Teledermatology is an effective method for delivering health care, with strong evidence supporting its use, yet barriers have stalled implementation, including lack of reimbursement, liability concerns, and licensing restrictions. 1,2 The coronavirus disease 2019 (COVID-19) pandemic crisis led to rapid adoption of telemedicine to continue care while minimizing in-person contact. 3 Historically, most teledermatology studies have focused on store-and-forward models, whereas during the COVID-19 pandemic, regulatory changes from the US Centers for Medicare and Medicaid Services prompted an increase in live-interactive video visits. These changes granted parity in reimbursements between video and in-person visits, removing eligibility and geographic restrictions. 4,5 We sought to assess dermatologists' perceptions of and experiences with teledermatology in the context of the COVID-19 pandemic and these new changes.Methods | In May and June 2020, an American Academy of Dermatology (AAD) Teledermatology Task Force subgroup surveyed AAD members regarding the effects of COVID-19 on teledermatology. Topics included modes used; situational appropriateness; and opinions regarding reimbursement, perceived need, barriers, and anticipated future use. Questions were tested for face validity and readability and approved by the Task Force and AAD representatives (see Supplement for detailed methods). The AAD administered the survey via email, collected and maintained data, and provided deidentified data for analysis. Participant representativeness based on age, sex,

The ventral tegmental area (VTA) is involved in adaptive reward and motivation processing and is composed of dopamine (DA) and GABA neurons. Defining the elements regulating activity and synaptic plasticity of these cells is critical to understanding mechanisms of reward and addiction. While endocannabinoids (eCBs) that potentially contribute to addiction are known to be involved in synaptic plasticity mechanisms in the VTA, where they are produced is poorly understood. In this study, DA and GABAergic cells were identified using electrophysiology, cellular markers, and a transgenic mouse model that specifically labels GABA cells. Using single-cell RT-qPCR and immunohistochemistry, we investigated mRNA and proteins involved in eCB signaling such as diacylglycerol lipase α, N-acyl-phosphatidylethanolamine-specific phospholipase D, and 12-lipoxygenase, as well as type I metabotropic glutamate receptors (mGluRs). Our results demonstrate the first molecular evidence of colocalization of eCB biosynthetic enzyme and type I mGluR mRNA in VTA neurons. Further, these data reveal higher expression of mGluR1 in DA neurons, suggesting potential differences in eCB synthesis between DA and GABA neurons. These data collectively suggest that VTA GABAergic and DAergic cells have the potential to produce various eCBs implicated in altering neuronal activity or plasticity in adaptive motivational reward or addiction.

Social media is increasingly cited in plastic surgeon surveys as a reason for undergoing cosmetic procedures, especially non-invasive procedures like onabotulinumtoxinA (Botox) and dermal fillers. We explored trends between social media usage and public interest in cosmetic procedures, as well as how these effects differ by procedure and by specialty (dermatology or plastic surgery). Google Trends was queried for search terms and compared with aggregate user data from Instagram and Facebook. Search terms were the brand names of medications, as these are how the general public knows the medications. Benjamini-Hochberg adjustment for multiple comparisons was used; p<0.02 was considered significant, except for comparisons between specialties, where p<0.01 was significant. The terms dermatologist, Botox, Juvederm, Radiesse, CoolSculpting, Kybella, and facelift have increased in popularity over time, whereas the terms Restylane, liposuction, rhinoplasty, and breast augmentation were decreasing in popularity (p<0.02). No temporal change was observed for Sculptra, Radiesse, blepharoplasty, rhinoplasty and plastic surgeon. Dermatologist (r¼Instagram/r¼Facebook)(0.58/0.54), Botox (0.80/0.47), Juvederm (0.69/0.46) Radiesse (-0.89/-0.40), CoolSculpting (0.81/0.44), and Kybella (0.89/0.43) were associated with Instagram and Facebook user numbers (p<0.02). Blepharoplasty (0.69) and rhinoplasty (0.66) were only associated with Instagram users (p<0.02). Juvederm (r¼0.89) was only associated with dermatologist; Sculptra (r¼0.27), blepharoplasty (r¼0.48), and rhinoplasty (r¼0.66) were only associated with plastic surgeon (p<0.01). Significant correlations were seen for all other search terms between both specialties. Online interest in non-invasive cosmetic procedures is increasing, potentially driven in part by social media. Further, these data suggest that interest in dermatology, compared to other specialties, may especially be increasing due to this phenomenon.

Purpose: Google Trends (GT) offers insights into public interests and behaviors and holds potential for guiding public health campaigns. We evaluated trends in US searches for sunscreen, sunburn, skin cancer, and melanoma and their relationships with melanoma outcomes.

Online skin cancer prevention campaigns should focus on the search terms sunburn and sunscreen, especially given the declining interest between 2004 and 2016 in the terms skin cancer and melanoma seen in multiple countries. Search term interests varied with melanoma outcomes and between countries, suggesting the importance of customizing approaches based on local population interests and geographic areas.

ImportanceMultiple patient-reported outcome measures (PROMs) for health-related quality of life (HRQoL) exist for patients with acne. However, little is known about the content validity and other measurement properties of these PROMs.ObjectiveTo systematically review PROMs for HRQoL in adults or adolescents with acne.Data SourcesEligible studies were extracted from PubMed and Embase (OVID).Study SelectionFull-text articles published in English or Spanish on development, pilot, or validation studies for acne-specific, dermatology-specific, or generic HRQoL PROMs were included. Development studies included original development studies, even if not studied in acne patients per Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) recommendations. If a study included several diagnoses, the majority (ie, over 50%) of patients must have acne or acne-specific subgroup analyses must be available. Abstract and full-text screening was performed by 2 independent reviewers.Data Extraction and SynthesisTwo independent reviewers assessed study quality applying the COSMIN checklist and extracted and analyzed the data. For each distinctive PROM, quality of evidence was graded by measurement property.Main Outcomes and MeasuresPROM properties (target population, domains, recall period, development language), PROM development and pilot studies, content validity (relevance, comprehensiveness, comprehensibility), and remaining measurement properties (structural validity, internal consistency, cross-cultural validity, reliability, measurement error, criterion validity, construct validity, and responsiveness). Quality of evidence was assigned for each measurement property of included PROMs. An overall recommendation level was assigned based on content validity and quality of the evidence of measurement properties.ResultsWe identified 54 acne PROM development or validation studies for 10 acne-specific PROMs, 6 dermatology-specific PROMs, and 5 generic PROMs. Few PROMs had studies for responsiveness. The only acne-specific PROMs with sufficient evidence for content validity were the CompAQ and Acne-Q. Based on available evidence, the Acne-Q and CompAQ can be recommended for use in acne clinical studies.Conclusions and RelevanceTwo PROMs can currently be recommended for use in acne clinical studies: the Acne-Q and CompAQ. Evidence on content validity and other measurement properties were lacking for all PROMs; further research investigating the quality of remaining acne-specific, dermatology-specific, and generic HRQoL PROMs is required to recommend their use.

nsurance companies use prior authorizations (PAs) to address inappropriate prescribing and unnecessary variations in care, commonly for expensive medications and procedures. However, PAs often delay and sometimes prevent essential and appropriate treatments and are associated with poor patient outcomes. 1,2 Prior authorizations add administrative burden to physician offices and appear to be increasing over time. [1][2][3][4][5] The American Medical Association has called for PA reform. 3 Dermatology has been disproportionately affected by price advances in biologic medications and substantial price increases for previously inexpensive generic medications [6][7][8][9] ; we suspect that this has had an effect on the occurrence of PAs. Some health insurance plans even require PAs for diagnostic skin biopsies, despite nearly universal approval of these PAs. 10 Data on the administrative burden and costs of PAs in dermatology are lacking. Thus, we sought to describe staffing costs required for PA management in our large academic center during September 2016.

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