Markette Smith

Internists and family physicians no longer account for most office visits by adolescents.

New data reveal that between 2000 and 2006, the proportion of visits by adolescents (aged 11-17 years) to general pediatricians increased from 38% to 53% (J. Pediatr. 2010 [doi:10.1016/j.jpeds.2010.01.003]).

“Previously it had been the case that this age group had a majority of visits to family physicians or internists,” noted Dr. Gary L. Freed and his associates at the University of Michigan, Ann Arbor, and the research committee of American Board of Pediatrics.

The reasons for the steady, upward shift could be due to a series of demographic trends in the United States, most notably the increasing number of older Americans, Dr. Freed and his associates said.

“Because a growing proportion of the population in the United States is in the adult and elder age range, it follows that family physicians, who care for patients across the life course, would have similar growing proportions of their patient panels at the expense of pediatric patients.”

As a result, there are fewer family physicians who are performing obstetrics, which affects the number of newborns entering their practices, the investigators noted.

Financial considerations also may help explain why internists and family physicians are seeing fewer child patients. The fact that Medicare reimbursement rates for the elderly are higher than Medicaid reimbursement rates for pediatric patients may be a factor, Dr. Freed noted.

In addition, concerns about an actual or imminent nationwide shortage of primary care physicians for adults and the elderly may be driving some family physicians and internists to focus exclusively on those age ranges (JAMA 2009;301:1920-2).

Researchers examined data from the National Ambulatory Medical Care Surveys (NAMCS). The surveys, which used a physician-patient encounter (doctor's visit) as a sampling unit, were conducted between 1980 and 2006 by the Centers for Disease Control and Prevention's National Center for Health Statistics. During the years studied, the total number of samples ranged from 20,760 to 71,594.

Physicians across 15 specialties were examined: family practice, osteopathy, internal medicine, pediatrics, general surgery, obstetrics and gynecology, orthopedic surgery, cardiovascular diseases, dermatology, urology, psychiatry, neurology, ophthalmology, otolaryngology, and a category containing all the other specialties.

The NAMCS then divided the physician specialties into four subcategories: pediatric generalists, pediatric specialists, nonpediatric generalists, and nonpediatric specialists.

The trend of more and more children seeking care from pediatricians (as opposed to nonpediatric generalists and nonpediatric specialists) is likely to continue as long as the elderly remain America's “fasting-growing age range,” Dr. Freed wrote.

The study also showed that the number of visits made by all children—from infancy to adulthood—to general pediatricians also continues to grow. The percentage of nonsurgical physician office visits that children aged 0-17 years made to general pediatricians rose to 71%. This is a 10% increase since 1996.

Disclosures: This study was funded by a grant from the American Board of Pediatrics Foundation. Dr. Freed and his colleagues reported no conflicts of interest.

Internists and family physicians no longer account for most office visits by adolescents.

New data reveal that between 2000 and 2006, the proportion of visits by adolescents (aged 11-17 years) to general pediatricians increased from 38% to 53% (J. Pediatr. 2010 [doi:10.1016/j.jpeds.2010.01.003]).

“Previously it had been the case that this age group had a majority of visits to family physicians or internists,” noted Dr. Gary L. Freed and his associates at the University of Michigan, Ann Arbor, and the research committee of American Board of Pediatrics.

The reasons for the steady, upward shift could be due to a series of demographic trends in the United States, most notably the increasing number of older Americans, Dr. Freed and his associates said.

“Because a growing proportion of the population in the United States is in the adult and elder age range, it follows that family physicians, who care for patients across the life course, would have similar growing proportions of their patient panels at the expense of pediatric patients.”

As a result, there are fewer family physicians who are performing obstetrics, which affects the number of newborns entering their practices, the investigators noted.

Financial considerations also may help explain why internists and family physicians are seeing fewer child patients. The fact that Medicare reimbursement rates for the elderly are higher than Medicaid reimbursement rates for pediatric patients may be a factor, Dr. Freed noted.

In addition, concerns about an actual or imminent nationwide shortage of primary care physicians for adults and the elderly may be driving some family physicians and internists to focus exclusively on those age ranges (JAMA 2009;301:1920-2).

Researchers examined data from the National Ambulatory Medical Care Surveys (NAMCS). The surveys, which used a physician-patient encounter (doctor's visit) as a sampling unit, were conducted between 1980 and 2006 by the Centers for Disease Control and Prevention's National Center for Health Statistics. During the years studied, the total number of samples ranged from 20,760 to 71,594.

Physicians across 15 specialties were examined: family practice, osteopathy, internal medicine, pediatrics, general surgery, obstetrics and gynecology, orthopedic surgery, cardiovascular diseases, dermatology, urology, psychiatry, neurology, ophthalmology, otolaryngology, and a category containing all the other specialties.

The NAMCS then divided the physician specialties into four subcategories: pediatric generalists, pediatric specialists, nonpediatric generalists, and nonpediatric specialists.

The trend of more and more children seeking care from pediatricians (as opposed to nonpediatric generalists and nonpediatric specialists) is likely to continue as long as the elderly remain America's “fasting-growing age range,” Dr. Freed wrote.

The study also showed that the number of visits made by all children—from infancy to adulthood—to general pediatricians also continues to grow. The percentage of nonsurgical physician office visits that children aged 0-17 years made to general pediatricians rose to 71%. This is a 10% increase since 1996.

Disclosures: This study was funded by a grant from the American Board of Pediatrics Foundation. Dr. Freed and his colleagues reported no conflicts of interest.

Internists and family physicians no longer account for most office visits by adolescents.

New data reveal that between 2000 and 2006, the proportion of visits by adolescents (aged 11-17 years) to general pediatricians increased from 38% to 53% (J. Pediatr. 2010 [doi:10.1016/j.jpeds.2010.01.003]).

“Previously it had been the case that this age group had a majority of visits to family physicians or internists,” noted Dr. Gary L. Freed and his associates at the University of Michigan, Ann Arbor, and the research committee of American Board of Pediatrics.

The reasons for the steady, upward shift could be due to a series of demographic trends in the United States, most notably the increasing number of older Americans, Dr. Freed and his associates said.

“Because a growing proportion of the population in the United States is in the adult and elder age range, it follows that family physicians, who care for patients across the life course, would have similar growing proportions of their patient panels at the expense of pediatric patients.”

As a result, there are fewer family physicians who are performing obstetrics, which affects the number of newborns entering their practices, the investigators noted.

Financial considerations also may help explain why internists and family physicians are seeing fewer child patients. The fact that Medicare reimbursement rates for the elderly are higher than Medicaid reimbursement rates for pediatric patients may be a factor, Dr. Freed noted.

In addition, concerns about an actual or imminent nationwide shortage of primary care physicians for adults and the elderly may be driving some family physicians and internists to focus exclusively on those age ranges (JAMA 2009;301:1920-2).

Researchers examined data from the National Ambulatory Medical Care Surveys (NAMCS). The surveys, which used a physician-patient encounter (doctor's visit) as a sampling unit, were conducted between 1980 and 2006 by the Centers for Disease Control and Prevention's National Center for Health Statistics. During the years studied, the total number of samples ranged from 20,760 to 71,594.

Physicians across 15 specialties were examined: family practice, osteopathy, internal medicine, pediatrics, general surgery, obstetrics and gynecology, orthopedic surgery, cardiovascular diseases, dermatology, urology, psychiatry, neurology, ophthalmology, otolaryngology, and a category containing all the other specialties.

The NAMCS then divided the physician specialties into four subcategories: pediatric generalists, pediatric specialists, nonpediatric generalists, and nonpediatric specialists.

The trend of more and more children seeking care from pediatricians (as opposed to nonpediatric generalists and nonpediatric specialists) is likely to continue as long as the elderly remain America's “fasting-growing age range,” Dr. Freed wrote.

The study also showed that the number of visits made by all children—from infancy to adulthood—to general pediatricians also continues to grow. The percentage of nonsurgical physician office visits that children aged 0-17 years made to general pediatricians rose to 71%. This is a 10% increase since 1996.

Disclosures: This study was funded by a grant from the American Board of Pediatrics Foundation. Dr. Freed and his colleagues reported no conflicts of interest.

Major Finding: Between 2000 and 2006, the proportion of visits to general pediatricians by adolescents jumped from 38% to 53%.

Data Source: National Ambulatory Medical Care Surveys conducted by the CDC's National Center for Health Statistics.

Disclosures: This study was funded by a grant from the American Board of Pediatrics Foundation. The authors reported no conflicts of interest.

Pediatricians are the No. 1 primary care providers to U.S. adolescents for the first time, according to the results of a survey.

New data reveal that between 2000 and 2006, the proportion of visits to general pediatricians by adolescents (aged 11-17 years) jumped from 38% to 53%, the investigators reported (J. Pediatr. 2010 March 15 [doi:10.1016/j.jpeds.2010.01.003]).

“Previously it had been the case that this age group had a majority of visits to family physicians or internists,” noted Dr. Gary L. Freed and his associates at the University of Michigan, Ann Arbor, and the research committee of the American Board of Pediatrics.

The reasons for the steady, upward shift could be due to a series of demographic trends in the United States, most notably the impact of aging Americans in society, said Dr. Freed.

The number of visits made by all children—from infancy to adulthood—to general pediatricians continues to grow as well. Overall, the percentage of nonsurgical physician office visits that children aged 0-17 years made to general pediatricians rose to 71%.

This is a 10% increase since 1996.

“Because a growing proportion of the population in the United States is in the adult and elder age range, it follows that family physicians, who care for patients across the life course, would have similar growing proportions of their patient panels at the expense of pediatric patients.” As a result, there are fewer family physicians who are performing obstetrics, which affects the number of newborns entering their practices, said Dr. Freed.

There also may be financial implications as to why internists and family physicians are seeing fewer child patients, as Medicare reimbursement rates for the elderly are higher than Medicaid reimbursement rates for pediatric patients, Dr. Freed noted.

In addition, there have been concerns of an actual or imminent shortage of primary care physicians for adults and the elderly, which may drive some family physicians and internists to focus exclusively on those age ranges (JAMA 2009;301:1920-2).

Researchers examined data from the National Ambulatory Medical Care Surveys (NAMCS). The surveys, which used a physician-patient encounter (doctor's visit) as a sampling unit, were conducted between 1980 and 2006 by the Centers for Disease Control and Prevention's National Center for Health Statistics. During the years studied, the total number of samples ranged from 20,760 to 71,594.

Physicians across 15 specialties were examined: family practice, osteopathy, internal medicine, pediatrics, general surgery, obstetrics and gynecology, orthopedic surgery, cardiovascular diseases, dermatology, urology, psychiatry, neurology, ophthalmology, otolaryngology, and a category containing all the other specialties.

The NAMCS then divided the physician specialties into four subcategories: pediatric generalists, pediatric specialists, nonpediatric generalists, and nonpediatric specialists.

The trend of more and more children seeking care from pediatricians (as opposed to nonpediatric generalists and nonpediatric specialists) is likely to continue as long as the elderly remain America's “fasting growing age range,” wrote Dr. Freed.

Major Finding: Between 2000 and 2006, the proportion of visits to general pediatricians by adolescents jumped from 38% to 53%.

Data Source: National Ambulatory Medical Care Surveys conducted by the CDC's National Center for Health Statistics.

Disclosures: This study was funded by a grant from the American Board of Pediatrics Foundation. The authors reported no conflicts of interest.

Pediatricians are the No. 1 primary care providers to U.S. adolescents for the first time, according to the results of a survey.

New data reveal that between 2000 and 2006, the proportion of visits to general pediatricians by adolescents (aged 11-17 years) jumped from 38% to 53%, the investigators reported (J. Pediatr. 2010 March 15 [doi:10.1016/j.jpeds.2010.01.003]).

“Previously it had been the case that this age group had a majority of visits to family physicians or internists,” noted Dr. Gary L. Freed and his associates at the University of Michigan, Ann Arbor, and the research committee of the American Board of Pediatrics.

The reasons for the steady, upward shift could be due to a series of demographic trends in the United States, most notably the impact of aging Americans in society, said Dr. Freed.

The number of visits made by all children—from infancy to adulthood—to general pediatricians continues to grow as well. Overall, the percentage of nonsurgical physician office visits that children aged 0-17 years made to general pediatricians rose to 71%.

This is a 10% increase since 1996.

“Because a growing proportion of the population in the United States is in the adult and elder age range, it follows that family physicians, who care for patients across the life course, would have similar growing proportions of their patient panels at the expense of pediatric patients.” As a result, there are fewer family physicians who are performing obstetrics, which affects the number of newborns entering their practices, said Dr. Freed.

There also may be financial implications as to why internists and family physicians are seeing fewer child patients, as Medicare reimbursement rates for the elderly are higher than Medicaid reimbursement rates for pediatric patients, Dr. Freed noted.

In addition, there have been concerns of an actual or imminent shortage of primary care physicians for adults and the elderly, which may drive some family physicians and internists to focus exclusively on those age ranges (JAMA 2009;301:1920-2).

Researchers examined data from the National Ambulatory Medical Care Surveys (NAMCS). The surveys, which used a physician-patient encounter (doctor's visit) as a sampling unit, were conducted between 1980 and 2006 by the Centers for Disease Control and Prevention's National Center for Health Statistics. During the years studied, the total number of samples ranged from 20,760 to 71,594.

Physicians across 15 specialties were examined: family practice, osteopathy, internal medicine, pediatrics, general surgery, obstetrics and gynecology, orthopedic surgery, cardiovascular diseases, dermatology, urology, psychiatry, neurology, ophthalmology, otolaryngology, and a category containing all the other specialties.

The NAMCS then divided the physician specialties into four subcategories: pediatric generalists, pediatric specialists, nonpediatric generalists, and nonpediatric specialists.

The trend of more and more children seeking care from pediatricians (as opposed to nonpediatric generalists and nonpediatric specialists) is likely to continue as long as the elderly remain America's “fasting growing age range,” wrote Dr. Freed.

Major Finding: Between 2000 and 2006, the proportion of visits to general pediatricians by adolescents jumped from 38% to 53%.

Data Source: National Ambulatory Medical Care Surveys conducted by the CDC's National Center for Health Statistics.

Disclosures: This study was funded by a grant from the American Board of Pediatrics Foundation. The authors reported no conflicts of interest.

Pediatricians are the No. 1 primary care providers to U.S. adolescents for the first time, according to the results of a survey.

New data reveal that between 2000 and 2006, the proportion of visits to general pediatricians by adolescents (aged 11-17 years) jumped from 38% to 53%, the investigators reported (J. Pediatr. 2010 March 15 [doi:10.1016/j.jpeds.2010.01.003]).

“Previously it had been the case that this age group had a majority of visits to family physicians or internists,” noted Dr. Gary L. Freed and his associates at the University of Michigan, Ann Arbor, and the research committee of the American Board of Pediatrics.

The reasons for the steady, upward shift could be due to a series of demographic trends in the United States, most notably the impact of aging Americans in society, said Dr. Freed.

The number of visits made by all children—from infancy to adulthood—to general pediatricians continues to grow as well. Overall, the percentage of nonsurgical physician office visits that children aged 0-17 years made to general pediatricians rose to 71%.

This is a 10% increase since 1996.

“Because a growing proportion of the population in the United States is in the adult and elder age range, it follows that family physicians, who care for patients across the life course, would have similar growing proportions of their patient panels at the expense of pediatric patients.” As a result, there are fewer family physicians who are performing obstetrics, which affects the number of newborns entering their practices, said Dr. Freed.

There also may be financial implications as to why internists and family physicians are seeing fewer child patients, as Medicare reimbursement rates for the elderly are higher than Medicaid reimbursement rates for pediatric patients, Dr. Freed noted.

In addition, there have been concerns of an actual or imminent shortage of primary care physicians for adults and the elderly, which may drive some family physicians and internists to focus exclusively on those age ranges (JAMA 2009;301:1920-2).

Researchers examined data from the National Ambulatory Medical Care Surveys (NAMCS). The surveys, which used a physician-patient encounter (doctor's visit) as a sampling unit, were conducted between 1980 and 2006 by the Centers for Disease Control and Prevention's National Center for Health Statistics. During the years studied, the total number of samples ranged from 20,760 to 71,594.

Physicians across 15 specialties were examined: family practice, osteopathy, internal medicine, pediatrics, general surgery, obstetrics and gynecology, orthopedic surgery, cardiovascular diseases, dermatology, urology, psychiatry, neurology, ophthalmology, otolaryngology, and a category containing all the other specialties.

The NAMCS then divided the physician specialties into four subcategories: pediatric generalists, pediatric specialists, nonpediatric generalists, and nonpediatric specialists.

The trend of more and more children seeking care from pediatricians (as opposed to nonpediatric generalists and nonpediatric specialists) is likely to continue as long as the elderly remain America's “fasting growing age range,” wrote Dr. Freed.

On the heels of the Food and Drug Administration's recent approval of polidocanol injections for the treatment of spider and reticular veins, Dr. Margaret W. Mann is working to educate her colleagues on how to cure the more serious implications of venous disease.

An estimated 55% of American women and 45% of American men suffer from some form of vein problem. Varicose veins affect one out of two people aged 50 and older, according to the Department of Health and Human Services.

Photo courtesy Dr. Margaret W. Mann

"So it is very much not a cosmetic issue," Dr. Mann said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation in Santa Monica, Calif. "And it is important to treat these patients before they develop serious sequelae to their disease."

Varicose veins are often inherited. If both parents have varicose veins, a person has an 89% risk of developing the condition; if one parent is affected, the risk is 47%; and if neither parent has them, the risk decreases to 20% (J. Dermatol. Surg. Oncol. 1994;20:318-26).

"When I approach a patient with telangiectasia and varicose veins, I know that it can be just the tip of the iceberg," said Dr. Mann, codirector of the dermatologic surgery and laser center at the University of California, Irvine. Early treatment is optimal to prevent worsening of the disease.

The path to curing venous disease lies in looking beyond the visible and treating the root of problem. Patients with severe spider veins along the ankle, prominent reticular veins greater than 5 mm, or palpable varicosities likely have underlying venous insufficiency, said Dr. Mann. These patients should undergo ultrasound examination to delineate their venous anatomy prior to treatment.

"In patients with outflow obstruction, varicosities must not be ablated because they are an important bypass pathway allowing blood to flow around the obstruction," explained Dr. Mann. "Specific diagnostic tests can distinguish between patients who will benefit from ablation of dilated superficial veins and those who will be harmed by the same procedure."

In patients diagnosed with great saphenous vein insufficiency, Dr. Mann recommends minimally invasive treatment with endovenous ablation and microphlebectomy. It is essential, according to Dr. Mann, to treat their underlying disease prior to treatment of their spider veins with the mind set that "everything is connected in a hierarchal way" and "therapy must start from a top down approach."

Dr. Mann disclosed she is a paid consultant with BioForm Medical (acquired by Merz Pharmaceuticas). SDEF and this news organization are owned by Elsevier.

On the heels of the Food and Drug Administration's recent approval of polidocanol injections for the treatment of spider and reticular veins, Dr. Margaret W. Mann is working to educate her colleagues on how to cure the more serious implications of venous disease.

An estimated 55% of American women and 45% of American men suffer from some form of vein problem. Varicose veins affect one out of two people aged 50 and older, according to the Department of Health and Human Services.

Photo courtesy Dr. Margaret W. Mann

"So it is very much not a cosmetic issue," Dr. Mann said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation in Santa Monica, Calif. "And it is important to treat these patients before they develop serious sequelae to their disease."

Varicose veins are often inherited. If both parents have varicose veins, a person has an 89% risk of developing the condition; if one parent is affected, the risk is 47%; and if neither parent has them, the risk decreases to 20% (J. Dermatol. Surg. Oncol. 1994;20:318-26).

"When I approach a patient with telangiectasia and varicose veins, I know that it can be just the tip of the iceberg," said Dr. Mann, codirector of the dermatologic surgery and laser center at the University of California, Irvine. Early treatment is optimal to prevent worsening of the disease.

The path to curing venous disease lies in looking beyond the visible and treating the root of problem. Patients with severe spider veins along the ankle, prominent reticular veins greater than 5 mm, or palpable varicosities likely have underlying venous insufficiency, said Dr. Mann. These patients should undergo ultrasound examination to delineate their venous anatomy prior to treatment.

"In patients with outflow obstruction, varicosities must not be ablated because they are an important bypass pathway allowing blood to flow around the obstruction," explained Dr. Mann. "Specific diagnostic tests can distinguish between patients who will benefit from ablation of dilated superficial veins and those who will be harmed by the same procedure."

In patients diagnosed with great saphenous vein insufficiency, Dr. Mann recommends minimally invasive treatment with endovenous ablation and microphlebectomy. It is essential, according to Dr. Mann, to treat their underlying disease prior to treatment of their spider veins with the mind set that "everything is connected in a hierarchal way" and "therapy must start from a top down approach."

Dr. Mann disclosed she is a paid consultant with BioForm Medical (acquired by Merz Pharmaceuticas). SDEF and this news organization are owned by Elsevier.

On the heels of the Food and Drug Administration's recent approval of polidocanol injections for the treatment of spider and reticular veins, Dr. Margaret W. Mann is working to educate her colleagues on how to cure the more serious implications of venous disease.

An estimated 55% of American women and 45% of American men suffer from some form of vein problem. Varicose veins affect one out of two people aged 50 and older, according to the Department of Health and Human Services.

Photo courtesy Dr. Margaret W. Mann

"So it is very much not a cosmetic issue," Dr. Mann said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation in Santa Monica, Calif. "And it is important to treat these patients before they develop serious sequelae to their disease."

Varicose veins are often inherited. If both parents have varicose veins, a person has an 89% risk of developing the condition; if one parent is affected, the risk is 47%; and if neither parent has them, the risk decreases to 20% (J. Dermatol. Surg. Oncol. 1994;20:318-26).

"When I approach a patient with telangiectasia and varicose veins, I know that it can be just the tip of the iceberg," said Dr. Mann, codirector of the dermatologic surgery and laser center at the University of California, Irvine. Early treatment is optimal to prevent worsening of the disease.

The path to curing venous disease lies in looking beyond the visible and treating the root of problem. Patients with severe spider veins along the ankle, prominent reticular veins greater than 5 mm, or palpable varicosities likely have underlying venous insufficiency, said Dr. Mann. These patients should undergo ultrasound examination to delineate their venous anatomy prior to treatment.

"In patients with outflow obstruction, varicosities must not be ablated because they are an important bypass pathway allowing blood to flow around the obstruction," explained Dr. Mann. "Specific diagnostic tests can distinguish between patients who will benefit from ablation of dilated superficial veins and those who will be harmed by the same procedure."

In patients diagnosed with great saphenous vein insufficiency, Dr. Mann recommends minimally invasive treatment with endovenous ablation and microphlebectomy. It is essential, according to Dr. Mann, to treat their underlying disease prior to treatment of their spider veins with the mind set that "everything is connected in a hierarchal way" and "therapy must start from a top down approach."

Dr. Mann disclosed she is a paid consultant with BioForm Medical (acquired by Merz Pharmaceuticas). SDEF and this news organization are owned by Elsevier.

Social media is the key to survival of private practices, according to Dr. Jeffrey Benabio.

"Your specialty depends on it," he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation in Santa Monica, Calif. "Word of mouth is the original social media platform. People connected live, in person," said Dr. Benabio, who practices in San Diego. Now word of mouth is spread through Ethernet cables and Wi-Fi connections. Patients log on and share their experiences.

He described the changing landscape in which nonphysicians, and to some extent advertisers, are usurping the dermatologist's role as the primary provider of health information pertaining to the skin.

"Our lack of presence will lead to loss of trust with the public; therefore, this is a critical time for us to demonstrate our value to the public as practitioners," he said. "The more comfortable people are with nonphysicians, the more difficult it will be for us to fight nonphysicians' expansion of their scope of practice."

And he is determined not to let this happen to him. Google Dr. Benabio's name and the first five Google results are for his blog, his profile on www.livestrong.com, his biography on the same site, his Facebook profile, and his LinkedIn profile. "I am every link for the first 15 pages of Google," he said.

The key to networking via the Internet is not as simple as creating a Web site and placing advertisements. "You cannot buy your way into a social network. You must build relationships by interacting and listening to your audience," said Dr. Benabio. "Heavy advertising, marketing, and spamming will only harm your online presence." Just like anything, it takes practice.

To help physicians get started with social media, he suggested the following:

• Join Facebook, Twitter, and Sermo (a physician-only social networking site).

• Talk about dermatology online, don't practice it. (For example, talk about psoriasis, but don't give medical advice); and always respect HIPAA.

• Share tips and news with colleagues, and be human and responsive with others.

• Create high-quality personal content that is interesting, helpful, or funny.

• Use head shots, never icons.

• Separate your personal and professional online presence.

• And lastly, and most important, remember what is posted online, stays there forever.

Dr. Benabio disclosed that he is a consultant for www.livestrong.com and an employee of Southern California Kaiser Permanente Medical Group.

SDEF and this news organization are owned by Elsevier.

Social media is the key to survival of private practices, according to Dr. Jeffrey Benabio.

"Your specialty depends on it," he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation in Santa Monica, Calif. "Word of mouth is the original social media platform. People connected live, in person," said Dr. Benabio, who practices in San Diego. Now word of mouth is spread through Ethernet cables and Wi-Fi connections. Patients log on and share their experiences.

He described the changing landscape in which nonphysicians, and to some extent advertisers, are usurping the dermatologist's role as the primary provider of health information pertaining to the skin.

"Our lack of presence will lead to loss of trust with the public; therefore, this is a critical time for us to demonstrate our value to the public as practitioners," he said. "The more comfortable people are with nonphysicians, the more difficult it will be for us to fight nonphysicians' expansion of their scope of practice."

And he is determined not to let this happen to him. Google Dr. Benabio's name and the first five Google results are for his blog, his profile on www.livestrong.com, his biography on the same site, his Facebook profile, and his LinkedIn profile. "I am every link for the first 15 pages of Google," he said.

The key to networking via the Internet is not as simple as creating a Web site and placing advertisements. "You cannot buy your way into a social network. You must build relationships by interacting and listening to your audience," said Dr. Benabio. "Heavy advertising, marketing, and spamming will only harm your online presence." Just like anything, it takes practice.

To help physicians get started with social media, he suggested the following:

• Join Facebook, Twitter, and Sermo (a physician-only social networking site).

• Talk about dermatology online, don't practice it. (For example, talk about psoriasis, but don't give medical advice); and always respect HIPAA.

• Share tips and news with colleagues, and be human and responsive with others.

• Create high-quality personal content that is interesting, helpful, or funny.

• Use head shots, never icons.

• Separate your personal and professional online presence.

• And lastly, and most important, remember what is posted online, stays there forever.

Dr. Benabio disclosed that he is a consultant for www.livestrong.com and an employee of Southern California Kaiser Permanente Medical Group.

SDEF and this news organization are owned by Elsevier.

Social media is the key to survival of private practices, according to Dr. Jeffrey Benabio.

"Your specialty depends on it," he said at a cosmetic dermatology seminar sponsored by Skin Disease Education Foundation in Santa Monica, Calif. "Word of mouth is the original social media platform. People connected live, in person," said Dr. Benabio, who practices in San Diego. Now word of mouth is spread through Ethernet cables and Wi-Fi connections. Patients log on and share their experiences.

He described the changing landscape in which nonphysicians, and to some extent advertisers, are usurping the dermatologist's role as the primary provider of health information pertaining to the skin.

"Our lack of presence will lead to loss of trust with the public; therefore, this is a critical time for us to demonstrate our value to the public as practitioners," he said. "The more comfortable people are with nonphysicians, the more difficult it will be for us to fight nonphysicians' expansion of their scope of practice."

And he is determined not to let this happen to him. Google Dr. Benabio's name and the first five Google results are for his blog, his profile on www.livestrong.com, his biography on the same site, his Facebook profile, and his LinkedIn profile. "I am every link for the first 15 pages of Google," he said.

The key to networking via the Internet is not as simple as creating a Web site and placing advertisements. "You cannot buy your way into a social network. You must build relationships by interacting and listening to your audience," said Dr. Benabio. "Heavy advertising, marketing, and spamming will only harm your online presence." Just like anything, it takes practice.

To help physicians get started with social media, he suggested the following:

• Join Facebook, Twitter, and Sermo (a physician-only social networking site).

• Talk about dermatology online, don't practice it. (For example, talk about psoriasis, but don't give medical advice); and always respect HIPAA.

• Share tips and news with colleagues, and be human and responsive with others.

• Create high-quality personal content that is interesting, helpful, or funny.

• Use head shots, never icons.

• Separate your personal and professional online presence.

• And lastly, and most important, remember what is posted online, stays there forever.

Dr. Benabio disclosed that he is a consultant for www.livestrong.com and an employee of Southern California Kaiser Permanente Medical Group.

SDEF and this news organization are owned by Elsevier.

Polidocanol injection for treating varicose veins has been approved by the Food and Drug Administration, according to the agency.

Distributed by BioFarm Medical Inc. as Asclera, polidocanol is approved to treat small spider and reticular veins, specifically those ranging in size from less than 1 mm to up to 3 mm. The injectable agent improves the appearance of varicose veins by damaging the cell lining of the blood vessels, thus causing vessels to close and be replaced by less-visible types of tissue.

"Varicose veins are a common condition. Asclera is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance," said Dr. Norman Stockbridge, director of the division of cardiovascular and renal products at the FDA's Center for Drug Evaluation and Research, Silver Spring, Md.

It is estimated that as many as 55% of American women and 45% of American men have some form of vein problem, according to the U.S. Department of Health and Human Services. Varicose veins affect half of people age 50 years and older.

Asclera is manufactured by the German company Chemische Fabrik Kreussler & Co.

Common adverse reactions to polidocanol include leakage and collection of blood from damaged blood vessels at the injection site (hematoma), bruising, irritation, discoloration, and pain at the injection site, the FDA said.

Most commonly occurring in the legs, varicose veins are caused by a number of factors, including genetics, age, female gender, pregnancy, and obesity; prolonged periods of standing may increase the risk for varicose veins, according to the agency.

Polidocanol has been used to treat varicose veins in Europe for more than 40 years.

Polidocanol injection for treating varicose veins has been approved by the Food and Drug Administration, according to the agency.

Distributed by BioFarm Medical Inc. as Asclera, polidocanol is approved to treat small spider and reticular veins, specifically those ranging in size from less than 1 mm to up to 3 mm. The injectable agent improves the appearance of varicose veins by damaging the cell lining of the blood vessels, thus causing vessels to close and be replaced by less-visible types of tissue.

"Varicose veins are a common condition. Asclera is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance," said Dr. Norman Stockbridge, director of the division of cardiovascular and renal products at the FDA's Center for Drug Evaluation and Research, Silver Spring, Md.

It is estimated that as many as 55% of American women and 45% of American men have some form of vein problem, according to the U.S. Department of Health and Human Services. Varicose veins affect half of people age 50 years and older.

Asclera is manufactured by the German company Chemische Fabrik Kreussler & Co.

Common adverse reactions to polidocanol include leakage and collection of blood from damaged blood vessels at the injection site (hematoma), bruising, irritation, discoloration, and pain at the injection site, the FDA said.

Most commonly occurring in the legs, varicose veins are caused by a number of factors, including genetics, age, female gender, pregnancy, and obesity; prolonged periods of standing may increase the risk for varicose veins, according to the agency.

Polidocanol has been used to treat varicose veins in Europe for more than 40 years.

Polidocanol injection for treating varicose veins has been approved by the Food and Drug Administration, according to the agency.

Distributed by BioFarm Medical Inc. as Asclera, polidocanol is approved to treat small spider and reticular veins, specifically those ranging in size from less than 1 mm to up to 3 mm. The injectable agent improves the appearance of varicose veins by damaging the cell lining of the blood vessels, thus causing vessels to close and be replaced by less-visible types of tissue.

"Varicose veins are a common condition. Asclera is indicated for the treatment of small types of varicose veins when the aim of treatment is to improve appearance," said Dr. Norman Stockbridge, director of the division of cardiovascular and renal products at the FDA's Center for Drug Evaluation and Research, Silver Spring, Md.

It is estimated that as many as 55% of American women and 45% of American men have some form of vein problem, according to the U.S. Department of Health and Human Services. Varicose veins affect half of people age 50 years and older.

Asclera is manufactured by the German company Chemische Fabrik Kreussler & Co.

Common adverse reactions to polidocanol include leakage and collection of blood from damaged blood vessels at the injection site (hematoma), bruising, irritation, discoloration, and pain at the injection site, the FDA said.

Most commonly occurring in the legs, varicose veins are caused by a number of factors, including genetics, age, female gender, pregnancy, and obesity; prolonged periods of standing may increase the risk for varicose veins, according to the agency.

Polidocanol has been used to treat varicose veins in Europe for more than 40 years.

A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.  

In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.  

The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.

“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.

A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.  

In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.  

The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.

“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.

A new 3.75% imiquimod cream for treating actinic keratoses has been approved by the Food & Drug Administration, the product’s manufacturer announced today.  

In clinical trials, Zyclara (Graceway Pharmaceuticals) reduced the total number of lesions by 82% in patients who averaged 11 lesions at baseline. Complete clearance of all lesions, including those that developed during treatment, was achieved in 36% of patients, compared with only 6% of patients who received the placebo.  

The new formulation is designed for once daily application, and according to Graceway, quickly treats a greater number of lesions over a larger area than its 5% imiquimod cream predecessor.

“Because AKs are precancerous and can develop on skin frequently exposed to the sun, such as the face or balding scalp, an effective treatment that can be used on large areas of skin is beneficial,” noted Dr. Darrell Rigel, a clinical professor of dermatology at New York University’s Medical Center. Dr. Rigel is an investor for Graceway Pharmaceuticals.

The first retinoid lotion for the treatment of acne vulgaris has received Food and Drug Administration approval, the manufacturer announced on Monday, March 22.

Differin Lotion 0.1% (adapalene) will be available by prescription in April for treating acne on the face and body of patients aged 12 years and older.

The approval comes after positive results were seen in two similarly designed 12-week, multicenter, controlled clinical studies comparing Differin 0.1% (Galderma) to a vehicle in 2,141 acne patients.

In both studies, Differin 0.1% was shown to significantly reduce inflammatory lesions. Dryness was the most commonly reported side effect, occurring in approximately 7% of patients during the first 2 weeks of treatment and decreasing thereafter. Other side effects included mild to moderate erythema, scaling, stinging, and burning.

"Because everyone's skin is unique, it is important to have multiple treatment options available in a variety of formulations," noted Dr. Linda Stein Gold in a press release. The lotion will help dermatologists further individualize acne treatment for their patients, said Dr. Gold, director of clinical research and division head of dermatology at Henry Ford Hospital in Detroit. 

Adapalene, a third generation retinoid, was initially approved by the FDA in 1996 as a liquid solution under the same name, Differin 0.1%. The solution has since then been discontinued.

Dr. Gold is an investigator for Galderma.

The first retinoid lotion for the treatment of acne vulgaris has received Food and Drug Administration approval, the manufacturer announced on Monday, March 22.

Differin Lotion 0.1% (adapalene) will be available by prescription in April for treating acne on the face and body of patients aged 12 years and older.

The approval comes after positive results were seen in two similarly designed 12-week, multicenter, controlled clinical studies comparing Differin 0.1% (Galderma) to a vehicle in 2,141 acne patients.

In both studies, Differin 0.1% was shown to significantly reduce inflammatory lesions. Dryness was the most commonly reported side effect, occurring in approximately 7% of patients during the first 2 weeks of treatment and decreasing thereafter. Other side effects included mild to moderate erythema, scaling, stinging, and burning.

"Because everyone's skin is unique, it is important to have multiple treatment options available in a variety of formulations," noted Dr. Linda Stein Gold in a press release. The lotion will help dermatologists further individualize acne treatment for their patients, said Dr. Gold, director of clinical research and division head of dermatology at Henry Ford Hospital in Detroit. 

Adapalene, a third generation retinoid, was initially approved by the FDA in 1996 as a liquid solution under the same name, Differin 0.1%. The solution has since then been discontinued.

Dr. Gold is an investigator for Galderma.

The first retinoid lotion for the treatment of acne vulgaris has received Food and Drug Administration approval, the manufacturer announced on Monday, March 22.

Differin Lotion 0.1% (adapalene) will be available by prescription in April for treating acne on the face and body of patients aged 12 years and older.

The approval comes after positive results were seen in two similarly designed 12-week, multicenter, controlled clinical studies comparing Differin 0.1% (Galderma) to a vehicle in 2,141 acne patients.

In both studies, Differin 0.1% was shown to significantly reduce inflammatory lesions. Dryness was the most commonly reported side effect, occurring in approximately 7% of patients during the first 2 weeks of treatment and decreasing thereafter. Other side effects included mild to moderate erythema, scaling, stinging, and burning.

"Because everyone's skin is unique, it is important to have multiple treatment options available in a variety of formulations," noted Dr. Linda Stein Gold in a press release. The lotion will help dermatologists further individualize acne treatment for their patients, said Dr. Gold, director of clinical research and division head of dermatology at Henry Ford Hospital in Detroit. 

Adapalene, a third generation retinoid, was initially approved by the FDA in 1996 as a liquid solution under the same name, Differin 0.1%. The solution has since then been discontinued.

Dr. Gold is an investigator for Galderma.

Major Finding: A total of 11.5% of parents had refused at least one physician-recommended vaccine for their child or children, and 25% of parents said they believe some vaccines cause autism in otherwise healthy children

Data Source: A national online survey of 1,552 parents with at least one child 17 years of age or younger.

Disclosures: None reported.

Nearly one in eight parents in the United States has refused at least one physician-recommended vaccine for their child or children.

Ninety percent of the 1,552 parents surveyed online said they strongly agree that getting vaccines, like MMR, varicella, meningococcal conjugate, and HPV, can protect their children from diseases, but also said they believe those same vaccines could have serious adverse effects. Indeed, 11.5% had refused at least one physician-recommended vaccine for their child or children.

Specifically, 25% of parents said they believe some vaccines cause autism in otherwise healthy children (Pediatrics 2010;125:654-9).

Hispanic (37%) parents were more likely than white (22%) or black (23%) parents to believe that vaccines cause autism in healthy children. Black (15%) parents were more likely than white (12%) or Hispanic (5%) parents to have ever refused a vaccine recommended by their child's physician.

“It's reassuring that the vast majority of parents in the United States, 9 in 10, are confident about the protection that vaccines give children. However, the fact that one in four parents believe erroneously that an otherwise healthy child can get autism from vaccines is very concerning,” lead author Dr. Gary L. Freed said in an interview.

The belief by a significant amount of American parents that vaccines cause autism could stem from the widely publicized and controversial 1998 research paper published in the Lancet by Dr. Andrew Wakefield that suggested certain vaccines could be linked to autism. The research has since then been largely debunked by the medical and science communities and the paper retracted by the British journal.

Nevertheless, Dr. Freed said he believes the media has perpetuated the misinformation, thus, causing many parents (including 11.5% of survey participants) to take a “thanks, but no thanks” attitude toward physician recommendations of childhood vaccines.

“The media and their coverage of both the erroneous information regarding a possible link between vaccines and autism, and the celebrities who promote these untruths do a tremendous disservice to parents and children,” said Dr. Freed, director of the division of general pediatrics and the child health evaluation and research unit at the University of Michigan Health System, Ann Arbor. “The media would better serve the public if they were to focus on the information provided by those with expertise and training regarding vaccines.”

Dr. Meg Fisher, chair of the section of infectious diseases at the American Academy of Pediatrics and medical director at Children's Hospital at Monmouth Medical Center, at Longbranch, N.J., agreed, saying that pediatricians now have the responsibility to reach out to their patients and communities as a whole to dispel widely held myths and disseminate the correct information to the public.

“It is essential that we communicate with our patients and their parents. We must take the time and develop skills which allow us to communicate better,” she said in an interview.

“This starts with the skill of listening without interrupting—not easy during a 10- to 15-minute visit where lots of advice is given, and there are lots of areas to be discussed from development to safety to immunizations to medications,” said Dr. Fisher. “At the public level, I think as pediatricians we should be able to talk at community gatherings, school gatherings or media opportunities. For example, I've spoken at a synagogue to a group of people and also sometimes at the hospitals.”

Indeed, in the survey 88% of the parents agreed with the statement “Generally I do what my doctor recommends about vaccines for my child(ren).”

Additional reasons for childhood vaccine refusal—beyond fears of autism—included a general skepticism of newer vaccines, namely varicella, meningococcal conjugate, and HPV. HPV was the most commonly refused vaccine (56%), as 78% of parents said they believe there has not been enough research on it. A majority also felt the same way about meningococcal conjugate (67%) and varicella (55%).

Moral and ethical concerns also played a role in parental attitudes toward the HPV vaccine, as 51% said it challenged their belief system, while 59% said they believe their children are at a low risk for contracting the sexually transmitted disease.

Major Finding: A total of 11.5% of parents had refused at least one physician-recommended vaccine for their child or children, and 25% of parents said they believe some vaccines cause autism in otherwise healthy children

Data Source: A national online survey of 1,552 parents with at least one child 17 years of age or younger.

Disclosures: None reported.

Nearly one in eight parents in the United States has refused at least one physician-recommended vaccine for their child or children.

Ninety percent of the 1,552 parents surveyed online said they strongly agree that getting vaccines, like MMR, varicella, meningococcal conjugate, and HPV, can protect their children from diseases, but also said they believe those same vaccines could have serious adverse effects. Indeed, 11.5% had refused at least one physician-recommended vaccine for their child or children.

Specifically, 25% of parents said they believe some vaccines cause autism in otherwise healthy children (Pediatrics 2010;125:654-9).

Hispanic (37%) parents were more likely than white (22%) or black (23%) parents to believe that vaccines cause autism in healthy children. Black (15%) parents were more likely than white (12%) or Hispanic (5%) parents to have ever refused a vaccine recommended by their child's physician.

“It's reassuring that the vast majority of parents in the United States, 9 in 10, are confident about the protection that vaccines give children. However, the fact that one in four parents believe erroneously that an otherwise healthy child can get autism from vaccines is very concerning,” lead author Dr. Gary L. Freed said in an interview.

The belief by a significant amount of American parents that vaccines cause autism could stem from the widely publicized and controversial 1998 research paper published in the Lancet by Dr. Andrew Wakefield that suggested certain vaccines could be linked to autism. The research has since then been largely debunked by the medical and science communities and the paper retracted by the British journal.

Nevertheless, Dr. Freed said he believes the media has perpetuated the misinformation, thus, causing many parents (including 11.5% of survey participants) to take a “thanks, but no thanks” attitude toward physician recommendations of childhood vaccines.

“The media and their coverage of both the erroneous information regarding a possible link between vaccines and autism, and the celebrities who promote these untruths do a tremendous disservice to parents and children,” said Dr. Freed, director of the division of general pediatrics and the child health evaluation and research unit at the University of Michigan Health System, Ann Arbor. “The media would better serve the public if they were to focus on the information provided by those with expertise and training regarding vaccines.”

Dr. Meg Fisher, chair of the section of infectious diseases at the American Academy of Pediatrics and medical director at Children's Hospital at Monmouth Medical Center, at Longbranch, N.J., agreed, saying that pediatricians now have the responsibility to reach out to their patients and communities as a whole to dispel widely held myths and disseminate the correct information to the public.

“It is essential that we communicate with our patients and their parents. We must take the time and develop skills which allow us to communicate better,” she said in an interview.

“This starts with the skill of listening without interrupting—not easy during a 10- to 15-minute visit where lots of advice is given, and there are lots of areas to be discussed from development to safety to immunizations to medications,” said Dr. Fisher. “At the public level, I think as pediatricians we should be able to talk at community gatherings, school gatherings or media opportunities. For example, I've spoken at a synagogue to a group of people and also sometimes at the hospitals.”

Indeed, in the survey 88% of the parents agreed with the statement “Generally I do what my doctor recommends about vaccines for my child(ren).”

Additional reasons for childhood vaccine refusal—beyond fears of autism—included a general skepticism of newer vaccines, namely varicella, meningococcal conjugate, and HPV. HPV was the most commonly refused vaccine (56%), as 78% of parents said they believe there has not been enough research on it. A majority also felt the same way about meningococcal conjugate (67%) and varicella (55%).

Moral and ethical concerns also played a role in parental attitudes toward the HPV vaccine, as 51% said it challenged their belief system, while 59% said they believe their children are at a low risk for contracting the sexually transmitted disease.

Major Finding: A total of 11.5% of parents had refused at least one physician-recommended vaccine for their child or children, and 25% of parents said they believe some vaccines cause autism in otherwise healthy children

Data Source: A national online survey of 1,552 parents with at least one child 17 years of age or younger.

Disclosures: None reported.

Nearly one in eight parents in the United States has refused at least one physician-recommended vaccine for their child or children.

Ninety percent of the 1,552 parents surveyed online said they strongly agree that getting vaccines, like MMR, varicella, meningococcal conjugate, and HPV, can protect their children from diseases, but also said they believe those same vaccines could have serious adverse effects. Indeed, 11.5% had refused at least one physician-recommended vaccine for their child or children.

Specifically, 25% of parents said they believe some vaccines cause autism in otherwise healthy children (Pediatrics 2010;125:654-9).

Hispanic (37%) parents were more likely than white (22%) or black (23%) parents to believe that vaccines cause autism in healthy children. Black (15%) parents were more likely than white (12%) or Hispanic (5%) parents to have ever refused a vaccine recommended by their child's physician.

“It's reassuring that the vast majority of parents in the United States, 9 in 10, are confident about the protection that vaccines give children. However, the fact that one in four parents believe erroneously that an otherwise healthy child can get autism from vaccines is very concerning,” lead author Dr. Gary L. Freed said in an interview.

The belief by a significant amount of American parents that vaccines cause autism could stem from the widely publicized and controversial 1998 research paper published in the Lancet by Dr. Andrew Wakefield that suggested certain vaccines could be linked to autism. The research has since then been largely debunked by the medical and science communities and the paper retracted by the British journal.

Nevertheless, Dr. Freed said he believes the media has perpetuated the misinformation, thus, causing many parents (including 11.5% of survey participants) to take a “thanks, but no thanks” attitude toward physician recommendations of childhood vaccines.

“The media and their coverage of both the erroneous information regarding a possible link between vaccines and autism, and the celebrities who promote these untruths do a tremendous disservice to parents and children,” said Dr. Freed, director of the division of general pediatrics and the child health evaluation and research unit at the University of Michigan Health System, Ann Arbor. “The media would better serve the public if they were to focus on the information provided by those with expertise and training regarding vaccines.”

Dr. Meg Fisher, chair of the section of infectious diseases at the American Academy of Pediatrics and medical director at Children's Hospital at Monmouth Medical Center, at Longbranch, N.J., agreed, saying that pediatricians now have the responsibility to reach out to their patients and communities as a whole to dispel widely held myths and disseminate the correct information to the public.

“It is essential that we communicate with our patients and their parents. We must take the time and develop skills which allow us to communicate better,” she said in an interview.

“This starts with the skill of listening without interrupting—not easy during a 10- to 15-minute visit where lots of advice is given, and there are lots of areas to be discussed from development to safety to immunizations to medications,” said Dr. Fisher. “At the public level, I think as pediatricians we should be able to talk at community gatherings, school gatherings or media opportunities. For example, I've spoken at a synagogue to a group of people and also sometimes at the hospitals.”

Indeed, in the survey 88% of the parents agreed with the statement “Generally I do what my doctor recommends about vaccines for my child(ren).”

Additional reasons for childhood vaccine refusal—beyond fears of autism—included a general skepticism of newer vaccines, namely varicella, meningococcal conjugate, and HPV. HPV was the most commonly refused vaccine (56%), as 78% of parents said they believe there has not been enough research on it. A majority also felt the same way about meningococcal conjugate (67%) and varicella (55%).

Moral and ethical concerns also played a role in parental attitudes toward the HPV vaccine, as 51% said it challenged their belief system, while 59% said they believe their children are at a low risk for contracting the sexually transmitted disease.

Early treatment of capsaicin-induced dermal pain with the use of topical antacids can be effective in quickly and significantly reducing skin irritation and discomfort, according to a recent study.

"Dermal exposure of capsaicin affects cutaneous sensory neurons, inducing burning, redness, irritation, and pain that sometimes can be excruciating and last for hours to days after exposure," wrote Susan Y. Kim-Katz, Pharm.D., and her associates.

However, the results of their study, published online in the American Journal of Emergency Medicine, suggested the pain can be alleviated within 30 minutes if treated with an antacid containing calcium or magnesium.

Participants in the study were recruited from the California Poison Control System (CPCS) 24-hour hotline from a pool of callers who reported dermal exposure to capsaicin over the 15-month period between January 2001 and April 2002. In addition, study participants contacted the CPCS a median of 1 hour after exposure.

In the 64 subjects whose data were analyzed for outcomes, 45 (70%) reported a positive response to antacid treatment as a 33% reduction in pain within 30 minutes, noted Dr. Kim-Katz, a clinical pharmacist at the University of California, San Francisco.

A majority of participants, 36 (56%), were exposed to unrefined capsaicin through natural peppers (such as jalapeño, habañero, or red chili), while the remaining subjects were exposed to refined capsaicin (as contained in personal protection sprays such as pepper spray, animal repellents, creams, or ointments). They were advised by the CPCS to coat or soak the affected area liberally with a room-temperature antacid product that contains calcium or magnesium, such as Maalox, Mylanta, Milk of Magnesia, or Tums (crushed and mixed with water).

When asked to assess their pain on a scale of 0 (no pain) to 10 (worst pain ever experienced) during the initial phone call to CPCS, the median initial pain score was 7.5. During a follow-up call 2 hours after the initial CPCS consultation, the mean decrease in pain score after treatment was 4.2 points (doi:10.1016/j.ajcm.2009.02.007).

The study's authors discussed similar studies that have supported this outcome, including a 1998 study. In that study, seven patients had "severe dermal discomfort" after "pepper-mace" exposure. Within minutes after they applied liquid Maalox to the affected area, the patients were pain free (Am. J. Emerg. Med. 1998;16:613-4).

Topical antacids may provide pain relief by raising extracellular pH, which decreases skin pain receptors' sensitivity to capsaicin, the researchers said. In addition, the presence of positively charged calcium and magnesium atoms in the antacid may suppress capsaicin's actions, they noted.

^{Organic "red hot chili peppers" from Hutchins Farm in Concord, Mass. (Image courtesy "Arden" via flickr creative commons)} 

Dr. Kim-Katz and several of her colleagues reported that they are on staff at the California Poison Control System, San Francisco Division.

Early treatment of capsaicin-induced dermal pain with the use of topical antacids can be effective in quickly and significantly reducing skin irritation and discomfort, according to a recent study.

"Dermal exposure of capsaicin affects cutaneous sensory neurons, inducing burning, redness, irritation, and pain that sometimes can be excruciating and last for hours to days after exposure," wrote Susan Y. Kim-Katz, Pharm.D., and her associates.

However, the results of their study, published online in the American Journal of Emergency Medicine, suggested the pain can be alleviated within 30 minutes if treated with an antacid containing calcium or magnesium.

Participants in the study were recruited from the California Poison Control System (CPCS) 24-hour hotline from a pool of callers who reported dermal exposure to capsaicin over the 15-month period between January 2001 and April 2002. In addition, study participants contacted the CPCS a median of 1 hour after exposure.

In the 64 subjects whose data were analyzed for outcomes, 45 (70%) reported a positive response to antacid treatment as a 33% reduction in pain within 30 minutes, noted Dr. Kim-Katz, a clinical pharmacist at the University of California, San Francisco.

A majority of participants, 36 (56%), were exposed to unrefined capsaicin through natural peppers (such as jalapeño, habañero, or red chili), while the remaining subjects were exposed to refined capsaicin (as contained in personal protection sprays such as pepper spray, animal repellents, creams, or ointments). They were advised by the CPCS to coat or soak the affected area liberally with a room-temperature antacid product that contains calcium or magnesium, such as Maalox, Mylanta, Milk of Magnesia, or Tums (crushed and mixed with water).

When asked to assess their pain on a scale of 0 (no pain) to 10 (worst pain ever experienced) during the initial phone call to CPCS, the median initial pain score was 7.5. During a follow-up call 2 hours after the initial CPCS consultation, the mean decrease in pain score after treatment was 4.2 points (doi:10.1016/j.ajcm.2009.02.007).

The study's authors discussed similar studies that have supported this outcome, including a 1998 study. In that study, seven patients had "severe dermal discomfort" after "pepper-mace" exposure. Within minutes after they applied liquid Maalox to the affected area, the patients were pain free (Am. J. Emerg. Med. 1998;16:613-4).

Topical antacids may provide pain relief by raising extracellular pH, which decreases skin pain receptors' sensitivity to capsaicin, the researchers said. In addition, the presence of positively charged calcium and magnesium atoms in the antacid may suppress capsaicin's actions, they noted.

^{Organic "red hot chili peppers" from Hutchins Farm in Concord, Mass. (Image courtesy "Arden" via flickr creative commons)} 

Dr. Kim-Katz and several of her colleagues reported that they are on staff at the California Poison Control System, San Francisco Division.

Early treatment of capsaicin-induced dermal pain with the use of topical antacids can be effective in quickly and significantly reducing skin irritation and discomfort, according to a recent study.

"Dermal exposure of capsaicin affects cutaneous sensory neurons, inducing burning, redness, irritation, and pain that sometimes can be excruciating and last for hours to days after exposure," wrote Susan Y. Kim-Katz, Pharm.D., and her associates.

However, the results of their study, published online in the American Journal of Emergency Medicine, suggested the pain can be alleviated within 30 minutes if treated with an antacid containing calcium or magnesium.

Participants in the study were recruited from the California Poison Control System (CPCS) 24-hour hotline from a pool of callers who reported dermal exposure to capsaicin over the 15-month period between January 2001 and April 2002. In addition, study participants contacted the CPCS a median of 1 hour after exposure.

In the 64 subjects whose data were analyzed for outcomes, 45 (70%) reported a positive response to antacid treatment as a 33% reduction in pain within 30 minutes, noted Dr. Kim-Katz, a clinical pharmacist at the University of California, San Francisco.

A majority of participants, 36 (56%), were exposed to unrefined capsaicin through natural peppers (such as jalapeño, habañero, or red chili), while the remaining subjects were exposed to refined capsaicin (as contained in personal protection sprays such as pepper spray, animal repellents, creams, or ointments). They were advised by the CPCS to coat or soak the affected area liberally with a room-temperature antacid product that contains calcium or magnesium, such as Maalox, Mylanta, Milk of Magnesia, or Tums (crushed and mixed with water).

When asked to assess their pain on a scale of 0 (no pain) to 10 (worst pain ever experienced) during the initial phone call to CPCS, the median initial pain score was 7.5. During a follow-up call 2 hours after the initial CPCS consultation, the mean decrease in pain score after treatment was 4.2 points (doi:10.1016/j.ajcm.2009.02.007).

The study's authors discussed similar studies that have supported this outcome, including a 1998 study. In that study, seven patients had "severe dermal discomfort" after "pepper-mace" exposure. Within minutes after they applied liquid Maalox to the affected area, the patients were pain free (Am. J. Emerg. Med. 1998;16:613-4).

Topical antacids may provide pain relief by raising extracellular pH, which decreases skin pain receptors' sensitivity to capsaicin, the researchers said. In addition, the presence of positively charged calcium and magnesium atoms in the antacid may suppress capsaicin's actions, they noted.

^{Organic "red hot chili peppers" from Hutchins Farm in Concord, Mass. (Image courtesy "Arden" via flickr creative commons)} 

Dr. Kim-Katz and several of her colleagues reported that they are on staff at the California Poison Control System, San Francisco Division.

Persistent or unusual diaper dermatitis may be a sign of a serious skin disease or systemic illness in infant patients.

Because rare and uncommon skin eruptions in the diaper area can appear to be a conventional rash caused by prolonged skin exposure to wetness, dermatologists should closely examine each referral they receive for diaper dermatitis and look for the warning signs of a more serious skin condition, according to Dr. Ilona J. Frieden.

"When pediatricians ask a dermatologist to see a patient with a diaper rash, it is usually an unusual one. Diaper rashes are common and most never require referral. Thus, if asked, dermatologists should always say 'Yes' to these referrals," said Dr. Frieden, director of pediatric dermatology at the University of California San Francisco Children's Hospital.

Among the unusual eruptions she discussed in her presentation at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation were psoriasis, granular parakeratosis, and clear cell papulosis. Diaper rash can also be a manifestation of a systemic illness such as group A streptococcal infection, Langerhans cell histiocytosis, a zinc or other nutritional deficiency, or an asymmetric periflexural exanthem.

Group A streptococcal infection can cause a perianal rash, but may also occur at other intertriginous sites. It is typically characterized by intense, bright-red colors; satellite lesions are usually absent. Treatment requires oral antibiotics, and repeat courses are sometimes necessary, noted Dr. Frieden.

Langerhans cell histiocytosis may present as persistent diaper dermatitis that may also occur in other sites, particularly the scalp, ear canal, and oral mucosa. Be on the lookout for petechiae, atrophy, or deep ulcerations, said Dr. Frieden; a biopsy is necessary to make a diagnosis.

Diaper dermatitis due to zinc deficiency is most commonly seen in preterm breast fed infants. Metabolic disturbances and cystic fibrosis can cause similar eruptions.

Asymmetric periflexural exanthem typically starts in a flexure, often at the axilla, but it can also begin in the posterior of the thigh, leading to confusion with diaper rash. It is characterized by small red papules at the periphery with a slightly dusky, scaly center, said Dr. Frieden. 

"This condition can last for several weeks and may be misdiagnosed as a contact dermatitis or other dermatologic condition," she said. "Eventually, many cases begin to become bilateral and more generalized." The cause of this exanthema is not known.

An obvious tip for preventing diaper dermatitis, or decreasing its prevalence, is frequent diaper changes to minimize skin exposure to urine and feces. Barrier creams can also be helpful as a preventative measure, she noted.

 "It is also important to note that the differential diagnosis of diaper rash during the newborn period differs from that of older infants in that the rash is less likely to be caused by an irritant and more likely to represent an infection or other condition," said Dr. Frieden.

^{Photo Courtesy: Dr. Ilona J. Frieden}

Dr. Frieden reported having no relevant conflicts of interest. SDEF and this news organization are owned by Elsevier.

Persistent or unusual diaper dermatitis may be a sign of a serious skin disease or systemic illness in infant patients.

Because rare and uncommon skin eruptions in the diaper area can appear to be a conventional rash caused by prolonged skin exposure to wetness, dermatologists should closely examine each referral they receive for diaper dermatitis and look for the warning signs of a more serious skin condition, according to Dr. Ilona J. Frieden.

"When pediatricians ask a dermatologist to see a patient with a diaper rash, it is usually an unusual one. Diaper rashes are common and most never require referral. Thus, if asked, dermatologists should always say 'Yes' to these referrals," said Dr. Frieden, director of pediatric dermatology at the University of California San Francisco Children's Hospital.

Among the unusual eruptions she discussed in her presentation at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation were psoriasis, granular parakeratosis, and clear cell papulosis. Diaper rash can also be a manifestation of a systemic illness such as group A streptococcal infection, Langerhans cell histiocytosis, a zinc or other nutritional deficiency, or an asymmetric periflexural exanthem.

Group A streptococcal infection can cause a perianal rash, but may also occur at other intertriginous sites. It is typically characterized by intense, bright-red colors; satellite lesions are usually absent. Treatment requires oral antibiotics, and repeat courses are sometimes necessary, noted Dr. Frieden.

Langerhans cell histiocytosis may present as persistent diaper dermatitis that may also occur in other sites, particularly the scalp, ear canal, and oral mucosa. Be on the lookout for petechiae, atrophy, or deep ulcerations, said Dr. Frieden; a biopsy is necessary to make a diagnosis.

Diaper dermatitis due to zinc deficiency is most commonly seen in preterm breast fed infants. Metabolic disturbances and cystic fibrosis can cause similar eruptions.

Asymmetric periflexural exanthem typically starts in a flexure, often at the axilla, but it can also begin in the posterior of the thigh, leading to confusion with diaper rash. It is characterized by small red papules at the periphery with a slightly dusky, scaly center, said Dr. Frieden. 

"This condition can last for several weeks and may be misdiagnosed as a contact dermatitis or other dermatologic condition," she said. "Eventually, many cases begin to become bilateral and more generalized." The cause of this exanthema is not known.

An obvious tip for preventing diaper dermatitis, or decreasing its prevalence, is frequent diaper changes to minimize skin exposure to urine and feces. Barrier creams can also be helpful as a preventative measure, she noted.

 "It is also important to note that the differential diagnosis of diaper rash during the newborn period differs from that of older infants in that the rash is less likely to be caused by an irritant and more likely to represent an infection or other condition," said Dr. Frieden.

^{Photo Courtesy: Dr. Ilona J. Frieden}

Dr. Frieden reported having no relevant conflicts of interest. SDEF and this news organization are owned by Elsevier.

Persistent or unusual diaper dermatitis may be a sign of a serious skin disease or systemic illness in infant patients.

Because rare and uncommon skin eruptions in the diaper area can appear to be a conventional rash caused by prolonged skin exposure to wetness, dermatologists should closely examine each referral they receive for diaper dermatitis and look for the warning signs of a more serious skin condition, according to Dr. Ilona J. Frieden.

"When pediatricians ask a dermatologist to see a patient with a diaper rash, it is usually an unusual one. Diaper rashes are common and most never require referral. Thus, if asked, dermatologists should always say 'Yes' to these referrals," said Dr. Frieden, director of pediatric dermatology at the University of California San Francisco Children's Hospital.

Among the unusual eruptions she discussed in her presentation at the annual Hawaii Dermatology Seminar sponsored by Skin Disease Education Foundation were psoriasis, granular parakeratosis, and clear cell papulosis. Diaper rash can also be a manifestation of a systemic illness such as group A streptococcal infection, Langerhans cell histiocytosis, a zinc or other nutritional deficiency, or an asymmetric periflexural exanthem.

Group A streptococcal infection can cause a perianal rash, but may also occur at other intertriginous sites. It is typically characterized by intense, bright-red colors; satellite lesions are usually absent. Treatment requires oral antibiotics, and repeat courses are sometimes necessary, noted Dr. Frieden.

Langerhans cell histiocytosis may present as persistent diaper dermatitis that may also occur in other sites, particularly the scalp, ear canal, and oral mucosa. Be on the lookout for petechiae, atrophy, or deep ulcerations, said Dr. Frieden; a biopsy is necessary to make a diagnosis.

Diaper dermatitis due to zinc deficiency is most commonly seen in preterm breast fed infants. Metabolic disturbances and cystic fibrosis can cause similar eruptions.

Asymmetric periflexural exanthem typically starts in a flexure, often at the axilla, but it can also begin in the posterior of the thigh, leading to confusion with diaper rash. It is characterized by small red papules at the periphery with a slightly dusky, scaly center, said Dr. Frieden. 

"This condition can last for several weeks and may be misdiagnosed as a contact dermatitis or other dermatologic condition," she said. "Eventually, many cases begin to become bilateral and more generalized." The cause of this exanthema is not known.

An obvious tip for preventing diaper dermatitis, or decreasing its prevalence, is frequent diaper changes to minimize skin exposure to urine and feces. Barrier creams can also be helpful as a preventative measure, she noted.

 "It is also important to note that the differential diagnosis of diaper rash during the newborn period differs from that of older infants in that the rash is less likely to be caused by an irritant and more likely to represent an infection or other condition," said Dr. Frieden.

^{Photo Courtesy: Dr. Ilona J. Frieden}

Dr. Frieden reported having no relevant conflicts of interest. SDEF and this news organization are owned by Elsevier.