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In This Issue of JAMA Dermatology |

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JAMA Dermatol. 2016;152(7):739. doi:10.1001/jamadermatol.2015.3268.
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Psoriasis is a chronic immune-mediated inflammatory skin disease characterized by keratinocyte proliferation, dendritic cell activation, proinflammatory cytokine release, and T-cell recruitment. Psoriasis has been associated with components of the metabolic syndrome, particularly obesity and type 2 diabetes mellitus. These comorbidities can lead to increased mortality, especially related to cardiovascular disease. In this cross-sectional twin study, Lønnberg et al demonstrate that psoriasis, type 2 diabetes, and obesity are strongly associated in adults after accounting for key confounding factors such as sex, age, and smoking.

Dermatology was an early adopter of telemedicine, and substantial evidence supports store-and-forward (asynchronous) teleconsultation models. Direct-to-consumer (DTC) teledermatology is expanding rapidly but is less well studied. Concerns exist regarding patient choice, clinician credentialing, coordination of care, and protocols for local referrals. With this series of structured dermatologic cases, Resneck et al demonstrate that, while DTC websites and apps have potential to expand access to care, doubts remain regarding diagnostic and treatment quality. Several standard practices are recommended to help DTC telemedicine companies deliver transparent, ethically provided, coordinated, high-quality care.

The UV radiation dependency of melanoma is not as clear or linear as in squamous cell carcinoma, and the effect of pigmentation variants on melanoma development has become more important in the evaluation of melanoma risk factors. The most important gene affecting pigmentation is the melanocortin-1 receptor (MC1R). In this case-control study, Wendt et al demonstrate that carriers of MC1R variants were at increased melanoma risk independent of their sun exposure. A genetic background pathway for melanoma may exist that differs from the sun-induced pathway.

Hirsutism is a frequent presenting complaint to dermatologists, affecting 5% to 15% of women of reproductive age. Qualitative reports reveal that hirsutism may cause depression, worry, embarrassment, and social withdrawal, but quantitative assessments of the effect of hirsutism on quality of life have been limited. In this study of clinic patients with polycystic ovarian syndrome (PCOS), Pasch et al demonstrate that patients view their hirsutism as more severe than their clinicians do. Self-ratings were more highly associated with negative quality-of-life effects than quantitative ratings of severity of hirsutism.

Bundled payment models are novel payment methods encouraged by the Affordable Care Act. Bundled payments are 1-time reimbursements that encompass all care for a particular condition for a particular patient for a specific time. Actinic keratosis (AK) is one of the most frequently managed conditions in US dermatology practices, and the direct cost of AK treatment is expected to grow. In this cohort cost-identification study, Kirby et al demonstrate that bundled payment models have the potential to decrease AK treatment costs. Specialists’ representatives can submit proposals for alternative payment models to a Technical Advisory Committee for consideration, offering a valuable opportunity to actively participate in reforms.





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