Dermatology Year In Review: Part 1 Clinical Pearls

Ted Rosen, MD

What’s new in dermatology?

1. Excessive tanning associated with alcohol and drug use, as well as various psychological problems.

2. Increased risk of skin cancer:

  • BCC: Large number of benign moles
  • Melanoma: non-ASA NSAIDs and Viagra ingestion

3.  New genital (and labial) HSV treatment: thermotherapy with Herpotherm device. Applied even a single time shortens outbreak. Heat: about 500C for 4 seconds.  
4. Psoriatic nail dystrophy complicated by concomitant dermatophyte infection 10-20%
5. Tattoo problems

  • Risk of nontuberculous mycobacterial infection
  • Risk of hiding a melanoma
  • Risk of pigment in regional lymph nodes, complicating sentinel node biopsy if needed

6. Clarithromycin and other macrolides have potential to cause fatal arrhythmia

7. Doxycycline 200mg/d plus adapalene/BPO can do almost as well as isotretinoin over 20 weeks in nodulocystic acne. The combo Rx is “noninferior” when safety is combined with efficacy

8. Psoriasis information

  • Risk of Crohn’s disease in US women (RR 4.0)
  • Severe psoriasis associated with increased risk of renal disease (RR 2.0)
  • Increased risk of various solid organ cancers (RR 1.5+)
  • Lindioil application found beneficial for nail psoriasis
  • Frequent telephone positive motivational interviews enhance adherence to Rx regimen

9. Vitiligo associated with cochlear dysfunction (60%!!!) Hearing loss or ringing in the ears

10. Hair dyes contain a variety of potential sensitizers, not just p-Phenylenediamine