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ODAC 2018

ODAC Dermatology Conference Returns to Orlando, Florida

By Aesthetic Dermatology, Medical Dermatology, ODAC Sessions, Patient Care, Surgical Dermatology
Orlando Florida Hotel

Source: Dermatology Times

The Orlando Dermatology Aesthetic & Clinical Conference (ODAC), formerly known as Orlando Derm, is scheduled for January 18-21 at the JW Marriott in Orlando.

This year’s meeting will open with presentations from physicians who will address advances in treating skin of color, hot topics in surgical dermatology and cutaneous malignancy, the latest on photodynamic therapy, and a year in review from the Journal of Drugs in Dermatology, among others.

Drs. Eric Bernstein and Jason Pozner will host a panel discussion on “My Top Picks for Laser and Energy Based Treatments.” And, Dr. Joel Cohen will give an overview of facial arterial supply.

During the general session on Saturday, Jan. 19, Dr. Brian Berman will address managing urticaria, which will be followed by talks by Dr. Deirdre Hooper on platelet rich plasma for hair growth and skin rejuvenation; Dr. Andrew Alexis on keloids and disorders of hyperpigmentation in skin of color; and, Drs. Bernstein and Pozner will address advances in non-surgical skin tightening.

On Sunday, January 20, Dr. Jean Bolognia will open the day’s general session with a review of advances in systemic therapies for melanoma.

For more information, visit ODAC online at https://orlandoderm.org.

Vascular Compromise

By ODAC Sessions, Patient Care
Dr. Joel Cohen presenting at ODAC dermatology conference

Source: Dermatology Times

Avoiding and treating vascular compromise with hyaluronic acid (HA) injections requires understanding the subtleties of underlying facial anatomy and keeping a well-stocked arsenal of treatments for impending necrosis, said an expert at the Orlando Dermatology Aesthetic and Clinical Conference (ODAC) in Miami.

“Some blood vessels may actually be in different locations than in some of the anatomic diagrams and cartoons that have long characterized their course,” said vice conference chair Joel L. Cohen, M.D., from Greenwood Village, Colorado, who serves on the teaching faculty for both the University of California, Irvine and the University of Colorado.

Although textbooks commonly depict the angular artery tracking adjacent to the nasofacial sulcus, he said, “it’s more common for the angular artery to be more lateral to that area, closer to the infraorbital distribution. In a recent cadaver study, only 19% of the time did the facial artery actually project upward along the side of the nose-cheek junction. But 32% of the time, the angular artery came off the facial artery earlier, and therefore coursed to more of the medial cheek area.”

The technique of aspirating before injecting is not foolproof. “There can be false negatives. A study indicates you probably have to pull back on the plunger for several seconds in order to physically be able to see if you’re in a vessel. We all surely realize that it is very difficult to have the needle in the exact spot you plan to inject, and then reposition your hand to pull back on the plunger of the syringe to try to aspirate, and then have your needle-tip remain in the exact same spot when you reposition again in order to inject. As you change your hand position to pull back on the plunger, you probably move a bit, maybe just a millimeter, from the original location to the location you later inject,” Dr. Cohen said.

A recent report also shows that it is possible to puncture and get into a vessel with small cannulas — the injectors aspirated blood despite using a cannula.

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Want to expand aesthetic dermatology business? Appeal to men

By Aesthetic Dermatology, Patient Care
Terrence Keaney Male Aesthetics at ODAC

Source: Dermatology Times

Bringing more men into an aesthetic dermatology practice can expand the patient population, increase business revenue, and pay long-term dividends in terms of patient loyalty and repeat business.

But men aren’t like women when it comes to aesthetic concerns, so the strategies used to market your aesthetic offerings to female patients might miss the mark with men, cautioned Terrence Keaney, MD.

Men are less cosmetically savvy and need more upfront education and counseling, Dr. Keaney said at the 2018 Orlando Dermatology Aesthetic and Clinical Conference.

“I spend more time explaining therapies and what might be best for them,” he noted. “I explain the scientific rationale and treatment mechanisms so they will be more comfortable.” Making sure they understand is important, because “men often nod and don’t ask questions.”

The extra effort up front can pay off.

“The beauty of men is when they get a great result and are happy with you, men are very physician loyal. Once they get a great result, they’re yours forever,” said Dr. Keaney, an assistant clinical professor of dermatology at George Washington University, Washington, and a private practice dermatologist in Arlington, Va.

Cost is the leading deterrent for men to embrace aesthetic procedures, a factor that also ranks first among women. Men are also concerned that results will not look natural and want information about safety and side effects, Dr. Keaney said. “These deterrents can be overcome with proper education and counseling.”

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Five Pearls Target Wound Healing

By Medical Dermatology, ODAC Sessions, Patient Care, Surgical Dermatology
Robert Kirsner at the ODAC Dermatology Conference

Source: Dermatology News

Another reason not to prescribe opioids for postoperative pain – besides potentially adding to the epidemic the nation – comes from evidence showing these agents can impair wound healing.

In addition, epidermal sutures to close dermatologic surgery sites may be unnecessary if deep suturing is done proficiently. These and other pearls to optimize wound closure were suggested by Robert S. Kirsner, MD, PhD, professor and chair of the department of dermatology and cutaneous surgery at the University of Miami.

Avoid opioids for postoperative pain

“We know the opioid epidemic is a big problem. An estimated 5-8 million Americans use them for chronic pain,” Dr. Kirsner said at the Orlando Dermatology Aesthetic and Clinical Conference. “And there has been a steady increase in the use of illicit and prescription opioids.”

Emerging evidence suggests opioids also impair wound healing (J Invest Dermatol. 2017;137:2646-9). This study of 715 patients with leg ulcers, for example, showed use of opioids the most strongly associated with nonhealing at 12 weeks. “We found if you took an opioid you were less likely to heal,” Dr. Kirsner said. They found opioids significantly impaired healing, even when the investigators controlled for ulcer area, duration, and patient gender.

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Best Practices Address Latest Trends in PDT, Skin Cancer Treatment

By Medical Dermatology, ODAC Sessions
ODAC Dermatology Conference Audience

Source: Dermatology News

Pearls for providers of photodynamic therapy (PDT) include tips on skin preparation, eye protection, and use of three new codes to maximize reimbursement. Also trending in medical dermatology are best practices for intralesional injections of 5-FU to treat the often challenging isomorphic squamous cell carcinomas (SCCs) or keratoacanthomas on the lower leg, as well as use of neoadjuvant hedgehog inhibitors to shrink large skin cancer lesions, according to Glenn David Goldman, MD.

“This talk is about what you can do medically as a dermatologic surgeon,” Dr. Goldman said at the Orlando Dermatology Aesthetic and Clinical Conference.

Use new billing codes for photodynamic therapy

There are now three new PDT billing codes. “Make sure your coders are using these properly. They are active now, and if you don’t use them, you won’t get paid properly,” said Dr. Goldman, professor and medical director of dermatology at the University of Vermont, Burlington. Specifically, 96567 is for standard PDT applied by staff; 96573 is for PDT applied by a physician; and 96574 is for PDT and curettage performed by a physician.

“Be involved, don’t delegate,” Dr. Goldman added. “If you do, you will get paid half as much as you used to, which means you will lose money on every single patient you treat.”

What type of PDT physicians choose to use in their practice remains controversial. “Do you do short-contact PDT, do you do daylight PDT? We’ve gone back and forth in our practice,” Dr. Goldman said. “I’m not impressed with daylight PDT. I know this is at odds with some of the people here, but at least in Vermont, it doesn’t work very well.”

The way PDT was described in the original trials (a photosensitizer applied in the office followed by PDT) “works the best, with one caveat,” Dr. Goldman said. The caveat is that dermatologists should aim for a PDT clearance that approaches the efficacy of 5-fluorouracil (5-FU). “If you can get to that – which is difficult by the way – I think your patients will really appreciate this.”

An additional PDT pearl Dr. Goldman shared involves skin preparation: the use of acetone to defat the skin, even in patients with very thick lesions. Apply acetone with gauze to the site for 5 minutes and “all of that hyperkeratosis just wipes away,” curette off any residual hyperkeratosis – and consider a ring anesthetic block to control pain for the patient with severe disease, he advised.

Another tip is to forgo the goggles that come with most PDT kits. Instead, purchase smaller, disposable laser eye shields for PDT patients, Dr. Goldman said. “They work better. You can get closer to the eye … and they are more comfortable for the patient.”

Dr. Goldman’s practice is providing more PDT and much less 5-FU for patient convenience. “I believe if someone is willing to go through 3 weeks of 5-FU or 12-16 weeks of imiquimod, they get the best results. However, most people don’t want to do that if they can sit in front of a light for 15 minutes.”

Consider intralesional injections for SCCs and KAs on the legs

An ongoing challenge in medical dermatology is preventing rapid recurrence of SCCs and/or keratoacanthomas (KAs) near sites of previous excision on the legs. “We all see this quite a bit. Often you get lesions on the leg, you cut them out, and they come right back” close to the excision site, Dr. Goldman said.

He does not recommend methotrexate injections for these lesions. “Methotrexate does not work. It doesn’t hurt, but I’ve injected methotrexate into squamous cell carcinomas many times and they’ve never gone away.” In contrast, 5-FU “works incredibly well. They go away, I’ve had tremendous success. This has changed the way we treat these lesions.” 5-FU is inexpensive and can be obtained from oncology pharmacies. One caveat is 5-FU injections can be painful and patients require anesthesia prior to injection.

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JDD honors Adam Friedman, M.D., for Educational Contributions

By Medical Dermatology, ODAC Sessions
Adam Friedman, MD faculty headshot

Source: Dermatology Times

Adam Friedman, M.D., was honored with the Innovations in Residency Training Award by the Journal of Drugs in Dermatology (JDD) at the Orlando Dermatology Aesthetic & Clinical Conference (ODAC) held in January. The award recognizes individuals who serve as exemplary role models for dermatology residents and innovate improvements in residency programs.

“Dr. Adam Friedman embodies the spirit of the award and more,” says Shelley Tanner, CEO and president of SanovaWorks, parent company of the JDD and ODAC. “He looks towards the future of dermatology and those who will carry it forward.”

Dr. Friedman is the residency program director and director of translational research at the George Washington University School of Medicine. He is also deputy chair of the American Academy of Dermatology’s Poster Task Force, senior editor of the Dermatology In-Review online workshop and cram pack, and director of the Oakstone Institute Dermatology Board Review.

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