Experts put forth their top pearls to help better take care of patients. Here’s what they said.
Examining every patient’s fingernails and utilizing oral minoxidil were among the top tips presented at the “Ten Things You Need to Know to Help You Take Better Care of Your Patients” session at the Fall Clinical Dermatology Conference for PAs & NPs held November 12 to 14, in Orlando, Florida, and virtual.
Here are some of the top tips shared by dermatologists:
1. Oral minoxidil for androgenetic alopecia can increase compliance in patients hesitant to utilize topical medications in their daily routine, or those concerned about effects of the vehicle on hairstyling, grooming, and coloring practices, said Matt L. Leavitt, DO, FAOCD, FISHRS, founder and executive chairman of Advanced Dermatology and Cosmetic Surgery.
2. Examine the palms in all pruritic patients, suggested Boni Elewski, MD, professor of dermatology at the University of Alabama. “Hyperlinear palms are a common sign of atopy and would help diagnose atopic dermatitis. One dry hand and 1 normal hand could be indicative of 1 hand/2 foot syndrome and explain pruritus resulting from dermatophytosis,” she said.
3. Elewski also recommends examining the fingernails of all patients. Nail pitting may be indicative of psoriasis and alopecia areata. “I see lots of ladies with alopecia. Many come in with fancy nails decorated with bling and I see that is the image they want to convey, but are so distressed by the hair loss,” Elewski told Dermatology Times®. “I try to see the person, and nails tell a lot.”
In addition, well-bitten nails are often seen in patients with neurodermatitis. “Patients may claim that they don't ‘pick’ their skin but will admit to nail biting (onychophagia). This is also seen in acne excoriae and other skin conditions,” Elewski said.
4. Find a specialty pharmacy that honors discounts and coupons, suggests Mark Lebwohl, MD, dean of clinical therapeutics at the Kimberly and Eric J. Waldman Department of Dermatology Mount Sinai Icahn School of Medicine. Lebwohl gave the example of a medication that cost $1,026 at CVS using commercial insurance but was only $25 at Manhattan Apothecary with commercial insurance.
5. For early detection of malignant melanoma, first use your clinical judgement when examining the skin, Darrel S. Rigel, MD, clinical professor of dermatology at Mount Sinai Icahn School of Medicine, advised. Think of “ABCD” when examining the clinical features of early malignant melanoma. “A” stands for Asymmetry, “B” signifies border irregularity, “C” is color variegation, and “D” is a diameter generally greater than 6 millimeters.
A second option is using technology and dermoscopy to augment your choices, Rigel added.
6. Trichoscopy is one of the most useful diagnostic tools when assessing alopecia, Leavitt said. Trichosocopic findings are well conserved in respect to alopecia subtype, and similar findings are observed regardless of race, gender, and age of the patient, he noted.
Leavitt, ML, Elewski, B, Lebwohl, M., Rigel, D. Ten things you need to know to help you take better care of your patients. PA & NP Fall Clinical Dermatology Conference 2021. November 12-14, 2021. Orlando, FL and virtual.