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2. Dermatologic Manifestations of Nutritional Deficiency

Author

Alana Deutsch and Jamie R. Manning

Subjects
medicine.medical_specialty, Neurology, business.industry, Mucocutaneous zone, Disease, medicine.disease, 03 medical and health sciences, Malnutrition, 0302 clinical medicine, Pathognomonic, Intervention (counseling), medicine, Etiology, 030212 general & internal medicine, Geriatrics and Gerontology, Intensive care medicine, business, 030217 neurology & neurosurgery, Nutritional deficiency
Abstract

Dermatologic manifestations of systemic diseases provide distinctive and reliable diagnostic clues that hasten time to intervention and improve overall outcomes. Notably, nutritional deficiencies are a class of diseases with representative and well-established dermatologic associations. Nutritional deficiencies can be primary or secondary and genetic or acquired; however, mucocutaneous findings remain characteristic irrespective of etiology. This review will summarize the major classifications of nutritional deficiencies with a focus on conditions relevant and of greatest impact to the geriatric population. Recent literature has largely supported the well-known, pathognomonic mucocutaneous findings associated with nutritional deficiencies as well as displayed atypical clinical presentations and elucidated pathophysiologic mechanisms, which increases awareness and expands the breadth of knowledge of these disorders. Total and specific micronutrient deficiencies can produce a vast array of mucocutaneous findings. These dermatologic manifestations of nutritional deficiencies are critical for all clinicians to recognize to enable prompt diagnosis and treatment. The geriatric population is specifically at-risk and attentiveness towards subtle signs of disease may substantially improve overall health outcomes.

Published
2020
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3. Navigating Barriers to Patient Access and Reimbursement in Mohs Micrographic Surgery

Author

Aimee Krausz, David H. Ciocon, Gian L. Vinelli, and Jamie R. Manning

Subjects
Adult, Male, medicine.medical_specialty, Skin Neoplasms, Cost Control, media_common.quotation_subject, medicine.medical_treatment, MEDLINE, Dermatology, Deductible, Micrographic surgery, Health Services Accessibility, Insurance Coverage, Reimbursement Mechanisms, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Health care, Mohs surgery, Humans, Medicine, Prior authorization, Practice Patterns, Physicians', Societies, Medical, Reimbursement, media_common, business.industry, General Medicine, Mohs Surgery, Payment, 030220 oncology & carcinogenesis, Family medicine, Female, Surgery, business
Abstract

Background Insurance companies have implemented new policies including excessive prior authorization (PA) requirements, high-deductible plans, and complicated billing structures in an effort to curb rising health care costs. Studies investigating the real-time impact on providers and patients are emerging, but few within the field of dermatology have been published. Objective To assess the impact of cost-cutting policies on patients and physicians. Methods A survey was electronically distributed to members of the American College of Mohs Surgery (ACMS). Results The majority of respondents (78.2%) practiced in a private setting, with no other demographic differences. The majority of respondents (70%) dedicated 1 to 2 employees to obtaining PAs. Fifty percent reported an average time of 30 minutes spent per PA. Fifty-six percent of respondents obtained PA from private insurance before Mohs surgery, whereas only 24.5% obtained PA from Medicare. Forty-nine percent of practitioners provided patients with a financial disclosure prior to Mohs surgery. Moreover, many practitioners reported screening patients for high-deductible policies and request an advanced deposit against the deductible. Sixty percent reported difficulty obtaining payment for service in the absence of an advanced deposit. Conclusion The burden of restrictive health care policies will have long-term consequences for the patient-provider interaction and patient outcomes.

Published
2019
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6. List of Contributors

Author

Anthony Abdullah, Michael Abrouk, Tashmeeta Ahad, Imtiaz Ahmed, Anwar Al Hammadi, Caroline Allen, Amer Ali Almohssen, Wisam Alwan, Mahreen Ameen, Sadegh Amini, Bryan E. Anderson, Grant J. Anhalt, Donald J. Baker, Harini Rajgopal Bala, Julia Baltz, David Banach, Cedric C. Banfield, Robert Baran, Ajoy Bardhan, Melissa C. Barkham, Ysabel M. Bello, Emma Benton, Wilma F. Bergfeld, Eric Berkowitz, Brian Berman, Jeffrey D. Bernhard, Daniel Bernstein, John Berth-Jones, Chinmoy Bhate, Bhavnit K. Bhatia, Jonathan E. Blume, Nevianna Bordet, Catherine Borysiewicz, Gary J. Brauner, Robert T. Brodell, Marc D. Brown, Robert M. Burd, Anne E. Burdick, Niraj Butala, Jeffrey P. Callen, Ivan D. Camacho, Helena Camasmie, Daniel Caplivski, Mitchell S. Cappell, Genevieve A. Casey, Lawrence S. Chan, Loi-Yuen Chan, Jennifer K. Chen, Chen 'Mary' Chen, Nicole Yi Zhen Chiang, Anthony J. Chiaravalloti, Fiona J. Child, Anthony C. Chu, Timothy H. Clayton, Steven R. Cohen, Elizabeth A. Cooper, Susan M. Cooper, Nick Collier, Christina M. Correnti, Ian H. Coulson, M. Laurin Council, Shawn E. Cowper, Nicholas M. Craven, Daniel Creamer, Ponciano D. Cruz, Carrie Ann R. Cusack, Adam Daunton, Mark D.P. Davis, Robert S. Dawe, David P. D’Cruz, David de Berker, Danielle M. DeHoratius, Min Deng, Seemal R. Desai, Georgina Devlin, John J. DiGiovanna, Alexander Doctoroff, Roni P. Dodiuk-Gad, Dawn Z. Eichenfield, Lawrence F. Eichenfield, Drore Eisen, Ure Eke, Dirk M. Elston, Patrick O.M. Emanuel, Clinton W. Enos, Shaheen H. Ensanyat, Anna F. Falabella, Aaron S. Farberg, Lawrence S. Feigenbaum, Kristen Heins Fernandez, Nicole Fett, Andrew Y. Finlay, Bahar F. Firoz, Elnaz F. Firoz, James E. Fitzpatrick, Amy E. Flischel, Kelly A. Foley, Derek Freedman, Georgina A. Fremlin, Richard Fried, Philip Friedlander, Adam Friedman, Amy K. Forrestel, Brian S. Fuchs, Joanna E. Gach, Anjela Galan, Jaya Ganesh, Amit Garg, Lauren Geller, Carlo M. Gelmetti, Elizabeth Ghazi, Sneha Ghunawat, Leonard H. Goldberg, Mark J.D. Goodfield, Marsha L. Gordon, Asha Gowda, Daniel A. Grabell, Matthew Grant, Clive E.H. Grattan, Malcolm W. Greaves, Justin J. Green, Christopher E.M. Griffiths, Charles A. Gropper, Anna L. Grossberg, Aditya K. Gupta, Ali S. Hadi, Suhail M. Hadi, Iris A. Hagans, Bethany R. Hairston, Analisa Vincent Halpern, Caroline Halverstam, Natasha Harper, Matthew J. Harries, John Harris, Shannon Harrison, Michael M. Hatch, Adrian H.M. Heagerty, Adelaide A. Hebert, Stephen E. Helms, Camile L. Hexsel, Doris M. Hexsel, Warren R. Heymann, Elisabeth M. Higgins, Claire L. Higgins, Whitney A. High, Herbert Hönigsmann, Marcelo G. Horenstein, George J. Hruza, Andrea Hui, Ran Huo, Sally H. Ibbotson, Sherrif F. Ibrahim, Andrew Ilchyshyn, Dina Ismail, Stefania Jablonska, Heidi T. Jacobe, William D. James, Aysha Javed, Gregor B.E. Jemec, Graham A. Johnston, Stephen K. Jones, Jacqueline M. Junkins-Hopkins, Jessica Kaffenberger, Kelly R. Kane, Antonios Kanelleas, Ayşe Serap Karadağ, Laura Karas, Ruwani P. Katugampola, Bruce E. Katz, Roselyn Kellen, Murtaza Khan, Hooman Khorasani, Ellen J. Kim, Hee J. Kim, Brian Kirby, Joslyn S. Kirby, Rachel S. Klein, Kate Kleydman, Dimitra Koch, John J. Kohorst, John Y.M. Koo, Sandra A. Kopp, Neil J. Korman, Carrie Kovarik, Kenneth H. Kraemer, Bernice R. Krafchik, Karthik Krishnamurthy, Knut Kvernebo, Charlene Lam, Peter C. Lambert, James A.A. Langtry, Amir A. Larian, Cecilia A. Larocca, E. Frances Lawlor, Clifford M. Lawrence, Mark G. Lebwohl, Oscar Lebwohl, Julia S. Lehman, Tabi A. Leslie, Stuart R. Lessin, Jacob O. Levitt, Fiona M. Lewis, Maryam Liaqat, Kristina J. Liu, Michael P. Loosemore, Thomas A. Luger, Omar Lupi, Boris D. Lushniak, Calum C. Lyon, Andrea D. Maderal, Bassel H. Mahmoud, Slawomir Majewski, Richard B. Mallett, Steven M. Manders, Ranon Mann, Yasaman Mansouri, David J. Margolis, Orit Markowitz, Alexander Marsland, Agustin Martin-Clavijo, Daniela Martinez, Catalina Matiz, Marcus Maurer, Kevin McKerrow, Nekma Meah, Giuseppe Micali, Robert G. Micheletti, Leslie G. Millard, James E. Miller, Jillian W. Wong Millsop, Daniel Mimouni, Ginat W. Mirowski, Sultan A. Mirza, Sonja Molin, Adisbeth Morales-Burgos, Warwick L. Morison, Cato Mørk, Colin A. Morton, Richard J. Motley, Megan Mowbray, Eavan G. Muldoon, Anna E. Muncaster, George J. Murakawa, Jenny E. Murase, Michele E. Murdoch, Adam S. Nabatian, Mio Nakamura, Rajani Nalluri, Zeena Y. Nawas, Glen R. Needham, Glenn C. Newell, Julia Newton-Bishop, Adam V. Nguyen, Rosemary L. Nixon, Jack C. O’Brien, Stephanie Ogden, Suzanne M. Olbricht, Sally Jane O’Shea, Cindy E. Owen, Michael Pan, Lisa Pappas-Taffer, Jennifer L. Parish, Lawrence Charles Parish, Michael Payette, Gary L. Peck, Sandra Pena, Jarad Peranteau, Frederick A. Pereira, William Perkins, Clifford S. Perlis, Robert G. Phelps, Tania J. Phillips, Maureen B. Poh-Fitzpatrick, Miriam Keltz Pomeranz, Samantha R. Pop, Pierluigi Porcu, James B. Powell, Lori D. Prok, Tia M. Pyle, Surod Qazaz, Vikram Rajkomar, Rabia S. Rashid, Mehdi Rashighi, Ravi Ratnavel, Christie G. Regula, Michael Renzi, Jean Revuz, Rachel V. Reynolds, Elisabeth Richard, Gabriele Richard, Darrell S. Rigel, Wanda Sonia Robles, Megan Rogge, Alain H. Rook, Jamie R. Manning, Ted Rosen, Misha Rosenbach, David Rosenfeld, Christopher Rowland Payne, Adam I. Rubin, Courtney Rubin, Malcolm H.A. Rustin, Thomas Ruzicka, Sara Samimi, Lawrence A. Schachner, Noah Scheinfeld, Bethanee J. Schlosser, Rhonda E. Schnur, Robert A. Schwartz, Matthew J. Scorer, Bryan A. Selkin, Jamie Seymour, Christine M. Shaver, Christopher R. Shea, Neil H. Shear, Tang Ngee Shim, Hiroshi Shimizu, Julia Siegel, Elisha Singer, Maral Kibarian Skelsey, Chris Sladden, Michael Sladden, Janellen Smith, Joanne E. Smucker, Najwa Somani, Lacy L. Sommer, Mary Sommerlad, Christine Soon, Jennifer A. Sopkovich, Nicholas A. Soter, James M. Spencer, Richard C.D. Staughton, Jane C. Sterling, Cord Sunderkötter, Saleem M. Taibjee, Deborah Tamura, Eunice Tan, William Y-M. Tang, Lynsey Taylor, Bruce H. Thiers, Lucy J. Thomas, Cody R. Thornton, Anne-Marie Tobin, Rochelle R. Torgerson, Antonella Tosti, Fragkiski Tsatsou, Yukiko Tsuji-Abe, William F.G. Tucker, Stephen K. Tyring, Jeremy Udkoff, Robin H. Unger, Walter P. Unger, Sarah Utz, Martha C. Valbuena, Peter van de Kerkhof, Abby S. Van Voorhees, Ramya Vangipuram, David Veitch, Vanessa Venning, Sarah G. Versteeg, Martha Viera, Carmela C. Vittorio, Ruth Ann Vleugels, Gorav N. Wali, Joanna Wallengren, Joy Wan, Karolyn A. Wanat, Gabriele Weichert, Anja K. Weidmann, Jeffrey M. Weinberg, Victoria P. Werth, Lucile E. White, Adam H. Wiener, Jonathan K. Wilkin, Nathaniel K. Wilkin, Jason Williams, Niall Wilson, Karen Wiss, Joseph A. Witkowski, Lauren E. Wiznia, Henry K. Wong, Junie Li Chun Wong, Andrew L. Wright, Cooper C. Wriston, Benedict C. Wu, Adam Wulkan, Andrea L. Zaenglein, Irshad Zaki, Joshua A. Zeichner, Tian Hao Zhu, John J. Zone, Christos C. Zouboulis, and Torstein Zuberbeir

Published
2018
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