Learn more about what treatments are on the rise for plaque psoriasis, the latest management advice and what trends are shaping the future of the disease. 

The changing treatment landscape of plaque psoriasis

Videos

In part 4 of our interview with Whitney Bowe, MD, she dives into the multiple methods physicians can use to treat adverse reactions from the COVID-19 vaccine in their dermal filler patients.

Treating COVID-19 Vaccine Reactions in Dermal Filler Patients

Podcasts

Recent reports have been surfacing in regard to adverse reactions in dermal fillers patients who have also received the COVID-19 vaccine. Whitney Bowe, MD, New York City, New York, discusses this phenomenon and provides some tips for preventing and treating these side effects.

The Cutaneous Connection- Episode 16: COVID-19 Vaccine and Dermal Fillers

Although there are many safe, effective treatments for actinic keratosis (AK) and skin cancers, beneficiary costs for the same procedures and provider availability differ significantly among U.S. states, reports a recent study.

In designing the study, lead author Abdullah Aleisa, MD, Mohs Micrographic Surgery (MMS) and Dermatologic Oncology fellow at Memorial Sloan Kettering Cancer Center, New York, N.Y., and his fellow researchers set out to analyze interstate variability in Medicare spending and access to care for these treatments. Aleisa presented results at the American Society for Dermatologic Surgery 2020 Annual Virtual Meeting.

The research team extracted information on spending on the treatments of interest and the number of Medicare providers and beneficiaries from the 2013-2014 Medicare provider Utilization and Payment Data for 13 states, encompassing 15 U.S. cities with populations over 400,000.

Data showed the average state-wide Medicare spending on AK treatment and skin cancer removal was $26.37 million and $28.18 million, respectively. Spending on skin cancer removal was highest with MMS at 79.62%, followed by destruction and excision at 11% and 8.84%, respectively. AK treatment spending was led by cryotherapy at 64.4%, followed by topical treatment and photodynamic therapy (PDT) at 31% and 4.6%, respectively.

“We found that there was a real, significant variation in the healthcare and procedure costs for actinic keratosis among the states, especially when you also account for the per-beneficiary spending not just the total Medicare spending,” says Aleisa. “We consistently found more expensive practice per beneficiary for almost all treatments.”

The study results confirmed dramatic differences in payments for topical AK treatment among states. It accounted for 18.47% of spending in Georgia but up to 56.67% in New York; for cryotherapy, from 40.76% in New York to 77.93% in the District of Columbia; and, for PDT, from 2.44% in Minnesota to 9.28% in Georgia. Similar fluctuations in pricing from state to state were also seen for skin cancer treatments.

Per-beneficiary spending for AK and skin cancer treatment demonstrated even greater variability. Here, data showed that the per-beneficiary spending for cryotherapy of AK ranged from $5.84 in Minnesota to $25.23 in Florida; for PDT, from $0.37 in Pennsylvania to $1.60 in Florida; for MMS, from $7.33 in Michigan to $29.72 in Florida; and for destruction of skin cancer, from $0.40 in Minnesota to $6.04 in Florida.

“Patient populations are definitely different in Florida and [there are] increased volumes of patients with AKs and skin cancers treated every year compared to other more northern states,” says Aleisa. “Nevertheless, that doesn’t explain why treatments should be more expensive than other states.”

Some theories suggest that differences in patient populations, environmental exposure, and patient preference be analyzed since all may account for some of the variability and play a role in the final calculus. For insurance coverages, market managers and supply chains may come into play.

Results of the study revealed that dermatologists comprised the majority of providers that billed Medicare for cryotherapy (54.68%), PDT (82.42%), excisions (74.08%), destruction (86.03%), and MMS (97.89%). Data also confirmed that dermatologists were not as available as other healthcare providers for specific therapies, highlighting the paucity of specialists for specific treatment options.

The significant variabilities regarding healthcare costs and availability of dermatologists for specialized treatments taps into a broader issue that likely can only be resolved by legislators, notes Aleisa. He recommends that future studies aim to clarify variations in Medicare spending among the states and in rural versus urban areas.

1. Aleisa, A, et al. State-level variation in Medicare spending and provider availability for the treatment of actinic keratosis and skin cancer. Oral abstract presented at: 2020 American Society for Dermatologic Surgery Virtual Annual Meeting; October 9 – 11, 2020.

Articles

A recent study found states' Medicare per-beneficiary spending between actinic keratosis and skin cancer differs widely.

Medicare spending on skin cancer, AK varies widely

Allergan Aesthetics, an AbbVie company, announced the expansion of its CoolSculpting portfolio with the launch of CoolSculpting Elite, a novel fat reduction system that uses CoolSculpting technology to target, freeze and eradicate fat cells and is equipped with applications that complement the body’s natural curves, according to a company press release.

CoolSculpting Elite is FDA cleared to treat visible fat bulges in nine areas of the body including the thigh, abdomen, flank, bra area, back, underneath the buttocks, upper arm, and the submental and submandibular areas.

"The number one aesthetic concern for consumers is excess body fat. CoolSculpting has been an industry-leader, creating the market for non-invasive fat reduction over 10 years ago. Now CoolSculpting Elite builds on that heritage with a completely re-invented next-generation technology that delivers results," said Carrie Strom, senior vice president at AbbVie, and president at Global Allergan Aesthetics. "We understand the challenges of today's world and as people prepare to go from being online to spending more time in person, CoolSculpting Elite can help them address their bothersome fat."

The new system will be introduced with a new C-shaped application collection that covers seven shapes and sizes, as well as targets up to an 18% larger cooling area compared to previous CoolSculpting applications, according to the company.

"CoolSculpting is a critical part of my business and a device I've relied on to help my patients achieve their desired outcome of reducing stubborn fat," said Sabrina Fabi, MD and associate research director at Cosmetic Laser Surgery in San Diego, California. "The dual applicators allow us to treat two areas at the same time, safely freezing twice the fat compared to using a single CoolSculpting applicator, which helps us save on time. With the Elite applicator collection we are able to treat a wide range of body areas and personalize each patient's treatment plan."

The company is currently taking orders for CoolSculpting Elite and plans to ship the first units in the first quarter of 2021.

1. Coolsculpting® by allergan aesthetics expands body contouring portfolio with coolsculpting® elite | abbvie news center. Accessed January 26, 2021. https://news.abbvie.com/news/press-releases/coolsculpting-by-allergan-aesthetics-expands-body-contouring-portfolio-with-coolsculpting-elite.htm?view_id=5591

Allergan Aesthetics plans on expanding its CoolSculpting portfolio with the launch of its novel CoolSculpting Elite device that targets visible fat in nine different areas of the body.

Allergan Aesthetics Expands CoolSculpting Portfolio

In part 3, Whitney Bowe, MD, suggests how physicians should manage their patients' expectations when it comes to HA fillers and the COVID-19 vaccine.


Managing Patient Expectations for Fillers and the COVID-19 Vaccine

Success and The Skin Cancer Foundation aimed at making a positive impact in communities around the country by allowing abobotulinumtoxinA (Dysport) patients to give back with each treatment, according to a company press release.

"At Galderma, we care deeply for people and for the communities in which we operate. We have an essential role to play in giving back, which is why we are proud to announce the launch of our Face for Change program," said Alisa Lask, vice president and general manager at Galderma. "Now when a consumer chooses Dysport, they are choosing to look good, feel good and do good!"

From Jan. 19, 2021, to Feb. 28, 2021, every patient who receives abobotulinumtoxinA from a licensed health care provider in accordance with the product's FDA-approved indication and labeling that is recorded by the health care provider in the ASPIRE Galderma Rewards loyalty program, Galderma will contribute $100 to either The Skin Cancer Foundation or Dress for Success.

"We are delighted by the launch of Galderma's Face for Change initiative," said Deborah S. Sarnoff, MD, president of The Skin Cancer Foundation. "It is encouraging to see leading organizations give back to their communities in a meaningful way, particularly during these unprecedented times. We appreciate their support of our mission to save and improve lives through skin cancer education."

"Our mission at Dress for Success is to empower women to achieve economic independence by providing support that will help them thrive in work and in life," said Joi Gordon, CEO at Dress for Success. "That is why we are proud to be a part of Galderma's Face for Change, an initiative that similarly seeks to give back to our communities and empower those around us."

More information about FACE for Change can be found 

1. Galderma. Galderma announces launch of face for change program. Accessed January 26, 2021. https://www.prnewswire.com/news-releases/galderma-announces-launch-of-face-for-change-program-301214615.html

Galderma announced the launch of its Face for Change program that allows abobotulinumtoxinA (Dysport) patients to give back with each treatment received to either Dress for Success or The Skin Cancer Foundation. 

Galderma Launches Face for Change Program

A refrigerated topical cosmetic formulation shows 90-day stability for platelet-rich plasma (PRP) and provides statistically significant improvement in facial appearance at 16 weeks, reports a new study

Although PRP has gained popularity in aesthetic medicine as an injectable, difficulties with stability and shelf-life slowed development of an effective topical vehicle. “Degranulation of PRP must be inhibited until the topical preparation is applied to the skin," the authors wrote.

Their research evaluated the role of platelet homeostasis in a novel PRP formulation. It also examined whether this topical vehicle could maintain platelet granule stability while delivering an effective PRP-containing anti-aging formulation.

A multi-site in vitro assessment tested platelet stability and morphology over 90 days. Researchers studied four samples: cosmetic base, PRP, cosmetic base+PRP, and cosmetic base+ PRP+hydrochloric acid (HCl) activator. They stored some samples at room temperature, others at 4°C refrigeration for 90 days and tested them at set times.

Analyte concentration analysis using enzyme-linked immunosorbent assay (ELISA) demonstrated that the PRP is substantially more inactive than control conditions as evaluated by analyte concentration curves (PDGF-AB, EGF, and P-selectin).

Platelet morphology analysis using scanning electron microscopy (SEM) and light microscopy (LM) showed the PRP has less aggregation/activation over time within the cosmetic base. It also verified that refrigeration is superior to room-temperature storage.

Though well-tolerated, the vehicle must be refrigerated at all times and removed from the refrigerator only at the time of application.

That resulted in a higher quality and quantity of preserved platelets compared to the control conditions at 30, 60, and 90 days and demonstrated topical clinical PRP facial benefits, conclude the authors.

A double-blind split face in vivo study (n=20) followed. This single-site study evaluated the effect of 5-7x and 2-3x baseline platelet count PRP on facial photoaging.

After subjects underwent a phlebotomy, 3 mL of PRP obtained from two different harvesting methods (one to obtain 60 mL of anti-coagulated blood, a second to obtain 20 mL) was added to the vehicle.

Subjects were randomized to determine which side of the face would receive the 60-mL PRP-containing cosmetic and which would receive the 20-mL formulation. Each cosmetic used in this double-blind study had a total of 3mL of PRP or 10% PRP in the cosmetic base (BioLyte complex in SoME, Aesthetics Biomedical, Phoenix, Ariz.).

Researchers applied one bottle to the randomized right face, the other to the randomized left face twice daily. Subjects returned to the center for identical study activities at week 8 and week 16, which marked completion. Eight volunteers underwent a 2-mm punch biopsy from the randomized left or right preauricular area at baseline—2 at week 8 and 6 at week 16.

The dermatologist investigator and subjects assessed each side of the face separately for efficacy. Data showed that both preparations produced statistically significant results at week 16. Both investigator assessment and histology established parity between the 20-mL and 60-mL PRP preparations.

Wooten and Rheins work for Aesthetics Biomedical, Inc, Phoenix, Ariz.

Draelos and Keller served as researchers for Aesthetics Biomedical, Inc.

Aesthetics Biomedical, Inc, Phoenix, funded the study.

1. Wooten S, Draelos ZD, Kellar R, Rheins L. The role of platelet homeostasis in a novel topical PRP formulation. 

2020;19(12):1215-1218. doi:10.36849/JDD.2020.5495. ABSTRACT

Results of a recent in vitro study show that a novel topical cosmetic vehicle successfully stabilizes and preserves platelet-rich plasma (PRP).

Positive study outcomes pave the way for topical PRP 

In the second part of our interview with Whitney Bowe, MD, she reveals the type of fillers that have been linked to adverse reactions in dermal filler patients who have received the COVID-19 vaccine.

Types of Fillers Causing Vaccine Reactions

In this expert interview, Whitney Bowe, MD, explains the rare adverse reactions the medical community has recently been seeing in dermal filler patients who received the COVID-19 vaccine.



Dermal Fillers and the Adverse Reactions From the COVID-19 Vaccine

features stories on the benefits of skin icing, the use of lavender oil in skincare and tips for stopping skin-picking. Meanwhile, 

writes about the best methods to treat and prevent blisters and 

dives into TikTok skinfluencers and their impact on the beauty industry.

Yes, You Can Freeze Your Face for Healthier Skin

How Hyram Yarbro and TikTok Skinfluencers Are Impacting the Beauty Industry

Lavender Oil Saved My Skin, But Read This Before Using the Popular Essential Oil

The Best Ways to Prevent (and Treat) Blisters

7 People Share What's Helped Them Stop Skin-Picking

This week’s edition of The Mainstream Patient features stories on skin icing, TikTok skinfluencers and their impact on the beauty industry, skin picking, blister care, plus more.