Article

To the Editor:

Approximately 3% of the US population, or 6.9 million adults, is affected by psoriasis.¹ Psoriasis has a substantial impact on quality of life and is associated with increased health care expenses and medication costs. In 2013, it was reported that the estimated US annual cost—direct, indirect, intangible, and comorbidity costs—of psoriasis for adults was $112 billion.² We investigated the prevalence and sociodemographic characteristics of adult psoriasis patients (aged ≥20 years) with financial insecurity utilizing the 2009–2014 National Health and Nutrition Examination Survey (NHANES) data.³

We conducted a population-based, cross-sectional study focused on patients 20 years and older with psoriasis from the 2009-2014 NHANES database to evaluate financial insecurity. Financial insecurity was evaluated by 2 outcome variables. The primary outcome variable was assessed by the question “Are you covered by health insurance or some other kind of health care plan (including health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills)?”³ Our secondary outcome variable was evaluated by a reported annual household income of less than $20,000. P values in Table 1 were calculated using Pearson χ² tests. In Table 2, multivariate logistic regressions were performed using Stata/MP 17 (StataCorp LLC) to analyze associations between outcome variables and sociodemographic characteristics. Additionally, we controlled for age, race/ethnicity, sex, education, marital status, US citizenship status, and tobacco use. Subsequently, relationships with P<.05 were considered statistically significant.

Our analysis comprised 480 individuals with psoriasis; 40 individuals were excluded from our analysis because they did not report annual household income and health insurance status (Table 1). Among the 480 individuals with psoriasis, approximately 16% (weighted) reported a lack of health insurance, and approximately 17% (weighted) reported an annual household income of less than $20,000. Among those who reported an annual household income of less than $20,000, approximately 38% (weighted) of them reported that they did not have health insurance.

Multivariate logistic regression analyses revealed that elderly individuals (aged >60 years), college graduates, married individuals, and US citizens had decreased odds of lacking health insurance (Table 2). Additionally, those with a history of tobacco use (adjusted odds ratio [AOR] 2.02; 95% CI, 1.00-4.05) were associated with lacking health insurance. Non-Hispanic Black individuals (AOR 2.26; 95% CI, 1.09-4.71) and US citizens (AOR 5.01; 95% CI, 1.28-19.63) had a significant association with an annual household income of less than $20,000 (P<.05). Lastly, males, those with education beyond ninth grade, and married individuals had a significantly decreased odds of having an annual household income of less than $20,000 (P<.05)(Table 2).

Our findings indicate that certain sociodemographic groups of psoriasis patients have an increased risk for being financially insecure. It is important to evaluate the cost of treatment, number of necessary visits to the office, and cost of transportation, as these factors can serve as a major economic burden to patients being managed for psoriasis.⁴ Additionally, the cost of biologics has been increasing over time.⁵ Taking all of this into account when caring for psoriasis patients is crucial, as understanding the financial status of patients can assist with determining appropriate individualized treatment regimens.

To the Editor:

Approximately 3% of the US population, or 6.9 million adults, is affected by psoriasis.¹ Psoriasis has a substantial impact on quality of life and is associated with increased health care expenses and medication costs. In 2013, it was reported that the estimated US annual cost—direct, indirect, intangible, and comorbidity costs—of psoriasis for adults was $112 billion.² We investigated the prevalence and sociodemographic characteristics of adult psoriasis patients (aged ≥20 years) with financial insecurity utilizing the 2009–2014 National Health and Nutrition Examination Survey (NHANES) data.³

We conducted a population-based, cross-sectional study focused on patients 20 years and older with psoriasis from the 2009-2014 NHANES database to evaluate financial insecurity. Financial insecurity was evaluated by 2 outcome variables. The primary outcome variable was assessed by the question “Are you covered by health insurance or some other kind of health care plan (including health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills)?”³ Our secondary outcome variable was evaluated by a reported annual household income of less than $20,000. P values in Table 1 were calculated using Pearson χ² tests. In Table 2, multivariate logistic regressions were performed using Stata/MP 17 (StataCorp LLC) to analyze associations between outcome variables and sociodemographic characteristics. Additionally, we controlled for age, race/ethnicity, sex, education, marital status, US citizenship status, and tobacco use. Subsequently, relationships with P<.05 were considered statistically significant.

Our analysis comprised 480 individuals with psoriasis; 40 individuals were excluded from our analysis because they did not report annual household income and health insurance status (Table 1). Among the 480 individuals with psoriasis, approximately 16% (weighted) reported a lack of health insurance, and approximately 17% (weighted) reported an annual household income of less than $20,000. Among those who reported an annual household income of less than $20,000, approximately 38% (weighted) of them reported that they did not have health insurance.

Multivariate logistic regression analyses revealed that elderly individuals (aged >60 years), college graduates, married individuals, and US citizens had decreased odds of lacking health insurance (Table 2). Additionally, those with a history of tobacco use (adjusted odds ratio [AOR] 2.02; 95% CI, 1.00-4.05) were associated with lacking health insurance. Non-Hispanic Black individuals (AOR 2.26; 95% CI, 1.09-4.71) and US citizens (AOR 5.01; 95% CI, 1.28-19.63) had a significant association with an annual household income of less than $20,000 (P<.05). Lastly, males, those with education beyond ninth grade, and married individuals had a significantly decreased odds of having an annual household income of less than $20,000 (P<.05)(Table 2).

Our findings indicate that certain sociodemographic groups of psoriasis patients have an increased risk for being financially insecure. It is important to evaluate the cost of treatment, number of necessary visits to the office, and cost of transportation, as these factors can serve as a major economic burden to patients being managed for psoriasis.⁴ Additionally, the cost of biologics has been increasing over time.⁵ Taking all of this into account when caring for psoriasis patients is crucial, as understanding the financial status of patients can assist with determining appropriate individualized treatment regimens.

To the Editor:

Approximately 3% of the US population, or 6.9 million adults, is affected by psoriasis.¹ Psoriasis has a substantial impact on quality of life and is associated with increased health care expenses and medication costs. In 2013, it was reported that the estimated US annual cost—direct, indirect, intangible, and comorbidity costs—of psoriasis for adults was $112 billion.² We investigated the prevalence and sociodemographic characteristics of adult psoriasis patients (aged ≥20 years) with financial insecurity utilizing the 2009–2014 National Health and Nutrition Examination Survey (NHANES) data.³

We conducted a population-based, cross-sectional study focused on patients 20 years and older with psoriasis from the 2009-2014 NHANES database to evaluate financial insecurity. Financial insecurity was evaluated by 2 outcome variables. The primary outcome variable was assessed by the question “Are you covered by health insurance or some other kind of health care plan (including health insurance obtained through employment or purchased directly as well as government programs like Medicare and Medicaid that provide medical care or help pay medical bills)?”³ Our secondary outcome variable was evaluated by a reported annual household income of less than $20,000. P values in Table 1 were calculated using Pearson χ² tests. In Table 2, multivariate logistic regressions were performed using Stata/MP 17 (StataCorp LLC) to analyze associations between outcome variables and sociodemographic characteristics. Additionally, we controlled for age, race/ethnicity, sex, education, marital status, US citizenship status, and tobacco use. Subsequently, relationships with P<.05 were considered statistically significant.

Our analysis comprised 480 individuals with psoriasis; 40 individuals were excluded from our analysis because they did not report annual household income and health insurance status (Table 1). Among the 480 individuals with psoriasis, approximately 16% (weighted) reported a lack of health insurance, and approximately 17% (weighted) reported an annual household income of less than $20,000. Among those who reported an annual household income of less than $20,000, approximately 38% (weighted) of them reported that they did not have health insurance.

Multivariate logistic regression analyses revealed that elderly individuals (aged >60 years), college graduates, married individuals, and US citizens had decreased odds of lacking health insurance (Table 2). Additionally, those with a history of tobacco use (adjusted odds ratio [AOR] 2.02; 95% CI, 1.00-4.05) were associated with lacking health insurance. Non-Hispanic Black individuals (AOR 2.26; 95% CI, 1.09-4.71) and US citizens (AOR 5.01; 95% CI, 1.28-19.63) had a significant association with an annual household income of less than $20,000 (P<.05). Lastly, males, those with education beyond ninth grade, and married individuals had a significantly decreased odds of having an annual household income of less than $20,000 (P<.05)(Table 2).

Our findings indicate that certain sociodemographic groups of psoriasis patients have an increased risk for being financially insecure. It is important to evaluate the cost of treatment, number of necessary visits to the office, and cost of transportation, as these factors can serve as a major economic burden to patients being managed for psoriasis.⁴ Additionally, the cost of biologics has been increasing over time.⁵ Taking all of this into account when caring for psoriasis patients is crucial, as understanding the financial status of patients can assist with determining appropriate individualized treatment regimens.

Studies have shown that breast cancer survivors have increased rates of age-related conditions, including cardiovascular disease and osteoporosis among others, therefore postulating that the biological aging process may be accelerated in this population.² Among 417 women enrolled in the prospective Sister Study cohort, paired blood samples collected an average of 7.7 years apart compared three epigenetic metrics of biological aging (calculated on the basis of DNA methylation data) between women who were diagnosed and treated for breast cancer (n = 190) vs those who remained breast cancer–free (n = 227) (Kresovich et al). Women diagnosed and treated for breast cancer had higher biological aging metrics than women who were cancer-free at the time of follow-up: PhenoAgeAccel³ (standardized mean difference [β] = 0.13; P = .04), GrimAgeAccel⁴ (β = 0.14; P = .01), and DunedinPACE⁵ (β = 0.37; P < .001). Regarding breast cancer therapies received, the increases in biological aging were most striking for those women who underwent radiation. The effect of cancer treatments, specifically chemotherapy and radiation, on DNA methylation profiles and accelerating the aging process has been demonstrated in prior studies as well.⁶ Future research should strive to improve our understanding of the specific mechanisms underlying these age-related changes, identify ways to affect those which are modifiable, and positively influence long-term cognitive and functional consequences.

The association between cardiometabolic abnormalities, including obesity, hyperinsulinemia, diabetes, hypertension, and dyslipidemia, and an elevated breast cancer risk has been demonstrated in various studies.⁷ Furthermore, dysregulation of obesity-related proteins plays a role in breast cancer development and progression. A study by Xu and colleagues evaluated the temporal relationships and longitudinal associations of body mass index (BMI), cardiometabolic risk score (CRS), and obesity-related protein score (OPS) among 444 healthy women in a breast cancer screening cohort. After adjustment for demographics, lifestyle, and reproductive factors, a 1-kg/m² increase in BMI per year increased CRS in both premenopausal (0.057 unit; P = .025) and postmenopausal women (0.054 unit; P = .033) and increased OPS by 0.588 unit (P = .001) in postmenopausal women. A significant association was also observed between CRS and OPS in postmenopausal women (β = 0.281; P = .034). These results support the importance of weight management and its effect on cardiometabolic and obesity-related parameters in breast cancer prevention. Research focused on lifestyle interventions to modify risk factors and effective implementation of these techniques will contribute to further reducing breast cancer risk.

Additional References

1. García-Albéniz X, Hernán MA, Logan RW, et al. Continuation of annual screening mammography and breast cancer mortality in women older than 70 years. Ann Intern Med. 2020;172(6):381-389. doi: 10.7326/M18-1199
2. Greenlee H, Iribarren C, Rana JS, et al. Risk of cardiovascular disease in women with and without breast cancer: The Pathways Heart Study. J Clin Oncol. 2022;40(15):1647-1658. doi: 10.1200/JCO.21.01736
3. Levine ME, Lu AT, Quach A, et al. An epigenetic biomarker of aging for lifespan and healthspan. Aging (Albany NY). 2018;10(4):573-591. doi: 10.18632/aging.101414
4. Lu AT, Quach A, Wilson JG, et al. DNA methylation GrimAge strongly predicts lifespan and healthspan. Aging (Albany NY). 2019;11(2):303-327. doi: 10.18632/aging.101684
5. Belsky DW, Caspi A, Corcoran DL, et al. DunedinPACE, a DNA methylation biomarker of the pace of aging. eLife. 2022:11:e73420. doi: 10.7554/eLife.73420
6. Sehl ME, Carroll JE, Horvath S, Bower JE. The acute effects of adjuvant radiation and chemotherapy on peripheral blood epigenetic age in early stage breast cancer patients. NPJ Breast Cancer. 2020;6:23. doi: 10.1038/s41523-020-0161-3
7. Nouri M, Mohsenpour MA, Katsiki N, et al. Effect of serum lipid profile on the risk of breast cancer: Systematic review and meta-analysis of 1,628,871 women. J Clin Med. 2022;11(15):4503. doi: 10.3390/jcm11154503

Studies have shown that breast cancer survivors have increased rates of age-related conditions, including cardiovascular disease and osteoporosis among others, therefore postulating that the biological aging process may be accelerated in this population.² Among 417 women enrolled in the prospective Sister Study cohort, paired blood samples collected an average of 7.7 years apart compared three epigenetic metrics of biological aging (calculated on the basis of DNA methylation data) between women who were diagnosed and treated for breast cancer (n = 190) vs those who remained breast cancer–free (n = 227) (Kresovich et al). Women diagnosed and treated for breast cancer had higher biological aging metrics than women who were cancer-free at the time of follow-up: PhenoAgeAccel³ (standardized mean difference [β] = 0.13; P = .04), GrimAgeAccel⁴ (β = 0.14; P = .01), and DunedinPACE⁵ (β = 0.37; P < .001). Regarding breast cancer therapies received, the increases in biological aging were most striking for those women who underwent radiation. The effect of cancer treatments, specifically chemotherapy and radiation, on DNA methylation profiles and accelerating the aging process has been demonstrated in prior studies as well.⁶ Future research should strive to improve our understanding of the specific mechanisms underlying these age-related changes, identify ways to affect those which are modifiable, and positively influence long-term cognitive and functional consequences.

The association between cardiometabolic abnormalities, including obesity, hyperinsulinemia, diabetes, hypertension, and dyslipidemia, and an elevated breast cancer risk has been demonstrated in various studies.⁷ Furthermore, dysregulation of obesity-related proteins plays a role in breast cancer development and progression. A study by Xu and colleagues evaluated the temporal relationships and longitudinal associations of body mass index (BMI), cardiometabolic risk score (CRS), and obesity-related protein score (OPS) among 444 healthy women in a breast cancer screening cohort. After adjustment for demographics, lifestyle, and reproductive factors, a 1-kg/m² increase in BMI per year increased CRS in both premenopausal (0.057 unit; P = .025) and postmenopausal women (0.054 unit; P = .033) and increased OPS by 0.588 unit (P = .001) in postmenopausal women. A significant association was also observed between CRS and OPS in postmenopausal women (β = 0.281; P = .034). These results support the importance of weight management and its effect on cardiometabolic and obesity-related parameters in breast cancer prevention. Research focused on lifestyle interventions to modify risk factors and effective implementation of these techniques will contribute to further reducing breast cancer risk.

Additional References

1. García-Albéniz X, Hernán MA, Logan RW, et al. Continuation of annual screening mammography and breast cancer mortality in women older than 70 years. Ann Intern Med. 2020;172(6):381-389. doi: 10.7326/M18-1199
2. Greenlee H, Iribarren C, Rana JS, et al. Risk of cardiovascular disease in women with and without breast cancer: The Pathways Heart Study. J Clin Oncol. 2022;40(15):1647-1658. doi: 10.1200/JCO.21.01736
3. Levine ME, Lu AT, Quach A, et al. An epigenetic biomarker of aging for lifespan and healthspan. Aging (Albany NY). 2018;10(4):573-591. doi: 10.18632/aging.101414
4. Lu AT, Quach A, Wilson JG, et al. DNA methylation GrimAge strongly predicts lifespan and healthspan. Aging (Albany NY). 2019;11(2):303-327. doi: 10.18632/aging.101684
5. Belsky DW, Caspi A, Corcoran DL, et al. DunedinPACE, a DNA methylation biomarker of the pace of aging. eLife. 2022:11:e73420. doi: 10.7554/eLife.73420
6. Sehl ME, Carroll JE, Horvath S, Bower JE. The acute effects of adjuvant radiation and chemotherapy on peripheral blood epigenetic age in early stage breast cancer patients. NPJ Breast Cancer. 2020;6:23. doi: 10.1038/s41523-020-0161-3
7. Nouri M, Mohsenpour MA, Katsiki N, et al. Effect of serum lipid profile on the risk of breast cancer: Systematic review and meta-analysis of 1,628,871 women. J Clin Med. 2022;11(15):4503. doi: 10.3390/jcm11154503

Studies have shown that breast cancer survivors have increased rates of age-related conditions, including cardiovascular disease and osteoporosis among others, therefore postulating that the biological aging process may be accelerated in this population.² Among 417 women enrolled in the prospective Sister Study cohort, paired blood samples collected an average of 7.7 years apart compared three epigenetic metrics of biological aging (calculated on the basis of DNA methylation data) between women who were diagnosed and treated for breast cancer (n = 190) vs those who remained breast cancer–free (n = 227) (Kresovich et al). Women diagnosed and treated for breast cancer had higher biological aging metrics than women who were cancer-free at the time of follow-up: PhenoAgeAccel³ (standardized mean difference [β] = 0.13; P = .04), GrimAgeAccel⁴ (β = 0.14; P = .01), and DunedinPACE⁵ (β = 0.37; P < .001). Regarding breast cancer therapies received, the increases in biological aging were most striking for those women who underwent radiation. The effect of cancer treatments, specifically chemotherapy and radiation, on DNA methylation profiles and accelerating the aging process has been demonstrated in prior studies as well.⁶ Future research should strive to improve our understanding of the specific mechanisms underlying these age-related changes, identify ways to affect those which are modifiable, and positively influence long-term cognitive and functional consequences.

The association between cardiometabolic abnormalities, including obesity, hyperinsulinemia, diabetes, hypertension, and dyslipidemia, and an elevated breast cancer risk has been demonstrated in various studies.⁷ Furthermore, dysregulation of obesity-related proteins plays a role in breast cancer development and progression. A study by Xu and colleagues evaluated the temporal relationships and longitudinal associations of body mass index (BMI), cardiometabolic risk score (CRS), and obesity-related protein score (OPS) among 444 healthy women in a breast cancer screening cohort. After adjustment for demographics, lifestyle, and reproductive factors, a 1-kg/m² increase in BMI per year increased CRS in both premenopausal (0.057 unit; P = .025) and postmenopausal women (0.054 unit; P = .033) and increased OPS by 0.588 unit (P = .001) in postmenopausal women. A significant association was also observed between CRS and OPS in postmenopausal women (β = 0.281; P = .034). These results support the importance of weight management and its effect on cardiometabolic and obesity-related parameters in breast cancer prevention. Research focused on lifestyle interventions to modify risk factors and effective implementation of these techniques will contribute to further reducing breast cancer risk.

Additional References

1. García-Albéniz X, Hernán MA, Logan RW, et al. Continuation of annual screening mammography and breast cancer mortality in women older than 70 years. Ann Intern Med. 2020;172(6):381-389. doi: 10.7326/M18-1199
2. Greenlee H, Iribarren C, Rana JS, et al. Risk of cardiovascular disease in women with and without breast cancer: The Pathways Heart Study. J Clin Oncol. 2022;40(15):1647-1658. doi: 10.1200/JCO.21.01736
3. Levine ME, Lu AT, Quach A, et al. An epigenetic biomarker of aging for lifespan and healthspan. Aging (Albany NY). 2018;10(4):573-591. doi: 10.18632/aging.101414
4. Lu AT, Quach A, Wilson JG, et al. DNA methylation GrimAge strongly predicts lifespan and healthspan. Aging (Albany NY). 2019;11(2):303-327. doi: 10.18632/aging.101684
5. Belsky DW, Caspi A, Corcoran DL, et al. DunedinPACE, a DNA methylation biomarker of the pace of aging. eLife. 2022:11:e73420. doi: 10.7554/eLife.73420
6. Sehl ME, Carroll JE, Horvath S, Bower JE. The acute effects of adjuvant radiation and chemotherapy on peripheral blood epigenetic age in early stage breast cancer patients. NPJ Breast Cancer. 2020;6:23. doi: 10.1038/s41523-020-0161-3
7. Nouri M, Mohsenpour MA, Katsiki N, et al. Effect of serum lipid profile on the risk of breast cancer: Systematic review and meta-analysis of 1,628,871 women. J Clin Med. 2022;11(15):4503. doi: 10.3390/jcm11154503

To the Editor:

The term ectopic breast tissue serves as an umbrella term that encompasses breast tissue positioned in anatomically incorrect locations, including the subtypes of supernumerary and aberrant breasts.¹ However, the more frequently used term is accessory breast tissue (ABT).¹ Supernumerary breasts have diverse variations of a nipple, areola, and/or ductal tissue and can span in size from a small mole to a fully functioning breast. This breast type maintains structured ductal systems connected to the overlying skin and experiences regular changes during the reproductive cycle. In contrast, an aberrant breast is isolated breast tissue that does not contain organized ductal systems.¹ Accessory breast tissue is prevalent in up to 6.0% of the world population, with Japanese individuals being the most affected and White individuals being the least affected.¹

Accessory breasts typically are located along the milk line—the embryologic precursor to mammary glands and nipples, which extend from the axillae to the groin and regress from the caudal end spanning to the groin.² For this reason, incomplete regression of the mammary ridge results in ABT, most commonly in the axillary region.³ Accessory breast tissue usually is benign and is considered an anatomical variant; however, because the histomorphology is similar to mammary gland tissue, accessory breasts have the same proliferative potential as anatomically correct breasts and therefore can form fibroadenomas, cysts, abscesses, mastitis, or breast cancer.⁴ Accessory breast carcinomas comprise 0.3% to 0.6% of all breast malignancies.⁵ Certain genodermatoses (ie, Cowden syndrome) also may predispose patients to benign or malignant pathology in ABT.⁶ We present a rare case of accessory breast cancer in the inframammary region masquerading as a cyst. These findings were further supported by ultrasonography and mammography.

A 45-year-old White woman presented to our clinic for removal of a dermal mass underlying a supernumerary nipple at the left inframammary fold. Her medical history was noncontributory and was only remarkable for uterine fibroids. She developed pain and swelling in the left breast 1 year prior, which prompted her to seek medical attention from her primary care physician. Diagnostic mammography was negative for any concerning malignant nodules, and subsequent BRCA genetic testing also was negative. Six months after the diagnostic mammography, she continued to experience pain and swelling in the left breast and was then referred for diagnostic ultrasonography; 2 masses in the left breast suspected as infected cysts with rupture were identified (Figure 1). She was then referred to our dermatology clinic for evaluation and surgical extirpation of the suspected cyst underlying the accessory breast. The area subsequently was excised under local anesthesia, and a second similar but smaller mass also was identified adjacent to the initial growth. Dermatopathologic examination revealed an estrogen receptor– (Figure 2A) and progesterone receptor–positive (Figure 2B), ERBB2 (HER2/neu)–negative, nuclear grade III ductal carcinoma in situ (Figure 3).

Various ABT classification methods have been proposed with Brightmore⁷ categorizing polymastia into 8 subtypes: (1) complete breast; (2) glandular tissue and nipple; (3) glandular tissue and areola; (4) glandular tissue only; (5) nipple, areola, and fat; (6) nipple only; (7) areola only; and (8) patch of hair only. De Cholnokey⁸ focused on axillary polymastia, dividing it into 4 classes: (1) axillary tumor in milk line without nipple or areola; (2) axillary tumor with areola with or without pigmentation; (3) nipple or areola without underlying breast tissue; and (4) complete breast with nipple, areola, and glandular tissue. Fenench’s⁹ method is preferred and simply describes ABT as 2 subtypes: supernumerary and aberrant.^1,2,10 One study observed 6% of ABT cancers were the supernumerary type and 94% were the aberrant type.¹ Ductal lumen stagnation increases the risk for accessory breast carcinoma development.¹⁰ Men have a higher prevalence of cancer in ABT compared to anatomically correct breast tissue.¹¹

There currently is no standardized guideline for ABT cancer treatment. The initial clinical impression of cancer of ABT may be misdiagnosed as lymphadenopathy, abscesses, or lipomas.¹² The risk for misdiagnosis is higher for cancer of ABT compared to normal breast tissue and is associated with a poorer prognosis.¹ Despite multiple screening modalities, our patient’s initial breast cancer screenings proved unreliable. A mammogram failed to detect malignancy, likely secondary to the area of concern being out of the standard imaging field. Ultrasonography also was unreliable and led to misdiagnosis as an infected sebaceous cyst with rupture in our patient. Upon review of the ultrasound, concerns were raised by dermatology that the mass was more likely an epidermal inclusion cyst with rupture given the more superficial and sac-free nature of sebaceous cysts, which commonly are associated with steatocystoma multiplex.¹³ Definitive diagnosis of ductal carcinoma in situ was made with dermatopathologic examination.

Prophylactic surgical excision of ABT has been recommended, suggesting that excisional biopsy and histopathologic examination is the more appropriate method to rule out malignancy. Surgical treatment of ABT may omit any risk for malignant transformation and may provide psychological relief to patients for aesthetic reasons.^10,12,14 The risk and benefits of prophylactic excision of ABT has been compared to prophylactic mastectomy of anatomically correct breasts,¹⁵ with some clinicians considering this definitive procedure unnecessary except in high-risk patients with a strong genetic predisposition.^16,17

Accessory breast tissue should be viewed as an anatomical variant with the option of surgical removal for symptomatic concerns, such as firm nodules, discharge, and pain. Although ABT is rare and cancer in ABT is even more uncommon (<1% of all breast cancers),^5,11 clinicians should be suspicious of benign diagnostic reports when the clinical situation does not fit the proposed narrative.

To the Editor:

The term ectopic breast tissue serves as an umbrella term that encompasses breast tissue positioned in anatomically incorrect locations, including the subtypes of supernumerary and aberrant breasts.¹ However, the more frequently used term is accessory breast tissue (ABT).¹ Supernumerary breasts have diverse variations of a nipple, areola, and/or ductal tissue and can span in size from a small mole to a fully functioning breast. This breast type maintains structured ductal systems connected to the overlying skin and experiences regular changes during the reproductive cycle. In contrast, an aberrant breast is isolated breast tissue that does not contain organized ductal systems.¹ Accessory breast tissue is prevalent in up to 6.0% of the world population, with Japanese individuals being the most affected and White individuals being the least affected.¹

Accessory breasts typically are located along the milk line—the embryologic precursor to mammary glands and nipples, which extend from the axillae to the groin and regress from the caudal end spanning to the groin.² For this reason, incomplete regression of the mammary ridge results in ABT, most commonly in the axillary region.³ Accessory breast tissue usually is benign and is considered an anatomical variant; however, because the histomorphology is similar to mammary gland tissue, accessory breasts have the same proliferative potential as anatomically correct breasts and therefore can form fibroadenomas, cysts, abscesses, mastitis, or breast cancer.⁴ Accessory breast carcinomas comprise 0.3% to 0.6% of all breast malignancies.⁵ Certain genodermatoses (ie, Cowden syndrome) also may predispose patients to benign or malignant pathology in ABT.⁶ We present a rare case of accessory breast cancer in the inframammary region masquerading as a cyst. These findings were further supported by ultrasonography and mammography.

A 45-year-old White woman presented to our clinic for removal of a dermal mass underlying a supernumerary nipple at the left inframammary fold. Her medical history was noncontributory and was only remarkable for uterine fibroids. She developed pain and swelling in the left breast 1 year prior, which prompted her to seek medical attention from her primary care physician. Diagnostic mammography was negative for any concerning malignant nodules, and subsequent BRCA genetic testing also was negative. Six months after the diagnostic mammography, she continued to experience pain and swelling in the left breast and was then referred for diagnostic ultrasonography; 2 masses in the left breast suspected as infected cysts with rupture were identified (Figure 1). She was then referred to our dermatology clinic for evaluation and surgical extirpation of the suspected cyst underlying the accessory breast. The area subsequently was excised under local anesthesia, and a second similar but smaller mass also was identified adjacent to the initial growth. Dermatopathologic examination revealed an estrogen receptor– (Figure 2A) and progesterone receptor–positive (Figure 2B), ERBB2 (HER2/neu)–negative, nuclear grade III ductal carcinoma in situ (Figure 3).

Various ABT classification methods have been proposed with Brightmore⁷ categorizing polymastia into 8 subtypes: (1) complete breast; (2) glandular tissue and nipple; (3) glandular tissue and areola; (4) glandular tissue only; (5) nipple, areola, and fat; (6) nipple only; (7) areola only; and (8) patch of hair only. De Cholnokey⁸ focused on axillary polymastia, dividing it into 4 classes: (1) axillary tumor in milk line without nipple or areola; (2) axillary tumor with areola with or without pigmentation; (3) nipple or areola without underlying breast tissue; and (4) complete breast with nipple, areola, and glandular tissue. Fenench’s⁹ method is preferred and simply describes ABT as 2 subtypes: supernumerary and aberrant.^1,2,10 One study observed 6% of ABT cancers were the supernumerary type and 94% were the aberrant type.¹ Ductal lumen stagnation increases the risk for accessory breast carcinoma development.¹⁰ Men have a higher prevalence of cancer in ABT compared to anatomically correct breast tissue.¹¹

There currently is no standardized guideline for ABT cancer treatment. The initial clinical impression of cancer of ABT may be misdiagnosed as lymphadenopathy, abscesses, or lipomas.¹² The risk for misdiagnosis is higher for cancer of ABT compared to normal breast tissue and is associated with a poorer prognosis.¹ Despite multiple screening modalities, our patient’s initial breast cancer screenings proved unreliable. A mammogram failed to detect malignancy, likely secondary to the area of concern being out of the standard imaging field. Ultrasonography also was unreliable and led to misdiagnosis as an infected sebaceous cyst with rupture in our patient. Upon review of the ultrasound, concerns were raised by dermatology that the mass was more likely an epidermal inclusion cyst with rupture given the more superficial and sac-free nature of sebaceous cysts, which commonly are associated with steatocystoma multiplex.¹³ Definitive diagnosis of ductal carcinoma in situ was made with dermatopathologic examination.

Prophylactic surgical excision of ABT has been recommended, suggesting that excisional biopsy and histopathologic examination is the more appropriate method to rule out malignancy. Surgical treatment of ABT may omit any risk for malignant transformation and may provide psychological relief to patients for aesthetic reasons.^10,12,14 The risk and benefits of prophylactic excision of ABT has been compared to prophylactic mastectomy of anatomically correct breasts,¹⁵ with some clinicians considering this definitive procedure unnecessary except in high-risk patients with a strong genetic predisposition.^16,17

Accessory breast tissue should be viewed as an anatomical variant with the option of surgical removal for symptomatic concerns, such as firm nodules, discharge, and pain. Although ABT is rare and cancer in ABT is even more uncommon (<1% of all breast cancers),^5,11 clinicians should be suspicious of benign diagnostic reports when the clinical situation does not fit the proposed narrative.

To the Editor:

The term ectopic breast tissue serves as an umbrella term that encompasses breast tissue positioned in anatomically incorrect locations, including the subtypes of supernumerary and aberrant breasts.¹ However, the more frequently used term is accessory breast tissue (ABT).¹ Supernumerary breasts have diverse variations of a nipple, areola, and/or ductal tissue and can span in size from a small mole to a fully functioning breast. This breast type maintains structured ductal systems connected to the overlying skin and experiences regular changes during the reproductive cycle. In contrast, an aberrant breast is isolated breast tissue that does not contain organized ductal systems.¹ Accessory breast tissue is prevalent in up to 6.0% of the world population, with Japanese individuals being the most affected and White individuals being the least affected.¹

Accessory breasts typically are located along the milk line—the embryologic precursor to mammary glands and nipples, which extend from the axillae to the groin and regress from the caudal end spanning to the groin.² For this reason, incomplete regression of the mammary ridge results in ABT, most commonly in the axillary region.³ Accessory breast tissue usually is benign and is considered an anatomical variant; however, because the histomorphology is similar to mammary gland tissue, accessory breasts have the same proliferative potential as anatomically correct breasts and therefore can form fibroadenomas, cysts, abscesses, mastitis, or breast cancer.⁴ Accessory breast carcinomas comprise 0.3% to 0.6% of all breast malignancies.⁵ Certain genodermatoses (ie, Cowden syndrome) also may predispose patients to benign or malignant pathology in ABT.⁶ We present a rare case of accessory breast cancer in the inframammary region masquerading as a cyst. These findings were further supported by ultrasonography and mammography.

A 45-year-old White woman presented to our clinic for removal of a dermal mass underlying a supernumerary nipple at the left inframammary fold. Her medical history was noncontributory and was only remarkable for uterine fibroids. She developed pain and swelling in the left breast 1 year prior, which prompted her to seek medical attention from her primary care physician. Diagnostic mammography was negative for any concerning malignant nodules, and subsequent BRCA genetic testing also was negative. Six months after the diagnostic mammography, she continued to experience pain and swelling in the left breast and was then referred for diagnostic ultrasonography; 2 masses in the left breast suspected as infected cysts with rupture were identified (Figure 1). She was then referred to our dermatology clinic for evaluation and surgical extirpation of the suspected cyst underlying the accessory breast. The area subsequently was excised under local anesthesia, and a second similar but smaller mass also was identified adjacent to the initial growth. Dermatopathologic examination revealed an estrogen receptor– (Figure 2A) and progesterone receptor–positive (Figure 2B), ERBB2 (HER2/neu)–negative, nuclear grade III ductal carcinoma in situ (Figure 3).

Various ABT classification methods have been proposed with Brightmore⁷ categorizing polymastia into 8 subtypes: (1) complete breast; (2) glandular tissue and nipple; (3) glandular tissue and areola; (4) glandular tissue only; (5) nipple, areola, and fat; (6) nipple only; (7) areola only; and (8) patch of hair only. De Cholnokey⁸ focused on axillary polymastia, dividing it into 4 classes: (1) axillary tumor in milk line without nipple or areola; (2) axillary tumor with areola with or without pigmentation; (3) nipple or areola without underlying breast tissue; and (4) complete breast with nipple, areola, and glandular tissue. Fenench’s⁹ method is preferred and simply describes ABT as 2 subtypes: supernumerary and aberrant.^1,2,10 One study observed 6% of ABT cancers were the supernumerary type and 94% were the aberrant type.¹ Ductal lumen stagnation increases the risk for accessory breast carcinoma development.¹⁰ Men have a higher prevalence of cancer in ABT compared to anatomically correct breast tissue.¹¹

There currently is no standardized guideline for ABT cancer treatment. The initial clinical impression of cancer of ABT may be misdiagnosed as lymphadenopathy, abscesses, or lipomas.¹² The risk for misdiagnosis is higher for cancer of ABT compared to normal breast tissue and is associated with a poorer prognosis.¹ Despite multiple screening modalities, our patient’s initial breast cancer screenings proved unreliable. A mammogram failed to detect malignancy, likely secondary to the area of concern being out of the standard imaging field. Ultrasonography also was unreliable and led to misdiagnosis as an infected sebaceous cyst with rupture in our patient. Upon review of the ultrasound, concerns were raised by dermatology that the mass was more likely an epidermal inclusion cyst with rupture given the more superficial and sac-free nature of sebaceous cysts, which commonly are associated with steatocystoma multiplex.¹³ Definitive diagnosis of ductal carcinoma in situ was made with dermatopathologic examination.

Prophylactic surgical excision of ABT has been recommended, suggesting that excisional biopsy and histopathologic examination is the more appropriate method to rule out malignancy. Surgical treatment of ABT may omit any risk for malignant transformation and may provide psychological relief to patients for aesthetic reasons.^10,12,14 The risk and benefits of prophylactic excision of ABT has been compared to prophylactic mastectomy of anatomically correct breasts,¹⁵ with some clinicians considering this definitive procedure unnecessary except in high-risk patients with a strong genetic predisposition.^16,17

Accessory breast tissue should be viewed as an anatomical variant with the option of surgical removal for symptomatic concerns, such as firm nodules, discharge, and pain. Although ABT is rare and cancer in ABT is even more uncommon (<1% of all breast cancers),^5,11 clinicians should be suspicious of benign diagnostic reports when the clinical situation does not fit the proposed narrative.

Artificial intelligence (AI) technology has increasingly been incorporated in medicine. In dermatology, AI has been used to detect and diagnose skin lesions, including skin cancer.¹ ChatGPT (OpenAI) is a novel, highly popular development in generative AI technology. A large language model released in 2022, ChatGPT is a chatbot designed to mimic human conversation and generate specific detailed information when prompted. Free and publicly available, it has been used by millions of people. ChatGPT’s application in the medical field currently is being evaluated across several specialties, including plastic surgery, radiology, and urology.^2-4 ChatGPT has the potential to assist health care professionals, including dermatologists, though its use raises important ethical considerations. Herein, we focus on the potential benefits as well as the pitfalls of using ChatGPT in dermatology clinical practice.

Potential Uses of ChatGPT in Practice

A major benefit of ChatGPT is its ability to improve clinical efficiency. First, ChatGPT can provide quick access to general medical information, similar to a search engine but with more natural language processing and contextual understanding to synthesize information.⁵ This function is useful for rapid concise answers to specific and directed questions. ChatGPT also can interact with its user by asking follow-up questions to produce more precise and relevant responses; this feature may help dermatologists form more accurate differential diagnoses. Additionally, ChatGPT can increase efficiency in clinical practice by drafting generic medical documents,² including templates for after-visit summaries, postprocedure instructions, referrals, prior authorization appeal letters, and educational handouts. Importantly, increased efficiency can reduce provider burnout and lead to improved patient care. Another useful feature of ChatGPT is its ability to output information modeling human conversation. Because of this feature, ChatGPT also could be employed in clinical practice to serve as an interpreter for patients during clinic visits. Currently, the use of virtual translators can be cumbersome and subject to technical constraints. ChatGPT can provide accurate and conversational translations for patients and dermatologists, improving the patient-provider relationship.

ChatGPT also can contribute to major advancements in the field of dermatology beyond the clinical setting. Because of its ability to draw from extensive data that have already been uploaded, there are some uses of ChatGPT in a research context: to assist in finding resources for research and reviews, formulating hypotheses, drafting study protocols, and collecting large amounts of data within seconds.⁶

ChatGPT also has potential in advancing medical education. It could be used by medical schools to model interactive patient encounters to help students practice taking a patient’s history and creating differential diagnoses.⁶ This application of ChatGPT may help medical students hone their clinical skills in a low-stress environment without the restrictions that can come with hiring and training standardized patients, especially when mimicking dermatologic clinical encounters.

Other possibilities for ChatGPT in dermatologic practice include survey administration, clinical trial recruitment, and even automatic high-risk medication monitoring. Despite the many potential applications of ChatGPT in clinical practice, the question raised in each scenario is the quality, accuracy, and safety of what it produces.

Potential Pitfalls of ChatGPT in Practice and Possible Mitigation Strategies

A main concern in using ChatGPT in clinical practice is its potential to produce inaccurate or biased information. When prompted to create a research abstract based on previously published research, ChatGPT drafted abstracts that were clear and digestible but supplemented with incorrect data.⁷ A group of medical researchers who reviewed these ChatGPT-generated abstracts mistook 32% of the abstracts as having been written by human researchers. The implications of this finding are worrisome. If inaccurate or false information is used by ChatGPT in documents sent to insurance companies or patients, the patient’s safety as well as the dermatologist’s license and credibility are at stake. Thus, dermatologists looking to use ChatGPT to draft generic medical documents should actively review the output to ensure that the information is accurate. Importantly, ChatGPT also is only currently programmed with information up to 2021, limiting its access to recently published research articles and updated International Classification of Diseases, Tenth Revision codes.⁵ The continued development of ChatGPT will lead to regular updates by OpenAI that resolve this shortcoming in the future. Further, AI models may encode and perpetuate harmful stereotypes and social biases that are present in training data.⁸

When considering its potential in clinical practice, ChatGPT itself states that it can aid in clinical decision-making by processing patient information, including history, current symptoms, and biopsy and test results. This is uncharted territory, and providers who use ChatGPT at this stage to aid in decision-making should regard it similarly to information retrieved from a search engine. The information produced by ChatGPT should be used to substantiate but not definitively confirm a diagnosis or dictate management. Clinical suspicion by the dermatologist should always trump ChatGPT output. If physicians recommend ChatGPT output over their own advice, it can become a liability, as the technology is not regulated to any degree. Patients also should be cautious when seeking and following medical advice from ChatGPT, as it could be misleading or incorrect and could undermine the patient-physician relationship.⁶

Additionally, the specific use of ChatGPT to evaluate patient health records raises concerns related to patient privacy and confidentiality. Providers should never enter patient information protected by the Health Insurance Portability and Accountability Act into ChatGPT or anywhere else on the internet. Mitigation of this risk is not currently possible; ChatGPT requires more development and further understanding to even consider its integration into current electronic health records without compromising patient confidentiality.

The Bottom Line

Overall, ChatGPT has the potential to improve efficiency in clinical practice by assisting with informational searches and document drafting. Importantly, increased efficiency can reduce provider burnout and lead to improved patient care. However, dermatologists should carefully weigh the ethical issues of nonmaleficence and justice in evaluating ChatGPT for accuracy, biases, and the protection of patient confidentiality.

Finally, we asked ChatGPT on February 28, 2023, what it thinks:

User: Should dermatologists use ChatGPT in clinical practice?

ChatGPT: As an AI language model, ChatGPT can be a useful tool in dermatology clinical practice, but it should be used with caution in conjunction with other sources of information and clinical judgement.

Dermatologists should be aware of the potential benefits and risks of using ChatGPT and make informed decisions about how to integrate it into their clinical practice. It’s important to remember that ChatGPT is not a substitute for clinical expertise or human interaction with patients, and it should only be used as a supplement to enhance the quality of patient care.

Dermatologists who choose to use ChatGPT should also be aware of its limitations and potential risks, such as limited accuracy, lack of context, and liability issues if it provides incorrect information or recommendations that lead to patient harm. Dermatologists should use their professional judgement and consult with other health care professionals when making important decisions regarding patient care.

Artificial intelligence (AI) technology has increasingly been incorporated in medicine. In dermatology, AI has been used to detect and diagnose skin lesions, including skin cancer.¹ ChatGPT (OpenAI) is a novel, highly popular development in generative AI technology. A large language model released in 2022, ChatGPT is a chatbot designed to mimic human conversation and generate specific detailed information when prompted. Free and publicly available, it has been used by millions of people. ChatGPT’s application in the medical field currently is being evaluated across several specialties, including plastic surgery, radiology, and urology.^2-4 ChatGPT has the potential to assist health care professionals, including dermatologists, though its use raises important ethical considerations. Herein, we focus on the potential benefits as well as the pitfalls of using ChatGPT in dermatology clinical practice.

Potential Uses of ChatGPT in Practice

A major benefit of ChatGPT is its ability to improve clinical efficiency. First, ChatGPT can provide quick access to general medical information, similar to a search engine but with more natural language processing and contextual understanding to synthesize information.⁵ This function is useful for rapid concise answers to specific and directed questions. ChatGPT also can interact with its user by asking follow-up questions to produce more precise and relevant responses; this feature may help dermatologists form more accurate differential diagnoses. Additionally, ChatGPT can increase efficiency in clinical practice by drafting generic medical documents,² including templates for after-visit summaries, postprocedure instructions, referrals, prior authorization appeal letters, and educational handouts. Importantly, increased efficiency can reduce provider burnout and lead to improved patient care. Another useful feature of ChatGPT is its ability to output information modeling human conversation. Because of this feature, ChatGPT also could be employed in clinical practice to serve as an interpreter for patients during clinic visits. Currently, the use of virtual translators can be cumbersome and subject to technical constraints. ChatGPT can provide accurate and conversational translations for patients and dermatologists, improving the patient-provider relationship.

ChatGPT also can contribute to major advancements in the field of dermatology beyond the clinical setting. Because of its ability to draw from extensive data that have already been uploaded, there are some uses of ChatGPT in a research context: to assist in finding resources for research and reviews, formulating hypotheses, drafting study protocols, and collecting large amounts of data within seconds.⁶

ChatGPT also has potential in advancing medical education. It could be used by medical schools to model interactive patient encounters to help students practice taking a patient’s history and creating differential diagnoses.⁶ This application of ChatGPT may help medical students hone their clinical skills in a low-stress environment without the restrictions that can come with hiring and training standardized patients, especially when mimicking dermatologic clinical encounters.

Other possibilities for ChatGPT in dermatologic practice include survey administration, clinical trial recruitment, and even automatic high-risk medication monitoring. Despite the many potential applications of ChatGPT in clinical practice, the question raised in each scenario is the quality, accuracy, and safety of what it produces.

Potential Pitfalls of ChatGPT in Practice and Possible Mitigation Strategies

A main concern in using ChatGPT in clinical practice is its potential to produce inaccurate or biased information. When prompted to create a research abstract based on previously published research, ChatGPT drafted abstracts that were clear and digestible but supplemented with incorrect data.⁷ A group of medical researchers who reviewed these ChatGPT-generated abstracts mistook 32% of the abstracts as having been written by human researchers. The implications of this finding are worrisome. If inaccurate or false information is used by ChatGPT in documents sent to insurance companies or patients, the patient’s safety as well as the dermatologist’s license and credibility are at stake. Thus, dermatologists looking to use ChatGPT to draft generic medical documents should actively review the output to ensure that the information is accurate. Importantly, ChatGPT also is only currently programmed with information up to 2021, limiting its access to recently published research articles and updated International Classification of Diseases, Tenth Revision codes.⁵ The continued development of ChatGPT will lead to regular updates by OpenAI that resolve this shortcoming in the future. Further, AI models may encode and perpetuate harmful stereotypes and social biases that are present in training data.⁸

When considering its potential in clinical practice, ChatGPT itself states that it can aid in clinical decision-making by processing patient information, including history, current symptoms, and biopsy and test results. This is uncharted territory, and providers who use ChatGPT at this stage to aid in decision-making should regard it similarly to information retrieved from a search engine. The information produced by ChatGPT should be used to substantiate but not definitively confirm a diagnosis or dictate management. Clinical suspicion by the dermatologist should always trump ChatGPT output. If physicians recommend ChatGPT output over their own advice, it can become a liability, as the technology is not regulated to any degree. Patients also should be cautious when seeking and following medical advice from ChatGPT, as it could be misleading or incorrect and could undermine the patient-physician relationship.⁶

Additionally, the specific use of ChatGPT to evaluate patient health records raises concerns related to patient privacy and confidentiality. Providers should never enter patient information protected by the Health Insurance Portability and Accountability Act into ChatGPT or anywhere else on the internet. Mitigation of this risk is not currently possible; ChatGPT requires more development and further understanding to even consider its integration into current electronic health records without compromising patient confidentiality.

The Bottom Line

Overall, ChatGPT has the potential to improve efficiency in clinical practice by assisting with informational searches and document drafting. Importantly, increased efficiency can reduce provider burnout and lead to improved patient care. However, dermatologists should carefully weigh the ethical issues of nonmaleficence and justice in evaluating ChatGPT for accuracy, biases, and the protection of patient confidentiality.

Finally, we asked ChatGPT on February 28, 2023, what it thinks:

User: Should dermatologists use ChatGPT in clinical practice?

ChatGPT: As an AI language model, ChatGPT can be a useful tool in dermatology clinical practice, but it should be used with caution in conjunction with other sources of information and clinical judgement.

Dermatologists should be aware of the potential benefits and risks of using ChatGPT and make informed decisions about how to integrate it into their clinical practice. It’s important to remember that ChatGPT is not a substitute for clinical expertise or human interaction with patients, and it should only be used as a supplement to enhance the quality of patient care.

Dermatologists who choose to use ChatGPT should also be aware of its limitations and potential risks, such as limited accuracy, lack of context, and liability issues if it provides incorrect information or recommendations that lead to patient harm. Dermatologists should use their professional judgement and consult with other health care professionals when making important decisions regarding patient care.

Artificial intelligence (AI) technology has increasingly been incorporated in medicine. In dermatology, AI has been used to detect and diagnose skin lesions, including skin cancer.¹ ChatGPT (OpenAI) is a novel, highly popular development in generative AI technology. A large language model released in 2022, ChatGPT is a chatbot designed to mimic human conversation and generate specific detailed information when prompted. Free and publicly available, it has been used by millions of people. ChatGPT’s application in the medical field currently is being evaluated across several specialties, including plastic surgery, radiology, and urology.^2-4 ChatGPT has the potential to assist health care professionals, including dermatologists, though its use raises important ethical considerations. Herein, we focus on the potential benefits as well as the pitfalls of using ChatGPT in dermatology clinical practice.

Potential Uses of ChatGPT in Practice

A major benefit of ChatGPT is its ability to improve clinical efficiency. First, ChatGPT can provide quick access to general medical information, similar to a search engine but with more natural language processing and contextual understanding to synthesize information.⁵ This function is useful for rapid concise answers to specific and directed questions. ChatGPT also can interact with its user by asking follow-up questions to produce more precise and relevant responses; this feature may help dermatologists form more accurate differential diagnoses. Additionally, ChatGPT can increase efficiency in clinical practice by drafting generic medical documents,² including templates for after-visit summaries, postprocedure instructions, referrals, prior authorization appeal letters, and educational handouts. Importantly, increased efficiency can reduce provider burnout and lead to improved patient care. Another useful feature of ChatGPT is its ability to output information modeling human conversation. Because of this feature, ChatGPT also could be employed in clinical practice to serve as an interpreter for patients during clinic visits. Currently, the use of virtual translators can be cumbersome and subject to technical constraints. ChatGPT can provide accurate and conversational translations for patients and dermatologists, improving the patient-provider relationship.

ChatGPT also can contribute to major advancements in the field of dermatology beyond the clinical setting. Because of its ability to draw from extensive data that have already been uploaded, there are some uses of ChatGPT in a research context: to assist in finding resources for research and reviews, formulating hypotheses, drafting study protocols, and collecting large amounts of data within seconds.⁶

ChatGPT also has potential in advancing medical education. It could be used by medical schools to model interactive patient encounters to help students practice taking a patient’s history and creating differential diagnoses.⁶ This application of ChatGPT may help medical students hone their clinical skills in a low-stress environment without the restrictions that can come with hiring and training standardized patients, especially when mimicking dermatologic clinical encounters.

Other possibilities for ChatGPT in dermatologic practice include survey administration, clinical trial recruitment, and even automatic high-risk medication monitoring. Despite the many potential applications of ChatGPT in clinical practice, the question raised in each scenario is the quality, accuracy, and safety of what it produces.

Potential Pitfalls of ChatGPT in Practice and Possible Mitigation Strategies

A main concern in using ChatGPT in clinical practice is its potential to produce inaccurate or biased information. When prompted to create a research abstract based on previously published research, ChatGPT drafted abstracts that were clear and digestible but supplemented with incorrect data.⁷ A group of medical researchers who reviewed these ChatGPT-generated abstracts mistook 32% of the abstracts as having been written by human researchers. The implications of this finding are worrisome. If inaccurate or false information is used by ChatGPT in documents sent to insurance companies or patients, the patient’s safety as well as the dermatologist’s license and credibility are at stake. Thus, dermatologists looking to use ChatGPT to draft generic medical documents should actively review the output to ensure that the information is accurate. Importantly, ChatGPT also is only currently programmed with information up to 2021, limiting its access to recently published research articles and updated International Classification of Diseases, Tenth Revision codes.⁵ The continued development of ChatGPT will lead to regular updates by OpenAI that resolve this shortcoming in the future. Further, AI models may encode and perpetuate harmful stereotypes and social biases that are present in training data.⁸

When considering its potential in clinical practice, ChatGPT itself states that it can aid in clinical decision-making by processing patient information, including history, current symptoms, and biopsy and test results. This is uncharted territory, and providers who use ChatGPT at this stage to aid in decision-making should regard it similarly to information retrieved from a search engine. The information produced by ChatGPT should be used to substantiate but not definitively confirm a diagnosis or dictate management. Clinical suspicion by the dermatologist should always trump ChatGPT output. If physicians recommend ChatGPT output over their own advice, it can become a liability, as the technology is not regulated to any degree. Patients also should be cautious when seeking and following medical advice from ChatGPT, as it could be misleading or incorrect and could undermine the patient-physician relationship.⁶

Additionally, the specific use of ChatGPT to evaluate patient health records raises concerns related to patient privacy and confidentiality. Providers should never enter patient information protected by the Health Insurance Portability and Accountability Act into ChatGPT or anywhere else on the internet. Mitigation of this risk is not currently possible; ChatGPT requires more development and further understanding to even consider its integration into current electronic health records without compromising patient confidentiality.

The Bottom Line

Overall, ChatGPT has the potential to improve efficiency in clinical practice by assisting with informational searches and document drafting. Importantly, increased efficiency can reduce provider burnout and lead to improved patient care. However, dermatologists should carefully weigh the ethical issues of nonmaleficence and justice in evaluating ChatGPT for accuracy, biases, and the protection of patient confidentiality.

Finally, we asked ChatGPT on February 28, 2023, what it thinks:

User: Should dermatologists use ChatGPT in clinical practice?

ChatGPT: As an AI language model, ChatGPT can be a useful tool in dermatology clinical practice, but it should be used with caution in conjunction with other sources of information and clinical judgement.

Dermatologists should be aware of the potential benefits and risks of using ChatGPT and make informed decisions about how to integrate it into their clinical practice. It’s important to remember that ChatGPT is not a substitute for clinical expertise or human interaction with patients, and it should only be used as a supplement to enhance the quality of patient care.

Dermatologists who choose to use ChatGPT should also be aware of its limitations and potential risks, such as limited accuracy, lack of context, and liability issues if it provides incorrect information or recommendations that lead to patient harm. Dermatologists should use their professional judgement and consult with other health care professionals when making important decisions regarding patient care.

The Cutis Editorial Board is now accepting applications for the 2024 Resident Corner column. The Editorial Board will select 2 to 3 residents to serve as the Resident Corner columnists for 1 year. Articles are posted online only at www.mdedge.com/dermatology but will be referenced in Index Medicus. All applicants must be current residents and will be in residency throughout 2024.

For consideration, send your curriculum vitae along with a brief (not to exceed 500 words) statement of why you enjoy Cutis and what you can offer your fellow residents in contributing a monthly column.

A signed letter of recommendation from the Director of the dermatology residency program also should be supplied.

All materials should be submitted via email to Melissa Sears ([email protected]) by November 1. The residents who are selected to write the column for the upcoming year will be notified by November 15.

We look forward to continuing to educate dermatology residents on topics that are most important to them!

The Cutis Editorial Board is now accepting applications for the 2024 Resident Corner column. The Editorial Board will select 2 to 3 residents to serve as the Resident Corner columnists for 1 year. Articles are posted online only at www.mdedge.com/dermatology but will be referenced in Index Medicus. All applicants must be current residents and will be in residency throughout 2024.

For consideration, send your curriculum vitae along with a brief (not to exceed 500 words) statement of why you enjoy Cutis and what you can offer your fellow residents in contributing a monthly column.

A signed letter of recommendation from the Director of the dermatology residency program also should be supplied.

All materials should be submitted via email to Melissa Sears ([email protected]) by November 1. The residents who are selected to write the column for the upcoming year will be notified by November 15.

We look forward to continuing to educate dermatology residents on topics that are most important to them!

The Cutis Editorial Board is now accepting applications for the 2024 Resident Corner column. The Editorial Board will select 2 to 3 residents to serve as the Resident Corner columnists for 1 year. Articles are posted online only at www.mdedge.com/dermatology but will be referenced in Index Medicus. All applicants must be current residents and will be in residency throughout 2024.

For consideration, send your curriculum vitae along with a brief (not to exceed 500 words) statement of why you enjoy Cutis and what you can offer your fellow residents in contributing a monthly column.

A signed letter of recommendation from the Director of the dermatology residency program also should be supplied.

All materials should be submitted via email to Melissa Sears ([email protected]) by November 1. The residents who are selected to write the column for the upcoming year will be notified by November 15.

We look forward to continuing to educate dermatology residents on topics that are most important to them!

The Diagnosis: Neonatal Lupus Erythematosus

A review of the medical records of the patient’s mother from her first pregnancy revealed positive anti-Ro/SSA (Sjögren syndrome A) (>8.0 U [reference range <1.0 U]) and anti-La/SSB (Sjögren syndrome B) antibodies (>8.0 U [reference range <1.0 U]), which were reconfirmed during her pregnancy with our patient (the second child). The patient’s older brother was diagnosed with neonatal lupus erythematosus (NLE) 2 years prior at 1 month of age; therefore, the mother took hydroxychloroquine during the pregnancy with the second child to help prevent heart block if the child was diagnosed with NLE. Given the family history, positive antibodies in the mother, and clinical presentation, our patient was diagnosed with NLE. He was referred to a pediatric cardiologist and pediatrician to continue the workup of systemic manifestations of NLE and to rule out the presence of congenital heart block. The rash resolved 6 months after the initial presentation, and he did not develop any systemic manifestations of NLE.

Neonatal lupus erythematosus is a rare acquired autoimmune disorder caused by the placental transfer of anti-Ro/SSA and anti-La/SSB antibodies and less commonly anti-U1 ribonucleoprotein antinuclear autoantibodies.^1,2 Approximately 1% to 2% of mothers with these positive antibodies will have infants affected with NLE.² The annual prevalence of NLE in the United States is approximately 1 in 20,000 live births. Mothers of children with NLE most commonly have clinical Sjögren syndrome; however, anti-Ro/SSA and anti-LA/SSB antibodies may be present in 0.1% to 1.5% of healthy women, and 25% to 60% of women with autoimmune disease may be asymptomatic.¹ As demonstrated in our case, when there is a family history of NLE in an infant from an earlier pregnancy, the risk for NLE increases to 17% to 20% in subsequent pregnancies^1,3 and up to 25% in subsequent pregnancies if the initial child was diagnosed with a congenital heart block in the setting of NLE.¹

Neonatal lupus erythematosus classically presents as annular erythematous macules and plaques with central scaling, telangictasia, atrophy, and pigmentary changes. It may start on the scalp and face and spread caudally.^1,2 Patients may develop these lesions after UV exposure, and 80% of infants may not have dermatologic findings at birth. Importantly, 40% to 60% of mothers may be asymptomatic at the time of presentation of their child’s NLE.¹ The diagnosis can be confirmed via antibody testing in the mother and/or infant. If performed, a punch biopsy shows interface dermatitis, vacuolar degeneration, and possible periadnexal lymphocytic infiltrates on histopathology.^1,2

Management of cutaneous NLE includes sun protection (eg, application of sunscreen) and topical corticosteroids. Most dermatologic manifestations of NLE are transient, resolving after clearance of maternal IgG antibodies in 6 to 9 months; however, some telangiectasia, dyspigmentation, and atrophic scarring may persist.^1-3

Neonatal lupus erythematosus also may have hepatobiliary, cardiac, hematologic, and less commonly neurologic manifestations. Hepatobiliary manifestations usually present as hepatomegaly or asymptomatic elevated transaminases or γ-glutamyl transferase.^1,3 Approximately 10% to 20% of infants with NLE may present with transient anemia and thrombocytopenia.¹ Cardiac manifestations are permanent and may require pacemaker implantation.^1,3 The incidence of a congenital heart block in infants with NLE is 15% to 30%.³ Cardiac NLE most commonly injures the conductive tissue, leading to a congenital atrioventricular block. The development of a congenital heart block develops in the 18th to 24th week of gestation. Manifestations of a more advanced condition can include dilation of the ascending aorta and dilated cardiomyopathy.¹ As such, patients need to be followed by a pediatric cardiologist for monitoring and treatment of any cardiac manifestations.

The overall prognosis of infants affected with NLE varies. Cardiac involvement is associated with a poor prognosis, while isolated cutaneous involvement requires little treatment and portends a favorable prognosis. It is critical for dermatologists to recognize NLE to refer patients to appropriate specialists to investigate and further monitor possible extracutaneous manifestations. With an understanding of the increased risk for a congenital heart block and NLE in subsequent pregnancies, mothers with positive anti-Ro/La antibodies should receive timely counseling and screening. In expectant mothers with suspected autoimmune disease, testing for antinuclear antibodies and SSA and SSB antibodies can be considered, as administration of hydroxychloroquine or prenatal systemic corticosteroids has proven to be effective in preventing a congenital heart block.¹ Our patient was followed by pediatric cardiology and was not found to have a congenital heart block.

The differential diagnosis includes other causes of annular erythema in infants, as NLE can mimic several conditions. Tinea corporis may present as scaly annular plaques with central clearing; however, it rarely is encountered fulminantly in neonates.⁴ Erythema multiforme is a mucocutaneous hypersensitivy reaction distinguished by targetoid morphology.⁵ It is an exceedingly rare diagnosis in neonates; the average pediatric age of onset is 5.6 years.⁶ Erythema multiforme often is associated with an infection, most commonly herpes simplex virus,⁵ and mucosal involvement is common.⁶ Urticaria multiforme (also known as acute annular urticaria) is a benign disease that appears between 2 months to 3 years of age with blanchable urticarial plaques that likely are triggered by viral or bacterial infections, antibiotics, or vaccines.⁶ Specific lesions usually will resolve within 24 hours. Annular erythema of infancy is a benign and asymptomatic gyrate erythema that presents as annular plaques with palpable borders that spread centrifugally in patients younger than 1 year. Notably, lesions should periodically fade and may reappear cyclically for months to years. Evaluation for underlying disease usually is negative.⁶

The Diagnosis: Neonatal Lupus Erythematosus

A review of the medical records of the patient’s mother from her first pregnancy revealed positive anti-Ro/SSA (Sjögren syndrome A) (>8.0 U [reference range <1.0 U]) and anti-La/SSB (Sjögren syndrome B) antibodies (>8.0 U [reference range <1.0 U]), which were reconfirmed during her pregnancy with our patient (the second child). The patient’s older brother was diagnosed with neonatal lupus erythematosus (NLE) 2 years prior at 1 month of age; therefore, the mother took hydroxychloroquine during the pregnancy with the second child to help prevent heart block if the child was diagnosed with NLE. Given the family history, positive antibodies in the mother, and clinical presentation, our patient was diagnosed with NLE. He was referred to a pediatric cardiologist and pediatrician to continue the workup of systemic manifestations of NLE and to rule out the presence of congenital heart block. The rash resolved 6 months after the initial presentation, and he did not develop any systemic manifestations of NLE.

Neonatal lupus erythematosus is a rare acquired autoimmune disorder caused by the placental transfer of anti-Ro/SSA and anti-La/SSB antibodies and less commonly anti-U1 ribonucleoprotein antinuclear autoantibodies.^1,2 Approximately 1% to 2% of mothers with these positive antibodies will have infants affected with NLE.² The annual prevalence of NLE in the United States is approximately 1 in 20,000 live births. Mothers of children with NLE most commonly have clinical Sjögren syndrome; however, anti-Ro/SSA and anti-LA/SSB antibodies may be present in 0.1% to 1.5% of healthy women, and 25% to 60% of women with autoimmune disease may be asymptomatic.¹ As demonstrated in our case, when there is a family history of NLE in an infant from an earlier pregnancy, the risk for NLE increases to 17% to 20% in subsequent pregnancies^1,3 and up to 25% in subsequent pregnancies if the initial child was diagnosed with a congenital heart block in the setting of NLE.¹

Neonatal lupus erythematosus classically presents as annular erythematous macules and plaques with central scaling, telangictasia, atrophy, and pigmentary changes. It may start on the scalp and face and spread caudally.^1,2 Patients may develop these lesions after UV exposure, and 80% of infants may not have dermatologic findings at birth. Importantly, 40% to 60% of mothers may be asymptomatic at the time of presentation of their child’s NLE.¹ The diagnosis can be confirmed via antibody testing in the mother and/or infant. If performed, a punch biopsy shows interface dermatitis, vacuolar degeneration, and possible periadnexal lymphocytic infiltrates on histopathology.^1,2

Management of cutaneous NLE includes sun protection (eg, application of sunscreen) and topical corticosteroids. Most dermatologic manifestations of NLE are transient, resolving after clearance of maternal IgG antibodies in 6 to 9 months; however, some telangiectasia, dyspigmentation, and atrophic scarring may persist.^1-3

Neonatal lupus erythematosus also may have hepatobiliary, cardiac, hematologic, and less commonly neurologic manifestations. Hepatobiliary manifestations usually present as hepatomegaly or asymptomatic elevated transaminases or γ-glutamyl transferase.^1,3 Approximately 10% to 20% of infants with NLE may present with transient anemia and thrombocytopenia.¹ Cardiac manifestations are permanent and may require pacemaker implantation.^1,3 The incidence of a congenital heart block in infants with NLE is 15% to 30%.³ Cardiac NLE most commonly injures the conductive tissue, leading to a congenital atrioventricular block. The development of a congenital heart block develops in the 18th to 24th week of gestation. Manifestations of a more advanced condition can include dilation of the ascending aorta and dilated cardiomyopathy.¹ As such, patients need to be followed by a pediatric cardiologist for monitoring and treatment of any cardiac manifestations.

The overall prognosis of infants affected with NLE varies. Cardiac involvement is associated with a poor prognosis, while isolated cutaneous involvement requires little treatment and portends a favorable prognosis. It is critical for dermatologists to recognize NLE to refer patients to appropriate specialists to investigate and further monitor possible extracutaneous manifestations. With an understanding of the increased risk for a congenital heart block and NLE in subsequent pregnancies, mothers with positive anti-Ro/La antibodies should receive timely counseling and screening. In expectant mothers with suspected autoimmune disease, testing for antinuclear antibodies and SSA and SSB antibodies can be considered, as administration of hydroxychloroquine or prenatal systemic corticosteroids has proven to be effective in preventing a congenital heart block.¹ Our patient was followed by pediatric cardiology and was not found to have a congenital heart block.

The differential diagnosis includes other causes of annular erythema in infants, as NLE can mimic several conditions. Tinea corporis may present as scaly annular plaques with central clearing; however, it rarely is encountered fulminantly in neonates.⁴ Erythema multiforme is a mucocutaneous hypersensitivy reaction distinguished by targetoid morphology.⁵ It is an exceedingly rare diagnosis in neonates; the average pediatric age of onset is 5.6 years.⁶ Erythema multiforme often is associated with an infection, most commonly herpes simplex virus,⁵ and mucosal involvement is common.⁶ Urticaria multiforme (also known as acute annular urticaria) is a benign disease that appears between 2 months to 3 years of age with blanchable urticarial plaques that likely are triggered by viral or bacterial infections, antibiotics, or vaccines.⁶ Specific lesions usually will resolve within 24 hours. Annular erythema of infancy is a benign and asymptomatic gyrate erythema that presents as annular plaques with palpable borders that spread centrifugally in patients younger than 1 year. Notably, lesions should periodically fade and may reappear cyclically for months to years. Evaluation for underlying disease usually is negative.⁶

The Diagnosis: Neonatal Lupus Erythematosus

A review of the medical records of the patient’s mother from her first pregnancy revealed positive anti-Ro/SSA (Sjögren syndrome A) (>8.0 U [reference range <1.0 U]) and anti-La/SSB (Sjögren syndrome B) antibodies (>8.0 U [reference range <1.0 U]), which were reconfirmed during her pregnancy with our patient (the second child). The patient’s older brother was diagnosed with neonatal lupus erythematosus (NLE) 2 years prior at 1 month of age; therefore, the mother took hydroxychloroquine during the pregnancy with the second child to help prevent heart block if the child was diagnosed with NLE. Given the family history, positive antibodies in the mother, and clinical presentation, our patient was diagnosed with NLE. He was referred to a pediatric cardiologist and pediatrician to continue the workup of systemic manifestations of NLE and to rule out the presence of congenital heart block. The rash resolved 6 months after the initial presentation, and he did not develop any systemic manifestations of NLE.

Neonatal lupus erythematosus is a rare acquired autoimmune disorder caused by the placental transfer of anti-Ro/SSA and anti-La/SSB antibodies and less commonly anti-U1 ribonucleoprotein antinuclear autoantibodies.^1,2 Approximately 1% to 2% of mothers with these positive antibodies will have infants affected with NLE.² The annual prevalence of NLE in the United States is approximately 1 in 20,000 live births. Mothers of children with NLE most commonly have clinical Sjögren syndrome; however, anti-Ro/SSA and anti-LA/SSB antibodies may be present in 0.1% to 1.5% of healthy women, and 25% to 60% of women with autoimmune disease may be asymptomatic.¹ As demonstrated in our case, when there is a family history of NLE in an infant from an earlier pregnancy, the risk for NLE increases to 17% to 20% in subsequent pregnancies^1,3 and up to 25% in subsequent pregnancies if the initial child was diagnosed with a congenital heart block in the setting of NLE.¹

Neonatal lupus erythematosus classically presents as annular erythematous macules and plaques with central scaling, telangictasia, atrophy, and pigmentary changes. It may start on the scalp and face and spread caudally.^1,2 Patients may develop these lesions after UV exposure, and 80% of infants may not have dermatologic findings at birth. Importantly, 40% to 60% of mothers may be asymptomatic at the time of presentation of their child’s NLE.¹ The diagnosis can be confirmed via antibody testing in the mother and/or infant. If performed, a punch biopsy shows interface dermatitis, vacuolar degeneration, and possible periadnexal lymphocytic infiltrates on histopathology.^1,2

Management of cutaneous NLE includes sun protection (eg, application of sunscreen) and topical corticosteroids. Most dermatologic manifestations of NLE are transient, resolving after clearance of maternal IgG antibodies in 6 to 9 months; however, some telangiectasia, dyspigmentation, and atrophic scarring may persist.^1-3

Neonatal lupus erythematosus also may have hepatobiliary, cardiac, hematologic, and less commonly neurologic manifestations. Hepatobiliary manifestations usually present as hepatomegaly or asymptomatic elevated transaminases or γ-glutamyl transferase.^1,3 Approximately 10% to 20% of infants with NLE may present with transient anemia and thrombocytopenia.¹ Cardiac manifestations are permanent and may require pacemaker implantation.^1,3 The incidence of a congenital heart block in infants with NLE is 15% to 30%.³ Cardiac NLE most commonly injures the conductive tissue, leading to a congenital atrioventricular block. The development of a congenital heart block develops in the 18th to 24th week of gestation. Manifestations of a more advanced condition can include dilation of the ascending aorta and dilated cardiomyopathy.¹ As such, patients need to be followed by a pediatric cardiologist for monitoring and treatment of any cardiac manifestations.

The overall prognosis of infants affected with NLE varies. Cardiac involvement is associated with a poor prognosis, while isolated cutaneous involvement requires little treatment and portends a favorable prognosis. It is critical for dermatologists to recognize NLE to refer patients to appropriate specialists to investigate and further monitor possible extracutaneous manifestations. With an understanding of the increased risk for a congenital heart block and NLE in subsequent pregnancies, mothers with positive anti-Ro/La antibodies should receive timely counseling and screening. In expectant mothers with suspected autoimmune disease, testing for antinuclear antibodies and SSA and SSB antibodies can be considered, as administration of hydroxychloroquine or prenatal systemic corticosteroids has proven to be effective in preventing a congenital heart block.¹ Our patient was followed by pediatric cardiology and was not found to have a congenital heart block.

The differential diagnosis includes other causes of annular erythema in infants, as NLE can mimic several conditions. Tinea corporis may present as scaly annular plaques with central clearing; however, it rarely is encountered fulminantly in neonates.⁴ Erythema multiforme is a mucocutaneous hypersensitivy reaction distinguished by targetoid morphology.⁵ It is an exceedingly rare diagnosis in neonates; the average pediatric age of onset is 5.6 years.⁶ Erythema multiforme often is associated with an infection, most commonly herpes simplex virus,⁵ and mucosal involvement is common.⁶ Urticaria multiforme (also known as acute annular urticaria) is a benign disease that appears between 2 months to 3 years of age with blanchable urticarial plaques that likely are triggered by viral or bacterial infections, antibiotics, or vaccines.⁶ Specific lesions usually will resolve within 24 hours. Annular erythema of infancy is a benign and asymptomatic gyrate erythema that presents as annular plaques with palpable borders that spread centrifugally in patients younger than 1 year. Notably, lesions should periodically fade and may reappear cyclically for months to years. Evaluation for underlying disease usually is negative.⁶

The American Diabetes Association recommends that patients on intensive insulin regimens self-monitor blood glucose (SMBG) to assist in therapy optimization.¹ To be useful, SMBG data must be captured by patients, shared with care teams, and used and interpreted by patients and practitioners.^2,3 Communication of SMBG data from the patient to practitioner can be challenging. Although technology can help in this process, limitations exist, such as manual data entry into systems, patient and/or practitioner technological challenges (eg, accessing interface), and compatibility and integration between SMBG devices and electronic health record (EHR) systems.⁴

The Boise Veterans Affairs Medical Center (BVAMC) in Idaho serves more than 100,000 veterans. It includes a main site, community-based outpatient clinics, and a clinical resource hub that provides telehealth services to veterans residing in rural neighboring states. The BVAMC pharmacy department provides both inpatient and outpatient services. At the BVAMC, clinical pharmacist practitioners (CPPs) are independent practitioners who support their care teams in comprehensive medication management and have the ability to initiate, modify, and discontinue drug therapy for referred patients.⁵ A prominent role of CPPs in primary care teams is to manage patients with uncontrolled diabetes and intensive insulin regimens, in which SMBG data are vital to therapy optimization. As collecting SMBG data from patients is seen anecdotally as time intensive, we determined the mean time spent by CPPs collecting patient SMBG data and its potential implications.

Methods

Pharmacists at BVAMC were asked to estimate and record the following: SMBG data collection method, time spent collecting data, extra time spent documenting or formatting SMBG readings, total patient visit time, and visit type. Time was collected in minutes. Extra time spent documenting or formatting SMBG readings included any additional time formatting or entering data in the clinical note after talking to the patient; if this was done while multitasking and talking to the patient, it was not considered extra time. For total patient visit time, pharmacists were asked to estimate only time spent discussing diabetes care and collecting SMBG data. Visit types were categorized as in-person/face-to-face, telephone, and telehealth using clinical video telehealth (CVT)/VA Video Connect (VVC). Data were collected using a standardized spreadsheet. The spreadsheet was pilot tested by a CPP before distribution to all pharmacists.

CPPs were educated about the project in March 2021 and were asked to record data for a 1-week period between April 5, 2021, and April 30, 2021. One CPP also provided delayed data collected from May 17 to 21, 2021, and these data were included in our analysis.

Descriptive statistics were used to determine the mean time spent by CPPs collecting SMBG data. Unpaired t tests were used to compare time spent collecting SMBG data by different collection methods and patient visit types. A P value of ≤ .05 was considered statistically significant. Data were organized in Microsoft Excel, and statistics were completed with JMP Pro v15.

Results

Eight CPPs provided data from 120 patient encounters. For all patient encounter types, the mean time spent collecting SMBG data was 3.3 minutes, and completing additional documentation/formatting was 1.3 minutes (Table 1).

When compared by the SMBG collection method, the longest time spent collecting SMBG data was with patient report (3.7 minutes), and the longest time spent documenting/formatting time was with meter download/home telehealth (2 minutes). There was no statistically significant difference in the time to collect SMBG data between patient report and other methods (3.7 minutes vs 2.8 minutes; P = .07).

When compared by visit type, there was not a statistically significant difference between time spent collecting SMBG data (3.8 minutes vs 3.2 minutes; P = .39) (Table 2).

Discussion

We found that the mean amount of time spent collecting and documenting/formatting SMBG data was only 4.6 minutes; however, this still represented a substantial portion of visit time. For telephone and CVT/VVC appointments, this represented > 25% of total visit time. While CPPs make important contributions to interprofessional team management of patients with diabetes, their cost is not trivial.^6-8 It is worth exploring the most effective and efficient ways to use CPPs. Our results indicate that streamlining SMBG data collection may be beneficial.

Pharmacy technicians, licensed practical nurses/clinical associates, registered nurses/nurse care managers, or other team members could help improve SMBG data collection. Using other team members is also an opportunity for comanagement, for team collaboration, and for more patients to be seen. For example, if a CPP currently has 12 patient encounters that last 20 minutes each, this results in about 240 minutes of direct patient care. If patient encounters were 16 minutes, CPPS could have 15 patient encounters in 240 minutes. Saved time could be used for other clinical tasks involved in disease management or clinical reminder reviews. While there are benefits to CPPs collecting SMBG data, such as further inquiry about patient-reported values, other team members could also be trained to ask appropriate follow-up questions for abnormal blood glucose readings. In addition, leveraging current team members and optimizing their roles could prevent the need to acquire additional full-time equivalent employees.

Another opportunity to increase efficiency in SMBG data collection is with SMBG devices and EHR integration.^4,9 However, integration can be difficult with different types of SMBG devices and EHR platforms. Education for patients and practitioners could help to ensure accurate and reliable data uploads; patient internet availability; data protection, privacy, and sharing; workflow management; and clear patient-practitioner expectations.¹⁰ For example, if patient SMBG data are automatically uploaded to practitioners, patients’ expectations for practitioner review of data and follow-up need to be determined.

We found a subset of patient encounters (n = 23) where data collection and documenting/formatting represented more than half of the total visit time. In this subset, 13 SMBG reports were pulled from a log or meter, 8 were patient reported, and 3 were meter download or home telehealth.

Limitations

A potential reason for the lack of statistically significant differences in SMBG collection method or visit type in this study includes the small sample size. Participation in this work was voluntary, and all participating CPPs had ≥ 3 years of practice in their current setting, which includes a heavy workload of diabetes management. These pharmacists noted self-established procedures/systems for SMBG data collection, including the use of Excel spreadsheets with pregenerated formulas. For less experienced CPPs, SMBG data collection time may be even longer. Pharmacists also noted that they may limit time spent collecting SMBG data depending on the patient encounter and whether they have gathered sufficient data to guide clinical care. Other limitations of this work include data collection from a single institution and that the time documented represented estimates; there was no external monitor.

Conclusions

In this analysis, we found that CPPs spend about 3 minutes collecting SMBG data from patients, and about an additional 1 minute documenting and formatting data. While 4 to 5 minutes may not represent a substantial amount of time for one patient, it can be when multiplied by several patient encounters. The time spent collecting SMBG data did not significantly differ by collection method or visit type. Opportunities to increase efficiency in SMBG data collection, such as the use of nonpharmacist team members are worth exploring.

Acknowledgments

Thank you to the pharmacists at the Boise Veterans Affairs Medical Center for their time and support of this work: Danielle Ahlstrom, Paul Black, Robyn Cruz, Sarah Naidoo, Anthony Nelson, Laura Spoutz, Eileen Twomey, Donovan Victorine, and Michelle Wilkin.

The American Diabetes Association recommends that patients on intensive insulin regimens self-monitor blood glucose (SMBG) to assist in therapy optimization.¹ To be useful, SMBG data must be captured by patients, shared with care teams, and used and interpreted by patients and practitioners.^2,3 Communication of SMBG data from the patient to practitioner can be challenging. Although technology can help in this process, limitations exist, such as manual data entry into systems, patient and/or practitioner technological challenges (eg, accessing interface), and compatibility and integration between SMBG devices and electronic health record (EHR) systems.⁴

The Boise Veterans Affairs Medical Center (BVAMC) in Idaho serves more than 100,000 veterans. It includes a main site, community-based outpatient clinics, and a clinical resource hub that provides telehealth services to veterans residing in rural neighboring states. The BVAMC pharmacy department provides both inpatient and outpatient services. At the BVAMC, clinical pharmacist practitioners (CPPs) are independent practitioners who support their care teams in comprehensive medication management and have the ability to initiate, modify, and discontinue drug therapy for referred patients.⁵ A prominent role of CPPs in primary care teams is to manage patients with uncontrolled diabetes and intensive insulin regimens, in which SMBG data are vital to therapy optimization. As collecting SMBG data from patients is seen anecdotally as time intensive, we determined the mean time spent by CPPs collecting patient SMBG data and its potential implications.

Methods

Pharmacists at BVAMC were asked to estimate and record the following: SMBG data collection method, time spent collecting data, extra time spent documenting or formatting SMBG readings, total patient visit time, and visit type. Time was collected in minutes. Extra time spent documenting or formatting SMBG readings included any additional time formatting or entering data in the clinical note after talking to the patient; if this was done while multitasking and talking to the patient, it was not considered extra time. For total patient visit time, pharmacists were asked to estimate only time spent discussing diabetes care and collecting SMBG data. Visit types were categorized as in-person/face-to-face, telephone, and telehealth using clinical video telehealth (CVT)/VA Video Connect (VVC). Data were collected using a standardized spreadsheet. The spreadsheet was pilot tested by a CPP before distribution to all pharmacists.

CPPs were educated about the project in March 2021 and were asked to record data for a 1-week period between April 5, 2021, and April 30, 2021. One CPP also provided delayed data collected from May 17 to 21, 2021, and these data were included in our analysis.

Descriptive statistics were used to determine the mean time spent by CPPs collecting SMBG data. Unpaired t tests were used to compare time spent collecting SMBG data by different collection methods and patient visit types. A P value of ≤ .05 was considered statistically significant. Data were organized in Microsoft Excel, and statistics were completed with JMP Pro v15.

Results

Eight CPPs provided data from 120 patient encounters. For all patient encounter types, the mean time spent collecting SMBG data was 3.3 minutes, and completing additional documentation/formatting was 1.3 minutes (Table 1).

When compared by the SMBG collection method, the longest time spent collecting SMBG data was with patient report (3.7 minutes), and the longest time spent documenting/formatting time was with meter download/home telehealth (2 minutes). There was no statistically significant difference in the time to collect SMBG data between patient report and other methods (3.7 minutes vs 2.8 minutes; P = .07).

When compared by visit type, there was not a statistically significant difference between time spent collecting SMBG data (3.8 minutes vs 3.2 minutes; P = .39) (Table 2).

Discussion

We found that the mean amount of time spent collecting and documenting/formatting SMBG data was only 4.6 minutes; however, this still represented a substantial portion of visit time. For telephone and CVT/VVC appointments, this represented > 25% of total visit time. While CPPs make important contributions to interprofessional team management of patients with diabetes, their cost is not trivial.^6-8 It is worth exploring the most effective and efficient ways to use CPPs. Our results indicate that streamlining SMBG data collection may be beneficial.

Pharmacy technicians, licensed practical nurses/clinical associates, registered nurses/nurse care managers, or other team members could help improve SMBG data collection. Using other team members is also an opportunity for comanagement, for team collaboration, and for more patients to be seen. For example, if a CPP currently has 12 patient encounters that last 20 minutes each, this results in about 240 minutes of direct patient care. If patient encounters were 16 minutes, CPPS could have 15 patient encounters in 240 minutes. Saved time could be used for other clinical tasks involved in disease management or clinical reminder reviews. While there are benefits to CPPs collecting SMBG data, such as further inquiry about patient-reported values, other team members could also be trained to ask appropriate follow-up questions for abnormal blood glucose readings. In addition, leveraging current team members and optimizing their roles could prevent the need to acquire additional full-time equivalent employees.

Another opportunity to increase efficiency in SMBG data collection is with SMBG devices and EHR integration.^4,9 However, integration can be difficult with different types of SMBG devices and EHR platforms. Education for patients and practitioners could help to ensure accurate and reliable data uploads; patient internet availability; data protection, privacy, and sharing; workflow management; and clear patient-practitioner expectations.¹⁰ For example, if patient SMBG data are automatically uploaded to practitioners, patients’ expectations for practitioner review of data and follow-up need to be determined.

We found a subset of patient encounters (n = 23) where data collection and documenting/formatting represented more than half of the total visit time. In this subset, 13 SMBG reports were pulled from a log or meter, 8 were patient reported, and 3 were meter download or home telehealth.

Limitations

A potential reason for the lack of statistically significant differences in SMBG collection method or visit type in this study includes the small sample size. Participation in this work was voluntary, and all participating CPPs had ≥ 3 years of practice in their current setting, which includes a heavy workload of diabetes management. These pharmacists noted self-established procedures/systems for SMBG data collection, including the use of Excel spreadsheets with pregenerated formulas. For less experienced CPPs, SMBG data collection time may be even longer. Pharmacists also noted that they may limit time spent collecting SMBG data depending on the patient encounter and whether they have gathered sufficient data to guide clinical care. Other limitations of this work include data collection from a single institution and that the time documented represented estimates; there was no external monitor.

Conclusions

In this analysis, we found that CPPs spend about 3 minutes collecting SMBG data from patients, and about an additional 1 minute documenting and formatting data. While 4 to 5 minutes may not represent a substantial amount of time for one patient, it can be when multiplied by several patient encounters. The time spent collecting SMBG data did not significantly differ by collection method or visit type. Opportunities to increase efficiency in SMBG data collection, such as the use of nonpharmacist team members are worth exploring.

Acknowledgments

Thank you to the pharmacists at the Boise Veterans Affairs Medical Center for their time and support of this work: Danielle Ahlstrom, Paul Black, Robyn Cruz, Sarah Naidoo, Anthony Nelson, Laura Spoutz, Eileen Twomey, Donovan Victorine, and Michelle Wilkin.

The American Diabetes Association recommends that patients on intensive insulin regimens self-monitor blood glucose (SMBG) to assist in therapy optimization.¹ To be useful, SMBG data must be captured by patients, shared with care teams, and used and interpreted by patients and practitioners.^2,3 Communication of SMBG data from the patient to practitioner can be challenging. Although technology can help in this process, limitations exist, such as manual data entry into systems, patient and/or practitioner technological challenges (eg, accessing interface), and compatibility and integration between SMBG devices and electronic health record (EHR) systems.⁴

The Boise Veterans Affairs Medical Center (BVAMC) in Idaho serves more than 100,000 veterans. It includes a main site, community-based outpatient clinics, and a clinical resource hub that provides telehealth services to veterans residing in rural neighboring states. The BVAMC pharmacy department provides both inpatient and outpatient services. At the BVAMC, clinical pharmacist practitioners (CPPs) are independent practitioners who support their care teams in comprehensive medication management and have the ability to initiate, modify, and discontinue drug therapy for referred patients.⁵ A prominent role of CPPs in primary care teams is to manage patients with uncontrolled diabetes and intensive insulin regimens, in which SMBG data are vital to therapy optimization. As collecting SMBG data from patients is seen anecdotally as time intensive, we determined the mean time spent by CPPs collecting patient SMBG data and its potential implications.

Methods

Pharmacists at BVAMC were asked to estimate and record the following: SMBG data collection method, time spent collecting data, extra time spent documenting or formatting SMBG readings, total patient visit time, and visit type. Time was collected in minutes. Extra time spent documenting or formatting SMBG readings included any additional time formatting or entering data in the clinical note after talking to the patient; if this was done while multitasking and talking to the patient, it was not considered extra time. For total patient visit time, pharmacists were asked to estimate only time spent discussing diabetes care and collecting SMBG data. Visit types were categorized as in-person/face-to-face, telephone, and telehealth using clinical video telehealth (CVT)/VA Video Connect (VVC). Data were collected using a standardized spreadsheet. The spreadsheet was pilot tested by a CPP before distribution to all pharmacists.

CPPs were educated about the project in March 2021 and were asked to record data for a 1-week period between April 5, 2021, and April 30, 2021. One CPP also provided delayed data collected from May 17 to 21, 2021, and these data were included in our analysis.

Descriptive statistics were used to determine the mean time spent by CPPs collecting SMBG data. Unpaired t tests were used to compare time spent collecting SMBG data by different collection methods and patient visit types. A P value of ≤ .05 was considered statistically significant. Data were organized in Microsoft Excel, and statistics were completed with JMP Pro v15.

Results

Eight CPPs provided data from 120 patient encounters. For all patient encounter types, the mean time spent collecting SMBG data was 3.3 minutes, and completing additional documentation/formatting was 1.3 minutes (Table 1).

When compared by the SMBG collection method, the longest time spent collecting SMBG data was with patient report (3.7 minutes), and the longest time spent documenting/formatting time was with meter download/home telehealth (2 minutes). There was no statistically significant difference in the time to collect SMBG data between patient report and other methods (3.7 minutes vs 2.8 minutes; P = .07).

When compared by visit type, there was not a statistically significant difference between time spent collecting SMBG data (3.8 minutes vs 3.2 minutes; P = .39) (Table 2).

Discussion

We found that the mean amount of time spent collecting and documenting/formatting SMBG data was only 4.6 minutes; however, this still represented a substantial portion of visit time. For telephone and CVT/VVC appointments, this represented > 25% of total visit time. While CPPs make important contributions to interprofessional team management of patients with diabetes, their cost is not trivial.^6-8 It is worth exploring the most effective and efficient ways to use CPPs. Our results indicate that streamlining SMBG data collection may be beneficial.

Pharmacy technicians, licensed practical nurses/clinical associates, registered nurses/nurse care managers, or other team members could help improve SMBG data collection. Using other team members is also an opportunity for comanagement, for team collaboration, and for more patients to be seen. For example, if a CPP currently has 12 patient encounters that last 20 minutes each, this results in about 240 minutes of direct patient care. If patient encounters were 16 minutes, CPPS could have 15 patient encounters in 240 minutes. Saved time could be used for other clinical tasks involved in disease management or clinical reminder reviews. While there are benefits to CPPs collecting SMBG data, such as further inquiry about patient-reported values, other team members could also be trained to ask appropriate follow-up questions for abnormal blood glucose readings. In addition, leveraging current team members and optimizing their roles could prevent the need to acquire additional full-time equivalent employees.

Another opportunity to increase efficiency in SMBG data collection is with SMBG devices and EHR integration.^4,9 However, integration can be difficult with different types of SMBG devices and EHR platforms. Education for patients and practitioners could help to ensure accurate and reliable data uploads; patient internet availability; data protection, privacy, and sharing; workflow management; and clear patient-practitioner expectations.¹⁰ For example, if patient SMBG data are automatically uploaded to practitioners, patients’ expectations for practitioner review of data and follow-up need to be determined.

We found a subset of patient encounters (n = 23) where data collection and documenting/formatting represented more than half of the total visit time. In this subset, 13 SMBG reports were pulled from a log or meter, 8 were patient reported, and 3 were meter download or home telehealth.

Limitations

A potential reason for the lack of statistically significant differences in SMBG collection method or visit type in this study includes the small sample size. Participation in this work was voluntary, and all participating CPPs had ≥ 3 years of practice in their current setting, which includes a heavy workload of diabetes management. These pharmacists noted self-established procedures/systems for SMBG data collection, including the use of Excel spreadsheets with pregenerated formulas. For less experienced CPPs, SMBG data collection time may be even longer. Pharmacists also noted that they may limit time spent collecting SMBG data depending on the patient encounter and whether they have gathered sufficient data to guide clinical care. Other limitations of this work include data collection from a single institution and that the time documented represented estimates; there was no external monitor.

Conclusions

In this analysis, we found that CPPs spend about 3 minutes collecting SMBG data from patients, and about an additional 1 minute documenting and formatting data. While 4 to 5 minutes may not represent a substantial amount of time for one patient, it can be when multiplied by several patient encounters. The time spent collecting SMBG data did not significantly differ by collection method or visit type. Opportunities to increase efficiency in SMBG data collection, such as the use of nonpharmacist team members are worth exploring.

Acknowledgments

Thank you to the pharmacists at the Boise Veterans Affairs Medical Center for their time and support of this work: Danielle Ahlstrom, Paul Black, Robyn Cruz, Sarah Naidoo, Anthony Nelson, Laura Spoutz, Eileen Twomey, Donovan Victorine, and Michelle Wilkin.

Key clinical point: Serum levels of thymic stromal lymphopoietin (TSLP) are significantly elevated in patients with atopic dermatitis (AD), with the levels being significantly higher in adults than in children and increasing significantly corresponding to the severity of AD.

Major finding: Patients with AD vs control individuals had significantly higher serum levels of TSLP (standardized mean difference [SMD] 2.21; P < .001). Serum TSLP levels were significantly higher in adults vs children with AD (P = .02) and had a significant positive association with AD severity (mild: SMD 1.15; P = .025; moderate: SMD 2.48; P = .024; severe: SMD 8.28; P = .000002).

Study details: The data come from a meta-analysis of 14 studies involving 1032 patients with AD and 416 control individuals without AD.

Disclosures: This study was funded by the Universidad Nacional Autónoma de México. The authors declared no conflicts of interest.

Source: García-Reyes MM et al. Serum thymic stromal lymphopoietin (TSLP) levels in atopic dermatitis patients: A systematic review and meta-analysis. Clin Exp Med. 2023 (Jul 29). doi: 10.1007/s10238-023-01147-5

Key clinical point: Serum levels of thymic stromal lymphopoietin (TSLP) are significantly elevated in patients with atopic dermatitis (AD), with the levels being significantly higher in adults than in children and increasing significantly corresponding to the severity of AD.

Major finding: Patients with AD vs control individuals had significantly higher serum levels of TSLP (standardized mean difference [SMD] 2.21; P < .001). Serum TSLP levels were significantly higher in adults vs children with AD (P = .02) and had a significant positive association with AD severity (mild: SMD 1.15; P = .025; moderate: SMD 2.48; P = .024; severe: SMD 8.28; P = .000002).

Study details: The data come from a meta-analysis of 14 studies involving 1032 patients with AD and 416 control individuals without AD.

Disclosures: This study was funded by the Universidad Nacional Autónoma de México. The authors declared no conflicts of interest.

Source: García-Reyes MM et al. Serum thymic stromal lymphopoietin (TSLP) levels in atopic dermatitis patients: A systematic review and meta-analysis. Clin Exp Med. 2023 (Jul 29). doi: 10.1007/s10238-023-01147-5

Key clinical point: Serum levels of thymic stromal lymphopoietin (TSLP) are significantly elevated in patients with atopic dermatitis (AD), with the levels being significantly higher in adults than in children and increasing significantly corresponding to the severity of AD.

Major finding: Patients with AD vs control individuals had significantly higher serum levels of TSLP (standardized mean difference [SMD] 2.21; P < .001). Serum TSLP levels were significantly higher in adults vs children with AD (P = .02) and had a significant positive association with AD severity (mild: SMD 1.15; P = .025; moderate: SMD 2.48; P = .024; severe: SMD 8.28; P = .000002).

Study details: The data come from a meta-analysis of 14 studies involving 1032 patients with AD and 416 control individuals without AD.

Disclosures: This study was funded by the Universidad Nacional Autónoma de México. The authors declared no conflicts of interest.

Source: García-Reyes MM et al. Serum thymic stromal lymphopoietin (TSLP) levels in atopic dermatitis patients: A systematic review and meta-analysis. Clin Exp Med. 2023 (Jul 29). doi: 10.1007/s10238-023-01147-5

Key clinical point: Dupilumab demonstrates favorable efficacy and manageable safety in pediatric patients with atopic dermatitis (AD), with greater improvements in clinical signs observed with an increase in the treatment duration.

Major finding: The overall pooled Eczema Area and Severity Index (EASI) 75 response rate was 57.4% (95% CI 48.1%-66.2%), whereas an Investigator's Global Assessment score of 0 or 1 was achieved by 35.2% (29.3%-41.5%) of patients. EASI 75 response rates were 26.8% (95% CI 20.7%-33.9%) and 84.9% (95% CI 79.6%-89.0%) after 2-8 weeks and 32-52 weeks of treatment, respectively. Treatment-emergent adverse events were mostly mild-to-moderate in severity.

Study details: This meta-analysis included 18 studies (7 clinical and 11 observational) involving 1275 children and adolescents with AD.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Xu Y et al. Efficacy and safety profile of dupilumab for the treatment of atopic dermatitis in children and adolescents: A systematic review and meta-analysis. Pediatr Dermatol. 2023 (Aug 2). doi: 10.1111/pde.15398

Key clinical point: Dupilumab demonstrates favorable efficacy and manageable safety in pediatric patients with atopic dermatitis (AD), with greater improvements in clinical signs observed with an increase in the treatment duration.

Major finding: The overall pooled Eczema Area and Severity Index (EASI) 75 response rate was 57.4% (95% CI 48.1%-66.2%), whereas an Investigator's Global Assessment score of 0 or 1 was achieved by 35.2% (29.3%-41.5%) of patients. EASI 75 response rates were 26.8% (95% CI 20.7%-33.9%) and 84.9% (95% CI 79.6%-89.0%) after 2-8 weeks and 32-52 weeks of treatment, respectively. Treatment-emergent adverse events were mostly mild-to-moderate in severity.

Study details: This meta-analysis included 18 studies (7 clinical and 11 observational) involving 1275 children and adolescents with AD.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Xu Y et al. Efficacy and safety profile of dupilumab for the treatment of atopic dermatitis in children and adolescents: A systematic review and meta-analysis. Pediatr Dermatol. 2023 (Aug 2). doi: 10.1111/pde.15398

Key clinical point: Dupilumab demonstrates favorable efficacy and manageable safety in pediatric patients with atopic dermatitis (AD), with greater improvements in clinical signs observed with an increase in the treatment duration.

Major finding: The overall pooled Eczema Area and Severity Index (EASI) 75 response rate was 57.4% (95% CI 48.1%-66.2%), whereas an Investigator's Global Assessment score of 0 or 1 was achieved by 35.2% (29.3%-41.5%) of patients. EASI 75 response rates were 26.8% (95% CI 20.7%-33.9%) and 84.9% (95% CI 79.6%-89.0%) after 2-8 weeks and 32-52 weeks of treatment, respectively. Treatment-emergent adverse events were mostly mild-to-moderate in severity.

Study details: This meta-analysis included 18 studies (7 clinical and 11 observational) involving 1275 children and adolescents with AD.

Disclosures: This study was supported by the National Natural Science Foundation of China. The authors declared no conflicts of interest.

Source: Xu Y et al. Efficacy and safety profile of dupilumab for the treatment of atopic dermatitis in children and adolescents: A systematic review and meta-analysis. Pediatr Dermatol. 2023 (Aug 2). doi: 10.1111/pde.15398

Key clinical point: Reduction in dupilumab dose to every 3 or 4 weeks does not decrease its efficacy in patients with persistently-controlled atopic dermatitis (AD), with clinical outcome measures remaining stable over time.

Major finding: After 144 weeks, similar to patients receiving 300 mg dupilumab every 2 weeks, those receiving 300 mg dupilumab every 3 and 4 weeks had significantly decreased mean Eczema Area and Severity Index, Severity Scoring of Atopic Dermatitis, Pruritus Numerical Rating Scale, and Sleep Numerical Rating Scale scores (all P < .05).

Study details: This multicenter retrospective observational study included 54 patients age ≥ 16 years with controlled moderate-to-severe AD treated with dupilumab for ≥ 1 year who were assigned to receive 300 mg dupilumab every 2 weeks (n = 27), 3 weeks (n = 17), or 4 weeks (n = 10).

Disclosures: This study received no specific funding from any sources. The authors declared no conflicts of interest.

Source: Sánchez-García V et al. Evaluation of dupilumab dosing regimen in patients with persistently controlled atopic dermatitis. J Eur Acad Dermatol Venereol. 2023 (Jul 17). doi: 10.1111/jdv.19348

Key clinical point: Reduction in dupilumab dose to every 3 or 4 weeks does not decrease its efficacy in patients with persistently-controlled atopic dermatitis (AD), with clinical outcome measures remaining stable over time.

Major finding: After 144 weeks, similar to patients receiving 300 mg dupilumab every 2 weeks, those receiving 300 mg dupilumab every 3 and 4 weeks had significantly decreased mean Eczema Area and Severity Index, Severity Scoring of Atopic Dermatitis, Pruritus Numerical Rating Scale, and Sleep Numerical Rating Scale scores (all P < .05).

Study details: This multicenter retrospective observational study included 54 patients age ≥ 16 years with controlled moderate-to-severe AD treated with dupilumab for ≥ 1 year who were assigned to receive 300 mg dupilumab every 2 weeks (n = 27), 3 weeks (n = 17), or 4 weeks (n = 10).

Disclosures: This study received no specific funding from any sources. The authors declared no conflicts of interest.

Source: Sánchez-García V et al. Evaluation of dupilumab dosing regimen in patients with persistently controlled atopic dermatitis. J Eur Acad Dermatol Venereol. 2023 (Jul 17). doi: 10.1111/jdv.19348

Key clinical point: Reduction in dupilumab dose to every 3 or 4 weeks does not decrease its efficacy in patients with persistently-controlled atopic dermatitis (AD), with clinical outcome measures remaining stable over time.

Major finding: After 144 weeks, similar to patients receiving 300 mg dupilumab every 2 weeks, those receiving 300 mg dupilumab every 3 and 4 weeks had significantly decreased mean Eczema Area and Severity Index, Severity Scoring of Atopic Dermatitis, Pruritus Numerical Rating Scale, and Sleep Numerical Rating Scale scores (all P < .05).

Study details: This multicenter retrospective observational study included 54 patients age ≥ 16 years with controlled moderate-to-severe AD treated with dupilumab for ≥ 1 year who were assigned to receive 300 mg dupilumab every 2 weeks (n = 27), 3 weeks (n = 17), or 4 weeks (n = 10).

Disclosures: This study received no specific funding from any sources. The authors declared no conflicts of interest.

Source: Sánchez-García V et al. Evaluation of dupilumab dosing regimen in patients with persistently controlled atopic dermatitis. J Eur Acad Dermatol Venereol. 2023 (Jul 17). doi: 10.1111/jdv.19348