Year In Review: Clinical Pearls

Ted Rosen, MD; James Treat, MD; Matthew Zirwas, MD

What’s new in dermatology? Here are some important clinical pearls that may help you in clinical practice…

  1. Younger patients with NMSC and melanoma at increased risk internal cancer
  1. Women with GU malignancies at increased risk of SCCA of the skin
  1. Four cups of coffee may contain enough caffeine to lower risk of new BCC in patient with prior occurrence of BCC
  1. Sildenafil use increases risk of melanoma?
  1. Freshwater injury: wound not improving with antibiotics, think algae!
  1. Acne: leads to stress, fatigue and reduced sexual activity
  1. Spironolactoneis an effective “add on” to retinoid in adult women with acne
  1. Dapsone gel reported to lead to methemoglobinemia (blue fingers, toes, lips, SOB): rare but serious potential adverse effect
  1. Adalimumab: acne conglobata (and hidradenitis supprativa)
  1. Lindioil (extract of Indigo naturalis plant) may help psoriatic nail dystrophy; AVAILABLE AT:
    1. etsy.com
    2. indigo-botanicals.com
  1. Vitamin D3 at high dose (~4000IU daily) may help refractory chronic idiopathic urticarial
  1. AFTER successful repigmentation of vitiligo: maintain on topical tacrolimus 0.1% BIW
  1. Vitiligo may be associated with auditory dysfunction
  1. Weekend only dosing of cyclosporine can be used as long term maintenance therapy in some atopics
  1. Oral Glucosamine increases efficacy of cyclosporine without increasing side effects, allowing lower doses to be effective
  1. Oral magnesium is worth trying in patients with difficult to control Hailey-Hailey
  1. Simvastatin helps venous stasis ulcers to heal
  1. Antihistamines make isotretinoin work better
  1. Nitroglycerin works for chondrodermatitis Nodularis Helicis
  1. It may be possible to prevent atopic dermatitis with emolliation started before 3 weeks of age
  2. Tonsillectomy should be considered in children with severe psoriasis that correlates with GRoup A Streptococcal infection
  3. Topical timolol can be very effective for early superficial hemangiomas.