Faculty Bibliography

IMPORTANCE:Hidradenitis suppurativa (HS) is a chronic autoinflammatory disease that is highly associated with affective disorders such as depression and anxiety. Recent studies have shown that patients with HS may also endorse high levels of internalized skin bias (ISB). This redirection of skin disease-related social stigma toward oneself may also play an important role in the associations between adverse psychopathology (eg, depression, anxiety) and health-related quality of life (HRQOL). OBJECTIVES:To evaluate the associations of ISB with other core outcomes in HS and to determine if ISB may mediate the associations between adverse psychopathological outcomes and impaired HRQOL. DESIGN, SETTING, AND PARTICIPANTS:A cross-sectional study of adult patients with HS recruited from 1 academic medical center as well as through virtual social and recruitment networks. Eligible participants completed an online survey comprised of 4 survey instruments along with demographic and disease history information from April 1, 2021, to July 15, 2021. MAIN OUTCOMES AND MEASURES:Measures included the Internalized Skin Bias Questionnaire (ISBQ), Burns Anxiety Inventory, the Beck Depression Inventory-II, the Hidradenitis Suppurativa Quality of Life (HiSQOL) instrument, along with demographic and disease history information. The primary outcome was HRQOL as measured by the HiSQOL. Data were analyzed in July through August 2021. RESULTS:The survey was completed by 230 of 279 patients (82.4%; mean [SD] age, 39.2 [11.2] years; 209 [90.9%] identified as female, 203 [88.7%] as not Hispanic, 178 [77.7%] as White). Depression and anxiety were shown to be a substantial burden in this sample, with 56.5% of participants' scores qualifying for moderate or greater anxiety and 45.7% moderate or greater depression. The mean (SD) HRQOL scores were moderately high at 34.5 (16.7), indicating strong levels of impairment. There was a moderate correlation between ISBQ score and depression (r = 0.67); and fair correlations with HRQOL (r = 0.52) and anxiety (r = 0.56). Therefore, ISB appears to positively mediate the associations between depression and anxiety (estimated proportions of total effect that were mediated, 38.7% and 24.9%, respectively) and HRQOL. After controlling for age, disease severity, and disease duration, both ISB and anxiety were positive predictors of impaired HRQOL. CONCLUSIONS AND RELEVANCE:This cross-sectional study found that ISB was associated with adverse psychopathology and impaired HRQOL in patients with HS. Furthermore, ISB appears to mediate the associations of depression and anxiety with HRQOL. Future studies are needed to design interventions targeted at addressing adverse psychopathology associated with ISB and improving HRQOL and well-being for patients with HS.

Major revisions for commonly reported office and outpatient evaluation and management (E/M) codes were implemented on January 1, 2021, by the American Medical Association and Centers for Medicare and Medicaid Services. The goal of these changes was to simplify and streamline these service codes, with time and medical decision-making (MDM) now being the sole determinants of the overall E/M level. We present an overview of the new guidelines, requirements, and code descriptors to aid in accurate documentation and billing. Additional resources are provided if further billing and coding questions arise.

In July 2021, the Centers for Medicare & Medicaid Services (CMS) published a proposed fee schedule that will negatively impact practices that perform dermatopathology services. In this article, we review the proposed new and improved codes and values for pathology consultation codes as well as new payment rates. We also discuss the proposed 2022 quality payment program (QPP), and we provide an update on the 21st Century Cures Act (Cures Act) and its impact on dermatopathology reports.

BACKGROUND:Allergic contact dermatitis (ACD) can exist in the setting of other dermatologic conditions. It is known that the treatment of these conditions can cause ACD, increasing both diagnostic and treatment difficulty. OBJECTIVE:The aim of this study was to determine the frequency of common dermatologic conditions in the setting of ACD and in specific patient populations. METHODS:A retrospective database study was completed using Truven Health to collect information on patch-tested ACD patients. Demographics and diagnostic information were retrieved. Of those with ACD, the presence of 15 dermatologic diagnoses was investigated. Subanalyses were conducted for each condition, including International Classification of Diseases, 10th Revision code specificity, demographics, and diagnostic information. RESULTS:A total of 6380 patients (76.83% female) were given a diagnosis of ACD via patch testing. Of those with concomitant disease, those most common include atopic dermatitis (23.98%), urticaria (16.69%), and acne (11.51%). Eight of the concomitant conditions were found to have statistical significance in comparing the average age of ACD diagnosis with the selected diagnoses (α = 0.05). CONCLUSIONS:Common dermatologic diseases can exist concomitantly with ACD, many of which can be treated by compounds that precipitate or worsen preexisting ACD. The average age of the diagnosis varies from concomitant diagnoses, which can contribute to difficulty in ACD diagnosis and treatment.