic location, especially at time of re-excision. For instance, an EMR “dot” was thought to be on the superior helix of right ear, but actually was too high on anatomical chart and was interpreted to be located on the right parietal scalp. My dermatopathology lab bridges to my EMR so that the dermatopathologist may see clinical picture too, minimizing the risk of reporting errors.

•

•

Set up exam rooms the same way, keeping shelves and drawers stocked in the same fashion and specimen containers located in the same places. This builds common habits and “muscle memory” for you and your staff, as well as any rotating physicians or students that may be eager to help you.

Establish policies that are simple and clear, and ensure all staff (and visitors) are aware of these.

For example:

o

Expiration dates for all perishable resources are checked monthly.

o

No specimen leaves the exam room unless the side of container has at least two forms of patient identification (i.e. name and date of birth) on container to avoid any chance of mixing up specimen containers.

o

If marking the tissue specimen for orientation, the surgeon will personally note or verbalize to scribe how it was oriented. For example, “suture at 12:00 position” or “suture at superior pole”.

This will reduce miscommunication with the dermatopathologist.

o

Surgeon will personally place the specimen into specimen container. Don’t leave the specimen out on the tray and rely on staffer to properly place into the container. This leaves potential for the specimen to be discarded with medical waste.

o Formalin

containers are on a specific shelf in every room, while Michel’s medium containers for DIF biopsies are located in another specific area

•

Regarding the latter policy, personally visualize every specimen going into the specimen container. This may sound straightforward, but, while I have a practiced hand at flicking the shaved

FALL 2017 tissue off of my flexible blade into a container, the tissue sometimes wraps around the blade and clings to its underside. This creates the illusion of the tissue being deposited into the container held by the outstretched hand of an assistant. Had it not been for the realization that tissue didn’t get in container, the blade with specimen still attached would have been discarded in the medical sharps container and my dermatopathology lab would have received an empty container!

•

When a labeled container leaves an exam room, it is placed at a nursing station where a dedicated printer for pathology specimen labels prints out an official label for the container complete with a demographic/information page to package with the specimen jar. These items are then transferred to the lab. It goes without saying that the less time a specimen sits on the counter, the less time there is for it to be misplaced or lost entirely.

Hopefully, these tips may be of help to some of you. Please feel free to share your tips by sending to Dr. Scott Lim at slimderm3243@gmail.com.

About the Author Dr. Lim has been a solo private practice dermatologist in Erie, PA since 1990. He is from Western Pennsylvania and is a graduate of Allegheny College. Dr. Lim completed medical school at the Philadelphia College of Osteopathic Medicine. He currently serves as Secretary of the PAD and is the editor of SkinLines.

Christen Mowad, MD Receives PAD Dermatologist of the Year Award The PAD recognized Christen Mowad, MD, a dermatologist from Danville, as the recipient of its 13th annual “Dermatologist of the Year Award.” The award was presented on October 21, 2017 during a special ceremony at the Academy’s 50th Annual Meeting at The Hotel Hershey, in Hershey, Pennsylvania.

This prestigious honor recognizes an Academy member who has made significant contributions to the specialty of dermatology, as well as to the leadership and/or educational programs of the Academy throughout his or her career.

Dr. Mowad is a past president of the PAD and has actively served the organization for over fifteen years.

As PAD president she skillfully navigated numerous issues pertinent to dermatology; she is a tireless advocate for patient safety and was present for the signing of Act 41, which provides regulation of indoor tanning facilities.

Dr. Mowad currently chairs the AAD/A Mohs/AUC Committee and was chosen because of her leadership and diplomacy. She is a true academic clinician and has spent her entire career in academic medicine. Her area of expertise is allergic contact dermatitis. She is a past president of the American Contact Dermatitis Society and a current board member. She has delivered many lectures at national meetings and is widely published in peer reviewed journals.

Dr. Mowad received her medical degree from the University of Pennsylvania School of Medicine, where she also completed her dermatology residency. She is currently the Director of Clinical Trials and Director of Contact and Occupational Dermatitis at Geisinger Medical Center, Division of Dermatology.

11

FACToid By: John Durkin, MD

Case A 30 year-old female with no significant past medical history presented to the clinic with progressive white spots in her skin and whitening of her hair. She stated that she was seen by ophthalmology six months prior for pain in her eyes and was diagnosed with uveitis. Shortly afterwards she started to develop the changes in her hair and skin. She was also complaining of large clumps of hair falling out. On exam she had several depigmented patches which fluoresced bright blue-white under Wood’s lamp examination as well as diffuse thinning of her hair. Poliosis was present on the scalp, eyebrows and eyelashes.

What’s the diagnosis?

A. Vogt-Koyanagi-Harada syndrome B. Griscelli syndrome C. Alezzandrini syndrome D. Segmental vitiligo

Continue to page 14 for the diagnosis

12

FALL 2017

Governor Wolf Signs Executive Order to Review Pennsylvania’s Professional Licensing System By: Milliron & Goodman On October 25, 2017, Pennsylvania Governor Tom Wolf signed an executive order1 calling for a review of the commonwealth’s professional licenses, including the State Board of Medicine. The purpose of the review is to benchmark Pennsylvania’s licensing requirements against national and regional averages. Moreover, the review is intended to ensure that professional licenses are free from unnecessary barriers to opportunity from excessive licensing requirements, fees and policies, while also protecting against public harm.

“Requiring a license to work in certain jobs helps to keep all of us safe, but those requirements should be fair relative to other states in our region and across the country,” said Governor Tom Wolf. “Overly burdensome requirements and fees can block some workers – especially minorities or spouses in military families who move frequently – from starting a career and supporting their families.”2 Under this executive order, the Bureau of Professional and Occupational Affairs3 (BPOA), within the Pennsylvania Department of State, will work with the various licensing boards and commissions to give them the tools they need to more efficiently regulate their industry. Specifically, the Commissioner of the BPOA will partner with the 29 boards and commissions in Pennsylvania to study each board’s licensing process, fees, training and continuing education requirements.

The Commissioner shall prepare a report for each type of professional and occupational license issued by each Board or Commission. The report shall compare Pennsylvania’s requirements with other states in our region and across the nation and include any reciprocity agreements with other states.

•

State Board of Funeral Directors,

•

State Board of Landscape Architects,

•

State Board of Massage Therapy,

•

State Board of Medicine,

•

State Board of Nursing,

•

State Board of Nursing Home Administrators,

•

State Board of Occupational Therapy,

•

State Board of Optometry,

•

State Board of Osteopathic Medicine,

•

State Board of Pharmacy,

•

State Board of Physical Therapy,

The boards and commissions included in the executive order are:

•

State Board of Podiatry,

•

State Board of Psychology,

•

State Board of Accountancy,

•

•

State Architects Licensure Board,

•

State Board of Auctioneer Examiners,

State Board of Social Workers, Marriage and Family Therapists, and Professional Counselors,

•

•

State Board of Barber Examiners,

State Board of Speech-Language Pathology and Audiology,

•

State Board of Certified Real Estate Appraisers,

•

State Board of Vehicle Manufacturers, Dealers, and Salespersons,

•

State Board of Chiropractic,

•

Navigation Commission, and

•

State Board of Cosmetology,

•

Real Estate Commission.

•

State Board of Crane Operators,

•

State Board of Dentistry,

•

State Board for Professional Engineers, Land Surveyors, and Geologists,

The BPOA provides administrative and legal support to professional and occupational licensing boards and commissions. Professional licensing

In addition, the Commissioner may establish an advisory group to assist with the research, data collection, and formatting of the reports. The advisory group shall be composed of members chosen by the Commissioner from the professional Boards and Commissions, BPOA staff, and any other persons the Commissioner deems necessary.

CONTINUED ON PAGE 15

13

BOARD-CERTIFIED DERMATOLOGIST

PITTSBURGH, PENNSYLVANIA • Nationally Recognized Practice • Established in 1981 • Competitive Compensation Package • Flexible, Part-Time Schedule The Skin Center Medical Spa, the #1 medspa in Pennsylvania and Ohio, is seeking a parttime board-certified dermatologist to meet the growing demand of our dermatology practice in our suburban Pittsburgh, PA office.

Founded by board-certified cosmetic surgeon, Dominic Brandy, MD, The Skin Center boasts a nationally accredited surgical center, a vein practice and four medical spa locations in addition to our dermatology practice.

With a 35-year history of excellence in elective cosmetic surgery, The Skin Center would afford you an opportunity to deliver patient-centered care with great autonomy.

As an integral member of our team of clinicians, PAs, RNs and aestheticians, you would become a trusted advocate and resource for your patients who seek both routine preventative care as well as those facing complex skin issues.

We are seeking clinical expertise in areas including: • Skin cancer screening and treatment • Medical and surgical treatment of both common and complex skin conditions (acne, eczema, psoriasis, actinic keratoses, cutaneous infections, alopecia, cysts, hyperhidrosis, warts, vitiligo, connective tissue diseases, hidradenitis, hair and nail disorders, etc.)

• Cosmetic procedures including soft tissue augmentation and neurotoxins

Contact: Please direct inquiries and CV to jbrandy@theskincentermd.com 2275 Swallow Hill Road, Suite 2500 Pittsburgh, PA 15220 (412) 429-1151 Fax: (412) 429-0211

FACTOID Continued form page 12 Diagnosis A. Vogt-Koyanagi-Harada syndrome

Discussion: Vogt-Koyanagi-Harada (VKH) syndrome is a multi-system autoimmune disease targeting melanocyte containing sites such as the eyes, inner ear, central nervous system, skin and hair. It is typically preceded by a viral illness like prodrome with headache, auditory changes, fatigue, and visual changes.

This is followed by the acute stage of the disease characterized by bilateral panuveitis. The convalescent stage of the disease begins weeks to months later with vitiligo like patches, poliosis of the scalp, eyebrows, and eyelashes as well as diffuse hair loss. The majority of patients progress to the chronic phase with recurrent uveitis. VKH is more common in Hispanic, Asian, and Indian ethnicities and typically affects younger women between the ages of 20 and 50. Treatment for VKH consists of immunosuppression which aims to prevent ocular complications such as glaucoma, cataracts, and vision loss.

Prednisone, cyclosporine, azathioprine, and TNF alpha inhibitors are among some of the recommended treatments.

Griscelli syndrome is a genetic condition presenting in childhood with poliosis, heterochromia, and hearing loss. Alezzandrini syndrome is a rare disorder presenting as unilateral pigment loss of the hair and skin, unilateral retinal degeneration, and unilateral hearing loss. Its clinical features overlap with VKH syndrome with the exception of the unilaterality.

Dermatology_AlleghenyCountyMedicalSociety_RecruitmentAd.indd 7/18/17 1 8:49 AM

14

Segmental vitiligo has a blaschkoid distribution and no associated ocular or neurologic abnormalities. despite possible metastasis to lymph nodes.

REFERENCES

Bordaberry MF. Vogt-Koyanagi-Harada disease: diagnosis and treatments update. Curr Opin Ophthalmol.

2010;21(6):430-5.

Lavezzo MM, Sakata VM, Morita C, et al. Vogt-Koyanagi-Harada disease: review of a rare autoimmune disease targeting antigens of melanocytes.

Orphanet J Rare Dis. 2016;11:29.

Robles BJF, Blanco-madrigal J, Sanchinel AAS, Pascual DH, Demetriopablo R, Blanco R. Anti-TNFα therapy and switching in severe uveitis related to Vogt-Koyanagi-Harada syndrome.

Eur J Rheumatol. 2017;4(3):226-228.

About the Author: Dr. Durkin is a dermatology resident at the Drexel University College of Medicine Department of Dermatology. Dr. Durkin is also a resident member of the PAD Board of Directors.

FALL 2017

GOVERNOR WOLF SIGNS Continued form page 13 protects the health and safety of the public from fraudulent and unethical practitioners. In Pennsylvania, approximately 20 percent of workers need a license to do their job.

The Commissioner’s findings will be submitted to the Governor within seven months (May 24, 2018) from the effective date of the order.

If you should have any questions about the Executive Order or study, please contact the Bureau of Professional and Occupational Affairs at 717-787-8503

or send them an e-mail at: RA-BPOA@ pa.gov .

REFERENCES 1

Executive Order 2017-03, 10/24/2017 http://www.oa.pa.gov/Policies/eo/ Documents/2017-03.pdf

PRESIDENT’S MESSAGE continued from page 1 will have superb leadership under the direction of our new president, Dr. Lorraine Rosamilia, and our dedicated Board of Directors.

2 Governor Wolf to Examine Overhaul of Pennsylvania’s Professional Licensing System. October 25, 2017 https://www.governor.pa.gov/governorwolf-examine-overhaul-pennsylvaniasprofessional-licensing-system/

About the Author Dr. Rosalie Elenitsas is Professor of Dermatology and Pathology at the University of Pennsylvania in Philadelphia where she practices both dermatology and dermatopathology. She is the director of Penn Cutaneous Pathology Services and the director of the Dermatopathology Fellowship training program.

She is a member of the Penn Dermatology Oncology Center focusing on malignant melanoma and other cutaneous tumors.

3 Bureau of Professional and Occupational Affairs, Pennsylvania Department of State http://www.dos.pa.gov/ ProfessionalLicensing/Pages/Bureau-ofProfessional-and-Occupational-Affairs. aspx

PENN CUTANEOUS PATHOLOGY SERVICES A facility of the University of Pennsylvania Health Systems

SUPPORT AN EXCEPTIONAL HISTORY OF EDUCATION, RESEARCH AND THE HIGHEST STANDARD IN PATIENT CARE

INTERNATIONALLY RECOGNIZED DERMATOPATHOLOGISTS

CALL TODAY!

866.DERM.LAB

6 Dermatopathologists with Specialties including: • Melanoma & Melanocytic Lesions • Pediatric Dermatopathology

FAST TURN-AROUND TIME

• Alopecia • Adnexal Tumors • Genetic Skin Diseases • Nail Disorders & Histopathology of the Nail Unit

ELECTRONIC INTERFACING

• Tropical & Infectious Dermatologic Conditions • Cutaneous Lymphoma

Oral Pathologist with Specialties in: IMMUNOFLUORESCENCE & ELISA TESTING

• Inflammatory & Autoimmune Mucosal Lesions, Oral Preneoplasia and Cancer

15