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Dermatology Weekly

Author: MDedge

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Stay current on medical, surgical, and aesthetic dermatology developments with Dermatology Weekly, a podcast featuring news relevant to the practice of dermatology, and peer-to-peer interviews with Doctor Vincent A. DeLeo, who interviews physician authors from Cutis on topics such as psoriasis, skin cancer, atopic dermatitis, hair and nail disorders, cosmetic procedures, environmental dermatology, contact dermatitis, pigmentation disorders, acne, rosacea, alopecia, practice management, and more. Plus, resident discussions geared toward physicians in-training. Subscribe now.

The information in this podcast is provided for informational and educational purposes only.
78 Episodes
This week, Nick Andrews talks with reporter Kari Oakes, whose feature for our January print issue highlighted the dermatologists working in Africa and here in the United States to promote inclusivity and provide care for people with albinism. The condition is much more common in parts of East Africa, where people with albinism are stigmatized and even hunted and maimed for body parts. The segment features David Colbert, MD, a Manhattan dermatologist whose foundation has partnered with the United Nations for an awareness-raising campaign. He also talks about the nuts and bolts of how even busy dermatologists can get involved in philanthropic and nonprofit work. *   *   * Hair loss from central centrifugal cicatricial alopecia (CCCA) often is attributed to hairstyling practices used by black women, but the scarring process actually is similar to other scarring conditions. Dr. Vincent A. DeLeo talks with Dr. Crystal Aguh about the pathogenesis of CCCA and its systemic implications. “Before you can even start to ask what causes [CCCA], you have to believe that there is a biological basis of disease, and so when you put the onus on the patient and the blame on the patient, then in reality you’re saying, 'Well if you didn’t do this, this would not occur,' and we’re really not seeing that in our patients,” explains Dr. Aguh. *   *   * Things you will learn in this episode: When CCCA was first described in the 1960s, it was initially called hot-comb alopecia. When hairstyling practices changed but CCCA persisted, it later became known as chemically induced alopecia. Later, it was associated with weaves and extensions. Research has shown there is a considerable overlap in gene expression patterns in CCCA and other scarring disorders such as uterine fibroids, hepatic fibrosis, and idiopathic pulmonary fibrosis. “This scarring process is very similar to other diseases of systemic scarring, and that really starts to shed light into the presentation of this disease,” explains Dr. Aguh. In one study, black women with CCCA were 5-times more likely to have uterine fibroids than black women who did not have CCCA, which speaks to a systemic process. The gene implicated in uncombable hair syndrome, PADI3, has been found to be upregulated in patients with CCCA, suggesting that disorders of hair shaft formation may subsequently lead to the abnormal scarring seen in CCCA patients. The inheritance pattern of CCCA still is unknown but is an avenue for future research. The systemic implications of CCCA, such as the link to uterine fibroids, show that it is more than an aesthetic disease: “The skin and the hair are really kind of window into what’s going on systemically, and [CCCA] is really important not just because the patient feels like they don’t look the way they want to but because it can adversely affect their health,” notes Dr. Aguh. Unlike other scarring alopecias, you cannot reliably use erythema or inflammation as a measure of activity in CCCA, as many patients have no clinical evidence of disease. As a result, topical treatment options such as intralesional steroid injections often are continued for years because it is difficult to tell if they are working. *  *  *   Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Crystal Aguh, MD (John Hopkins University, Baltimore) *   *   * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
Leukemia cutis should be high on the differential in patients presenting with leukemia. Dr. Vincent DeLeo talks with Dr. Lindsay Strowd and Wasim Haidari about their research on the presentation of leukemia cutis and clinical implications. “For us as dermatologists, to recognize that you may not know that the patient has leukemia at the time that you’re actually evaluating them I think points to the need to biopsy any spots that look unusual or a little bit different in nature,” notes Dr. Strowd. *   *   * We bring you the latest in dermatology news and research: Oral lichen planus prevalence estimates go global Dr. Daniel Siegel discusses the translational science behind natural ingredients *   *   * Things you will learn in this episode: Leukemia cutis tends to present in patients with acute myeloid leukemia (AML) but also can present in other forms of the disease. Clinically, leukemia cutis is thought to present most commonly as solitary nodules, but recent research revealed that the primary presentation may include multiple papules or other unusual presentations such as mucosal and ulcerative lesions. Thorough and comprehensive full skin examinations are important in patients with leukemia: “Biopsy for leukemia cutis certainly is most times diagnostic for the disease, but I think paying attention to the entire skin surface of a patient with leukemia is also vitally important because [lesions] are not always going to present on the trunk or the arms or legs where they’re easily identifiable. Some of our patients have lesions on the scalp, the mucosal surfaces like the oral mucosa, and in the genital region as well,” says Dr. Strowd. Leukemia cutis can present at various stages during the course of leukemia, and time to diagnosis varies depending on subtype. For AML, study results indicated that the average interval between diagnosis of leukemia and leukemia cutis was about 5 months; however, many patients developed cutaneous findings at the onset of leukemia or with relapse. Leukemia cutis is considered a negative prognostic factor and may be associated with a shorter overall mortality in leukemia patients. It is important for dermatologists to have a good close working relationship with their oncology colleagues to facilitate prompt evaluation of leukemia patients who may present to their oncologist or another specialist with cutaneous findings. Hosts: Elizabeth Mechcatie; Terry Rudd; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Lindsay Strowd, MD, and Wasim Haidari, BS, BA (Wake Forest School of Medicine, Winston-Salem, North Carolina) *   *   * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
Costs associated with dermatology residency applications average $10,000 per applicant. Dr. Daniel Mazori talks to Dr. Aamir Hussain about ways to reduce costs for applicants, particularly during the interview process when frequent long-distance travel may be required. “Right now we’re in this lose-lose situation where applicants feel like they need to apply to every single program to maximize their chances and program directors are overwhelmed by hundreds of applications for one or two spots,” advises Dr. Hussain. *   *   * We bring you the latest in dermatology news and research: Dupilumab-induced head and neck erythema described in atopic dermatitis patients It’s a common side effect that’s underreported in clinical practice and clinical trials. Calif. woman poisoned by methylmercury-containing skin cream The patient has undergone extensive chelation therapy, but she remains unable to verbalize or care for herself. *   *   * Things you will learn in this episode: Many dermatology applicants apply to residency programs they are not genuinely interested in to maximize their chances of matching in a very competitive specialty. Program directors who are overwhelmed by hundreds of applications for one or two may use arbitrary metrics to weed out candidates because there currently is no way to evaluate who has a genuine interest in the program. A cap on the number of applications permitted per applicant would reduce application fees and help students focus on programs that are the best fit for them. According to Dr. Hussain, 50-60 applications generally is a reasonable number: “After that point, there seem to be diminishing returns in the number of interviews you’re getting for every application you send out in addition to that.” Dermatology applicants often choose to write separate personal statements or contact their programs of choice directly. An option to flag applications for the programs a candidate is most interested in may be an effective way to formalize this process. Regional interview coordination among all the dermatology programs in certain cities or areas of the country would allow applicants to interview with multiple programs at the same time and save on travel costs, in addition to providing neutral ground for home applicants; however, that would require coordination and buy-in from every dermatology program in the region. Video conferencing could reduce travel costs during the interview process but would need to be standardized for every applicant, as candidates who participate in video interviews are consistently rated lower than those who have in-person interviews. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York, Brooklyn); Aamir Naveed Hussain, MD, MAPP (Northwell Health, Manhasset, N.Y.) *   *   * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
In the Resident Takeover episodes of Dermatology Weekly, Cutis Resident Corner columnists Drs. Daniel Mazori, Elisabeth Tracey, and Julie Croley have discussed lifestyle issues such as burnout in residents as well as management concerns such as treating hidradenitis suppurativa. In this episode, Dr. Mazori counts down the top downloaded Resident Takeovers in 2019. Psychodermatology, Episode 26: Drs. Tracey, Croley, and Mazori discussed the challenges of treating patients with both psychiatric and dermatologic diseases. They reviewed medical treatment modalities and considered when referral to a mental health professional is needed. Effective communication with patients, Episode 16: The three residents discussed how to set expectations with patients about therapeutic management and provided communication strategies for improving compliance with therapy and ensuring patients have the correct instructions. Being on-call as a dermatology resident, Episode 12: They talked about premade biopsy kits, tricks for achieving hemostasis in the hospital, portable electronic gadgets, and creative alternatives for basic items.  Prescribing combined OCs, Episode 20: In the most-accessed Resident Takeover of 2019, they talked about prescribing combined oral contraceptives (COCs). COCs have many uses in dermatology, but dermatologists often underutilize them and don’t feel comfortable prescribing them. They also reviewed the basics of prescribing COCs for dermatologic conditions. Hosts: Elizabeth Mechcatie, Terry Rudd Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
Dr. Vincent DeLeo counts down the top downloaded peer-to-peer interviews of Dermatology Weekly in 2019. Along with his colleagues, Dr. DeLeo has covered important topics to help change the way dermatologists practice medicine, from treating rosacea in the skin of color population to understanding the sunscreen regulatory process for improving sunscreen ingredients. Nail education, Episode 10: Dr. Shari Lipner discussed nail education gaps in the American Academy of Dermatology Basic Dermatology Curriculum and strategies to close the gaps to improve nail education for medical students and dermatology residents. Dr. Lipner also broke down the mnemonic for identifying nail melanomas. Pediatric wart management, Episode 9: Dr. Nanette B. Silverberg provided a detailed treatment paradigm for managing pediatric warts. She also reviewed new and established treatment options in six therapeutic categories. Rosacea in the skin of color population, Episode 18: Dr. Susan Taylor discussed how dermatologists can improve the diagnosis and treatment of rosacea in the skin of color population. She highlighted clinical clues to distinguish rosacea from mimickers such as connective tissue diseases, seborrheic dermatitis, cutaneous sarcoidosis, and acne vulgaris. Sunscreen update, Episode 14: Dr. Candrice Heath interviewed Dr. Vincent DeLeo on the new sunscreen regulations issued by the U.S. Food and Drug Administration. Dr. DeLeo explained the complicated sunscreen regulatory process and provided tips for alleviating patient fears about sunscreen use. Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
In this resident takeover of the podcast, three dermatology residents—Dr. Elisabeth Tracey, Dr. Julie Croley, and Dr. Daniel Mazori—discuss how to talk with patients about hidradenitis suppurativa (HS) myths, tobacco use, and weight loss. They also provide strategies for managing flares and weigh medical vs. surgical treatment of HS. We bring you the latest in dermatology news and research: 1. Atopic dermatitis in egg-, milk-allergic kids may up anaphylaxis risk Egg- and milk-allergic patients with atopic dermatitis had more incidents of anaphylaxis; no impact seen in cases of peanut allergies. 2: iPLEDGE vexes dermatologists treating transgender patientsIn a survey, half of dermatologists report uncertainties when registering transgender patients in iPLEDGE. *   *   * Things you will learn in this episode: Dispel the myths of HS. Some patients may worry that HS is contagious or infectious, sexually transmitted, or a result of poor hygiene. “I think this often stems from misinterpretation of the fact that HS is multifactorial and may implicate skin flora in part of the pathogenesis,” Dr. Croley says. “I think this really highlights the importance of patient education.” When recommending smoking cessation, avoid sounding accusatory and discuss how tobacco use has been correlated with HS. “I like to follow this by asking about the patient’s personal smoking status,” Dr. Croley explains. “I find the strategy useful in making the patient feel comfortable about talking about this topic.” Suggest weight-loss strategies to address obesity in HS, such as diet, exercise, and referral to a nutritionist, to give patients strategies to achieve that goal. Adopt a policy that allows patients who experience a flare to visit the clinic without an appointment. “I think part of it is giving them the anticipatory guidance that flares may happen, probably will happen,” says Dr. Mazori. Consider prescribing short courses of either oral antibiotics or oral steroids in the event that patients with HS experience a flare. Reserve surgery for severe or refractory disease. Laser hair removal (eg, with the Nd:YAG laser) is helpful for mild to moderate disease. Evidence supports using this intervention for treating affected areas and the pilosebaceous unit. For patients who cannot afford laser treatment, suggest cosmetic clinics that are affiliated with a residency program, “because I think in general those tend to make it more accessible,” Dr. Mazori suggests. *   *   * Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation, Ohio); Julie Ann Amthor Croley, MD (The University of Texas Medical Branch at Galveston); Daniel R. Mazori, MD (State University of New York Downstate Medical Center, Brooklyn) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
Dermatologists often are the first to notice allergic contact dermatitis exposure patterns in the pediatric population. Vincent DeLeo, MD, talks with Dr. Margo Reeder, Dr. Amber Reck Atwater, and Jennifer M. Tran about patch test practices in children for the diagnosis of ACD. Because children have unique product and environmental exposures, panels should be customized based on the patient’s exposure history. “Not only is ACD prevalent in children but also that the allergen profile is unique when compared to adults,” advises Dr. Reeder. *   *   * Help us make this podcast better! Please take our short listener survey: *   *   * We bring you the latest in dermatology news and research: Repeat LTBI testing best in patients taking biologics with new risk factors Just 1.2% of patients taking biologics with negative tuberculosis test results converted to positive results in annual tuberculosis screenings. More states pushing plans to pay for telehealth care But fair payment remains a challenge for providers. *   *   * Things you will learn in this episode: Two studies – the North American Contact Dermatitis Group and the Pediatric Contact Dermatitis Registry – have shown positive patch test reactions in children at rates of 57% and 48%, respectively. Improve patch testing your pediatric patients by learning about nuances such as their unique exposures and how to work with the smaller surface area of their skin. Take a thorough history by asking parents to “walk through a day in the life of their child” to uncover exposures from personal care products, topical medications, hobbies, and any individuals who interact with them. “It’s where you truly have to bring out your inner Sherlock Holmes to determine what and where potential allergens are,” Ms. Tran advises. Common allergens found in the pediatric population include nickel, cobalt, neomycin, balsam of Peru, lanolin, fragrance mix I, and propylene glycol. Reassure worried children about patch testing by providing education and using distraction techniques. “We have photos, including photos of kids undergoing patch testing that we can show before we apply the patches just to show them exactly what’s going to happen,” Dr. Reeder says. “Distraction is important too.” Currently, three pediatric patch test screening series are available: T.R.U.E. Test, North American Pediatric Patch Test Series, and Pediatric Baseline Patch Test Series. Consult the Table online for information on these forms of patch testing. Allergen exposure can occur from sports equipment, jewelry, braces, keys, zippers, school chairs, electronics, and toys. “Musical instruments have also been implicated in contact dermatitis in children,” Dr. Atwater adds, “and believe it or not, toilet seat dermatitis has also been reported.” Consider patch testing in atopic dermatitis when the patient’s dermatitis has changed, is significantly different, or involves new areas of the skin. Guests: Margo Reeder, MD (department of dermatology, University of Wisconsin, Madison); Amber Reck Atwater, MD; (department of dermatology, Duke University, Durham, N.C.); Jennifer M. Tran (department of dermatology, University of Wisconsin, Madison) *   *   * Show notes by Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
Hidradenitis suppurativa literature has expanded in the last few years, but there is still a delay in diagnosis for most patients due to a lack of familiarity with the condition. Dr. Vincent DeLeo talks with Dr. Alexandra P. Charrow about treatment recommendations based on disease severity and for patient lifestyle modifications. *   *   * Help us make this podcast better! Please take our short listener survey: *   *   * Are you a fan of our podcast? Recommend it to a friend on Twitter by tagging @MDedgeDerm, and we’ll give you a shout-out in our next episode. *   *   * We bring you the latest in dermatology news and research: Certolizumab safety profile varies widely across indicationsSystemic corticosteroid use and body mass index affect the risk of serious adverse events with certolizumab. Naturopaths emphasize role of diet in atopic dermatitis Allopathic and naturopathic providers diverge in opinions on the role of diet in cause and treatment of AD. *   *   * Things you will learn in this episode: Many patients with hidradenitis suppurativa present to the ED because they have a severe flare. “We find that patients have a very long lag time from when they come in to all these different specialists and to the emergency department and the time in which they’re given a definitive diagnosis,” according to Dr. Charrow. Monitor for severe infection. “Hidradenitis is a complicated condition because it is a chronic inflammatory condition, and for that reason, patients will often have labs that mimic an infection,” said Dr. Charrow. The Hurley staging system, used in both surgical and clinical settings, can be used for HS and is divided into three disease stages: stage I is isolated nodules or isolated abscesses; stage II is wide areas separated by sinus tracts or scarring; and stage III includes multiple lesions with near-diffuse involvement and formation of sinus tracts and scarring. Recommend lifestyle modifications, such as taking medications for smoking cessation that are not nicotine replacements, as these could aggravate disease; avoiding hair removal strategies that cause regrowth and the possibility of developing ingrown hairs; and avoiding progestin-only and first-generation oral contraceptives. Use a short course of antibiotics to control flares for Hurley stage I disease. A longer course of an antibiotic, such as tetracycline for 3-6 months, can be used to prevent further flaring. Consider a combination of spironolactone and tetracycline for Hurley stage II. Depending on whether these medications work, adalimumab also can be considered for stage II. Medications for Hurley stages I and II can be used for stage III, but if these are ineffective, providing care could be “tough” because the clinician might need to negotiate with insurance companies for other medications such as infliximab. “There’s only one medication that has been FDA approved for hidradenitis and that’s Humira, and only 50% of the patients in the pioneer trial demonstrated significant improvement, which means that there’s half of patients who have no FDA-approved treatment for their disease,” Dr. Charrow noted. “We are reaching for things for which there is no FDA approval but for which there is some pretty good evidence.” Consult a table of treatment considerations for HS based on severity, which is available online. Ensure that patients with HS feel safe and have an emotional outlet during the visit because they can have a high psychiatric and psychological comorbidity profile. “The disease can be exceptionally isolating. Many patients find they can’t work, they can’t live normal lives . . . It’s helpful to be mindful of just how stigmatizing this condition can be,” Dr. Charrow advised. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Alexandra P. Charrow, MD, MBE (Brigham and Women’s Hospital, Boston) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie *   *   * For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm
This week’s episode features highlights of the AAD 2019 Summer Meeting.  Adam Friedman, MD, takes a closer look at nanotechnology from a dermatology perspective. Topical therapies often “have a very hard time getting to where they need to be, and nanotechnology, just by size alone, can really offer some unique benefits,” says Dr. Friedman, professor of dermatology and the interim chair of the dermatology department at George Washington University, Washington. Justin Ko, MD, director and chief of medical dermatology, Stanford (Calif.) Health Care, spoke with MDedge reporter Ted Bosworth about the use of augmented intelligence in dermatology. Dr. Ko is the coauthor of the American Academy of Dermatology’s position statement on augmented intelligence, which was released in May 2019. Henry W. Lim, MD, Henry Ford Hospital, Detroit, spoke with MDedge reporter Kari Oakes about potential environmental effects of sunscreen ingredients (particularly coral reef bleaching), as well as the FDA’s widely reported sunscreen absorption study published in May – and whether sunscreen use may be contributing to the increase in frontal fibrosing alopecia. Andrew Alexis, MD, professor and chair of the department of dermatology, Mount Sinai St. Luke’s, New York, provided practical information on treating hyperpigmentation in an interview with MDedge reporter Ted Bosworth. He details his views on the length of time he considers the use of hydroquinone-based therapies to be safe, as well as the use of non–hydroquinone based. Seemal R. Desai, MD, who is on the faculty at the University of Texas Southwestern Medical Center, Dallas, talked with MDedge editor Elizabeth Mechcatie about the treatment of patients with pigmentary disorders. The increasing interest in pigmentary disorders, particularly in patients with skin of color, “continues to be something that’s very relevant and very valid” to dermatologists, said Dr. Desai, who is the immediate past president of the Skin of Color Society. *  *  *   Help us make this podcast better! Please take this short listener survey: *  *  *   Show notes by: Elizabeth Mechcatie   For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm
Mohs micrographic surgery (MMS) entails many controversies – from specialty certification to the types of tumors treated. Three dermatology residents – Dr. Julie Croley, Dr. Elisabeth Tracey, and Dr. Daniel Mazori – discuss MMS for melanoma and other tumors as well as reimbursement for and the cost-effectiveness of the procedure. They also highlight controversies surrounding the Mohs Appropriate Use Criteria (AUC). “It appears further investigation is needed to elucidate and optimize solutions to many of the current controversies associated with Mohs micrographic surgery,” Dr. Croley says.  * * * Help us make this podcast better! Please take our short listener survey: *   *   * Are you a fan of our podcast? Recommend it to a friend on Twitter by tagging @MDedgeDerm, and we’ll give you a shout out in our next episode. *   *   * We bring you the latest in dermatology news and research: Apremilast for Behçet’s oral ulcers: Benefits maintained at 64 weeksReassuring results of a long-term extension of the phase 3 RELIEF trial. Melanoma incidence drops in younger age groups Fewer teens and young adults developed melanoma between 2006 and 2015, while incidence increased in older adults. In Oregon, ‘war on melanoma’ takes flight A research project hopes to shrink melanoma mortality by emphasizing education, screening. *   *   * Things you will learn in this episode: The 5-year survival in metastatic rates for melanomas treated with Mohs micrographic surgery (MMS) with frozen sections were the same or better when compared with historical controls treated with conventional wide local excision. Immunostaining in melanoma may improve accuracy but includes many challenges: It is time-consuming, reagents can be costly and could expire, some cases are equivocal, clinicians’ exposure to immunostaining education is limited, and training is required to interpret margins. “So there are a lot of barriers to using immunostaining,” Dr. Croley says, “but I think it has a lot of potential in the future.” Utilization of MMS has increased in recent years, possibly due to superior efficacy for appropriately chosen cases and it is being expanded to treat other tumors such a melanoma and Merkel cell carcinoma. There is wide variation in mean number of Mohs stages among dermatologic surgeons. Mailing out individual reports of practice patterns to high-outlier physicians resulted in a reduction in mean stages per tumor as well as an associated cost savings when compared with outlier physicians who did not receive these reports. Codes for MMS are frequently reviewed by a Relative Value Scale Update Committee, and the procedure is listed as a potentially misvalued service according to the Centers for Medicare & Medicaid Services. “Reimbursements for Mohs surgery and reconstructive surgery have gone down by more than 20% in the last 15 years – at least, in part, as a result of this scrutiny,” Dr. Tracey states. Mohs AUC has been criticized for classifying most primary superficial basal cell carcinomas as appropriate for MMS and for not considering variables such as operating on multiple tumors on the same day and operating on a tumor that is incorporating into an adjacent wound. Specialty certification in MMS has been a split issue. “Proponents have argued that certification could bring more consistency and decrease divisiveness among dermatologists,” Dr. Mazori says. “Opponents of certification have argued that it could disenfranchise many dermatologists.” Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Julie Ann Amthor Croley, MD (University of Texas Medical Branch at Galveston); Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Daniel R. Mazori, MD (State University of New York, Brooklyn) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie *  *  *   For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm
Vitiligo is not the only condition that can lead to depigmentation; there are other conditions that dermatologists see less commonly that can result in vitiligolike depigmentation, such as photolichenoid dermatitis. Consider underlying diagnoses such as human immunodeficiency virus when treating patients with photolichenoid dermatitis. Dr. Vincent DeLeo talks with Dr. Nada Elbuluk about the common causes and clinical presentation of photolichenoid dermatitis. Dr. Elbuluk emphasizes the importance of screening for underlying medical conditions by describing a case of a photolichenoid eruption in a patient with undiagnosed HIV. “It’s fascinating to see patients like this who remind us that depigmentation or pigmentary changes can be associated with underlying medical conditions,” advises Dr. Elbuluk. “Keeping that kind of differential in the back of our minds is really important so we don’t miss important underlying diagnoses such as HIV.” *   *   * Help us make this podcast better! Please take our short listener survey: *   *   * We bring you the latest in dermatology news and research: 1. Patients taking TNF inhibitors can safely receive Zostavax Investigators found no confirmed varicella infection cases at 6 weeks. 2. AAD-NPF pediatric psoriasis guideline advises on physical and mental care Topics in this guideline for pediatric psoriasis include systemic and topical treatments, management of comorbidities, and quality of life. 3. Expert reviews strategies for diagnosing, treating onychomycosis The ideal treatment for onychomycosis would not pose a systemic risk to the liver, heart, or other organs, and would not require lab monitoring. *  *  *   Things you will learn in this episode: Common histopathologic findings of photolichenoid dermatitis include a dense bandlike lymphocytic infiltrate in the superficial papillary dermis abutting the upper dermis, which can be accompanied by an interface change at the dermoepidermal junction. NSAIDs and sulfamethoxazole-trimethoprim are the most common medications that cause photolichenoid eruptions, particularly in patients with HIV, among others. Patients with HIV who have photolichenoid eruptions typically have advanced HIV or AIDS with a low CD4 count. Taking a photosensitizing medication is not required to develop a photolichenoid eruption in patients with HIV. Biopsy patients who have photolichenoid eruptions can confirm that there is no underlying medical condition. “When our patient came in, actually we were worried more about discoid lupus,” Dr. Elbuluk describes. “So as part of that [work-up], we ordered an ANA.” Laboratory workup should include HIV and a hepatitis panel. Consider HIV when seeing a patient with a photodistributed eruption that is more lichenoid or presents with depigmentation. Ask screening questions about sexual history and order bloodwork. “This is a really good case and example of how we, as dermatologists, can be so instrumental in diagnosing internal disease,” Dr. Elbuluk adds.   Guest: Nada Elbuluk, MD (formerly of the department of dermatology at New York University; currently with the University of Southern California, Los Angeles) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie *  *  *   For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm
Pediatric atopic dermatitis (AD) is more prevalent in African American children. Dr. Lynn McKinley-Grant, president of the Skin of Color Society, talks with Dr. Amy McMichael about the quality-of-life impact on pediatric patients with AD as well as skin care in this patient population. They also discuss the clinical presentation of AD in the skin of color population. “We have to open our minds up to all of the ways that atopic dermatitis can look in every skin type,” Dr. McMichael says. “Then we don’t miss it, and we don’t minimize how severe it is when we’re taking care of those patients.” *   *   * Help us make this podcast better! Please take our short listener survey: *   *   * We bring you the latest in dermatology news and research: 1. Nemolizumab for prurigo nodularis impresses in phase 2b study Interleukin-31 signaling is a promising therapeutic target in prurigo nodularis. 2. Acoustic pulse boosts laser tattoo removal  Device “clears” skin cells after single passes and allows single office visits to pack more punch. 3. Severe psoriasis associated with increased cancer risk, mortalityBecause these were associations only, any underlying mechanism is still unclear. *  *  *   Things you will learn in this episode: African American children with AD (aged 2-17 years) have a 1.5-fold higher chance of being absent for 6 days in a 6-month school period than do non-Hispanic children, and they have higher chronic absenteeism, compared with white children. Some parents/guardians purchase topical products with fragrances that are inappropriate for patients with AD. “Consumers have no idea what’s good, so they just buy them and they use them,” Dr. McMichael says. “They can often make things a lot worse.” Resident training should focus on learning how skin diseases present in all skin types. “You do have to be cognizant of pigment being present and wonder, ‘OK, is this postinflammatory or is this truly inflammatory?’ ” Dr. McMichael advises. For children who want to engage in athletics, treatment should be more aggressive. Consider using systemic treatments more readily or prescribing dupilumab (Dupixent). “We have to be cognizant of when flares occur that perhaps these patients should not participate in activities at that time, but if they want to -- and certainly it’s healthy to do so -- then we need to step up to the plate and treat them appropriately,” emphasizes Dr. McMichael. Patients with AD have a higher prevalence of contact sensitization to fragrances, including balsam of Peru. It is essential to find out what products your patients with AD are using on their skin. Ask them such questions as: What are you using to cleanse your face? What are you using as a moisturizer? Do you put anything else on your face or skin? Debunk inaccurate information that your patients and parents are consuming about AD medications. “You have to encourage them that it’s not all about steroids. We have other options now and that they need to consider them,” Dr. McMichael adds.   Hosts: Lynn McKinley-Grant, MD (Howard University College of Medicine, Washington, DC) Guests: Amy McMichael, MD (department of dermatology, Wake Forest University, Winston-Salem, N.C.) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm
How can you integrate decision-making resources into your clinical practice? In this resident takeover of the podcast, three dermatology residents — Dr. Daniel Mazori, Dr. Elisabeth Tracey, and Dr. Julie Croley — discuss clinical decision support tools such as scoring systems and other resources available for dermatologists. These tools should be used as a supplement, not as a substitute for one’s clinical judgment. “The optimal treatment for patients in a complex medical system requires not just coming to the correct diagnosis and using your clinical judgment to make a decision but effectively communicating that decision to the insurance companies [and] to the primary team that’s taking care of them on the inpatient service. ... Some objective data can really be useful in those situations,” advises Dr. Tracey. *   *   * Help us make this podcast better! Please take our short listener survey: *   *   * We bring you the latest in dermatology news and research: 1. No tacrolimus/cancer link in atopic dermatitis in 10-year study 2. PASI-75 with ixekizumab approaches 90% in pediatric psoriasis study 3. NAM offers recommendations to fight clinician burnout *  *  *   Things you will learn in this episode: Evaluate for psoriatic arthritis with the Psoriasis Epidemiology Screening Tool (PEST). “It’s the kind of thing that I’ll use in addition to asking a patient with psoriasis questions about symptoms like joint pain and morning stiffness,” Dr. Mazori says. Consider and for clinical decision support, to formulate differential diagnoses, and as a resource for patient education. “The other day, I had a patient who was diagnosed with scabies,” Dr. Tracey explains. “We were counseling the patient on how to decontaminate their environment. I wanted to get the exact number of hours their belongings needed to be in a plastic bag or how to wash their clothes. So, we went on UpToDate and read it together in the clinic.” The SCORTEN system predicts hospital mortality from Stevens-Johnson syndrome/toxic epidermal necrolysis and is useful for the primary team. “I’ve found it useful ... as a measure of risk to communicate to the primary team, even the patient’s family,” Dr. Mazori says. But the SCORTEN isn’t perfect. “There are studies that have found it can overestimate or underestimate mortality,” he warns. To differentiate cellulitis from pseudocellulitis in adult patients, consider the ALT-70 score. “It gives me an objective measure of risk to communicate to the primary team in support of one diagnosis or another in addition to my clinical judgment,” advises Dr. Mazori. The Mohs Appropriate Use Criteria (AUC) helps guide decision making for Mohs micrographic surgery, but it has been scrutinized for classifying most primary superficial basal cell carcinomas as appropriate for treatment, omitting important European trials, and for having ratings that are based on expert opinion rather than evidence. The MyDermPath+ app can assist clinicians in forming differentials based on histopathologic patterns. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York Downstate Medical Center); Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Julie Ann Amthor Croley, MD (University of Texas Medical Branch at Galveston) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm
Skin appearance is a sign of internal health, and patients who have appropriate vitamin levels naturally have healthier skin. Dr. Vincent DeLeo talks with Dr. Gary Goldenberg about the data on vitamins and supplements that have been shown to improve the skin’s appearance and health. Dr. Goldenberg discusses the controversies surrounding the quality of products and the need for dermatologists to remain up-to-date on products their patients may be taking already. “A discussion of nutrition and supplements really is a part of any dermatologic evaluation, just like skin care should be part of every dermatologic evaluation,” advises Dr. Goldenberg. *   *   * Help us make this podcast better! Please take our short listener survey: *   *   * We bring you the latest in dermatology news and research: 1. Rituximab bests mycophenolate in pemphigus vulgaris Rituximab showed a superior overall benefit/risk profile, compared with mycophenolate mofetil. 2. Once-daily oral JAK inhibitor for atopic dermatitis effective in phase 3 study Abrocitinib may have taken a step closer to becoming the first once-daily oral Janus kinase 1 inhibitor to be approved for atopic dermatitis. 3. Online resources influencing cosmetic treatment choices Rate and review websites affect almost 70% of consumers seeking providers for cosmetic procedures. *  *  *   Things you will learn in this episode: Patients who have good nutrition also will have appropriate vitamin levels, which contributes to having healthier skin. Dr. Goldberg explains, “Patients who have really low vitamin D levels will not be as healthy and cannot have as healthy skin as those who have more normal vitamin D levels.” Studies have shown that internal vitamin C levels reduce oxidative stress and help with the appearance of fine wrinkles, lines, and pigmentation. “As far as topical vitamin C goes, I think that there [are] good data showing that vitamin C improves the appearance of skin. But the issue with vitamin C is the delivery of the product into the skin,” advises Dr. Goldenberg. Vitamin E is one of the best antioxidants, according to Dr. Goldenberg, and is especially helpful for UV-induced oxidative stress. Carotenoids, which are derived from vitamin A, can help reduce oxidative stress associated with UV-induced radiation and UV-induced erythema. “We also know that carotenoids actually improve UV-damaged cells such as for patients with a history of skin cancer,” says Dr. Goldenberg. Studies have reported that oral collagen supplements can improve skin health and appearance. However, Dr. Goldenberg remains skeptical: “It’s still unclear to me if the improvement is due to the actual collagen or to the water that patients may be taking the collagen in, especially if it’s a powder.” Hydration is very important for skin appearance and health, he adds. Imedeen supplementation has some data that show antioxidant properties. Although it’s too early to say that Imedeen is completely effective, studies report efficacy for skin appearance and health. In terms of side effects associated with vitamins and supplements, Dr. Goldenberg advises that not all supplements have the same quality, and patients should consult a nutritionist for advice on which vitamins and supplements are needed. “Not all supplements are going to have the same quality. So if you’re going with the least expensive ones, they may have the least absorption. Now the most expensive ones may have the prettiest packaging and not necessarily be the highest quality of the vitamin.” Dermatologists, as skin experts, need to be aware of the data on vitamins and supplements because diet or nutrition is a common question among patients. For example, patients with acne, psoriasis, eczema, or rosacea may inquire if their condition is caused by a supplement they take or by the lack of supplements. “[We] have to be aware of all of the positive and negative data that’s out there and what I call ‘pseudo’ data, which is blogging, Instagram influencers, etc.,” Dr. Goldenberg says. Guests: Gary Goldenberg, MD (Icahn School of Medicine at Mount Sinai, New York, and Goldenberg Dermatology, PC, New York) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm Gary Goldenberg on Twitter: @Goldenberg_Derm
There is a consumer trend to avoid additives in hair care products and consider natural alternatives. Dr. Lynn McKinley-Grant, president of the Skin of Color Society, talks with Dr. Amy McMichael about shampoo ingredients and the importance of cleansing the scalp in the skin of color population. Dr. McMichael also discusses how hairstyling practices in this population can lead to hair loss and damage to the hair shaft. “We just have to be more healthy in our choices of how we do those styles and how we cleanse our scalp and our hair when we’re wearing those styles,” advises Dr. McMichael. We bring you the latest in dermatology news and research: 1. Psoriasis registry data provide evidence that adalimumab reduces mortality 2. Tape strips useful to identify biomarkers in skin of young children with atopic dermatitis 3. Short-term statin use linked to risk of skin and soft tissue infections *  *  *   Things you will learn in this episode: Do patients need to avoid shampoos containing sulfates and parabens? “Sulfates are just one of the many ways that we can cleanse the scalp and the hair. It is a detergent, and when that detergent is removed, in order to cleanse the hair another detergent has to be put into its place,” explains Dr. McMichael There are "no data to suggest that these other detergents are better or safer or even helpful for our hair shaft.” Only patients with a true allergic contact sensitization to parabens need to avoid products with this ingredient. Patients need to understand that the “no-poo” method and dry shampoos are not cleansing the scalp. “There’s an idea that you can shampoo as infrequently as you want,” says Dr. McMichael. “That’s really not true. In order for your scalp to be healthy and to grow healthy hair, you need to have it cleansed. And once weekly is preferred but certainly every 2 weeks is reasonable.” Patients may rinse their hair with water and baking soda, apple cider vinegar, and tea tree oil without knowing how they interact with the bacterial and yeast components on the scalp. “And they can be bad for the hair shaft,” Dr. McMichael adds. Conditioners are not a good replacement for shampoo, especially for patients with a scalp condition. “Conditioners alone are not meant to cleanse,” Dr. McMichael explains. For women of African descent, consider dandruff shampoo products that are manufactured and tested for this patient population. Central centrifugal cicatricial alopecia (CCCA) is the most prominent form of hair loss in the United States in women of African descent. Clinicians should help patients with or who are at risk for CCCA to minimize traction, tension, and trauma to the scalp caused by some hair care practices. In a recent study of more than 5,000 patients, CCCA seems to have an association with type 2 diabetes mellitus. “As we move forward, we need to start thinking about the whole patient,” Dr. McMichael advises. “It’s not just the scalp that we’re dealing with. It’s not just the hairstyle. But what is the health and underlying metabolism issue of some of these patients and can we as dermatologists be helpful in getting them to better health.” Dermatologists in residency need more training in hair care practices of patients with skin of color that encompasses the wide cultural differences in hairstyling methods and scalp conditions across different populations.   Host: Lynn McKinley-Grant, MD (Howard University, Washington) Guest: Amy McMichael, MD (Wake Forest University, Winston-Salem, N.C.) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to Email the show: Interact with us on Twitter: @MDedgeDerm
Atopic dermatitis (AD) is associated with various ocular comorbidities that can result in permanent vision loss if left untreated. Dr. Soo Jung Kim talks with Dr. Vincent DeLeo about the incidence of keratoconjunctivitis, keratoconus, glaucoma, retinal detachment, and other ocular conditions associated with AD. Dr. Kim offers tips on spotting these complications and managing them but also indicates when referral to an ophthalmologist is necessary.  We also bring you the latest in dermatology news and research. 1. Nivolumab-ipilimumab nets long-term survival in advanced melanoma An update of CheckMate 067 finds that with combination nivolumab and ipilimumab therapy, 52% of patients were alive at 5 years. 2. Lifetime indoor tanning raises risk of cutaneous squamous cell carcinoma Researchers found a dose-response association between number of indoor tanning sessions and SCC risk in Norwegian women. 3. FDA approves afamelanotide for treatment of rare condition with light-induced pain This is the first treatment approved to help patients with erythropoietic protoporphyria increase their exposure to light.   *  *  *   Things you will learn in this episode: Patients with AD may develop blepharitis, presenting with itching and irritation of the eyelids, as well as tearing, foreign body sensations, and even photophobia. The mainstay treatment of blepharitis is good eyelid hygiene with the use of warm compresses and gentle scrubbing of the lid margins. About 25%-52% of patients with AD have atopic keratoconjunctivitis. Clinicians should look out for red conjunctivae, hyperemia, and papillary hypertrophy of the conjunctivae. “Ultimately, if this is not treated in a timely manner, patients could have visual impairment,” explains Dr. Kim. Keratoconus is the progressive thinning and bulging of the cornea that can affect the cornea’s topography. “Patients experience imaging blurring as well as imaging distortions,” Dr. Kim describes. “We’re not exactly sure why atopic dermatitis patients develop more keratoconus, but it’s been believed that chronic, habitual eye rubbing is most likely to be the cause due to the periocular itching.” “Glaucoma is not necessarily a complication of atopic dermatitis; it’s more a complication of the steroid use,” explains Dr. Kim. Glaucoma in AD may be asymptomatic until advanced stages; therefore, clinicians should regularly screen patients who have a prolonged history of topical steroid application around the eye area, a family history of glaucoma, or a history of other ocular problems. Cataracts occur in 8%-25% of patients with AD, usually younger adults. Interior or posterior subcapsular cataracts are more common in these patients compared to nuclear and cortical cataracts, which are more common in the general population. Routine periodic screening by an ophthalmologist is required when patients have onset of periorbital atopic dermatitis, prolonged use of topical or systemic steroids, or a family history of cataracts. The incidence of retinal detachment is 4%-8% in patients with AD. “This is a lot higher than the general population, which is around 0.005%,” Dr. Kim says. “This retinal detachment occurs usually more bilaterally at a younger age, compared to cases without atopic dermatitis.” These patients should be quickly referred to an ophthalmologist for surgical repair. Patients with AD are at greater risk for herpetic ocular disease, and active ocular herpetic infections require urgent referral to an ophthalmologist. Dupilumab has been associated with ocular complications in patients with AD. Host: Vincent DeLeo, MD  Guest: Soo Jung Kim, MD, PhD (Baylor College of Medicine, Houston, Texas) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Atopic dermatitis (AD) is a highly challenging dermatologic condition for U.S. military members, especially for those deployed overseas with less-than-ideal access to care. Dr. Josephine Nguyen, president of the Association of Military Dermatologists, talks with Dr. Emily Wong about the military’s medical standards for evaluating individuals with AD who want to join the service. They also discuss how deployment can exacerbate symptoms of AD. “What is most important to understand regarding the military and any medical issue, including atopic dermatitis, is that we do not want a person’s medical condition to worsen because of their military service, or for them not to be able to receive the medical care they need,” advises Dr. Wong. “On the other hand, medical standards are in place to also ensure that the overall mission of the military can be done safely.” We also bring you the latest in dermatology news and research. 1. Apple cider vinegar soaks fall short in atopic dermatitis Acetic acid, particularly apple cider vinegar, has become prominent among emerging natural remedies for atopic dermatitis. 2. Long-term opioid use more common in hidradenitis suppurativa The results suggest that periodic assessment of pain and screening for long-term opioid use may be warranted. *  *  *   Mark your calendars for our upcoming MDedge Dermatology Twitter Chat on skin cancer, this Tuesday, Oct. 8, beginning at 8 p.m. EDT. You can join the discussion with Dr. Julie Amthor Croley, Dr. Candrice Heath and Dr. Anthony Rossi as they review what’s new in sunscreen, skin of color, melanoma, and more. *  *  *   Things you will learn in this episode: Individuals with AD that persists after 12 years of age may be disqualifying to enter the military. Additionally, any history of recurrent or chronic dermatitis within the last 2 years that requires frequent treatments also is disqualifying. “I will say, in some cases, waivers are possible,” Dr. Wong adds. “Usually those waivers occur when the diagnosis wasn’t quite accurate to begin with. Maybe they had one case of contact dermatitis from poison ivy, but it’s not actually a chronic condition.” Atopic dermatitis is one of the main conditions that affect military service members overseas, not battle injuries. Military members with AD may be hard pressed to find relief from environmental factors that provoke or exacerbate symptoms. When military members are deployed, there are few choices for maintaining hygiene. “They certainly don’t often have choice of soap,” Dr. Wong says. “They don’t have the ability to necessarily carry around moisturizers. So a lot of the things we typically would use to treat our atopic dermatitis patients are just simply not available.” Access to systemic medications for AD also can be difficult. Stress while being deployed is a concern in military members with AD. “Military deployments create an environment – a stress – that many people have not experienced before,” explains Dr. Wong. “Even if they really understand their skin and what flares their skin, they may not know what to expect in some of these environments that military members are expected to work in.” Military uniforms and gear can exacerbate AD. In a deployed setting, if a service member experiences a severe exacerbation of AD that prevents him/her from performing the job, then he/she may need to leave the unit, leaving the rest of the unit unexpectedly without those skills. “That is really the impact that we try to avoid,” explains Dr. Wong, “in setting some of the medical standards that we have, in making sure we appropriately evaluate and screen people before they go on deployment.” Smallpox is considered a potential biologic weapon that could be used by adversaries. Military members receive the smallpox vaccine before being deployed overseas. However, members with a history of or current AD or any skin condition that compromises the epidermis are exempt from receiving the smallpox vaccine. If the service member has a family member at home who has AD or is pregnant, then that military member will receive the smallpox vaccine after reaching the deployed location. “Certainly, patients who are receiving the smallpox vaccination need to be very careful when around other patients with atopic dermatitis,” advises Dr. Nguyen.   Host: Josephine Nguyen, MD Guest: Emily B. Wong, MD (Uniformed Services Health Education Consortium, Joint Base San Antonio–Lackland, Tex.) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
Dermatology residents may be among the least burned-out residents across specialties, but burnout syndrome still affects almost one in three dermatology residents. In this special resident takeover of the podcast, three dermatology residents — Dr. Julie Croley (@dr.skinandsmiles), Dr. Elisabeth Tracey, and Dr. Daniel Mazori — discuss sources of stress for dermatology residents as well as tools to identify and combat burnout to ultimately be a better provider. “The low-stress perception of dermatologists may counterintuitively or paradoxically make recognizing burnout within others and ourselves challenging, so I think it’s important for residents and faculty to be aware that this occurs in such a high prevalence,” reports Dr. Croley. We also bring you the latest in dermatology news and research. 1. Parent survey sheds some light on suboptimal compliance with eczema medications Nearly half of children with atopic dermatitis were not getting their medications as prescribed. 2. Meta-analysis finds platelet-rich plasma may improve hair growth Five studies reported statistically significant increases in hair density in favor of PRP over placebo. 3. Business case for interoperability remains elusive Bringing ownership of health data to the individual and setting a clearer definition of health IT standards are important drivers of interoperability. Things you will learn in this episode: Jeffrey Benabio quipped in a Dermatology News column, “The phrase ‘dermatologist burnout’ may seem as oxymoronic as jumbo shrimp, yet both are real.” Burnout is a syndrome of emotional exhaustion, depersonalization, and a sense of reduced personal accomplishment. For dermatology residents, the preliminary internship year plus the first year of residency can be the most stressful. “You have 2 years of being the least experienced person in your department,” explains Dr. Tracey, “and so that adds to the stress of the sense of lack of accomplishment during that time.” Board examinations are a top stressor for dermatology residents. Institutions are recognizing and addressing burnout among residents by offering wellness lectures, yoga classes, and social events to counteract the stresses of residency. Some also hold town hall meetings and forums that allow residents and other department members to raise concerns and find concrete solutions to shared problems. Formalizing feedback to residents, especially positive feedback, also is important. Residents — and all health care providers — need to take care of themselves to provide the best care to their patients. “It’s all about balance and about creating time for those other things that are important to you and not feeling guilty about setting aside time to do those things. We don’t always need to be productive and always be working,” Dr. Tracey adds. Setting both short- and long-term goals may be helpful in preventing burnout. Don’t lose sight of the ultimate goal — becoming a dermatologist — but set and focus on goals for the day or the week. First-year residents can help to create a positive culture within their departments. Instead of commiserating with colleagues only about a hard day, “sharing cool cases or talking about interesting things that you’ve learned” can create a better environment for everyone, Dr. Tracey advises. The idea that dermatology residents can’t or don’t experience burnout is a myth. “Just like a rare diagnosis, it’s sometimes harder to spot than something that we see all the time,” says Dr. Mazori. If a resident is starting to feel burned out, it is essential to reach out to a trusted friend or colleague to address the issues. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Julie Ann Amthor Croley, MD (University of Texas Medical Branch at Galveston); Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Daniel R. Mazori, MD (State University of New York, Brooklyn). Show notes by: Ann M. Hoppel, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at      Email the show: Interact with us on Twitter: @MDedgeDerm
The flea bite is a problem for a variety of populations — from those in natural disaster scenarios to pet owners. Dr. Vincent DeLeo talks with Dr. Dirk M. Elston about cat fleas and other issues in environmental dermatology. Dr. Elston discusses vector-borne diseases, including endemic typhus and cat-scratch disease, caused by organisms transmitted by fleas, as well as interventions to remove fleas and treat their bites. Dr. Elston also gets personal and talks about how he got interested in bugs following his time in the military. We also bring you the latest in dermatology news and research. 1. States pass record number of laws to reel in drug prices Measures include authorizing imported prescription drugs, screening for excessive price increases by drug companies, and establishing oversight boards to set drug prices. 2. Peanut allergy pill gets thumbs-up from FDA advisory panel The approval of Palforzia is on condition that a black-box warning and medication guide are included in the packaging. 3. Dr. Henry W. Lim takes a closer look at new data on sunscreens. Things you will learn in this episode: All fleas are vectors for disease in humans. “You see dog fleas on cats, and cat fleas on dogs,” Dr. Elston explains. “You’ll see poultry fleas on dogs, especially in the Carolinas. But there are certain fleas that historically have been the ones that carry most disease.” Cat fleas (Ctenocephalides felis) can carry endemic typhus and are typically found in south Texas and southern California. Oriental rat fleas are a vector for disease in other parts of the United States, including areas of California and the Southwest. One of the clues for identifying endemic typhus would be a small rickettsial or black depressed eschar at the site of the original bite. Flea bites — presenting as papular, vesicular, intensely pruritic— tend to occur on the lower parts of the body. “The fact that they’re grouped on the lower extremity, the papular vesicular or bolus quality does suggest the possibility of fleas,” reports Dr. Elston. For houses or abodes that have long been unoccupied (e.g., 2-3 years), new owners walking on the floorboards may rapidly activate the pupae living in them. Flea treatments for animals include fipronil, which is applied on the animal’s neck and spreads like an oil over its body. Oral agents containing ivermectin for heart worm and fleas; however, ivermectin can be fatal for some animals, such as collie dogs. Disease depends on the type of vector. “If you have the organism transmitted by a louse, you’re likely to get endocarditis,” Dr. Elston explains. “Whereas if it’s a flea, you are more likely to get cat-scratch disease rather than sepsis and endocarditis.” Long-term therapy with macrolides is a mainstay treatment of cat scratch disease. Children with cat-scratch disease who present with systemic disease, including neurologic disease, should be managed together with an infectious disease specialist. Guests: Dirk M. Elston, MD (Medical University of South Carolina, Charleston); Henry W. Lim, MD (Henry Ford Medical Center, Detroit) Show notes by Jason Orszt, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
Household and personal care products are common sources of contact allergy in dermatology patients. Dr. Vincent DeLeo talks with Dr. Amber Atwater and Dr. Margo Reeder and about the epidemic of allergic contact dermatitis associated with methylisothiazolinone (MI), a common preservative found in many water-based products. Dr. Reeder and Dr. Atwater discuss the emergence of MI as a contact allergen and highlight some of the common and lesser-known sources of MI exposure. We also bring you the latest in dermatology news and research. 1. Thread lifts making a comeback, but long-term effects remain unclear Patients with moderate skin sagging are better candidates than those with severe skin sagging. 2. New evidence supports immune system involvement in hidradenitis suppurativa Microscopy identifies signs of immune dysregulation in the blood of hidradenitis suppurativa patients. 3. Dr. Andrew Alexis discusses topical treatment options for pigmentary disorders Things you will learn in this episode: Methylisothiazolinone (MI) has been used for decades as a preservative in combination with methylchloroisothiazolinone; however, higher concentrations of MI alone have been used in personal care products beginning in the 2000s: “That’s really when we began to see patients being exposed to MI and subsequently developing contact allergy,” notes Dr. Reeder. Common sources of MI exposure include liquid and water-based products such as dish soaps, shampoos, household cleaners, hair conditioners and dyes, laundry products, and soaps and cleansers. Latex-based paints containing MI can result in airborne contact dermatitis from off-gassing when the paint is curing on the wall. Another common source of MI contact dermatitis is slime, a sticky play substance that children concoct out of household products such as glue or cleaning agents that contain MI. Contact allergy to MI may present in a photodistributed pattern and also has been associated with photoaggravation. Patients also may demonstrate lasting photosensitivity even when avoiding the allergen; therefore, it is important to consider including MI when performing photopatch testing. Two additional potentially allergenic isothiazolinones found in household products and industrial chemicals include benzisothiazolinone and octylisothiazolinone. The T.R.U.E. Test includes MI in a mix with methylchloroisothiazolinone but not on its own, which has been known to miss a considerable number of patients who are allergic to MI; therefore, patch testing to MI alone may be beneficial in patients with allergic contact dermatitis who test negative for MI contact allergy using the T.R.U.E. Test. Many patients are sensitized to MI when it is used in leave-on products. The European Union has banned MI from use in these products, but currently there are no regulations in the United States. Hosts: Elizabeth Mechcatie, Terry Rudd, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Margo Reeder, MD (University of Wisconsin, Madison); Amber Reck Atwater, MD (Duke University, Durham, North Carolina); Andrew F. Alexis, MD, MPH (Icahn School of Medicine at Mount Sinai, New York. Show notes by Alicia Sonners, Melissa Sears, and Elizabeth Mechcatie. You can find more of our podcasts at Email the show: Interact with us on Twitter: @MDedgeDerm
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