DOCSLIB.ORG

Treatment for Skin Conditions Page 1 of 17

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Treatment for Skin Conditions Page 1 of 17 Version 2.0 Johns Hopkins HealthCare LLC Policy Number CMS16.02 Medical Policy Effective Date 08/02/2021 Medical Policy Review Date 05/18/2021 Subject Revision Date 05/18/2021 Treatment for Skin Conditions Page 1 of 17 This document applies to the following Participating Organizations: EHP Johns Hopkins Advantage MD Priority Partners US Family Health Plan Keywords: Laser treatment, Phototherapy, Psoralens and ultraviolet A (PUVA), Skin conditions Table of Contents Page Number I. ACTION 1 II. POLICY DISCLAIMER 1 III. POLICY 1 IV. POLICY CRITERIA 2 V. DEFINITIONS 6 VI. BACKGROUND 7 VII. CODING DISCLAIMER 8 VIII. CODING INFORMATION 9 IX. REFERENCES 13 X. REFERENCE STATEMENT 17 XI. APPROVALS 17 I. ACTION New Policy X Revising Policy Number CMS16.02 & CMS01.04 Superseding Policy Number Archiving Policy Number Retiring Policy Number II. POLICY DISCLAIMER Johns Hopkins HealthCare LLC (JHHC) provides a full spectrum of health care products and services for Employer Health Programs, Priority Partners, Advantage MD and US Family Health Plan. Each line of business possesses its own unique contract and guidelines which, for benefit and payment purposes, should be consulted first to know what benefits are available for coverage. Specific contract benefits, guidelines or policies supersede the information outlined in this policy. III. POLICY For Advantage MD refer to: Medicare Coverage Database • Local Coverage Determination (LCD) L34938 Removal of Benign Skin Lesions • Local Coverage Article: Billing and Coding: A57113 Removal of Benign Skin Lesions • Local Coverage Determination (LCD) L35090 Cosmetic and Reconstructive Surgery © Copyright 2021 by The Johns Hopkins Health System Corporation and/or The Johns Hopkins University Version 2.0 Johns Hopkins HealthCare LLC Policy Number CMS16.02 Medical Policy Effective Date 08/02/2021 Medical Policy Review Date 05/18/2021 Subject Revision Date 05/18/2021 Treatment for Skin Conditions Page 2 of 17 • National Coverage Determination (NCD) 250.4 Treatment of Actinic Keratosis • National Coverage Determination (NCD) 250.1 Treatment of Psoriasis For Employer Health Programs (EHP) refer to: • Plan specific Summary Plan Descriptions (SPD's) For Priority Partners (PPMCO) refer to: Code of Maryland Regulations • No specific information located in COMAR 10.67.01 – 10.67.13 (Accessed 4/7/2021) For US Family Health Plan refer to: TRICARE Policy Manuals • TRICARE Policy Manual 6010.60-M, April 1, 2015, Chapter 4, Section 2.1 Cosmetic, Reconstructive, and Plastic Surgery-General Guidelines • TRICARE Policy Manual 6010.60-M, April 1, 2015, Chapter 7, Section 17.1 Dermatological Procedures-General • TRICARE Policy Manual 6010.60-M, April 1, 2015, Chapter 4, Section 3.1 Laser Surgery IV. POLICY CRITERIA A. Laser Treatments 1. When benefits are provided under the member's contract, JHHC considers laser treatment of select skin conditions medically necessary when ALL of the following criteria are met: a. Standard medical therapy has been optimized for a minimum of three months (as confirmed through review of pharmacy claims and medical records), AND; b. There is a confirmed diagnosis of: i. Localized plaque psoriasis affecting <10% of total body surface area. • For the treatment of plaque psoriasis the Psoriasis Area and Severity Index (PASI) score, or other objective response measurement to document treatment efficacy is required (Refer to Definitions). ii. Port wine stains and other vascular (malformations) of the face and neck. iii. Vitiligo of the face and hands iv. Symptomatic scarring resulting from a therapeutic intervention (example: surgery), disease or trauma. (see CMS03.12, Cosmetic and Reconstructive Services); v. Treatment of vascular lesions when resulting from a complication of medical condition (e.g.,. scleroderma, surgical scarring or when affecting a vital structure, associated with recurrent bleeding, painful nodules, or functional impairment; vi. Hidradenitis refractory to all medical treatment as reported in medical records; vii. Hair growth in undesirable locations on skin graft or flap; viii. Targeted permanent removal of ingrown hairs may be considered medically necessary when the condition is recurrent and is causing symptomatic (e.g., infected, painful, tender) cysts or skin lesions such as pilonidal cysts and pseudofolliculitis barbae. Medical documentation is required to determine medical necessity. © Copyright 2021 by The Johns Hopkins Health System Corporation and/or The Johns Hopkins University Version 2.0 Johns Hopkins HealthCare LLC Policy Number CMS16.02 Medical Policy Effective Date 08/02/2021 Medical Policy Review Date 05/18/2021 Subject Revision Date 05/18/2021 Treatment for Skin Conditions Page 3 of 17 c. Unless specific benefits are provided under the member’s contract, JHHC considers ultra-violet B (UVB) in conjunction with pulsed dye laser in the treatment of plaque psoriasis experimental and investigational as it does not meet Technology Evaluation Criteria (TEC). d. Unless specific benefits are provided under the member’s contract, JHHC considers laser treatment cosmetic for all other conditions including, but not limited to the following: i. Acne scarring; ii. Dyschromia; iii. Hair removal, (except when medically indicated, e.g., hidradenitis, hair in undesirable location on skin graft or flap); iv. Tattoo removal; v. Removal of spider angioma, (except as above when medically indicated, e.g., treatment of vascular lesions when a complication of medical condition (e.g., scleroderma, surgical scarring)); vi. Removal of telangiectasias; vii. Rosacea; viii. Improving or reducing wrinkles; ix. Regenerating skin collagen; x. Reducing sun-damaged or aging skin e. Unless specific benefits are provided under the member’s contract, JHHC considers laser treatment experimental and investigational for all other indications, as it does not meet Technology Evaluation Criteria (TEC). B. Phototherapy Treatments 1. When benefits are provided under the member’s contract JHHC considers phototherapy for skin conditions medically necessary when All the following general conditions are met: a. The goal of therapy is not primarily cosmetic, defined as carried out with the primary intent to change or improve appearance in the absence of specific functional deficit(s), AND; b. Therapy has a defined and measurable end-point, (or if continued improvement is documented, treatment may be considered indefinitely in order to maintain such improvement, as noted below), c. A maximum of 3 treatments per week for 2 months may be considered on initial request. AND; i. If no improvement is documented within the first 2 months of treatment, additional treatments are not considered medically necessary. ii. If improvement is documented in the medical record, up to 3 treatments per week may be considered for an additional 4 months. iii. If continued improvement is documented, and/or maintenance of improvement is documented, up to 2 treatments a week may be considered indefinitely d. Therapy is discontinued when the end-point is reached or there is limited or no measurable response to treatment. e. The specific phototherapy type criteria in 2 or 3 below are met. 2. Psoralens and Ultraviolet A (PUVA): a. When benefits are provided under the member's contract, JHHC considers psoralens and ultraviolet A (PUVA) treatments medically necessary for the following conditions when medical records demonstrate that conventional therapies have been optimized and failed: i. Vitiligo © Copyright 2021 by The Johns Hopkins Health System Corporation and/or The Johns Hopkins University Version 2.0 Johns Hopkins HealthCare LLC Policy Number CMS16.02 Medical Policy Effective Date 08/02/2021 Medical Policy Review Date 05/18/2021 Subject Revision Date 05/18/2021 Treatment for Skin Conditions Page 4 of 17 ii. Moderate to severe psoriasis (i.e., psoriasis involving 7% or more of the body, or severe psoriasis involving the hands, feet or scalp); iii. Urticaria pigmentosa (cutaneous mastocytosis); iv. Pruritus of polycythemia vera; v. Chronic eczematous dermatitis including atopic dermatitis vi. Parapsoriasis; vii. Lichen planus; viii. Pityriasis lichenoides; ix. Photodermatoses; x. Necrobiosis lipoidica; xi. Morphea and localized skin lesions associated with scleroderma and systemic sclerosis xii. Granuloma annulare; xiii. Eosinophilic folliculitis and other pruritic eruptions of HIV infection; xiv. Cutaneous manifestations of graft versus host disease; xv. Mycosis fungoides including lymphomatoid papulosis; xvi. Chronic palmoplantar pustulosis; xvii. Alopecia areata; xviii.Pruritus of renal disease xix. Pityriasis rubra pilaris xx. Lymphomatoid papulosis b. Unless specific benefits are provided under the member's contract, JHHC considers Home PUVA and/ or PUVA treatment experimental and investigational for all other medical diagnoses, as it does not meet Technology Evaluation Criteria (TEC). 3. UVA, UVA1 and UVB to include narrowband UVB: a. When benefits are provided under the member's contract, JHHC considers UVA or UVB medically necessary for the following conditions when medical records demonstrate that conventional therapies have been optimized and failed: i. Mycosis fungoides including lymphomatoid papulosis ii. Chronic eczematous dermatitis including atopic dermatitis; iii. Vitiligo iv. Moderate to severe psoriasis(i.e., psoriasis involving 7% or more of the body, or severe psoriasis involving the hands, feet or scalp); v. Prurigo nodularis; vi. Pityriasis rosea; vii. Pityriasis lichenoides; viii. Photodermatoses; ix. Parapsoriasis;
Load more

Recommended publications
  • Blistering, Papulosquamous, Connective Tissue and Alopecia Kathleen Haycraft, DNP, FNP/PNP-BC, DCNP, FAANP Objectives
    Blistering, Papulosquamous, Connective Tissue and Alopecia Kathleen Haycraft, DNP, FNP/PNP-BC, DCNP, FAANP Objectives • Identify examples of papulosquamous disease and state treatment options • Identify examples of connective tissue disease and state treatment options • Identify examples of blistering diseases and state treatment options • Identify examples of alopecia and state treatment options Papulosquamous Psoriasis • Latin means “itchy plaque”. • In truth it is less itchy than yeast and eczema • Variable • Painful in high friction spots Psoriasis Plaque ©kathleenhaycraft Psoriasis ©kathleen haycraft ©kathleenhaycraft The clue to the vaginal pic ©kathleenhaycraft ©kathleenhaycraft Plantar Psoriasis ©kathleenhaycraft Palmar Psoriasis ©kathleenhaycraft Nivolumab induced Psoriasis ©[email protected] Psoriasis and its many forms • Plaque..85% • Scalp • Palmoplantar • Guttate • Inverse • Erythrodermic • Psoriatic arthritis • Psoriatic nails Cause • Affects 2 to 5% of the population • Many mediators including the T cell lymphocyte. • Many chemicals downstream including TNF alpha, PDE, Il 12, 23, 17 as well as a variety of inflammatory cytokines • These chemicals are distributed throughout the body • Imbalance between pro inflammatory and anti-inflammatory chemicals • Can be triggered by strep, HIV, Hepatitis, and a wide variety of infectious organisms Psoriasis causes • Koebner phenomenon after surgery or trauma • Drugs such as beta blockers, lithium, antimalarials • The cytokines result in proliferation of keratinocytes and angiogenesis (resulting in the Auspitz sign) • May be mild to severe and location of scalp, genitalia, face may trump degree of psoriasis (BSA- Comorbidities • Reviewed in the cutaneous manifestations of systemic disease • Range from depression to MI, psoriatic arthritis, malignancy, Dm • Future treatments may be based on how they treat the comorbids • Diagnose with visual or biopsy Treatment • Topical corticosteroids..caution to not over use particularly in high risk areas.
    [Show full text]
  • History of Psoriasis and Parapsoriasis
    History of Psoriasis and Parapsoriasis By Karl Holubar Summary Parapsoriasis is «oï a disease entity. Jt is an auxiliary term introduced in J 902 to group several dermatoses w>itk a/aint similarity to psoriasis. Tlie liistorical development leading to tlie creation o/ t/ie term parapsoriasis is outlined and t/te Itistory o/psoriasis is 6rie/ly reviewed. Semantic and terminological considerations Obviously, para-psoriasis as a term has been created in analogy to psoriasis. We should remember similar neologisms in medical language, e. g. protein and para-protein; typhoid and para-typhoid, thyroid and para-thyroid, phimosis and para-phimosis, eventually, pemphigus and para-pemphigus (the latter in 1955 this term was to be employed instead of pemphigoid but was not accepted by the dermatological world). Literally, para is a Greek preposition, (with the genitive, dative and accusative), meaning: by the side of, next to something, alongside something. In medicine, para is used often as a prefix to another term, which designates a condition somewhat similar to the one under consideration. The same holds for psoriasis and parapsoria- sis. In detail, though, it is a bit more complicated. Parapsoriasis has more than one "/at/ier", three in fact: ideiurick /Iu.spitz f 1835—1886,), Paul Gerson Luna (A850—1929j and Louis Procç fI856—I928J. Auspitz, in 1881, had published a new system of skin diseases the seventh class of which was called epidermidoses, subdivided into liypcrlcfiratose.s, parakeratoses, kerato/y- ses, the characteristics of which were excessive keratinization, abnormal keratinization and insufficent keratinization. When Unna, in 1890®, pub- lished his two reports on what he called parakeratosis variegata, he referred to Auspitz' system and term when coining his own.
    [Show full text]
  • Dermatological Indications of Disease - Part II This Patient on Dialysis Is Showing: A
    “Cutaneous Manifestations of Disease” ACOI - Las Vegas FR Darrow, DO, MACOI Burrell College of Osteopathic Medicine This 56 year old man has a history of headaches, jaw claudication and recent onset of blindness in his left eye. Sed rate is 110. He has: A. Ergot poisoning. B. Cholesterol emboli. C. Temporal arteritis. D. Scleroderma. E. Mucormycosis. Varicella associated. GCA complex = Cranial arteritis; Aortic arch syndrome; Fever/wasting syndrome (FUO); Polymyalgia rheumatica. This patient missed his vaccine due at age: A. 45 B. 50 C. 55 D. 60 E. 65 He must see a (an): A. neurologist. B. opthalmologist. C. cardiologist. D. gastroenterologist. E. surgeon. Medscape This 60 y/o male patient would most likely have which of the following as a pathogen? A. Pseudomonas B. Group B streptococcus* C. Listeria D. Pneumococcus E. Staphylococcus epidermidis This skin condition, erysipelas, may rarely lead to septicemia, thrombophlebitis, septic arthritis, osteomyelitis, and endocarditis. Involves the lymphatics with scarring and chronic lymphedema. *more likely pyogenes/beta hemolytic Streptococcus This patient is susceptible to: A. psoriasis. B. rheumatic fever. C. vasculitis. D. Celiac disease E. membranoproliferative glomerulonephritis. Also susceptible to PSGN and scarlet fever and reactive arthritis. Culture if MRSA suspected. This patient has antithyroid antibodies. This is: • A. alopecia areata. • B. psoriasis. • C. tinea. • D. lichen planus. • E. syphilis. Search for Hashimoto’s or Addison’s or other B8, Q2, Q3, DRB1, DR3, DR4, DR8 diseases. This patient who works in the electronics industry presents with paresthesias, abdominal pain, fingernail changes, and the below findings. He may well have poisoning from : A. lead. B.
    [Show full text]
  • Differential Diagnosis in Dermatology
    Differential Diagnosis in Dermatology ZohrehTehranchi Dermatologist COMMON ACNE AND CYSTIC ACNE Rosacea Rosacea PERIORAL DERMATITIS ECZEMA/DERMATITIS Chronic irritant dermatitis Dyshidrotic eczematous dermatitis Childood atopic dermatitis Autosensitization dermatitis (“id” reaction): dermatophytid Seborrheic dermatitis PSORIASIS VULGARIS Pemphigus vulgaris BULLOUS PEMPHIGOID (BP) Pityriasis rosea small-plaque parapsoriasis Large-plaque parapsoriasis (parapsoriasis en plaques) LICHEN PLANUS (LP) GRANULOMA ANNULARE (GA) Erythema multiforme ERYTHEMA NODOSUM Actinic keratoses Bowen disease (Squamous cell carcinoma in situ) Bowen disease and invasive SCC Squamous cell carcinoma: invasive on the lip Squamous cell carcinoma, well differentiated Squamous cell carcinoma, undifferentiated Squamous cell carcinoma, advanced, well differentiated, on the hand Keratoacanthoma showing different stages of evolution BASAL CELL CARCINOMA (BCC) Basal cell carcinoma, ulcerated: Rodent ulcer A large rodent ulcer in the nuchal and Bas cell calarcinoma: sclerosing type retroauricular area extending to the temple Basal cell carcinoma, sclerosing, nodular, Superficial basal cell carcinoma: solitary lesion and multiple lesions Superficial basal cell carcinoma, invasive Basal cell carcinoma, pigmented Dysplastic nevi Superficial spreading melanoma: arising within a dysplastic nevus Congenital nevomelanocytic nevus Melanoma: arising in small CNMN Melanoma in situ: lentigo maligna Melanoma in situ, superficial spreading type Superficial spreading melanoma, vertical
    [Show full text]
  • Papular Pityriasis Rosea
    Continuing Medical Education Papular Pityriasis Rosea 2nd Lt Ronald M. Bernardin, MSC, USAF; Maj Steven E. Ritter, MC, FS, USAF; Lt Col Michael R. Murchland, MC, FS, USAF GOAL To describe a case of papular pityriasis rosea (PR) OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Outline the varying clinical presentations of PR. 2. Discuss the theoretical etiologies of PR. 3. Describe therapy for PR. CME Test on page 48. This article has been peer reviewed and Medicine is accredited by the ACCME to provide approved by Michael Fisher, MD, Professor of continuing medical education for physicians. Medicine, Albert Einstein College of Medicine. Albert Einstein College of Medicine designates Review date: June 2002. this educational activity for a maximum of 1.0 hour This activity has been planned and implemented in category 1 credit toward the AMA Physician’s in accordance with the Essential Areas and Policies Recognition Award. Each physician should claim of the Accreditation Council for Continuing Medical only those hours of credit that he/she actually spent Education through the joint sponsorship of Albert in the educational activity. Einstein College of Medicine and Quadrant This activity has been planned and produced in HealthCom, Inc. The Albert Einstein College of accordance with ACCME Essentials. Pityriasis rosea (PR) is a seasonal papulosqua- and treatment options. Papular PR is atypical, pre- mous disorder that can be easily confused with a senting in a minority of patients, and may pose a wide variety of similar appearing cutaneous disor- diagnostic challenge. Being familiar with these ders.
    [Show full text]
  • Pediatric Psoriasis
    Pediatric Papulosquamous and Eczematous Disorders St. John’s Episcopal Hospital Program Director- Dr. Suzanne Sirota-Rozenberg Dr. Brett Dolgin, DO Dr. Asma Ahmed, DO Dr. Anna Slobodskya, DO Dr. Stephanie Lasky, DO Dr. Louis Siegel, DO Dr. Evelyn Gordon, DO Dr. Vanita Chand, DO Pediatric Psoriasis Epidemiology • Psoriasis can first appear at any age, from infancy to the eighth decade of life • The prevalence of psoriasis in children ages 0 to 18 years old is 1% with an incidence of 40.8 per 100,000 ppl • ~ 75% have onset before 40 years of age What causes psoriasis? • Multifactorial • Genetics – HLA associations (Cw6, B13, B17, B57, B27, DR7) • Abnormal T cell activation – Th1, Th17 with increased cytokines IL 1, 2, 12, 17, 23, IFN-gamma, TNF-alpha • External triggers: – Injury (Koebner phenomenon) – medications (lithium, IFNs, β-blockers, antimalarials, rapid taper of systemic corticosteroids) – infections (particularly streptococcal tonsillitis). Pediatric Psoriasis Types: • Acute Guttate Psoriasis – Small erythematous plaques occurring after infection (MOST common in children) • 40% of patients with guttate psoriasis will progress to develop plaque type psoriasis • Chronic plaque Psoriasis – erythematous plaques with scaling • Flexural Psoriasis – Erythematous areas between skin folds • Scalp Psoriasis – Thick scale found on scalp • Nail Psoriasis – Nail dystrophy • Erythrodermic Psoriasis– Severe erythema covering all or most of the body • Pustular Psoriasis – Acutely arising pustules • Photosensitive Psoriasis – Seen in areas of sun
    [Show full text]
  • Photochemotherapy
    Photochemotherapy Policy Number: Original Effective Date: MM.02.015 11/09/2004 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration June 1, 2016 Section: Medicine Place(s) of Service: Home; Office I. Description Photochemotherapy utilizing ultraviolet light type A (UVA) therapy is a treatment that involves exposing the patient to a photosynthesizing agent (psoralens) through oral ingestion or through bath water in conjunction with ultraviolet A light (sunlight or artificial light) for photochemotherapy of skin conditions. UVA therapy utilizing psoralens is also known as PUVA therapy. Photochemotherapy utilizing ultraviolet light type B (UVB) therapy is a treatment that involves exposing the patient to ultraviolet light type B or middle-wave ultraviolet light. It is generally used in combination with tar or anthralin. II. Criteria/Guidelines A. Photochemotherapy utilizing UVA therapy is covered (subject to Limitations/Exclusions and Administrative Guidelines) for the following diagnoses: 1. Pinta 2. Cutaneous T-cell lymphoma 3. Chronic Graft versus Host Disease refractory to standard immunosuppressive drug treatment 4. Psoriasis 5. Parapsoriasis 6. Atopic dermatitis 7. Lichen planus 8. Pityriasis rosea B. Bath water PUVA is covered if all of the following are met: 1. Patient has extensive, severe psoriasis 2. Patient had prior inability to tolerate systemic PUVA therapy and other conventional therapies. 3. Patient had no prior treatment involving carcinogenic materials (with the exception of methotrexate) including tar and UVB treatments, radiation therapy, and arsenic therapy. Photochemotherapy 2 C. Photochemotherapy utilizing UVB therapy is covered (subject to Limitations/Exclusions and Administrative Guidelines) for the following diagnoses: 1. Psoriasis 2. Parapsoriasis 3.
    [Show full text]
  • Buffalo Medical Group, P.C. Robert E
    Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 2 FOOT- 1 HAND SYNDROME 2 foot - 1 hand syndrome is a superficial infection of the skin caused by the common athlete's foot fungus. It is quite common for people to have a minor amount of an athlete's foot condition. This would appear as slight scaling and/or itching between the toes. In addition, patients may have thickened toenails as part of the athlete's foot condition. Again the problem on the feet is very common and often patients are not even aware of it. In some patients, however, the athlete's foot fungus can spread to another area of the body. For some strange and unknown reason, it seems to affect only one hand. That is why the condition is called 2 foot - 1 hand syndrome. It is not clear why the problem develops in only one hand or why the right or left is involved in some patients. Fortunately there is very effective treatment to control this minor skin problem. If the problem with the superficial fungus infection is confined to the skin, then a short course of treatment with an oral antibiotic is all that is required. This antibiotic is very safe and normally clears the skin up fairly rapidly. It is often used with a topical cream to speed the healing process. If, however, the fingernails of the affected hand are also involved then a more prolonged course of the antibiotic will be necessary.
    [Show full text]
  • Home Phototherapy Order Form
    Physician’s Written Order for Home Phototherapy Fax to: 605-322-2475 or Email: [email protected] This form is a Prescription and Statement of Medical Necessity for Daavlin home phototherapy products Rx used for the treatment of skin conditions such as psoriasis. All fields required for insurance approval. First Name _______________________ Last Name _________________________ DOB ____/____/____ Gender: M F Address _____________________________________________ City_________________________ State_____ Zip__________ Patient Info: Patient Phone #________________________________ Alt Phone # or Email _______________________________________________ HCPCs: Product and Description: Physician Name ___________________________________ DermaPal: Hand-held treatment wand for scalp, Practice __________________________________________ E0691 spot treatment or travel. Includes comb attachment. NPI# ______________________________________________ E0691 1 Series: Small, light-weight panel for hands, face, Address _________________________________________ feet, elbows, or any other localized treatment area. City ______________________ State ____ Zip _________ 7 Series 8 Lamp: Six foot tall, multi-directional unit Info: Physician Prescribing Phone (____)______________*Fax (____)______________ Home Phototherapy Product: Home Phototherapy E0694 for large areas and/or full body treatment. * IMPORTANT: We will use this fax number to fax the Prescriber’s Dosing Guide ICD-10 Code: Description: ICD-10 Code Estimated Duration of Need: ___ Months (
    [Show full text]
  • A Retrospective Study of the Probability of the Evolution of Parapsoriasis En Plaques Into Mycosis Fungoides
    Acta Derm Venereol 2005; 85: 318–323 INVESTIGATIVE REPORT A Retrospective Study of the Probability of the Evolution of Parapsoriasis en Plaques into Mycosis Fungoides Liisa VA¨ KEVA¨ 1, Seppo SARNA3, Annikki VAALASTI4, Eero PUKKALA5, Arja-Leena KARINIEMI2 and Annamari RANKI1 Departments of 1Dermatology and Venereal Diseases and 2Pathology, Skin and Allergy Hospital, Helsinki University Hospital, 3Department of Public Health, University of Helsinki, Helsinki, 4Department of Dermatology, Tampere University Hospital, Tampere and 5Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland Parapsoriasis en plaque has been suggested to be an early with parapsoriasis en plaque in fact represent early manifestation of mycosis fungoides (cutaneous T-cell MF (5, 6). lymphoma). We explored the disease course of patients According to current dermatology textbooks, para- with small plaque or large plaque parapsoriasis in a 26- psoriasis en plaques is divided into two clinically year retrospective cohort analysis of 105 parapsoriasis different entities: small plaque parapsoriasis (SPP) and patients, who were clinically and histopathologically large plaque parapsoriasis (LPP). LPP in particular is followed up in Helsinki and Tampere University often clinically indistinguishable from MF (7, 8). The Hospitals. Eventual later cancers of these patients were differential diagnosis of SPP and LPP is usually based verified from the Finnish Cancer Registry. In the small both on clinical and histopathological findings, because plaque parapsoriasis group, 7 patients (10%) and in the both diseases have superficial lymphocyte inflammation large plaque parapsoriasis group 12 patients (35%), with various degree of epidermotropism. The diagnosis developed histologically confirmed mycosis fungoides of MF is based on the atypical features of infiltrating during a median of 10 and 6 years, respectively.
    [Show full text]
  • 059 BCBSA Reference Number: 2.01.47; 2.01.86
    Medical Policy Phototherapy: PUVA, UV-B and Targeted Phototherapy Table of Contents • Policy: Commercial • Coding Information • Information Pertaining to All Policies • Policy: Medicare • Description • References • Authorization Information • Policy History • Endnotes Policy Number: 059 BCBSA Reference Number: 2.01.47; 2.01.86 Related Policies Dermatologic Applications of Photodynamic Therapy, #463 Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity Medicare HMO BlueSM and Medicare PPO BlueSM Members Photochemotherapy with psoralen plus ultraviolet A (PUVA) - OFFICE SETTING PUVA treatment for the following conditions may be considered MEDICALLY NECESSARY: • Parapsoriasis • Atopic dermatitis/ Eczema • Lichen planus • Urticaria pigmentosa • Chronic recalcitrant dermatitis • Pruritus • Dyshidrosis • pityriasis lichenoides chronica • Alopecia areata (if conservative treatment has failed) • Vitiligo. PUVA for the treatment of severe, disabling psoriasis, which is not responsive to other forms of conservative therapy (eg, topical corticosteroids, coal/tar preparations, and ultraviolet light), may be considered MEDICALLY NECESSARY.5 PUVA treatment as initial (primary) treatment for mycosis fungoides stage I (early infiltrative) and stage II (infiltrative plaques) may be considered MEDICALLY NECESSARY. PUVA treatment is INVESTIGATIONAL for other conditions not listed above. 1 Relative Contraindications to PUVA Therapy1 The following are relative contraindications to PUVA therapy. Coverage is determined at the physician’s
    [Show full text]
  • Clinical Pattern of Papulosquamous Dermatoses: an Observational Study Conducted at Tertiary Care Center, Ujjain, Madhya Pradesh, India
    International Journal of Research in Dermatology Varma K et al. Int J Res Dermatol. 2020 Mar;6(2):230-236 http://www.ijord.com DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20200602 Original Research Article Clinical pattern of papulosquamous dermatoses: an observational study conducted at tertiary care center, Ujjain, Madhya Pradesh, India Krishnendra Varma, Ujjwal Kumar, Varun Kumar* Department of Dermatology, Venereology and Leprology, R.D Gardi Medical College, Ujjain, Madhya Pradesh, India Received: 11 November 2019 Accepted: 10 January 2020 *Correspondence: Dr. Varun Kumar, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Papulosquamous dermatoses is a complex group of disorder characterized by scaly papules and plaques. There is a need to study the exact, pattern and prevalence of this disorder in different age groups and their line of treatment. Objective of the study was to observe the clinical pattern of various papulosquamous dermatoses and their prevalence at tertiary care center, Ujjain. Methods: This was an observational study done in R.D. Gardi Medical college, Ujjain over a period of one year. A total of 229 cases including male and female of papulosquamous dermatoses were enrolled from the outpatient department. All patients were studied clinically and relevant data was recorded. Microsoft excel was used for data entry and analysis was done using SPSS version 23.
    [Show full text]