Summer 2004 derm newsletter
The Virginia Dermatological Society
Volume 6 Number 5
B U L L E T I N
I have enjoyed serving as president of the
fortunate to have Virginia dermatologists as
Virginia Dermatological Society this past
leaders in the American Academy of Dermatol-
ogy: David Pariser, MD is President-Elect and
dermatologists in Virginia. In the fall, I
Evan Farmer, MD is Vice President. We are
represented our Society as a delegate at the
certainly proud of their accomplishments, and
of the accomplishments of dermatologists who
serve in their local medical societies and in the
MSV Foundation, headed by Lawrence E.
Blanchard, III, MD, awarded the state’s
Award, given annually to the specialty with
Cordodo, MD is leaving for California to begin
the highest percentage of members contribut-
a fellowship in pediatric dermatology. Amalie
ing to the annual fund. I’m proud of the
Derdeyn, MD who will soon begin practice in
Charlottesville will assume the duties of
secretary-treasurer in July. New ideas and newleadership are always important to the
continued success of our Society. Those who
legislative issues before the General Assem-
are interested in the positions of President and
Secretary-Treasurer for 2008 should please
members, restrictions on the use of tanning
contact me at firstname.lastname@example.org or by phone
beds by teenagers have been put in place, and
at (434) 924-1966. Thank you for the privilege
and pleasure I’ve had of serving you in this
physician use of products and devices that
can alter the living layers of the skin. We are
Notes from the Medicare Carrier
wish to participate in. If you choose not to
participate with these plans, educate your
someone who can better address your concerns.
office staff so they will recognize a medicare
advantage insurance card. Allowing one patient
Medical Society of Virginia
to come in opens your practice to all of them.
change in reimbursement for cryotherapy. The
Medicare Advantage Plans. These plans are
only reason we have been fortunate enough to
be so well compensated for this procedure is
At the March 31st meeting of the Virginia
which replace a patients traditional Medicare.
current payment system was instituted.
Patients are unaware that they are not enrolled
Unlike other specialties, dermatology went
presented Virginia’s dermatologists with its
along and made an effort to capture as much
Power of Partnership
Award. This award
physicians is that if you accept one patient and
revenue as was possible instead of fighting the
bill the plan you are “deemed” to particiapte in
the plan even though you have not signed a
codes were up for review that this would be a
contract nor seen a fee schedule. You must, by
reduction because that is inevitable - codes are
contribution to MSVF’s annual fund.
accept the fee schedule which is often far below
reimbursement. The dedicated physicians who
traditional Medicare. You, as a taxpayer, are
represent the AAD were able to salvage most
Foundation to Dr. Julia Padgett, President
also being taken “advantage” of, because these
of the previous pay scale. If we were to start
of the Virginia Dermatological Society.
plans bill CMS for more than what Medicare
costs for the same services, while at the same
therapy as a “new” code we would be lucky to
get two dollars per lesion in the opinion of
health of Virginians. To learn more about
experts in coding and reimbursement.
I cannot of course recommend any action for
MSVF’s physician-driven initiatives or to
you to take concerning your own practice or
If you have any questions or concerns with
make a contribution, visit their website at
business decision, however, each of us should
medicare please contact me at (804) 282-0831
be given all the relevant information to come to
Bortz, the Foundation’s Executive Director
make informed choices about which plan we
Of course, I can’t solve all problems but will do
SPEAKERS PEARLS FROM THE TIDEWATER, RICHMOND AND
VIRGINIA DERMATOLOGICAL SOCIETIES MEETING
Joseph B. Bikowski, MD Cases About Faces and Vehicular
Antoinette F. Hood, MD Dermatology at EVMS and Advances in
Look out for pseudo rhinophyma with swelling of the
She reminded us to think of nephrogenic systemic fibrosis when
nasal bridge due to constriction of lymph channels from
Kimberly A. Scott, MD Really Great Cases from Eastern Virginia
Doxycycline beats minocycline in its anti-inflammatory
effect. Doxycycline is 33 times and minocycline 12 timesthe anti-inflammatory effect of tetracycline.
Cases included bullous tinea corporis, milia-like-syringomas,eccrine angiomatosis, erythema caloricum, cryptoccus neoformans,
For facial redness, scaling, and folliculitis think demodex
neurolytic acral erythema (with hepatitis C), primary systemic
amyloidosis, nephrogenic systemic fibrosis, verrucous sarcoidosis,neonatal HSV, and bullous dermatomyositis.
For severe angular cheilitis, do a culture and sensitivity.
Dr. Bikowski likes to treat with desonide ointment and
Judith V. Williams, MD and David Darrow, MD Vascular
either ketoconazole cream or mupirocin ointment.
Molluscum responds well to daily applications of
Dr. Willams reminded us that hemangiomas can cause
permanent dysfunction, pain when ulcerating, andpossible permanent visual loss.
“Pomade” acne on the forehead may be pityrosporumfolliculitis. The same yeast organism may be the cause of
In 25% of cases there is more than one lesion. There can
Grover’s. Treat with oral ketoconazole or Diflucan.
You can double or even triple the dose of a non-sedating
It’s best to use a team approach for hemangiomas, and to
manage early and modify the life cycle of these lesions.
Treatments include observation, pulsed dye laser, topical,
If a patient on isotretenoin does not have hyperlipidemia
intra-lesional and systemic steroids, surgical removals,
after thirty-days, it won’t happen.
Brian B. Adams, MD, MPH. Cutaneous Infections that Sideline
Dr. Darrow reminds us that ulcerated hemangiomas
Athletes and Traumatic Hair and Nail Injuries in Athletes.
In treating infections in athletes think of fomites
Robert J. Pariser, MD The Story of Syphilis: It’s Still Our
including mats, equipment, towels, and weights.
Whirlpools are also a good way of spreading infections.
Think lues! While there are only 1,000 new cases of MF a year,
HSV is not spread by fomites, but in wrestling there is a
there are 34,000 new cases of Syphilis a year.
30% chance of contacting the virus if exposure to anactive lesion. Lesions show up on the head and neckmost.
HSV is frequently misdiagnosed as impetigo or tinea.
Look for scalloped lesion edges.
HPV or tinea can spread readily through shower floors,wet pool decks, and the weight room.
For friction blisters, the blisters need to be ruptured
three times over 24 hours. Preventive measures includeantiperspirants, Johnson & Johnson’s Liquid Bandage
and petrolatum. Also consider the use of gloves, well-
sized shoes, and synthetic, not cotton, socks.
Look for “joggers’ toes” involving the longest toe andfeaturing a thickened toenail, periungual hemorrhage, and
The three favorite sunscreens of Dr. Adams’ athletes are:Blue Lizard, Ocean Potion, and Banana Boat spray.
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