Airborne Contact Dermatitis in the USA

Greetings from Sudhir Polisetty! As evident by my Pinterest page, I am passionate about all things dermatology, especially those associated with psoriasis, dermatitis, skin lymphoma, melanoma, and pityriasis rosacea. This blog post in particular relates to a condition that I treat frequently: Airborne Contact Dermatitis (ABCD).

According to the National Center for Biotechnology Information, ABCD is an inflammatory reaction of the skin, most commonly affecting the hands. The condition is caused by exposure to irritants or allergenic agents. Irritant chemicals or physical agents such as solvents and soaps account for nearly 80% of cases. In turn, 20% of cases involve allergic contact and affect patients with sensitivity to an allergen. Commonly reported plant based allergens include goldenrod, ragweed, and sunflowers.

Clinical Key states that contact dermatitis affects both men and women of all ages, although it occurs most during adulthood. In fact, age plays a large role in what type of dermatitis the patient is experiencing. For example, infants are most likely to experience irritant contact dermatitis due to diapers, while older children have reactions caused by plants; poison ivy, etc. It is common for adolescents and adults to experience this condition from different soaps, lotions, or jewelry.

While men and women both contract the disease in equal amounts, the contact allergens by which they receive it varies. Women are commonly affected by the nickel found in jewelry, while men frequently receive dermatitis from chromate, a chemical found in industrial processes.

In order to improve a patient’s symptoms, it is important to establish a precise diagnosis. To do so, physicians must perform a physical exam, establish the allergen, determine what sites are involved, and obtain the patient’s history. After diagnosis, I recommend that my patients avoid the allergens responsible for the inflammatory reaction. In severe cases, systemic therapy or topical creams can help.

Learn more about me, dermatology, and the services I provide by visiting the following: http://expertfile.com/experts/sudhir.polisetty or http://sudhirpolisetty.weebly.com

Thanks for reading!

Sudhir Polisetty

The Causes of Acne

Greetings! Sudhir Polisetty here. As a practicing General and Surgical Dermatologist with impressive credentials, I have been fortunate enough to treat many unique conditions. Over the course of my career at The Dermatology Center in New Albany, Indiana, one of the most common conditions patients sought treatment for is acne. According to an article on info.com, acne is a skin disease that involves the oil glands at the base of hair follicles, and is caused for several reasons.

Oil Overproduction-

As acne begins in the hair follicles, when the sebaceous gland produces too much sebum (oil) than needed, it mixes with common bacteria and skin cells and forms a type of plug. Most people who suffer from acne during adolescence, since puberty causes the sebaceous gland to grow. This could result in a:

Whitehead- When the follicle wall bulges.

Blackhead-When the plug reaches the surface of the skin.

Pimple-When the follicle becomes infected or inflamed.

Irregular Shedding of Skin Cells-

When skin cells shed regularly, they are able to surface without issues. On the other hand, when the skin cells shed irregularly, they mix with the oils and cause hair follicles to become plugged.

Buildup of Bacteria-

Once a follicle is plugged, bacteria begins multiplying in the surrounding area. By picking at the whitehead or blackhead, the bacteria multiplies more aggressively and creates a painful pimple.

Hormonal/Hereditary Causes-

The Mayo Clinic claims that genetics plays a large role in how much sebum the body produces and individuals are more susceptible to acne if their parents also suffered from the condition. Hormonal shifts, such as pregnancy, menstruation, and menopause can also affect a person's complexion.

Other Causes-

Some breakouts can be triggered from pressure and friction. Common culprits include telephones, backpacks, and make-up. Heavy concealers or other products that are non-comedogenic can cause clogged pores or actually worsen the condition.

Learn more about me on zerply.com!

Thanks for reading!

Sudhir Polisetty

Free Dermatology Drug Samples Come at a Cost

Greetings! Sudhir Polisetty here, back with another dermatology blog. According to a new U.S. study discussed in Reuters, dermatologists tend to prescribe more expensive medications when they give their patients drug samples. Unfortunately, while the samples are intended to be beneficial, this leads to an unnecessary increase in patients’ medical bills.

Dr. Alfred Lane, the study’s senior author, addressed fellow dermatologists about this issue, stating,"You have to realize that these samples are making you write more expensive prescriptions."

In an editorial accompanying the new study in JAMA Dermatology, a statistic shows that in 2011, the drug industry distributed $6.3 billion of samples. Dr. Kenneth Katz, however, noted that Kaiser Permanente Northern California has a strict policy against samples. A similar prohibition has been in place since 2004 at The Stanford University School of Medicine.

In his new study, Dr. Lane and his colleagues compared 2010 prescription data from first-time acne and rosacea patients at Stanford, to a national database of dermatologists from across the U.S. Their findings show that dermatologists in the national database gave about 25 percent of patients samples with their prescriptions, and that nine out of ten drugs prescribed by practices in the database were for the more expensive branded and branded-generic drugs.

Since the drugs prescribed were more expensive, the cost of the treatment per visit was much higher. The study showed that an average of $465 worth of treatments were prescribed each visit compared to an average of $200 per visit at Stanford. Lane was shocked at the findings and never expected it to be twice as much.

Dr. Katz said it is time for dermatologists to get rid of drug samples all together. He hopes that these surprising statistics will encourage all to do the same.

Read more about the study here: http://www.reuters.com/article/2014/04/17/us-dermatology-drug-idUSBREA3G27U20140417

Thanks for reading!

Sudhir Polisetty

AAD Speakers Address Future of Dermatology

Hello and welcome back to my general dermatology blog. My name is Sudhir Polisetty and I am a practicing General and Surgical Dermatologist. Recently there has been discussion about the future of dermatology and the challenges facing dermatologists because of the Affordable Care Act (ACA). In fact, this was the subject of many speakers at the American Academy of Dermatology (AAD) annual meeting plenary session.

At the meeting, associate professor and vice-chair of dermatology Jack S. Resnick Jr., MD, noted that often, our specialty is behind the curve when it comes to innovation and if we do not adapt, we run the risk of being commoditized and marginalized. He claimed, “We really need to think about how we would design the perfect physician-led team to provide the best care. We let the market drive it instead, and we’re playing catch up.”

Teledermatology, a subspecialty of dermatology that I covered in my last blog post, involves exchanging medical information over large distances using telecommunication technologies. Resnick mentions this subspecialty as an area with huge potential growth.

Most of the changes facing dermatologists are a result of the ACA. This act includes reforms intended to reduce cost; shift toward quality over quantity; and increase coverage and affordability. To do so, a number of mechanisms have been put in place that change the dynamic of dermatology. Limiting provider networks and the pressure to create larger physician groups are just a few of the modifications.

Brett Coldiron, MD and future AAD president encourages dermatologists to become more involved with their specialties and organizations like the American Medical Association. Coldiron claims, “We can no longer thrive as a small isolated specialty outside of organized medicine and politics in general. The forces of change are hard upon us. … Our work is cut out for us.”

View a full summary of the event’s discussions here: http://www.healio.com/dermatology/practice-management/news/online/%7B6aba59dc-76d2-4ebf-8a0f-1a7a502c4b49%7D/aad-speakers-address-the-future-of-dermatology

Thanks for reading!
Sudhir Polisetty

Learn more about me on my Expertfile profile, or by viewing my listing on Manta: www.manta.com/c/mt4gf8f/sudhir-polisetty-md‎

Mobile Teledermatology Shows Potential for HIV Patients

Welcome back to my general dermatology blog. My name is Sudhir Polisetty and I write this blog to help others stay abreast of interesting dermatology research and headlines. Today’s blog concerns a new study appearing in JAMA Dermatology about the potential to improve access to care for HIV-positive patients.

Face-to-face evaluations by a board certified dermatologist is the golden standard of dermatology, so little research is available on the effectiveness of mobile teledermatology. The study’s authors note that few have investigated this format’s reliability and validity while none, to the researchers’ knowledge, have used the technology in sub-Saharan Africa among HIV-positive patients. They hoped this study would provide a better understanding of whether mobile teledermatology would produce valid assessments when measured against face-to-face consultations.

The cross-sectional study in Gaborone, Botswana, evaluated 76 HIV-positive patients aged 18 years and older. Each of these patients had a skin or mucosal condition that had not been previously evaluated by a dermatologist.” To make accurate comparisons, researchers began by having patients evaluated in person by a board certified dermatologist. Next, their vitals and photos taken with a 5-megapixel camera were collected and transmitted via mobile phone to a password-protected website. A team of three dermatologists and one oral medicine specialist were then tasked with providing a diagnosis based only on the info collected remotely. Researchers also assessed test-retest reliability by asking the same specialists to make recommendations a few months later without looking at their previous comments.

Specialists agreed with their initial primary diagnoses between 52 and 80 percent of the time. Agreement between primary diagnoses from face-to-face evaluations and mobile teledermatology ranged from 47 to 57 percent while agreement on how to treat the primary diagnosis ranged from 32 and 51 percent. Researchers concluded that much work is still left to be done in order to optimize and validate the use of teledermatology on a large scale.

Learn more about the study in this write-up from Healio Dermatology: http://www.healio.com/infectious-disease/dermatology/news/online/%7B7a32becd-9f87-4ea0-b93c-54636a512e57%7D/mobile-teledermatology-shows-potential-for-hiv-patients

Thanks for reading,
Sudhir Polisetty

You can learn more about me on my Zerply profile, or on the US News & World Report: http://health.usnews.com/doctors/sudhir-polisetty-696608

Lure of Cosmetic Procedures Compounds Dermatologist Shortage

Welcome back to my general dermatology blog. My name is Sudhir Polisetty and I am a dermatologist with The Dermatology Center in New Albany, Indiana. This week’s blog focuses on a major story concerning the future of dermatology, a shortage of general dermatologists.

As the Star Tribune explains, the popularity of higher paying cosmetic procedures such as Botox, lip augmentation, and chemical peels is causing many medical students to shy away from general dermatology. Minnesota has 4.3 dermatologists for every 100,000 residents and the state’s medical school only graduates five dermatologists each year. Those who do graduate devote much of their time to practicing the cosmetic procedures mentioned above instead of lower-paying procedures for identifying and treating melanoma, psoriasis, and a host of other skin conditions. The shortage in dermatologists is already leading to delays in diagnosis and treatment of conditions such as skin cancer according to a few of the physicians interviewed in the article.

One reason for the disparity could be the rise in salaries for dermatologists since 1995, with cosmetic dermatologists seeing a much larger jump than general dermatologists. This has caused many dermatologists to devote their time to cosmetic procedures. In the Twin Cities alone, cosmetic dermatology accounts for between 20 and 40 percent of the average dermatologist’s schedule.

Unfortunately the need for general dermatologists will only increase in the years ahead. The threat of skin cancer continues to grow, with the latest estimates being that one in every 50 Americans will develop melanoma during their lifetimes. Skin cancer rates are also rising, with more and more Americans relying on tanning beds and long exposure to the sun to improve their appearance.

Fortunately there are many reasons to specialize in general dermatology. Dermatologists do not have advertising costs like cosmetic dermatologists do and as mentioned earlier, demand for their services will continue to go up in the years ahead.

Thanks for reading,

Sudhir Polisetty

Learn more about me on my about.me page, or view other interesting dermatology articles by following me on Pinterest: www.pinterest.com/sudhirpolisetty/‎

FDA Warns of Wart Removers Catching Fire

Some freeze-away wart treatments pose fire hazard.

Hello again and welcome back to my dermatology blog. A recent consumer report has shown some concern about the safety of in-home wart removal products, which are proving to be quite flammable.

Warts are the result of human papillomavirus (HPV) and are very common. They are usually small and blister-like, resemble a cauliflower, and are most commonly found on the hands or feet. While they may disappear on their own, some may linger and require treatment. There are many over the counter products available that can aid in wart removal including creams, tapes, injections, and more. If in-home treatments do not work, many turn to other procedures with guaranteed results. Cryosurgery is very common and involves freezing the wart with liquid nitrogen. Today, there is more HPV awareness than ever before. Vaccines such as Gardasil are available and are used to prevent many of the most common types of HPV.

Recently, the FDA put out a warning about wart freezing products catching fire during in-home use. Since 2009, there have been 14 reports about cryogenic wart removers catching fire and causing blisters or burns to the skin. The products available for in-home use are very similar to what you would receive at a dermatologist’s office, minus the controlled environment and skilled professional administering the treatment. While the label comes with a clear warning cautioning users to its flammability, FDA nurse consultant Karen Nast, RN, is worried that people may not be aware of how little it takes to ignite these products. She claims that while flames and cigarettes are the obvious threat, curling and straightening irons can be enough to send the product up in flames.

Since wart treatment is generally inexpensive, I encourage you to consider treatments performed in your doctor's office, or at least consulting with your dermatologist before taking action on your own.

Learn more about affected brands in the FDA’s official statement: http://www.fda.gov/forconsumers/consumerupdates/ucm381429.htm

Thanks for reading!
Sudhir Polisetty

For more dermatology news and research, follow my pins on Pinterest or learn more about me here: http://about.me/sudhir.polisetty

Tips for Dry Winter Skin

Welcome back to my blog. My name is Sudhir Polisetty and I am a dermatologist at The Dermatology Center in New Albany, Indiana. With record breaking cold temperatures and wind chills sweeping the country last week, I got a lot of questions about dry winter skin. It’s common for skin to dry out during the winter and this can lead to itching, cracking, flaking, and bleeding in certain cases. Fortunately the USNews and World Report recently shared a few tips for preventing and treating dry skin.

Avoid Long, Hot Showers

One tempting way to escape cold weather is to relax in a long, scalding hot shower. As Dr. Stephen Stone of the American Academy of Dermatology notes, “Being in the water for a long time and using hot water can be extremely drying to the skin.” Keep skin from drying by making efforts to take shorter showers using only warm water.

Consider Skin Cream

Applying a skin cleanser following a shower might help reduce itching while moisturizer, ointments, and creams are also shown to be more effective than skin lotion. Instead of rubbing skin cream, which can cause irritation, gently pat the cream onto your skin.

Know Your Skin Care Products

If you use soap, deodorant, or products that contain fragrances, these products will often cause irritation if your skin is already dry. Evaluate the ingredients of any skin care products you use to make sure that product is not exacerbating the problem.

Use Proper Hand Washing Techniques

Washing hands too frequently during winter can dry out the skin, so consider alternating between a washing hands and using hand sanitizer. Additionally, get into the habit of applying moisturizer or hand cream after washing hands.

If dry skin continues to be an issue, make an appointment with your dermatologist. He or she will be able to prescribe stronger ointment or diagnose underlying health conditions, such as eczema.

Thanks for reading,

Sudhir Polisetty

Learn more about me on my MD.com profile, or read more of my dermatology blog posts on Wordpress: http://sudhirpolisetty.wordpress.com/blog/

Most Dermatology Residency Programs Offered Cosmetic Training

Welcome back to my blog. My name is Sudhir Polisetty and I am a dermatologist practicing in New Albany, Indiana. Although I do not address cosmetic dermatological procedures, I recognize that it is a very important dermatology specialty. According to a new article in JAMA Dermatology, cosmetic dermatological surgical training is offered by most dermatology residency programs in the United States.

Researchers conducted the study by e-mailing a survey to 114 American dermatology residency program directors (PDs). The primary goal of the survey was to determine which resources are available for cosmetic dermatology training in the United States, though it also sought to gauge overall PD attitudes towards cosmetic dermatology training during residency. Other questions focused on strategies that training programs used to overcome all barriers seen in resident-performed cosmetic dermatology procedures, such as discounted prices.

46 percent of the contacted group responded to the survey (53 PDs). According to the results, all but three programs (94%) provided cosmetic dermatology training using botulinum toxin while 47 of the 53 (89%) offered training with hyaluronic acid fillers. 60 percent of the surveyed programs offered discount pricing for some cosmetic procedures, with the most frequently discounted procedures being:

• Botulinum toxin (94% discounted)
• Hyaluronic acid fillers (84%)
• Vascular lasers (53%)
• Hair removal lasers (38%)

When asked for their general attitudes on cosmetic dermatology training in residency programs, 38 percent of respondents believed it should be necessary. 17 percent of respondents believed it was appropriate for residents to gain hands-on training with cosmetic dermatology procedures while only 27 percent said residents should not be required to perform any cosmetic procedures.

The researchers concluded that while most programs offer hands-on cosmetic dermatology training, there are several barriers to training. They believed procedural competency is imperative to ensure patient safety. Ideally I would like to see a survey with a higher response rate, as 53 PDs is a small sample size.

You can learn more about the survey and its findings on Healio: http://www.healio.com/dermatology/aesthetic-cosmetic-surgery/news/online/%7B0325e9df-5b1b-4bce-a29e-e78df23dacde%7D/most-dermatology-residency-programs-offered-cosmetic-training

Thanks for reading,

Sudhir Polisetty

Learn more about me on my about.me page, or by viewing my MD.com profile: http://sudhirpolisetty.md.com/