Karen Nash

After the U.S. Supreme Court of the United States upheld the constitutionality of the 2010 Patient Protection and Affordable Care Act (ACA), including the individual mandate requiring all Americans to purchase health insurance, a number of professional medical organizations reiterated concern about potential effects of the law.

Recently, Northwestern University Feinberg School of Medicine surveyed their third- and fourth-year residents and found that even though it is not on the official curriculum, the residents are learning defensive medicine. Whether it's an attending mentioning that a particular biopsy isn't necessary or deciding not to offer a patient a particular medication because it of a potential lawsuit, the residents are seeing defensive medicine in practice.

It's summertime, and once again, people are looking for reasons to enjoy the sun. Assertions that sunscreens are detrimental to health are surfacing once more. This time, the question is whether sunscreens provide so much protection from sun exposure that they inhibit the body's natural production of vitamin D, leading to deficiencies.

Three years after Roche pulled Accutane off the market, On Call wondered whether dermatologists were still using isotretinoin, whether they see problems from these portended side effects, and whether patients and their parents are as concerned about the medication as they used to be.

On Call talked to dermatologists across the country and asked them to explain when they believe Mohs surgery is appropriate, whether they consider the surgery overused, and whether they've run into issues with reimbursement.

Politics is a popular but touchy subject. We wondered whether dermatologists' patients are raising the issue of healthcare reform during visits, and, if so, how the derms are handling those questions.

In healthcare reform discussions, there is an emphasis on primary care. We wondered what dermatologists think of this, and whether this could diminish specialty practices and/or impact patient care.

Older patients are encouraged to moisturize and avoid contributors to dry skin.

Are dermatologists coming out of residencies prepared for dealing with the challenges of running a practice? We asked dermatologists around the country if they think young physicians are prepared to make business decisions.

When psoriasis is restricted to the nails, it creates a dilemma for doctor and patient, an expert says.

Dysport is being touted as the first serious competitor to Botox.

Despite urging from President Obama, both houses of Congress went home for their August break without passing any version of healthcare reform. All facets of reform appear to be on the table still, while the proposals being considered have a multitude of interpretations.

With the appropriate software, electronic medical record (EMR) systems will enable physicians to e-prescribe medications and send them directly to the pharmacy before patients leave the exam room.

Sensitivity to nickel has been increasing over the past two decades. Contact dermatitis occurs with exposure to nickel, which is found in common items such as zippers, cell phones and shoelaces. Individuals with nickel sensitivity should avoid repeat exposure, as the response increases each time. A movement is under way to request a reduction in the allowable amount of nickel that manufacturers use in products in the United States.

The final quarter of 2008 offered some unexpected and severe challenges to the United States - a collapse on Wall Street, rising unemployment, threatened bankruptcy of at least two of the big three automakers, rising healthcare coverage issues and rising levels of violence in the Mideast. At the same time, the United States elected its first black president and a highly Democratic–weighted Congress. 2009 is likely to be a year of change and readjustment.

Suturing is not always the best answer for closing a wound site, an expert says. Some newer materials may offer advantages over suturing and traditional protective antibiotic coverings for second-intention healing (SIH).

Medical technology changes so often that sometimes it seems as if one hardly gets something new in the office before it's outdated and another bit of technology is on the horizon.

While fractional lasers appear to be offering some of the best results currently in treating signs of aging in the skin and reducing the downtime associated with the procedures, work is continuing on ways to optimize the results that can be obtained. Varying wavelengths and depths as well as combining the laser treatments with retinoids are providing doctors better answers for their patients.

Dissolving away fat seems like a dream come true for a lot of people. It's also the subject of contoversy. Lipodissolve has been banned in Brazil and almost banned in Kansas. Questions arise about the efficacy and safety of the fat-dissolving technique, yet doctors who do the procedure regularly contend the fat-dissolving procedure is an excellent addition to their fat loss armamentarium.

The year 2008 is under way. It's a year that promises a lot of discussion of healthcare delivery and costs, and promises of change. On Call wondered what direction dermatologists expect to take in their practices in the coming year. What are their priorities for their practices? What are their New Year's resolutions for their practices? For several of the dermatologists who spoke to On Call, the business end of their practice is slated to get a lot of attention this year as they try to run their offices as efficiently as possible.

When a patient suffering from an open wound also presents with a compromised immune system, it can lead to increased complications and additional difficulties in caring for the wound - but it can be done. The keys to successfully healing the wound are "recognition and vigilance."

When the concept of telemedicine was introduced several years ago with the intent of broadening patient access to a decreasing number of specialists, dermatology was considered possibly the best specialty to use the new system because it is such a visual field.

Psychodermatology can go beyond the trichotillomania or excoriation of severe psychosis and can present with virtually the same symptoms as completely physiologically caused skin conditions.

National report - Human growth hormone (HGH) should not be used for anti-aging purposes, as the therapy has demonstrated little efficacy and carries the risk of potentially serious side effects, a recent literature review indicates.

National report - Keep this in mind when bizarre cases show up - "Zebras are rare, but not everything is a horse," and, "Break down the systems causing hard-to-diagnose dermatologic conditions," ask questions, take time to diagnose - and don't be afraid to not know the answer the first day.

The advent of laser technology, botulinum toxin type A, Accutane (Roche) and Mohs Surgery are just a few of the areas of advancement in dermatology - major steps that have, in some ways, revolutionized the medical specialty.

Survey results recently released by the American College of Physician Executives paint a grim picture of physician morale across the United States. The survey indicates that nearly 60 percent of physicians have considered leaving the practice of medicine for varied reasons including: declining reimbursement, increasing patient loads, lack of respect and loss of autonomy.

The gold standard for treating keloids really hasn't changed in 20 years. Intralesional cortisone injections are still the best approach.

Dermatology patients represent a diverse population that spans a wide range of ages, ethnicities, cultural backgrounds and educational levels.

For decades doctors and patients have used hydroquinone products to reduce differentiations in skin tones.