Latest news with #JAMADermatology
Medscape
2 days ago
- Health
- Medscape
Volume Fueling Rise in Part D Specialty Derm Drug Spending
Prescription volume for specialty medications, not price hikes, largely seems to be the main factor in the ongoing huge increase in Medicare Part D dermatology drug spending, according to a new study. Harvard Medical School researchers reported that from 2013 to 2022, prices were higher and rose faster for specialty medications, but that 80% of the increase in spending 'was due to increased prescriptions, not prices.' Price increases only accounted for 20% of the total growth in Medicare Part D dermatologic drug spending during the study period, lead author Edward L. Kong, PhD, told Medscape Medical News . Specialty medications — primarily immunomodulators — 'are just very expensive in general,' and are being rapidly adopted by clinicians, which is driving increased spending, said Kong, who is pursuing an MD degree at the Harvard-MIT Health Sciences and Technology program. Kong and Arash Mostaghimi, MD, MPA, MPH, medical director of the dermatology consult service at Brigham and Women's Hospital, and associate professor, Harvard Medical School, both in Boston, published their findings in JAMA Dermatology on July 16. They examined some 95 million prescriptions for Medicare beneficiaries, written by almost 25,000 dermatologists and dermatology-focused advanced practice clinicians. Inflation-adjusted spending increased an average of 16% a year, reaching $2.95 billion in 2022. Over the study time period, specialty drug spending increased just under 30% a year, reaching $2.4 billion in 2022. Spending on nonspecialty medications only grew 0.7% annually during the study period. By 2022, specialty medications accounted for 81% of all dermatology drug spending, having risen from a third of spending in 2013. Even so specialty medications only represented about 3% of all Medicare Part D dermatology prescriptions in 2022. Four of the specialty drugs were introduced before 2013: adalimumab (Humira), etanercept (Enbrel), ustekinumab (Stelara), and vismodegib (Erivedge). Six came on the market after 2013: apremilast (Otezla), secukinumab (Cosentyx), ixekizumab (Taltz), dupilumab (Dupixent), guselkumab (Tremfya), risankizumab-rzaa (Skyrizi), and sonidegib (Odomzo). The older medications had higher price growth than the six newer therapies during the study period. Humira, at the high end, had a 12% price increase per year, while Skyrizi, at the low end, had a 5% yearly decrease. It's possible that biosimilars for Humira and Stelara — introduced in 2023 and this year — might help restrain cost growth, wrote Kong and Mostaghimi. The introduction of generic oral JAK inhibitors such as tofacitinib may also put a dent in spending, they noted. Medicare will also likely achieve cost savings in 2026 on Enbrel and Stelara, which are included as part of a law — the Inflation Reduction Act— that gave the health program the power to negotiate prices of certain medications. Patients for affordable drugs now estimate that list prices for Enbrel will drop from around $7000 to $2355 and for Stelara from $13,836 to $4695. The study did not examine the value of the high-cost specialty drugs, but the rise in prescriptions — indicated by each of the 10 achieving a 1% market share — shows that the medications are being embraced, wrote Kong and Mostaghimi. The authors' work is similar to other studies that have documented major increases in Medicare Part D dermatologic drug spending being driven in part by increased adoption of specialty medications. A 2022 study in the Journal of the American Academy of Dermatology found that from 2013 to 2019, the price of six dermatology drugs in the top 10 most-prescribed medications decreased, mostly among nonspecialty medications. But in 2013, Enbrel was the most expensive medication in the top 50 most prescribed. Enbrel had been replaced in 2019 by Humira. In 2020, researchers reported in the Journal of Dermatological Treatment that annual spending on immunomodulator medications by Medicare Part D increased 303% from $1.7 billion in 2012 to $6.9 billion in 2018. 'Immunomodulator spending is growing and may be more substantial than previously reported posing significant burden on patients and the health system,' the authors wrote. Kong and Mostaghimi agreed, writing that 'the growing significance of specialty medications will have important implications for healthcare costs and patient affordability.' Kong reported receiving grants from the National Institute on Aging. Mostaghimi reported receiving personal fees from Hims & Hers Health, AbbVie, Sun Pharma, Digital Diagnostics, Eli Lilly, Equillium, ASLAN Pharmaceuticals, Boehringer Ingelheim, Figure 1, Indomo, Olaplex, Legacy Healthcare, Pelage, Q32 Bio, Astria Therapeutics, ACOM Health, Bioniz, Concert, and Digital Diagnostics; equity from ACOM Health, Figure 1, and Hims & Hers Health; licensing or royalties from Concert and Pfizer; and research funding from Aclaris, Concert, Eli Lilly, and Incyte outside the submitted work.
News18
2 days ago
- Health
- News18
The Hidden Burden Of Vitiligo: Why Skin Treatments Alone Aren't Enough
Last Updated: People with vitiligo often carry a psychological burden. Experts have noted how this condition has considerable psychological and social impacts. Despite being widely perceived as a cosmetic condition, vitiligo carries a significant psychological burden, especially in societies where appearance holds more power. And with over a million people in India alone navigating this skin condition, experts say it's time we start treating vitiligo as a holistic health concern, not just a dermatological one. ' Vitiligo, frequently viewed as simply a cosmetic issue, has considerable psychological and social impacts, especially when depigmentation occurs on visible areas such as the face or hands," says Dr. Kanishka Meel, a psychiatrist on Practo. 'For many, it goes beyond the surface. Patients commonly experience poor self-esteem, chronic anxiety, body image problems, and even depression." The numbers back this up. A global study published in JAMA Dermatology reported that 55% of vitiligo patients experience moderate to severe depressive symptoms. Alarmingly, among Indian patients with visible lesions, this shoots up to nearly 90% – a statistic that reflects not just individual distress, but a deeper social failure. The Stigma of Being Seen The emotional toll is intensified by everyday experiences of social alienation. Many individuals living with vitiligo report being stared at, excluded, or treated as if their condition were contagious. 'The stigma surrounding vitiligo remains a difficult reality," Dr. Meel notes. 'There is a prevailing myth, especially in India, that vitiligo is a punishment for misdeeds in a past life. This karmic interpretation leads to shame and isolation, especially among women." This stigma doesn't just exist in public. It seeps into schools, workplaces, and families, shaping lives from a young age. Women, in particular, may face social rejection, reduced marital prospects, and professional hurdles, all stemming from the visibility of their condition. One lesser-discussed layer of emotional distress stems from fear about the condition being hereditary. 'Patients often express guilt or anxiety over whether their children might inherit the condition," Dr. Meel shares. 'This adds another layer of psychological strain that's often overlooked." Vitiligo is an autoimmune disorder in which the body mistakenly attacks its pigment-producing cells. But that biological reality often creates a feedback loop with mental health. 'Long-term psychological stress can intensify autoimmune responses," explains Dr. Meel. 'There's a two-way relationship between depression and vitiligo – visible patches can trigger sadness and isolation, and depressive states may further compromise immune function and skin recovery," she adds. The Urgency of Early Care and Psychological Support Timely diagnosis and treatment can go a long way in managing vitiligo. From topical creams and light therapy to newer immunomodulatory strategies, dermatological treatments continue to advance. But Dr. Meel emphasises that treating the skin alone is not enough. 'Psychological counselling should be woven into treatment plans," she advises. 'Dermatologists should collaborate with psychiatrists to help patients navigate the emotional effects of the illness." Awareness programs in schools, workplaces, and communities can also shift public perception and support those who live with the condition. 'Support structures significantly alter the course. A subtle gesture – like a classmate correcting a misunderstanding, or a parent offering empathy – can strengthen someone's mental resilience enormously," she says. Can Diet Help Vitiligo Too? Possibly While there's no specific diet that cures vitiligo, nutrient-dense, anti-inflammatory foods can help regulate immune function and reduce stress levels. Many patients also find value in lifestyle practices that focus on gut health, mindfulness, and emotional well-being, complementing medical care. In essence, early care, compassionate communities, and informed conversations are crucial to support those navigating vitiligo, not just as patients, but as whole human beings. First Published: July 18, 2025, 13:22 IST Disclaimer: Comments reflect users' views, not News18's. Please keep discussions respectful and constructive. Abusive, defamatory, or illegal comments will be removed. News18 may disable any comment at its discretion. By posting, you agree to our Terms of Use and Privacy Policy.
Medscape
08-07-2025
- Health
- Medscape
Experts Define On-Treatment Remission for Plaque Psoriasis
Despite dramatic treatment advances in recent years, the dermatology community has lacked a unified definition for what remission means in plaque psoriasis. Now, a multistage Delphi consensus process involving nearly 100 stakeholders — dermatologists, patients, payers, and others — has yielded a proposed benchmark: 0% body surface area (BSA) involvement or an Investigator Global Assessment (IGA) score of 0 sustained for at least 6 months while on treatment. Published online on June 18 in JAMA Dermatology , the consensus statement reflects the work of the Remission Workgroup of the National Psoriasis Foundation, which sought to clarify a concept increasingly relevant in clinical practice and research. 'Defining on-treatment remission in plaque psoriasis represents a meaningful step forward for the field,' April W. Armstrong, MD, MPH, University of California, Los Angeles, and coauthors wrote. 'Until now, the absence of a clear, consensus-based definition has hindered the ability of clinicians, researchers, patients, and payers to uniformly evaluate treatment success and long-term disease control.' Why This Matters The need for a shared definition stems from growing interest in treatment endpoints that go beyond a 75% improvement in the Psoriasis Area and Severity Index (PASI) and minimal disease activity. While off-treatment remission has been loosely defined in prior work, on-treatment remission — where patients experience complete skin clearance while continuing therapy — remained undefined, according to the authors. The consensus group emphasized that having a measurable, time-bound goal for remission is not only clinically useful but also deeply meaningful for patients. During pre-Delphi interviews, patients defined remission as 'the complete absence of signs and symptoms,' including flares, pain, itch, and redness. The Process The consensus was developed through a systematic literature review followed by a multistage Delphi process. The review identified 106 studies and 41 unique definitions of remission, but very few included duration of disease control as a criterion. To address this, the workgroup engaged 92 stakeholders: 13 patients, 25 clinicians and researchers, 6 payers, 7 life sciences professionals, and 41 psoriasis specialists (dermatologists, rheumatologists, and one cardiologist) in the Delphi rounds. The final definition — BSA of 0% or IGA of 0 sustained for ≥ 6 months while on treatment — was chosen for its clinical feasibility and potential for global adoption. The Delphi participants agreed that both prescription and nonprescription treatments (including phototherapy, dietary, and physical interventions) may qualify as 'on treatment.' What About PASI and Patient-Reported Outcomes? Although a PASI score of 0 also reached high agreement levels, BSA and IGA were selected for their simplicity and wider global utility, according to the authors. Patient-reported outcomes and biomarkers were not included in the definition to preserve feasibility in both clinical trial and routine practice settings. The group acknowledged these omissions, stating that 'remission can include patient-reported outcomes and biomarkers,' but also noted limitations in validation and practical implementation. Implications for Practice According to the workgroup, the proposed remission benchmark is meant to guide therapeutic conversations and expectations — setting a higher bar than low disease activity or a PASI 90 score. It also provides a common language for use in research, clinical practice, and payer evaluations. For clinicians, the definition offers a framework for deep, sustained control. For patients, it introduces a tangible and empowering treatment goal. For industry and regulatory stakeholders, it creates consistency for evaluating therapies. 'Achieving this standard for on-treatment remission will likely result in a deeply meaningful impact on the lives of patients with psoriasis,' the authors concluded. The study was funded by the National Psoriasis Foundation. All authors are members of the Remission Workgroup of the National Psoriasis Foundation, and many reported having financial disclosures with many pharmaceutical companies.
NDTV
28-06-2025
- Health
- NDTV
Fungus, Cuts, HIV: That Pedicure Comes With Risks No One Tells You About
It was just another self-care day for 59-year-old Anita House from Flowery Branch, Georgia, when she and her sister headed to their usual local salon for some routine services. It was a place House had visited many times. However, things took a sharp turn when, just two days after her pedicure, a seemingly minor infection on her toe worsened rapidly. The infection grew so severe that House eventually had to get her toes amputated. This incident occurred in 2019. According to House, the infection likely started when a salon worker removed an ingrown toenail on her right foot's big toe. While this practice is quite common in many nail salons, House believes the technician cut a little too deep, causing excessive bleeding. "That's [my guess] of when bacteria got in. I can't prove it in a court of law, but if I was a betting woman, that would be my bet," she told Fox News. Unfortunately, House's story isn't the only one of its kind. In 2021, a Florida nail salon was ordered to pay Rs 14.5 crore (approx $1.75 million) to Clara Shellman, who lost her leg after a botched pedicure. According to Shellman and her lawyer, the salon used dirty tools that led to an infection and aggravated her peripheral arterial disease. Her foot had to be amputated during treatment. The salon, now permanently shut, bore full responsibility for the incident. Pedicures, though generally considered safe, can be dangerous when done incorrectly. From cuts and fungal infections to even life-threatening conditions like sepsis or HIV, poor hygiene and bad technique can have serious consequences. The Fish Pedicure Banned in many parts of the US, Canada and Europe, fish pedicures are becoming increasingly popular in India. You can even spot them being offered on busy street corners. Also known as fish spas or fish therapy, these treatments involve placing your feet in a tank of water filled with Garra rufa (or "doctor fish") that nibble away dead skin. The idea is to leave your feet smooth and exfoliated. But there are hidden risks. A 2018 case study published in JAMA Dermatology warned about a woman in her twenties who developed onychomadesis -- a condition where toenails detach and fall off -- after a fish pedicure. She had gone to a dermatologist after months of unexplained nail shedding. A 2024 report by Dermatocare adds that if someone with an open wound or infection dips their feet into a fish tank, the water can easily become contaminated. This can transmit bacterial infections and viruses like HIV or hepatitis to others. With more salons offering unusual options, from ice cream pedicures to wine soaks, it's clear that indulgent foot treatments are on trend. But when not done right, they can go very, very wrong. So, does this mean you should stop getting pedicures altogether? Not necessarily. But being cautious is key. Things To Keep In Mind Before Getting A Pedicure 1. Avoid shaving your legs beforehand Shaving creates micro-cuts on the skin, making it easier for bacteria to enter. Ideally, avoid shaving for at least 24 hours before your appointment. 2. Inspect the salon's hygiene practices Make sure the tools are sterilised and foot tubs are cleaned thoroughly between clients. Ask if they use disposable liners or hospital-grade disinfectant. 3. Don't let anyone cut your cuticles or ingrown nails Cutting cuticles can create open wounds and increase your infection risk. Push them back gently instead. And never allow a technician to remove ingrown nails; leave that to a medical professional. 4. Bring your own tools if possible If you can, carry your own nail file, buffer, and even clippers, to reduce exposure to reused equipment. 5. Don't get a pedicure if you have open cuts or infections If your feet have wounds, cracked skin, or even a bug bite, postpone your appointment. Bacteria can easily enter through compromised skin. 6. Choose a salon with a licence and trained technicians Not all salons operate within regulations. Opt for one that has visibly displayed licences and employs trained professionals. Pro Tip: Check Google review first. 7. Skip risky treatments like fish pedicures They may look fun and relaxing, but they come with too many hygiene and health risks to be worth it. 8. Diabetics should consult a doctor first If you have diabetes or poor circulation, even a small nick can be dangerous. Speak to a medical professional before booking a pedicure. Final Line While pedicures can be a form of self-care, they shouldn't come at the cost of your health. With just a few precautions and a little bit of awareness, you can enjoy your salon visits without fear. So, go ahead and treat yourself - but smartly.
Medscape
26-06-2025
- Health
- Medscape
AI-Derived Risk Score May Improve Risk Stratification of Squamous Cell Carcinomas
An artificial intelligence (AI)-enabled prognostication system created through retrieval augmented generation (RAG) appears to offer significantly better predictive capability, particularly regarding poor outcomes, for cutaneous squamous cell carcinoma (cSCC) compared with the Brigham and Women's Hospital (BWH) and American Joint Committee on Cancer Staging Manual, Eighth Edition (AJCC8) systems, according to a recently published study. The authors say their model illustrates how targeted application of general-purpose large language models (LLMs) can help develop and refine future prognostication systems. Limited Guidance Neil K. Jairath, MD 'Currently,' Neil K. Jairath, MD, told Medscape Dermatology , 'up to 30% of bad outcomes in cSCC — recurrence, metastasis, and death — occur in what we classify as 'low-stage' tumors using existing systems, leaving practitioners with limited guidance for risk stratification.' Jairath is chief resident in dermatology at New York University, New York City, and is co-first author on the paper, which was published online on June 11 in JAMA Dermatology . To address the clinical-practice gap, he and his coauthors comprehensively searched PubMed, Embase, and the Cochrane Library, and selected 10 manuscripts for inclusion in an RAG knowledge base that informed creation of the model. Rather than relying solely on general training data, Jairath said, using RAG grounded the AI model in authoritative, domain-specific knowledge. 'This approach allowed us to leverage the collective insights from high-impact cSCC literature that represents decades of clinical research. Unlike purely AI-generated calculators that might produce unreliable outputs, RAG ensures our system is built on validated medical evidence,' he explained. Detailed prompting of a customized generative pretrained transformer (GTP-4, OpenAI) produced the AI-Derived Risk Score (AIRIS) prognostication system, which assigns 0-3 points to factors such as tumor diameter, depth, and the presence of immunosuppression. Total scores > 1 signify high-risk tumors. ** When validated on 2379 primary tumors, AIRIS demonstrated superior performance compared with the BWH and AJCC8systems across all key metrics. Most importantly, said Jairath, AIRIS showed dramatically improved sensitivity for identifying poor outcomes: 49% for local recurrence, 74% for nodal metastasis, and 83% for distant metastasis. The corresponding figures for BWH staging, the more reliable of the comparators, were 26%, 37%, and 38%. 'AIRIS's improved sensitivity means we can better identify high-risk patients who need enhanced surveillance or adjuvant therapy, while avoiding overtreatment of truly low-risk cases,' said Jairath. Although AIRIS prognostication showed the highest sensitivity for each outcome, it had the lowest specificity (85%-87%). 'We argue that this trade-off is clinically beneficial,' Jairath and colleagues wrote, 'as the magnitude increases in sensitivity across outcomes (nearly 20%-35%) appear to outweigh the loss of specificity (approximately 7% across outcomes).' In an accompanying editorial, authors led by Emily S. Ruiz, MD, MPH, academic director of the Mohs and Dermatologic Surgery Center at BWH in Boston, applauded AIRIS's clinically intuitive point-based system. Unlike current staging systems, these authors added, AIRIS assigns different point values to different risk factors. 'However,' they wrote, 'its formulation of several risk factors presents challenges for clinical applicability.' Although previous staging systems record invasive depth by tissue level, for example, the model uses millimeters. 'Translational research experience suggests that many molecular answers lie at the tumor's leading edge,' Jairath said. He referred to a study published in the Journal of Investigative Dermatology in 2014 that showed differential matrix metalloproteinase (MMP) profiles there, suggesting a possible contribution of interleukin-24 to SCC invasion through enhanced focal expression of MMP7. 'As we direct more translational efforts toward this interface,' he said, 'millimeter-level measurements may provide the granularity needed for molecular correlations and personalized therapy decisions.' Welcome Dialogue Veronica Rotemberg, MD, PhD The foregoing comments regarding millimeter-level measurements represent 'the kind of discussion that we must have when looking at different ways to incorporate AI into clinical practice,' said Veronica Rotemberg, MD, PhD, a dermatologist and director of dermatology informatics at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City. She was not an author of the study or editorial but was the handling editor at JAMA Dermatology who focuses on AI papers. Presently, she said in an interview, if one queries an LLM about recurrence risk for a specific tumor, it is impossible to know what calculations produce the prediction. Instead, Rotemberg said, Jairath and colleagues used an LLM to create a transparent prognostication system. 'If you're an individual patient using this system, you're not using AI directly at all.' Patients and physicians can simply use the authors' table in the paper to tally points. 'You don't know exactly what went into generating this table,' Rotemberg said, 'although you mostly know because you know the papers that were used to inform it.' Nevertheless, she said it's too early to predict how AIRIS will impact clinical practice. Authors' validating the model on data not used to create or train it surpasses the validation efforts associated with many reported AI-enabled models, Rotemberg said. 'But the gold standard for any prediction model is prospective studies in its intended-use setting,' she added. 'We need to know, when faced with this scoring system, what decisions do people make, and how does that affect health?' For now, said Rotemberg, the study represents an exciting and necessary step in that direction. Going forward, Jairath said, he and his colleagues hope to expand AIRIS validation studies and would welcome the opportunity to test AIRIS on larger data sets. AIRIS study authors reported no funding sources but acknowledged the use of GPT-4 (OpenAI) as a base model. Jairath is CEO and cofounder of DermFlow and of Bedside Bike. He is also chief medical officer of AI Regent and an advisor to Marit Health. Rotemberg is an associate editor for AI of JAMA Dermatology but did not author the AIRIS study or editorial. Her comments do not represent the views of MSKCC. Ruiz is a consultant for Regeneron, Checkpoint Therapeutics, Feldan Therapeutics, and Merck. Additionally, she is an investigator for Regeneron, Castle Biosciences, and Merck. Editorial coauthor William Lotter, PhD, of the Dana-Farber Cancer Institute in Boston reported receiving personal fees from SpringTide Ventures and Servier, nonfinancial support from Dekang Medical, and grants from the National Institute of Biomedical Imaging and Bioengineering. John Jesitus is a Denver-based freelance medical writer and editor.
