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Photodynamic therapy (PDT) with aminolevulinic acid (ALA) is an effective and cosmetically favorable treatment for actinic keratoses (AKs). However, the shallow penetration depth of ALA, prolonged incubation times, and treatment-associated pain limit widespread use of PDT as standard field therapy for AK. In this randomized clinical trial, Petukhova et al demonstrate that microneedle pretreatment before a 20-minute incubation of ALA resulted in an AK clearance rate of 76%, comparable to conventional PDT. In addition to expediting the protocol, microneedle treatment was virtually painless. This protocol may shorten treatment time and achieve greater patient satisfaction without compromising efficacy.
External store-and-forward (SAF) teledermatology systems typically operate outside of electronic health records (EHRs), and limitations include care fragmentation, inadequate communication among clinicians, and privacy and security concerns. Internal SAF systems within existing EHRs should be the standard for large health care organizations. In this case series, Carter et al demonstrate that, compared with traditional in-person dermatology referrals, an internal SAF system with Epic EHR improved access to dermatologic care by reducing the time to evaluation and time to treatment. After implementation, a greater percentage of referred patients were actually treated by a dermatologist than in the prior year.
Highlights. JAMA Dermatol. 2017;153(7):623. doi:10.1001/jamadermatol.2016.1693
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