What is the difference between cpt code 92017 and 92019

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Advisory Committees. Public Safety Communication Act of The Manny Alert Act. All patients were monitored clinically, by laboratory investigation, and by digital image analysis. All patients were followed-up with for 24 weeks.

All patients tolerated alefacept well, without any adverse events. None of the patients showed any re-pigmentation. However, 1 patient developed new de-pigmented patches during treatment with alefacept.

The authors concluded that alefacept as a monotherapy for vitiligo treatment did not result in any patient improvement, and further evaluation in larger studies may be required. Wong and Lin stated that topical calcineurin inhibitors e.

These investigators reviewed the English language literature to define their roles in treatment of vitiligo. Double-blind studies showed that tacrolimus 0. When used alone, tacrolimus 0. Other studies suggested it can also be effective for facial lesions. Moreover, the authors concluded that additional studies would further clarify the role of topical calcineurin inhibitors in vitiligo.

In , the Unites States Food and Drug Administration FDA issued an alert about a possible link between topical tacrolimus and pimecrolimus and cases of lymphoma and skin cancer in children and adults, and in placed a "black box" warning on the prescribing information for these medications.

No definite causal relationship has been established; however, the FDA recommended that these agents only be used as second-line agents for atopic dermatitis. These investigators described the preliminary results of 4 patients with generalized vitiligo who developed re-pigmentation using afamelanotide in combination with narrowband UV-B NB-UV-B phototherapy.

Patients were treated 3 times weekly with NB-UV-B and starting in the 2nd month received a series of 4 monthly implants containing 16 mg of afamelanotide. Afamelanotide induced faster and deeper re-pigmentation in each case.

All patients experienced follicular and confluent areas of re-pigmentation within 2 days to 4 weeks after the initial implant, which progressed significantly throughout treatment. All patients experienced diffuse hyper-pigmentation. The authors proposed that afamelanotide represents a novel and potentially effective treatment for vitiligo. The combined therapy of NB-UV-B and afamelanotide appears to promote melanoblast differentiation, proliferation, and eumelanogenesis.

They stated that further studies are necessary to confirm these observations. Mulekar and Isedeh evaluated the evidence for the safety, effectiveness and applicability of the various surgical methods in the treatment of vitiligo. These investigators reviewed studies reporting on autologous mini-punching grafting, blister roof grafting suction epidermal blister grafting , cultured and non-cultured cellular melanocyte keratinocyte transfer, split thickness skin grafting STSG.

While all methods vary in their re-pigmentation outcomes, STSG is found to have the highest re-pigmentation success rate. Overall, post-operative complications included milia, scarring, cobblestone appearance or hyper-pigmentation of treated areas.

The authors concluded that this review highlighted the need for more randomized controlled trials in this field, under-pinned by a more standardized objective approach to the assessment of re-pigmentation following surgical interventions.

Al Jasser reported the benefit of autologous non-cultured melanocyte-keratinocyte transplantation MKT in patients with vitiligo-associated leukotrichia. All 4 patients showed significant re-pigmentation in vitiligo-associated leukotrichia after MKT. The authors concluded that melanocyte-keratinocyte transplantation may represent a good therapeutic option for the re-pigmentation of vitiligo-associated leukotrichia. Moreover, they stated that larger prospective studies are needed to determine the true response rate and mechanism of re-pigmentation.

In a pilot study, Ruiz-Arguelles et al reported the findings of treatment of vitiligo with a chimeric monoclonal antibody to CD Three of the patients showed an overt clinical and histological improvement of the disease, 1 presented slight improvement and the remaining patient showed no changes.

Improvement was neither associated with changes in laboratory parameters nor to a specific human leucocyte antigen D-related HLA-DR phenotype. The authors concluded that these preliminary results were encouraging, and further clinical trials should be undertaken. Eleftheriadou and colleagues noted that hand-held NB-UVB units are light-weight devices that may overcome the need to treat vitiligo in hospital-based phototherapy cabinets, allowing early treatment at home that may enhance the likelihood of successful re-pigmentation.

The pilot Hi-Light trial examined the feasibility of conducting a large multi-center, randomized controlled trial RCT on the use of such devices by exploring recruitment, adherence, acceptability, and patient education. The overall duration of the trial was 7months; 3 months recruitment and 4 months treatment. Participants were randomly allocated to active or placebo groups ratio. The primary outcome measure was the proportion of eligible participants who were willing to be randomized.

The secondary outcomes included proportion of participants expressing interest in the trial and fulfilling eligibility criteria, withdrawal rates and missing data, proportion of participants adhering to and satisfied with the treatment, and incidence of NB-UVB short-term adverse events.

This pilot trial has explored many of the uncertainties that need to be overcome before embarking on a full scale trial, including the development of a comprehensive training package and treatment protocol. The study has shown strong willingness of participants to be randomized, very good treatment adherence and re-pigmentation rates, and provided evidence of feasibility for a definitive trial.

This trial was not intended as an efficacy trial. In a meta-analysis, Dang et al examined the effect of topical calcineurin inhibitors as monotherapy or combined with phototherapy for vitiligo treatment. A total of 13 studies were included in the meta-analysis. Subgroup analysis was performed to examine if the combination with phototherapy was a source of heterogeneity.

The trial sequence analysis indicated that the results of combined therapy by lesion report were reliable and conclusive. However, in the patient report trials, the frequency of lesions on the hand and foot was higher, and the effect of combined therapy was still non-significant. The authors concluded that calcineurin inhibitors showed a better therapeutic effect than placebo in the treatment of vitiligo with phototherapy.

However, the typical UV-resistant sites i. Moreover, they stated that because of concerns about photo-carcinogenesis, the clinical application of combined therapy should be explored with caution. These investigators undertook a literature search and included the relevant studies passing the selection criteria. After the relevant data were extracted from each study, they statistically analyzed the strength of association between the CAT gene and vitiligo risk.

A total of 7 relevant studies were identified, comprising 1, patients with vitiligo and 1, controls. The genotype distribution in the controls of all studies complied with Hardy-Weinberg equilibrium. They stated that further studies with larger sample sizes are needed to confirm these findings.

A total of 8 case-control studies with 2, cases and 4, controls were included in the meta-analysis. However, larger primary studies with the consideration of gene-environment and gene-gene interactions are still needed to further evaluate the interaction of CAT gene polymorphism with vitiligo susceptibility.

Liang et al noted that cytotoxic T-lymphocyte antigen-4 CTLA-4 is a critical negative regulator of T-cell activation and proliferation. A total of 14 studies comprising 6 on psoriasis cases, controls and 8 on vitiligo 1, cases, 2, controls were included. A total of 6 case-control studies including 1, vitiligo cases and 2, control subjects were included in this meta-analysis.

They stated that as few studies are available in this field and current evidence remains limited, these results must be corroborated with well-designed and larger studies in the future.

Li and colleagues evaluated the association between vitiligo and human leukocyte antigen- HLA- A. Nineteen case-control studies comprising patients and controls were included, in which 33 HLA-A alleles were reported. Twelve alleles, seven alleles, and 19 alleles were common to three ethnicities, both types of vitiligo, and both typing methods, respectively. In the subgroup analysis by ethnicity and typing methods, the association of six alleles and five alleles was inconsistent in three populations and both typing methods, respectively.

In the subgroup analysis by clinical type, the association of all seven alleles was consistent in both types of vitiligo. The association of some alleles varies in terms of ethnicity and typing methods. This study has some limitations. First, the meta-analysis only included published studies.

Second, vitiligo may be influenced by not only genetic factors but also environmental factors. The results of the meta-analysis should be interpreted cautiously owing to the lack of available data regarding vitiligo development and its relationship with genetic and environmental factors.

Further studies may assess the possible gene-environment interactions in the association. Third, the relatively small samples of some HLA-A alleles limited the statistical power. Finally, we were not able to perform subgroup for each HLA-A allele due to the limited number of eligible studies, which might have affected the results.

Therefore, more studies with larger sample sizes focusing on each HLA-A allele are needed to confirm these findings. Despite the limitations listed above, this study still has some strength. To the best of our knowledge, this is the first meta-analysis evaluating the association between vitiligo and a number of HLA-A alleles. Moreover, the association of some alleles varies in terms of ethnicity and typing methods.

However, further well-designed studies with larger sample sizes are still needed to confirm our findings. Agarwal and Changotra stated that protein tyrosine phosphatase, non-receptor type 22 gene, which translates to lymphoid tyrosine phosphatase, is considered to be a susceptibility gene marker associated with several autoimmune diseases. However, these studies showed conflicting results.

Meta-analysis of the same was conducted earlier that included fewer number of publications in their study. Data analysis was performed by RevMan 5. No publication bias was detected in the funnel plot study. The major drawbacks of this meta-analysis were that as a consequence of ethnic-based studies, these investigators were unable to satisfy data by gender or vitiligo-type. Li and co-workers stated that genetic variants are linked to vitiligo and associated autoimmune diseases. This meta-analysis demonstrated that within the Caucasian population, the NLRP1 rs polymorphism may correlate with a decreased risk of vitiligo-associated autoimmune diseases, especially autoimmune Addison's disease, T1DM, or SLE.

The authors concluded that they identified a potential genetic relationship in the Caucasian population between the NLRP1 rs polymorphism and a decreased susceptibility to autoimmune diseases, especially autoimmune Addison's disease, T1DM, or SLE. These autoimmune diseases were all tightly associated with vitiligo. However, these researchers did not observe a strong association between NLRP1 rs, rs, or rs and vitiligo risk, according to the currently very limited data.

They stated that given the fact of insufficient statistical power as stated above, more data are needed to confirm these statements, and further determine the role of NLRP1 SNPs in the presence of vitiligo, or vitiligo together with autoimmune diseases. Janowska and colleagues stated that vitiligo is a multi-factorial acquired dermatosis characterized by achromic or hypochromic macules and by the absence of functioning melanocytes. Treatment depends on the extent of the affected areas and on disease activity.

Surgical techniques have proven to be effective in stable cases but can be time-consuming and, in some cases, aesthetically unsatisfying or painful for the patients. These researchers evaluated the clinical safety and effectiveness of a new automatic epidermal skin harvesting device in patients with stable localized vitiligo over a minimum month period.

Epidermal skin grafts can used in patients with acute and hard to heal chronic wounds, burns and stable vitiligo. The use of advanced therapies may improve the quality of life, have cost benefits and accelerate re-pigmentation of patients with vitiligo. In a pilot study, the authors stated that this system was seen to be a safe and effective means of harvesting epidermal micrografts containing melanocytes for use in patients with stable vitiligo unresponsive to standard therapies.

Cai and associates stated that epidermal grafting has several advantages over full-thickness or split-thickness grafts in the treatment of complex non-healing wounds. These include the low risk of donor site complications, minimal patient discomfort, and abstention from the operating room. Traditionally, the lack of reliable epidermal harvesting techniques has limited its clinical utilization.

The development of an automated suction blister epidermal graft SBEG harvesting device may facilitate clinical utilization of this technique.

These researchers presented a case series of multi-morbid patients who were poor surgical candidates and were treated with this technique. A total of 12 patients underwent 14 epidermal grafting procedures. Among the 2 acute wounds less than or equal to 3 months and 10 chronic wounds, the average wound size was Following the procedure, all donor sites healed within 1 week; 3 patients were lost to follow-up.

Of the remaining 9 patients, 4 patients had complete resolution of their wounds at a median follow-up of Among those with partial resolutions, the average wound size was 4. No donor or recipient site complications were observed. The authors concluded that the automated SBEG harvesting device was a safe and effective option for treating complex non-healing wounds in multi-morbid patients who may be poor surgical candidates.

The main drawback of this study was selection bias associated with the retrospective design. These investigators stated that in dealing with complex wounds, patient selection is an integral component of a successful outcome; patients with co-morbidities not suitable for the operating room, wound healing issues, and compliance concerns are poor candidates for traditional skin grafts. The autologous epidermal grafts effectively circumvent these problems and present an attractive alternative.

The creation of an automated SBEG harvesting technique further simplified the procedure and minimized post-operative complications.

The authors concluded that although this study has shown success in a variety of patients, identification of the ideal patient population may be of interest in follow-up studies.

Krishna and colleagues stated that vitiligo is a common pigmentary disorder of the skin with a great amount of social stigma attached to it. Although various medical modalities are available for the treatment of stable vitiligo, surgical modality remains the treatment of choice for stable and localized vitiligo. The surgical options range from simple punch grafting to the recent epidermal harvesting methods using a negative pressure unit.

Although successful use of multiple methods of epidermal grafting has been reported, most of them are cumbersome and time-consuming. These researchers noted that new automated epidermal harvesting system now commercially available involves a tool that applies both heat and suction concurrently to normal skin to induce epidermal micrografts; it serves as a safe, quick and cost-effective method without anesthesia, with a very minimal downtime for healing and requires an optimal expertise.

The duration of re-pigmentation appeared to be faster and more uniform compared to other procedures. The authors concluded that more controlled studies are needed to prove the effectiveness of negative pressure epidermal harvesting in patients with stable vitiligo.

Samadi and colleagues stated that janus kinase family JAKs has recently attracted the attention of many researchers, and several JAK inhibitor drugs have been developed targeting different members of the JAK family. Tofacitinib and ruxolitinib are FDA approved drugs in this family for rheumatoid arthritis and myeloproliferative diseases, respectively. The authors concluded that although the available evidence shows promising results, it is still too early to draw a firm conclusion about the place of these drugs in dermatological treatment.

Vu and colleagues noted that limited evidence exists for use of tofacitinib in atopic dermatitis AD , alopecia areata AA and vitiligo. These investigators presented the case of a year old white man with a lifelong history of AD presented with an acute exacerbation of the disease with secondary infection.

He also had a 4-year history of AA with previous alopecia totalis and a 3-year history of non-segmental multi-focal vitiligo. The AA and vitiligo had been persistent but stable during the preceding 3 months. The subject was treated with tofacitinib 5 mg twice-daily over 6 months. Concurrent treatment included prednisolone 5 mg daily and betamethasone dipropionate ointment.

The authors concluded that their report added to the growing evidence to support use of tofacitinib in AD, AA and perhaps vitiligo. Moreover, they stated that randomized controlled studies are needed to validate its efficacy in these dermatological conditions. Dillon and colleagues stated that latanoprost LT is a prostaglandin F2-alpha analog that can induce skin pigmentation, a side effect discovered via its use in the treatment of glaucoma.