Journal of Dermatology for Physician Assistants

The official journal of the Society of Dermatology Physician Assistants

SDPA Digital 2020 Conference Summary

A Memorable Virtual Conference Experience that Combined Education with Gamification to Successfully bring Together the Derm PA Community

In 2020, we saw wide-scale adoption of telecommunications. An ever-changing variable to all aspects of planning, the COVID-19 pandemic accelerated us to move virtually all interactions, well, virtual. Traditional in-person events were either completely canceled or re-formatted to take place exclusively in the virtual setting. This response required a reimagining of how people come together to deliver education, share ideas, and network. While the obvious solution on how to socialize while remaining socially distant was to “go virtual,” hosting a conference completely online was largely uncharted territory and presented a multitude of technological challenges.

For the Society of Dermatology Physician Assistants (SDPA), extensive reconstruction of its Fall 2020 conference (originally scheduled to take place in person in Miami, Florida) required an all-hands-on-deck approach and collective enthusiasm to embrace the challenge of pivoting to a 100-percent virtual conference. SDPA Digital—a unique and innovative virtual conference experience—succeeded in remotely delivering the same high-quality, interactive education for which SDPA is known and fostering the same comradery among the Derm PA community traditionally seen at a live event.

EDUCATION
SDPA responded to member needs by offering 47 hours of free continuing medical education (CME) in the form of on-demand educational sessions from previous conferences and a webinar series titled, “Empowering the Dermatology PA during the COVID-19 Crisis and Beyond.” When the Board of Directors made the difficult decision to hold a fully virtual conference experience in lieu of its planned in-person meeting in sunny Florida, society leadership and staff already had a working backup plan.

SDPA Digital 2020, launched October 29, 2020, brought the look and feel of education offered at in-person meetings, with a combination of live and pre-recorded presentations and the opportunity to ask presenters questions and get their answers in real-time. Sessions covered a variety of topics relevant to the derm PA audience. From the staples of medical education—review of the literature, updates on disease states—to the more focused deeper dialogues, SDPA Digital’s conference agenda was designed to deliver a comprehensive learning experience.

SESSION HIGHLIGHTS & KEY TAKEAWAYS

What’s New in the Literature?
SDPA Digital 2020 Medical Director Joslyn S. Kirby, MD, MS, MEd from the Department of Dermatology at Penn State Milton S. Hershey Medical Center in Hershey, Pennsylvania, kicked off Day 1 of educational sessions with a review of the literature.

Much of the literature in 2020 focused on COVID-19 findings and pandemic-related topics. Dr. Kirby reflected on the early days of the pandemic, when reports of “COVID Toes” circulated, and said this initially sparked “real hope and optimism” among healthcare providers who originally thought that such a visual, tell-tale symptom could potentially help them recognize COVID in patients and intervene early. She underscored the importance of remembering that skin rashes, such as morbilliform rashes and chilblain-like lesions, seen during the pandemic were not definitive of a patient testing positive for the virus, but rather skin manifestations known to have other causes.

She addressed how COVID health and safety responses like increased hand washing and extended use (>6 hours of wear) of personal protective equipment, especially in front-line workers, affected the skin. Next, she provided an overview on how the pandemic impacted patients on maintenance therapies like biologics and small molecule therapies, describing recommendations from the recent body of literature as well as her own practice’s experience. The main takeaway from the discussion was that, according to the literature, it is safe for patients to initiate and maintain effective biologics as there is no evidence of increased rates of severe COVID symptoms among this patient population as compared to patients not on biologics.
Dr. Kirby highlighted an American Academy of Dermatology clinical practice guideline of care for the management of primary cutaneous melanoma that included updated treatment recommendations for patients with primary cutaneous melanoma. Key updates to the guidelines were as follows: 1) the reporting of thickness to the nearest 0.1 mm rather than to the nearest 0.01 mm (e.g., a thickness of 0.75 to 0.84 mm would be rounded to 0.8 mm) and 2) Microsatellitosis should not be included in this primary tumor measurement but commented on separately, and 3) transit or satellite lesions will automatically move a melanoma into a stage 3 or higher category.

Other topics touched upon in this presentation were as follows:
◗ Inspection, biopsy, histology, and risk factors for re-occurrence of basal cell carcinomas
◗ Surgical scar revision technique comparisons.
• Takeaway: No difference in scar improvement scores between ablative and nonablative fractional lasers.
◗ What’s Out There: Potential applications of platelet-rich plasma (PRP)
◗ Needs of transgender individuals and how dermatology care providers can address them with neurotoxins and fillers.
• Takeaway: We can use our tools to help people live in their bodies
◗ There have been updates on approvals of drugs indicated for atopic dermatitis. Dupilimuab is now approved for patients six years of age and older.
• Takeaway: Counsel patients on “what to expect and what to do” if they experience adverse events; injection site reactions (most common), conjunctivitis, and keratitis.
◗ Biologics newly improved for pediatric patient population (ages 4 and older) for psoriasis treatment.
• Janus kinase (JAK) Inhibitors for Alopecia Areata: Research shows great improvement in hair growth; however, it is important to note that it can take a while (i.e., up to one year of continued use) according to the recent studies.
• Takeaway: Maintenance therapy is needed when treating AA with JAK inhibitors\

What’s New in Management in Skin of Color?
Faculty member Temitayo A. Ogunleye, MD, Assistant Professor of Dermatology at the University of Pennsylvania, Department of Dermatology, in Philadelphia, Pennsylvania, reviewed common dermatologic disorders, examined recent research, provided an overview of literature, and reviewed practice changes that may help mitigate bias in skin of color patients. She listed the following key takeaways from the presentation:

Psoriasis
1. Black patients are less likely to use biologics for moderate to severe disease.
2. Black patients are more likely to be unfamiliar with biologics and careful counseling may help guide therapy.
3. We should adequately educate our skin of color patients about all options available for treatment for severe disease.

Alopecia
1. African Americans may have higher odds of alopecia areata compared with whites and that Asians may have lower odds of the disease.
2. Physicians should be aware of possible racial disparities in alopecia areata.
3. Consider this diagnosis in atypical presentations of alopecia.

Acne
1. Minority populations may receive fewer prescriptions for system treatment of acne such as oral contraceptives, spironolactone, oral antibiotics, and isotretinoin.
2. Remember to offer systemic therapies (and discuss risks appropriately) in your Black, Latino and Asian patients.

Melanoma
1. Black patients had longer time from diagnosis to definitive surgery (TTDS) for melanoma than Non‐Hispanic White patients after other sociodemographic factors were controlled for, and racial differences in TTDS persisted after stratification by insurance type and melanoma stage.
2. Although type of melanoma and controversies in treatment may play a role in this disparity, consciously make an effort to ensure timely treatment for your Black patients with melanoma.

Update on Infectious Diseases
Robert G. Micheletti, MD, Assistant Professor of Dermatology and Medicine, Chief of Hospital Dermatology Director, Cutaneous Vasculitis Clinic, Penn Vasculitis Center at the University of Pennsylvania provided an update on infectious disease. First, Dr. Micheletti reviewed the latest literature on cutaneous manifestations of COVID-19, detailing the five major clinical patterns of skin involvement in patients with COVID-19:

1) Chilblain‐like—violaceous erythema on
fingers /toes
2) Vesicular eruption—small monomorphic vesicles
3) Urticarial lesions—trunk and extremities
4) Morbilliform—some cases pityriasis rosea‐like or pseudovesicular
5) Livedoid—vasculopathy/coagulopathy

Other topics discussed included sexually transmitted infections with particular focus on the diagnosis and treatment of syphilis, infections in the immunosuppressed patient, and classic presentations of Lyme disease, Rocky Mountain Spotted Fever and dengue. Dr. Micheletti emphasized that numerous common and uncommon infectious processes may involve the skin, and that skin findings may be the presenting sign/symptom of an important systemic infection. He encouraged providers to keep an open mind and approach skin findings in the context of the patient’s overall medical situation. It is important to recognize how immunosuppression plays an important role in infections and that timely dermatology input may be critical.

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