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Much of health care today consists of treatment of disease. Few resources are allocated to prevent disease. Many treatments are not delivered optimally because of a lack of patient discipline and insufficient follow-up by physicians and other health care providers.

Prevention as a Replacement for Breakdown Medicine

A 5-year-old boy with a history of atopic dermatitis since 6 weeks of age, presents with a rash around his mouth that has been present for approximately 1 year. The patient’s mother reports that desonide topical cream was applied to the affected area for about 5 days, which initially resulted in improvement, however the rash returned after this medication was discontinued. The rash also recently improved after the patient took amoxicillin for an infection. She also notes that the patient has been licking his lips more frequently.

On examination there is an erythematous papulopustular eruption restricted to the perioral region, with sparing of the vermillion border. Mild hyperpigmentation is noted on the patient’s neck. There is no active involvement of other areas of the body.

The eruption has been present for 1 year and is restricted to the perioral region. What is included in your differential? 

Clinical Topics

Rash Around the Mouth of a 5-year-old Child

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. She has a history of multiple non-melanoma skin cancers.

Squamous cell carcinoma in situ (Bowen  disease)

Lichenoid keratosis (an inflammatory variant of seborrheic keratosis)

A 76-year-old woman seeks your attention for an asymptomatic “red spot” on her neck. What does this look like to you?

What's This "Red Spot"?

A 67-year-old woman seen in clinic for unrelated concerns is incidentally noted to have a “rash” on her flank. She says it appeared in adulthood and has been stable for some years. On the right lower back, there is an asymptomatic reticulated erythema without scale or ulceration

. The patient admits to regular heating pad use on her lower back for pain. The remainder of the skin examination is within normal limits.

The patient says the incidental finding appeared in adulthood and has been stable for years. Can you identify this reticulated erythema?

An Asymptomatic Rash on the Low Back of an Older Woman 

People who become aware that they have lingering symptoms after a COVID-19 infection will most likely consult their primary care clinician first, says American Academy of Physical Medicine & Rehabilitation (AAPM&R)

Flanagan, in a recent conversation with Patient Care, said that while the number of specialty clinics established to care for this expanding population is growing, the current estimate that 27 million Americans have or have had post-acute sequelae of COVID-19 signals that the supply of health care services is already significantly outstripped by demand.

In this video, Flanagan underscores the huge task ahead for primary care clinicians. He also highlights AAPM&R work with multidisciplinary collaborators to define standards of care for long COVID and to widely disseminate educational materials, particularly to primary care. More information on the AAPM&R work is below.

is president-elect of the American Academy of Physical Medicine and Rehabilitation and Chair, Rehabilitation Medicine, New York University Grossman School of Medicine Medical Director, Rusk Rehabilitation, New York University Langone Health, in New York, New York.  (Twitter: 

In March 2021, AAPM&R launched the multidisciplinary post-acute sequelae of COVID-19 (PASC) Collaborative of experts with an overarching goal to foster engagement and share experiences across disciplines and specialties that will move the US health care system towards defining standards of care for persons experiencing long COVID-19/PASC.

To date the Collaborative has published 4 consensus guidance statements on the assessment and treatment of complications in patients with post-acute sequelae of SARS-CoV-2. Please take time to 

 on long COVID-associated cardiovascular complications, cognitive symptoms, breathing discomfort, and fatigue.

NYU Langone Rusk Rehabilitation medical director Steven Flanagan, MD, discusses the "second crisis" of the pandemic and the impact on primary care.  



The Brunt of the Long COVID Patient Burden May Fall on Primary Care, says Rehabilitation Medicine Expert

 brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The 

provides a concise summary of one of the website's leading stories you may not have seen.

On October 17, 2024, we reported on a study presented at IDWeek 2024 that examined the association between social vulnerability, race, and influenza, COVID-19, and respiratory syncytial virus (RSV) vaccine uptake in the US. 

Researchers analyzed data from 341 029 patients who were diagnosed with acute respiratory infections at University Hospitals of Cleveland between October 2023 and April 2024. Patient demographics and vaccination statuses were collected from health records and matched with data from the US CDC’s Social Vulnerability Index (SVI). Researchers then geocoded and segmented the data into quartiles, with Q5 being the highest SVI category and Q1 being the lowest.

Among the cohort, 60% were women and 81% were White, according to investigators. Black individuals were overrepresented among individuals in SVI Q4 at 37% and underrepresented among the least vulnerable population (ie, Q1) at 3.2%, despite making up 14% of the study’s population.

Vaccine uptake among all participants regardless of SVI quartile and race was 37% for influenza, 14% for SARS-CoV-2, and 8.8% for RSV. Vaccination rates decreased, however, as the SVI quartile increased, particularly among Black participants. 

After investigators adjusted for age, sex, and race, they found that the odds of receiving an influenza vaccine were lower for Black individuals compared to White individuals in all SVI quartiles, with the greatest disparity in SVI Q5 (Black: prevalence ratio [PR] 0.59, 95% CI 0.57-0.61; White: PR 0.72, 95% CI 0.70-0.75). Similarly, they also reported that the odds of receiving a SARS-CoV-2 vaccine and RSV vaccine were lower for Black individuals compared to White individuals across all SVI quartiles.

"Even when controlling for demographic factors, household income, health insurance coverage and geographic location, the study’s findings maintain that neighborhood factors and race are significantly associated with vaccination status against common respiratory viruses. Disparities this vast are not to be overlooked — they require multifaceted interventions that meet people where they are socially and increase access to essential preventive measures.”

Your daily dose of the clinical news you may have missed.

Social, Racial Disparities in Flu, COVID-19, RSV Vaccine Uptake: Daily Dose

Mark P. Kajdos

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