Diffuse Bullous Skin Lesions

By Jessica Sheu, BA; Joan Fernandez, BS; Christopher Rizk, MD

In Case 1, 55-year-old man presents to the clinic with multiple tense bullae diffusely involving his trunk and extremities that overlie urticarial plaques. In Case 2, 40-year-old African American man presented to the clinic with a few small flaccid blisters as well as multiple crusted erosions and some areas of post-inflammatory hyperpigmentation on his back and in the creases of his elbows.

Managing Infection Risk in Psoriasis: Expert Q&A

More research is needed to better understand the pathophysiologic mechanisms that result in increased risk for infection among individuals with psoriasis.

Skin Disease and Metabolic Syndrome: Early Warning Signs of a Greater Problem

Skin disorders, particularly those with known inflammatory mechanisms, may be considered potential early markers for the development of insulin resistance leading to metabolic syndrome, type 2 diabetes, and cardiovascular disease.

Machine Learning in Dermatology: Overcoming Data Gaps in Skin Cancer Detection for Smarter Diagnosis

We can leverage the agility of machine learning to point out unmet clinical needs and improve clinical practice.

Opinion: Does Religion Have a Place in Medicine?

Benjamin Frush MD, a resident in internal medicine-pediatrics at Vanderbilt University Medical Center in Nashville, argues in favor of a role that physicians can play in integrating religion into their clinical practice. Rob Poole MB, FRCPsych, contends that physicians should never incorporate a religious element into clinical practice.

Liposuction: Reducing Complications As Well As Fat

Clinicians can prevent most untoward events by proper patient selection and surgical technique and instructing patients about pre and post-procedure care.

Acne in Skin of Color: Cautions for Chemical Peels

Recent studies suggest that with some caveats, patients with Fitzpatrick skin types IV to VI can achieve satisfactory results without serious adverse effects.

Case Report: Unusual Combined Merkel, Squamous Cell Carcinoma in Situ

By Fasiha Syed, BS, German Treyger, DO, Chelsea Duggan, DO, Stephen Olsen, MD, Steven Grekin, DO

Investigators report a rare case of combined Merkel cell and squamous cell carcinoma confined almost exclusively to the epidermis.

Addressing Cardiovascular Risks in Psoriasis: Guidance for Clinical Practice

Psoriasis is often comorbid with cardiovascular disorders and tends to have a dose-response relationship with its metabolic comorbidities.

Expert Roundtable: Ethical Issues in Acne Care for Transgender Patients

In dermatology, ethical dilemmas may arise when providing acne care to transgender individuals, particularly female-to-male patients receiving testosterone treatment.

Should You Record Your Patient Encounters? An Interview With Dr James Ryan

Patients are increasingly recording physician visits on their phones, should physicians do the same. MPR spoke with physician who advocates for recording in clinical practice.

Body Dysmorphic Disorder: Ethical Questions and Surgical Contraindications

The potential consequences of providing cosmetic treatment to a patient with BDD can extend beyond ethical concerns.

Pay-Per-Care in Dermatology, Part 2: Alternative Pay Practices Make Their Case

Advocates of direct-pay models have pointed to ways in which out-of-pocket costs of noninsurance accepting practices are often lower than what would be charged under insurance because of copays, deductibles, and stratification of coverage that often excludes all or portions of treatment.

Should Physicians Treat Family and Friends? Three Experts Weigh In

Although all of the guidelines acknowledge that there are emergent situations in which providing care for a family member or friend is not only permissible but also essential, other situations are frowned upon.

Pay-Per-Care in Dermatology: Exploring Why and How Dermatologists Are Flipping the Script on Insurance Payments

Dermatology Advisor asked 3 practitioners from different regions of the United States how and why they chose their particular practice models.

Case Report: Skin Mottling Linked to Infection

A 44-year-old woman presents to her local emergency department after 5 days of persistent fever, productive cough, and worsening dyspnea on exertion.

A Few Bad Apples: Managing Malpractice Claims

By Tafari Mbadiwe, MD, JD

Ranking or otherwise gauging physician quality isn't just a way to assign bragging rights — performance metrics can be used to set reimbursement levels, tailor insurance, and identify physicians who are falling behind.

Tapping Social Media for Skin Cancer Prevention: What You Can Do

Any images and personal stories that remind people about skin cancer, what to look for, even scars after surgery, really help save lives.

The Psychosocial Impact of Rosacea: Should Dermatologists Be Concerned?

The erythematotelangiectatic, papulopustular, phymatous, and ocular forms of rosacea can lead to psychological distress.

Seeing the Light: Dermatologists Weigh In on Light Therapy for Acne

With minimal adverse effects, light therapy has become an alternative treatment in women of childbearing age who cannot use systemic retinoids due to teratogenic effects.

Tips on Improving Communication With Older Patients

Communication with older patients can be complicated for several reasons.

Under the Microscope: Medicine's #MeToo Moment

No single solution to address sexual harassment in medicine exists, but physicians of all genders must come together to make progress.

Treating Rosacea: Unique Clinical Characteristics Inform Treatment

Current reviews suggest that limited outcomes to individual therapies point to the need for new treatments that target underlying cellular and molecular mechanisms.

Metabolic Syndrome and Skin Disorders: Association Is More Than Skin Deep

Knowing that certain characteristics increase the risk for dermatology patients who may have metabolic syndrome will enable clinicians to identify patients who may have specific cardiovascular risks.

The Role of Psychological Stress in Acne: Insights for Improved Outcomes

While researchers have not pinpointed the exact mechanism of how stress affects the skin, one theory posits that it acts as a signal exchange with the endocrine, nervous, and immune systems.

Conflict of Interest in Dermatology: Is the AAD Doing Enough?

The suggestion of bias in the development of dermatology clinical practice guidelines emerging from the study by Checketts and colleagues has attracted several critical responses including methodological flaws, limitations of the OPD as the data source, and data analysis that is inconsistent with the available evidence.

Addressing Hyperpigmentation in Skin of Color

Clinicians need to be mindful that certain treatments might be counterproductive and counsel patients about gentle skin care and to use sunscreen daily.

The Little Guy vs Big Data: Is ICD-10 Coding Still Valuable in Health Care?

While ICD-10-CM may be an improvement on an old process, big data is the revolution that has the potential to change health care forever.

USPSTF: Behavioral Counseling for Skin Cancer Prevention Beneficial in Younger Patients

There is sufficient evidence indicating that behavioral counseling interventions lead to a moderate increase in sun protection behaviors among individuals with fair skin types aged 6 months to 24 years.

Comorbidities in Rosacea: Considerations for Diagnosis and Treatment

Like most autoimmune diseases, rosacea involves dysregulation of the inflammatory response and may share pathogenesis with several common comorbidities, including cardiovascular, psychiatric, gastrointestinal, autoimmune, and neurologic conditions.

Navigating Biosimilars in Dermatology

With demonstrated superior efficacy and safety profiles compared with previously used conventional treatment options, the expectation of outcomes with biologic agents is at worst a well-controlled disease, and at best, disease remission.

A Closer Look at Immunotherapy for Melanoma

By C. Andrew Kistler, MD, PharmD, RPh

While the primary treatment for melanoma is surgical excision, patients with metastatic disease require additional therapy; immunotherapy is an innovative class of medications accumulating data for use in this patient-group.

Isotretinoin in Adolescents: The Ethics of Awkward Discussions

As these medications require contraceptive use, dermatologists may have to navigate confidentiality issues with their adolescent patients who may not want to involve their parents in discussions of their sexuality and contraceptive use.

Guidelines: Treating Basal, Squamous Cell Carcinoma

The American Academy of Dermatology has released guidelines for the treatment and prevention of basal cell and squamous cell carcinoma.

Prioritizing Telemedicine Research: More Evidence Needed to Increase Adoption

The adoption of telehealth technology continues to expand, but requires further research to fully realize the potential it has to address socially desirable goals such as improving the patient experience of care.

Personalized Medicine in Psoriasis: Patient Stratification Is Key Step Forward

Although truly personalized medicine is not yet feasible in psoriasis treatment, a stratified approach to selection of therapies may offer some of the benefits of personalized medicine.

Atopic Dermatitis: Practical Recommendations for Step-Up Therapy

Although the step-care approach is the current standard of care, this approach is flawed in several ways with respect to achieving optimal outcomes.

Combatting Compassion Fatigue and Burnout

Compassion fatigue can affect workers across the spectrum of helping professions, and it is extremely prevalent among physicians.

Advanced Melanoma May Benefit From Encorafenib, Binimetinib Combination

The FDA accepted a New Drug Application to support the combination of the MEK inhibitor, binimetinib, and the BRAF inhibitor, encorafenib, for treating patients with BRAF-mutated unresectable or metastatic melanoma.

Hand Dermatitis and Hygiene in the Workplace

While application of alcohol to irritated skin causes a burning sensation, it is actually less damaging to skin than detergent-based cleansers.

How to Manage EHRs While Not Compromising Patient Care

Neda Ratanawongsa, MD, MPH, Associate Chief Health Informatics Officer for Ambulatory Services, shares her insight on how to best manage the challenge of staying on top of electronic health record requirements while also optimizing patient encounters.

Stress and Psoriasis: What Is the Connection?

As patients commonly cite stress as a precipitating or exacerbating factor for psoriasis, relieving psychological distress should be part of the treatment strategy.

Next Steps Toward Machine Learning in Dermatology

Improved accuracy in the diagnosis of dermatologic conditions may be achieved through machine learning technology.

Needlestick and Sharps Safety in the Dermatology Practice

Sharps and needlestick injuries are common in dermatology practice, but they need not be inevitable.

How Climate Change Affects the Incidence, Distribution of Infectious Diseases

Scientists warn that unless there is an adequate response and proactive measures are taken, society will soon have to deal with direct and indirect effects of the changing climate on human health.

Underlying Etiologies of Cutaneous Flushing

Cutaneous flushing, although common and often benign, may signal a more serious underlying pathology when the presentation extends beyond episodic warmth and redness of the face, head, and neck.

Teledermatology: Experts Weigh in on Benefits, Barriers

Dermatology is a specialty that especially lends itself to telemedicine, as patients and referring physicians can electronically share images of skin concerns via text, email, or video chat.

How Can We Improve Campaigns Supporting Adult Vaccination?

Educational campaigns regarding the value of vaccines should go beyond facts and statistics to integrating social psychological considerations with health communication principles.

Early Identification of Infantile Hemangiomas to Prevent Complications

By Sarah Lund; Maura Holcomb, MD

Infantile hemangiomas are common benign tumors that occur in childhood, and it is important for clinicians who work with children to be familiar with methods of identifying these lesions.

Promise of Nitric Oxide for Skin and Soft Tissue Infections

The increasing resistance to various anti-infective agents by bacteria and fungi—in particular Staphylococcus aureus, which is responsible for the majority of skin infections—is of particular concern and presents increasing challenges in treating skin and soft tissue infections (SSTIs).

Elimination Diets for Atopic Dermatitis: Are They Effective?

Atopic dermatitis exerts a significant burden on patient quality of life, as well as on overall healthcare spending.

Diagnosing and Managing Gorlin Basal Cell Nevus Syndrome

By Naveen Pattisapu, BA; Adam Rees, MD

An overview of symptoms, risk factors, diagnostic workup, and more information on diagnosing and managing gorlin basal cell nevus syndrome.

Managing Acne in Pregnancy: Treatment Considerations and Current Recommendations

For pregnant women who are adjusting to their changing body image, appropriate management of acne is a key component of maintaining self-esteem and overall well-being.

Psoriasis Treatments: Current and Emerging Medications

By Eman Bahrani, BA; Maura Holcomb, MD

A number of therapeutic options exist for patients with psoriasis, including phototherapy and systemic and biologic agents.

Mental Health Screening in Dermatology: Uncovering Comorbid Psychopathology

Knowing how to communicate properly to patients who may be at risk for or having suicidal thoughts or actions is imperative to detecting psychiatric illness and ensuring proper care.

Skin Cancer Screening: Making It a Priority in Your Practice

There are more new cases of skin cancer each year than of breast, prostate, lung, and colon cancers combined, which means skin cancer detection should become a part of almost every medical visit.

Antibiotic Resistance in Acne: Strategies for Prevention and Treatment

Strategies for preventing resistance include shortening the duration of antibiotics and avoiding monotherapy of either oral or topical antibiotics.

Review: Sun-Exposed Skin Diseases

By Young Moon; Danielle Brown; Maura Holcomb, MD

An overview of porphyrias, lupus erythematosus, rosacea, drug-induced photosensitivity, polymorphous light eruption, and solar urticaria.

Clinical Guidance: Evaluation and Treatment of Minor Burns

The most common causes of minor superficial burns are sunburns and minor thermal injuries.

Coal Tar for Psoriasis: Alternative Treatment Update

Coal tar is one of the oldest known treatments for psoriasis, as it reduces scaling, itching, and inflammation.

Countertransference: How to Set Aside Emotions for Sound Clinical Decision-Making

Recognizing the existence of transference and countertransference is critical for clinicians because both positive and negative feelings for patients can result in poor clinical decision-making.

Expert Q&A: Atopic Dermatitis and the Role of Microbial Modulation

Dermatology Advisor discussed the status of probiotic supplementation and microbial modulation for the treatment and prevention of atopic dermatitis with 2 international experts.

Adults With Hand-Foot-and-Mouth Disease: Review and Case Study

By Susan Renda, DNP, ANP-BC, CDE, FNAP; Michael Sanchez, DNP, CRNP, NP-C, FNP-BC, AAHIVS

In adults, the disease may often go undiagnosed because clinicians may be relatively inexperienced in identifying childhood illnesses in adults.

Evaluating Efficacy of Checkpoint Inhibitors in Melanoma

For older patients with metastatic melanoma, it is safe for them to undergo immunotherapy.

Dabrafenib and Trametinib for Melanoma: Q&A With Keith Flaherty, MD

Keith Flaherty, MD, was interviewed about recent findings regarding targeted therapies for melanoma.

Assessing Disease Aspects in Psoriatic Arthritis

Effective treatment of PsA requires adequate assessment of the disease.

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