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Prescription drug costs impose a significant financial burden on the United States healthcare system. Patients with chronic dermatologic diseases often require long-term and expensive prescription drugs. In an effort to expand drug availability, pharmaceutical companies fund patient assistance programs (PAPs) to assist disadvantaged patients in gaining access to high-priced brand name medications with no suitable therapeutic alternative. Patients and clinical staff often face difficulty navigating the various PAPs. Herein, we seek to explore the utility, criteria, and challenges in PAPs and provide a practical discourse for dermatologists caring for medically indigent patients. [ABSTRACT FROM AUTHOR]

The article discusses the economic burdens of hidradenitis suppurativa (HS) by referring to manufacturer-reported benchmarks such as Average Wholesale Price (AWP) and wholesale acquisition cost (WAC). Topics discussed include National Average Drug Acquisition Cost, weight-based dosing, per-patient cost of systemic antibiotic treatment, and costs of intravenous infliximab infusions.

The practice of adorning the body with permanent ink dates back to the late Neolithic period. Today, a large proportion of the younger generation has at least one tattoo. Despite the recent popularity of tattoos, there are prolific reports within the literature detailing the adverse cutaneous reactions that occur following the intradermal injection of tattoo inks. Such reactions can occur immediately or years later. In addition to these known reactions, consumer preference for "animal-friendly" products has shifted the ingredients used in tattoos and has ushered in the era of "vegan tattoos." Because of its recent emergence and the lack of regulation of intradermal pigment by the United States Food and Drug Administration, we remain unsure of the potential reactions of these new ingredients. Currently, we can only predict complications by extrapolating from the known reactions of the topical administration of these same plant-based ingredients. In this article, we elucidate some potential reactions in an effort to warn the dermatologic community of the need to educate patients and encourage Federal reporting and regulation. [ABSTRACT FROM AUTHOR]

Introduction: Prices for immunomodulators used in dermatological conditions are rising in the United States. While Medicare Part-D solely covers medication costs, Medicare Part-B covers outpatient infusion and injection costs given by medical professionals. We aim to analyze recent trends in Medicare Part-B spending on immunomodulators and their biosimilars used in the treatment of common chronic inflammatory dermatoses., Methods: The 2012-2018 Medicare Part-B spending data on immunomodulators commonly used for dermatologic conditions were extracted from the Centers for Medicare and Medicaid Services database. Inflation was adjusted to reflect 2012-dollar amounts using the Consumer Price Index., Results: Medicare Part-B spending has increased by 27.5% from 2012 to 2018 ($2.5B, $3.2B). Average annual total spending (AATS) is greatest for rituximab ($1,522,757,520), and average annual spending per maintenance dose (AASPMD) is greatest for ustekinumab-90 mg ($12,976). The percent change in AASPMD increased for all immunomodulators with Etanercept-50 mg having the greatest percent change (+64.6%, +$285.70). Infliximab had a greater AATS and AASPMD than its biosimilars., Discussion: Medicare Part-B spending is often overlooked but plays a big role in federal healthcare spending. Exploring the strategic use of less expensive biosimilars could help mitigate spending.

Immunomodulators are the most expensive prescription medications used in dermatology for chronic skin conditions. Each year, rising costs for immunomodulators pose significant financial burdens on patients and the healthcare system as a whole. Using the Centers for Medicare and Medicaid Services (CMS) we collected Medicare Part D (Medicare-D) and Medicaid spending data for immunomodulators with dermatologic indications or off-label use from 2012-2018. The average annual spending and average annual spending per dosage unit (AASPDU) was calculated for each of the thirteen included medications. Combined Medicare-D and Medicaid spending increased 319.9% from $2.5B in 2012 to $10.6B in 2018, with an average of $6.2B spent annually. For both Medicare-D and Medicaid, adalimumab ($1.8B, $968.8 m), etanercept ($1.4B, $467.5 m), and ustekinumab ($258.8 m, $131.0 m) had the highest overall annual spending. Additionally, ustekinumab ($16,825, $15,576), guselkumab ($10,132, $9,543), and ixekizumab ($4,895, $4,673) had the highest AASPDU for both Medicare-D and Medicaid. Medicare-D and Medicaid spending for immunomodulators has grown substantially (319.9%) from 2012-2018 and is likely to continue to rise. Given this increase in federal spending and continued emergence of new immunomodulators, it is important to learn how we can counteract the trends and reduce future expenses for patients and our healthcare system.

Competing Interests: V.Y.S. is a stock shareholder of Learn Health and has served as an advisory board member and investigator and/or received research funding from Sanofi Genzyme, Regeneron, AbbVie, Eli Lilly, Novartis, SUN Pharma, LEO Pharma, Pfizer, Menlo Therapeutics, Burt's Bees, GpSkin, the National Eczema Association, Global Parents for Eczema Research, the Foundation for Atopic Dermatitis, and Skin Actives Scientific. The other authors have no funding or conflicts of interest to declare.

Atopic dermatitis (AD) is a chronic inflammatory dermatosis presenting with inflamed and itchy skin. Recent studies have shown an inverse relationship between socioeconomic status and the severity of AD. Low socioeconomic status (LSES) individuals with AD face specific barriers that may impede management. These include forgoing doctor's appointments due to transportation costs, inability to take time off from work, and lack of affordable childcare services. Unaffordable medications and over-the-counter products for managing AD further present as significant challenges for LSES patients. This article aims to offer practical and affordable recommendations to help mitigate the challenges faced by LSES patients with AD and thereby alleviate disease burden and improve treatment outcomes.

Objective: Topical probiotics have been used for skin care and treatment since the early 20th century. Over the past decade, there has been a dramatic surge of commercially-available topical probiotic products. We conducted a systematic search of clinical data relating to the use of topical probiotics and identified relevant clinical and regulatory gaps., Methods: PubMed and Google Scholar searches were conducted for trials and reviews of probiotics. FDA definitions of cosmetics, drugs, and regulation of topical probiotics were reviewed., Results: Topical probiotics have shown efficacy in a number of limited trials, particularly those involving the treatment of acne, atopic dermatitis, and rosacea. However, there is a paucity of literature on the safety profiles, mechanistic action, and therapeutic potential of topical probiotic products. Several regulatory gaps exist, including approval and classification of topical probiotic products by the FDA; currently there are no topical probiotic products the FDA has approved as drugs., Conclusion: With increasing popularity among the general public, but insufficient clinical data to demonstrate large-scale effectiveness and a thorough understanding of side effects, there is a need for further mechanistic and clinical investigation, as well as improved regulation and standardization of topical probiotic products.

Objective: To quantify and compare the physiochemical properties of various topical emollients and to correlate these findings with the products' potential to maintain the stratum corneum (SC) acid milieu, while possessing the appropriate water content for skin rehydration, user adherence, and comfort., Material and Methods: The pH and hydrophilic fraction of 31 skin moisturizers sold in the US were measured. Hydrophilic Index (HI) was calculated using the "HI equation." The two parameters were charted using a scatter plot with quadrant divisions. Products with lower hydrophilicity were considered "more greasy" and assigned a lower HI as compared to their counterparts with a higher hydrophilicity., Results: Our findings are in good accordance with common clinical impressions: lotions generally have higher HI, while ointments have lower HI. The majority of the products tested fall into low HI, suggesting that a large percentage of the products may be rich in overall lipid content. The pH values range widely, from 3.7 to 8.2, with the majority of the products close to the physiologic skin pH of 4 to 6., Conclusion: This study introduces HI as a novel method of quantifying the aqueous content of topical emollients. When considered together with pH, the two indices can guide providers in choosing the most suitable emollients for patients with skin diseases involving altered acid mantle and barrier disruption, such as atopic dermatitis, irritant contact dermatitis, and ichthyosis vulgaris.