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In This Issue of JAMA Dermatology
November 2018


JAMA Dermatol. 2018;154(11):1239. doi:10.1001/jamadermatol.2017.3863

In the US aging population, there is an unmet need for dermatologic care. In this study, using county-level data from the Area Health Resources File, Feng et al report that from 1995 to 2013, dermatologist density increased the most in rural areas, but the gap between metropolitan and other areas also widened. The findings suggest that substantial disparities exist in the geographic distribution of dermatologists, potentially affecting patient care.


Understanding childhood nevus development may point to possible causes of melanoma and prevention strategies. In this longitudinal cohort study of children aged 3 to 16 years, Asdigian et al report that nevus accumulation increased linearly over time but at a faster rate in boys than girls, although girls accumulated more nevi on body sites intermittently sun exposed. While sun protection should be emphasized for all children, increased attention might be merited for boys generally and for girls during the adolescent years and for intermittently sun-exposed body sites.

Changes in the use and cost of actinic keratosis (AK) in the aging population is not well understood. In this Medicare claims analysis of Part B fee-for-service beneficiaries, Yeung et al report that the number of AK lesions per 1000 beneficiaries increased substantially from 2007 to 2015, while the inflation-adjusted payments decreased. These findings suggest that AK treatment may be increasingly burdensome to patients, causing them to not seek treatment, and that AK treatment value analysis is warranted.


Differences among US outpatients and the dermatology services they receive are not well characterized. In this study using data from the Medical Expenditure Panel Survey, Tripathi et al report that patients who were male, uninsured, Midwestern, from a lower income group, had a lower educational level, or had Medicaid or Medicare coverage were less likely to receive outpatient dermatologic care. The findings suggest a need to further characterize patient differences to deliver quality outpatient dermatologic care to disadvantaged populations.


Up to half of patients with psoriasis report using complementary and alternative medicine (CAM) in their treatment regimen, but little is known about its effectiveness. In this systematic review, Gamret et al found that indigo naturalis, curcumin, dietary modification, fish oil, meditation, and acupuncture had the most robust evidence of efficacy in the treatment of plaque psoriasis. These findings will serve as a resource for dermatologists treating patients with psoriasis who are increasingly also using CAM.

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