Breakout Bulletin: July 27-July 31

You’re busy. Between patients, prior authorizations, inbox messages, and everything else on your plate, keeping up with the literature is the first thing that slips. Dermatology Times NP/PA Connect is here to make sure it doesn’t. Each week, we pull the most clinically relevant news from across dermatology and bring it straight to your inbox — what’s new, what it means, and what’s worth watching. This week: a new ICD-10 code brings formal recognition to topical steroid withdrawal, a national survey maps how much prescribing authority NPs and PAs already hold in atopic dermatitis, and a systematic review makes the case for AI as a triage partner in under-resourced clinics.

Topical Steroid Withdrawal Gets Its Own Diagnosis Code

The CDC approved a new ICD-10 code for topical steroid withdrawal (TSW) earlier this year, clearing 3 formal reviews and a 50-50 split among reviewing board members before passing with support from the American Academy of Dermatology. On the Derm Dispatch video series, Renata Block, DMSc, MMS, PA-C, spoke with Kelly Barta, president and executive director of the International Topical Steroid Awareness Network (ITSAN), about what the code changes. Barta said it gives patients a formal diagnosis within the health system for the first time and lets researchers begin capturing incidence and prevalence data, along with improving insurance coverage for patients who cannot work, attend school, or care for their families during flares.¹

ITSAN spent 4 years building an IRB-approved patient registry with 14 surveys covering medical history, steroid use, and outcomes after discontinuation. It launched in December 2025 on the National Organization for Rare Disorders' IAmRare platform and has enrolled about 500 of a targeted 5000 participants worldwide. The international scope lets ITSAN look for regional patterns, including topical steroid use in skin-lightening products in parts of Africa and India, and may help clarify how TSW differs from severe eczema.¹

Barta also cited a National Eczema Association and National Psoriasis Foundation survey finding that more than half of patients feel uneasy discussing steroid use with their clinician, pointing to loaded terms like “misuse” or “abuse” as a common source of distrust for patients who followed their clinician's instructions. Reframing the conversation as an evolving understanding rather than a judgment.¹

that will take the temperature down and allow for a real conversation. — Kelly Barta

▶ Why it matters: The new code gives you a billable diagnosis and a way to validate patients whose steroid concerns have been dismissed, so use it, and watch your language when TSW comes up in the exam room.

MORE ON RARE DISEASE

NPs and PAs Are Prescribing Biologics but Confidence Lags Behind

The 2025 Adelphi Real World NP/PA AD Wave II Disease Specific Programme, presented at the PANP360 conference in Scottsdale, Arizona, from May 29 to 31, 2026, surveyed 40 nurse practitioners and 68 physician assistants managing 561 adults with atopic dermatitis. Nearly all reported independent authority to initiate and renew advanced therapies, including biologics (97.2%), topical JAK inhibitors (97.2%), and oral JAK inhibitors (95.4%). Only 1 of 108 respondents reported no prescribing authority for AD therapies, and the American Academy of Dermatology guideline was the most commonly followed, cited by 75.9%.²

Authorization outpaced comfort. Most respondents felt comfortable prescribing biologics (86.9%), but confidence dropped sharply for oral JAK inhibitors (41.7%), systemic corticosteroids (39.8%), and traditional systemic immunosuppressants (11.1%). When choosing therapy, relief of itching (80.6%), long-term safety (78.7%), and long-term disease control (76.9%) ranked as the most important goals, while scarring and blistering were rated hardest to treat and sleep disturbance and itching as most burdensome for patients.²

▶ Why it matters: If you're solid on biologics but shakier on oral JAKs or systemic immunosuppressants, you're not alone, so lean on AAD guidance and peer consultation before the confidence gap becomes a prescribing gap.

MORE ON NPPA CONNECT

AI Is Already Shrinking Dermatology Wait Times

A systematic review by Kimberly Madison, DNP, AGPCNP-BC, WCC, and Jade Trevino, BSN, RN, evaluated 32 studies published between 2019 and 2024 on AI-assisted dermatology, teledermatology, and workforce strategies in provider-shortage settings. Across the literature, AI-supported tools consistently shortened wait times, often to fewer than 30 days, streamlined referrals, and supported safe task shifting to primary care clinicians, NPs, PAs, and nurses.³

AI-supported diagnostic tools showed sensitivities of approximately 85% to 97% for suspicious skin lesions, and several studies reported dermatologist-level performance when AI was paired with clinician judgment. One study found a 53% reduction in unnecessary in-person referrals through AI-assisted image analysis. Madison and Trevino frame the technology as a decision-support tool, not a replacement for clinical judgment, arguing that understanding its strengths and limits should become as routine for dermatology nurses as knowing drug classes.³

...I do want them to feel confident to sit at any table and have the conversation.— Kimberly Madison, DNP, AGPCNP-BC, WCC

▶ Why it matters: Consider where AI-assisted triage could shorten your own referral pipeline, particularly in an underserved or provider-short area, and treat digital fluency as a skill worth building now, not later.

MORE ON AI IN DERMATOLOGY

Better Biopsies Start Before the Specimen Leaves Your Office

At the 2026 Society for Pediatric Dermatology Annual Meeting, Adnan Mir, MD, PhD, a pediatric dermatologist at Montefiore Medical Center and dermatopathologist at Dermpath Diagnostics, told NPs and PAs that a useful pathology result begins before the specimen reaches the lab. He stressed choosing the appropriate biopsy technique for the suspected diagnosis and completing requisition forms with lesion duration, distribution, size, and other clinical detail that narrows the differential before a pathologist looks under the microscope.⁴

Mir encouraged clinicians to treat dermatopathology as an ongoing conversation rather than a single report. When histopathology does not match the clinical picture, he said direct outreach, even a phone call or email, can prompt a pathologist to reconsider the differential: “I need to hear about it because I may not have the whole picture.” He pointed NPs and PAs toward American Academy of Dermatology lectures as a starting point, noting that education tailored specifically to experienced advanced practice clinicians remains limited.⁴

▶ Why it matters: A pathology report that doesn't fit your clinical picture isn't the end of the conversation, so pick up the phone before you accept a diagnosis that doesn't make sense.

MORE ON PEDIATRIC DERMATOLOGY

New York Extends NP Authority While Practices Rethink Vendor Contracts

New York has extended independent practice authority for qualified nurse practitioners through July 1, 2030, preserving the framework in place since 2022. Gov Kathy Hochul signed the extension on May 28, 2026, moving the expiration from July 1, 2026, to July 1, 2030; NPs with more than 3600 practice hours can continue seeing patients without a written collaborative agreement tied to a physician. Separate bills that would make the authority permanent remain in committee, so the 2030 sunset stays the reference point for now.⁵

Elsewhere in practice management, Roman Bronfenbrener, MD, of the University of Pennsylvania Perelman School of Medicine, pointed to Clarity's 2026 State of Dermatology Report finding that nearly half of independent dermatologists surveyed had considered selling, and argued peer networks are an underused resource for decisions like vendor selection; he cited cleaning service quotes ranging from about $700 to $5000 a month, with some higher-priced vendors marketing themselves as health care specific. A related Dermatology Times column argued that job offer and compensation decisions are too often driven by informal, crowdsourced advice rather than a structured review of compensation structure, restrictive covenants, and productivity expectations.⁵

MORE ON PRACTICE MANAGEMENT

▶ Why it matters: If you practice in New York, the compliance deadline is off your radar until 2030; either way, run vendor quotes and job offers past peer benchmarks rather than gut feel or social media before you sign anything.

References:

1. Bader K, Block R, Barta K. The Cutaneous Connection: new ICD-10 code offers validation for patients with topical steroid withdrawal. Dermatology Times. July 22, 2026. Accessed July 27, 2026. https://www.dermatologytimes.com/view/the-cutaneous-connection-new-icd-10-code-offers-validation-for-patients-with-topical-steroid-withdrawal
2. Heaning S. Most APPs authorized to independently prescribe advanced AD therapies. Dermatology Times. July 22, 2026. Accessed July 27, 2026. https://www.dermatologytimes.com/view/most-apps-authorized-to-independently-prescribe-advanced-ad-therapies
3. Madison K, Trevino J, Heaning S. AI-assisted dermatology shows promise for reducing wait times. Dermatology Times. July 27, 2026. Accessed July 27, 2026. https://www.dermatologytimes.com/view/ai-assisted-dermatology-shows-promise-for-reducing-wait-times
4. Mir A, Bosslett M. How NPs/PAs and dermatopathologists can collaborate for better pediatric skin diagnoses. Dermatology Times. July 27, 2026. Accessed July 27, 2026. https://www.dermatologytimes.com/view/how-nps-pas-and-dermatopathologists-can-collaborate-for-better-pediatric-skin-diagnoses
5. Heaning S. The Practice Brief. Dermatology Times. July 21, 2026. Accessed July 27, 2026. https://www.dermatologytimes.com/view/the-practice-brief