Discover and read the best of Twitter Threads about #Derm
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Another case to discuss, Cylindroma on 91yo female abdomen. it’s multiple in dermatomal distribution with extreme pain. There is this nerve entrapment at the base of the section. Histology seems benign but somewhat infiltrated nodules at the base. Q below #dermpath #derm 
It is challenging to treat, and also a concern if this is malignant based on clinical behavior. I am suggesting to excise the prominent nodules with local radiation for the rest of small nodules in the region. Any other thoughts ?
This patient has no history of syndromic features, but she had to remove 2 ft intestines in the past(I couldn’t get the detail but assume obstruction or diverticulitis).
Vamos con un caso 📄 muy interesante de la guardia de ayer.
Mujer 👵🏼 de 82 años con antecedentes de interés de DM2, HTA y anemia crónica que acude por estas lesiones localizadas en cara interna de muslos y piernas de 5 días de evolución:
Mujer 👵🏼 de 82 años con antecedentes de interés de DM2, HTA y anemia crónica que acude por estas lesiones localizadas en cara interna de muslos y piernas de 5 días de evolución:
Lo primero de todo es describir bien las lesiones.
¿Cuál es la lesión elemental primaria que se aprecia?
¿Cuál es la lesión elemental primaria que se aprecia?
En la imagen, se aprecian ampollas (>0,5 cm) tensas sobre una base eritematosa. Algunas de ellas están rotas, dando aspecto erosionado a las mismas.
Después de definir 🕵🏼♀️🕵🏽 las lesiones, ¿Cuál sería el siguiente paso a realizar?
Después de definir 🕵🏼♀️🕵🏽 las lesiones, ¿Cuál sería el siguiente paso a realizar?
The last few days on #medtwitter have been difficult. Seeing so many happy "I matched!" emails interspersed with devastating news of not matching makes you question the entire system. And there's reason to. There are a lot of problems, and not very easy solutions. A few here...1/
Medical training is too expensive – in time, tuition, & opportunity costs. This makes Match Day the ultimate high-stakes situation. The costs of not matching are unfathomable. 2/
The costs of higher education in this country must be addressed. Professional & graduate degrees should not be reserved for the privileged. Certain specialties should not be available based on socioeconomic class, race/ethnicity, or background. 3/
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Hi #dermtwitter! Back for another #tweetorial/#medthread on nails! Today we’re learning about:
ONYCHOMYCOSIS- nail fungus!
This is THE most common nail condition- so follow along!
Education from @naildisorders
#medstudenttwitter #medtwitter #meded #FOAMed
Hi #dermtwitter! Back for another #tweetorial/#medthread on nails! Today we’re learning about:
ONYCHOMYCOSIS- nail fungus!
This is THE most common nail condition- so follow along!
Education from @naildisorders
#medstudenttwitter #medtwitter #meded #FOAMed
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Onychomycosis is more common in adults than kids.
Trauma, diabetes, immunosuppression, tinea pedis, psoriasis, and family history are some risk factors
Pro tip- check the feet for tinea pedis if you suspect onychomycosis!
@podiatrytoday
Onychomycosis is more common in adults than kids.
Trauma, diabetes, immunosuppression, tinea pedis, psoriasis, and family history are some risk factors
Pro tip- check the feet for tinea pedis if you suspect onychomycosis!
@podiatrytoday
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Patients with onychomycosis present with nail discoloration (yellow to brown), onycholysis (nail separation), nail brittleness, or nail thickening.
The big toenail is most frequently affected.
Fingernail involvement without also have toenail involvement is uncommon.
Patients with onychomycosis present with nail discoloration (yellow to brown), onycholysis (nail separation), nail brittleness, or nail thickening.
The big toenail is most frequently affected.
Fingernail involvement without also have toenail involvement is uncommon.
Here we go! I'm excited to share a #tweetorial on how to prep for the upcoming virtual interview season.
#Match2022 #MedStudentTwitter #MedEd #dermtwitter
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#Match2022 #MedStudentTwitter #MedEd #dermtwitter
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Your #tweetorial road map:
1. Set Up (to ring light or not to ring light)
2. Question Prep (!!)
3. General Advice (there will always be surprises, here's how to handle them)
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1. Set Up (to ring light or not to ring light)
2. Question Prep (!!)
3. General Advice (there will always be surprises, here's how to handle them)
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Set Up pt 1: Background.
There are typically three main approaches to interview backgrounds. First, let's do a poll, what's the #MedTwitter favorite?
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There are typically three main approaches to interview backgrounds. First, let's do a poll, what's the #MedTwitter favorite?
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In an effort to conserve #PPE & increase #socialdistancing, many #dermatology services have switched to a heavily #telemedicine model. So today, I present to you:
HOW TO TAKE PHOTOS & CALL A #DERM CONSULT - a #covid19 era #tweetorial.
#MedEd #FOAMEd #dermtwitter #medtwitter
In an effort to conserve #PPE & increase #socialdistancing, many #dermatology services have switched to a heavily #telemedicine model. So today, I present to you:
HOW TO TAKE PHOTOS & CALL A #DERM CONSULT - a #covid19 era #tweetorial.
#MedEd #FOAMEd #dermtwitter #medtwitter
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Let's start with appropriateness of consult. We are trying hard to limit nonurgent consults for the above reasons. The following can wait for when #coronavirus isn't everywhere.
- nonmelanoma skin CA
- old rashes with a known dx
- missed a derm appt and happens to be in house
Let's start with appropriateness of consult. We are trying hard to limit nonurgent consults for the above reasons. The following can wait for when #coronavirus isn't everywhere.
- nonmelanoma skin CA
- old rashes with a known dx
- missed a derm appt and happens to be in house
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If it's an urgent issue, it's helpful to start with the photo. Any camera phone should be fine. If on Epic, you can use Haiku to upload directly the the EMR.
NB: texting photos isn't HIPAA compliant. We'll usually refer to the EMR, or email the photos in a secure system.
If it's an urgent issue, it's helpful to start with the photo. Any camera phone should be fine. If on Epic, you can use Haiku to upload directly the the EMR.
NB: texting photos isn't HIPAA compliant. We'll usually refer to the EMR, or email the photos in a secure system.
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ERYTHEMA MULTIFORME – a #dermatology #tweetorial/#medthread!
#MedEd #FOAMEd #dermatologia #dermtwitter #medtwitter #derm pc: @dermnetnz
Let's warm up with a question for all y'all tweeps out there!
What is the most common trigger for erythema multiforme (EM) in adults?
ERYTHEMA MULTIFORME – a #dermatology #tweetorial/#medthread!
#MedEd #FOAMEd #dermatologia #dermtwitter #medtwitter #derm pc: @dermnetnz
Let's warm up with a question for all y'all tweeps out there!
What is the most common trigger for erythema multiforme (EM) in adults?
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EM is an immunologic syndrome usually triggered by infection in adults. We usually consider HSV and mycoplasma. A simple history for cold sores or genital ulcers can be telling, but mycoplasma can go undetected symptomatically.
What primary lesions do you expect in EM?
EM is an immunologic syndrome usually triggered by infection in adults. We usually consider HSV and mycoplasma. A simple history for cold sores or genital ulcers can be telling, but mycoplasma can go undetected symptomatically.
What primary lesions do you expect in EM?
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EM is usually made up of papular (raised) targets. Pic1 is of EM; you can see the 3 zones in a typical target (red rim, then white, then red center). Versus SJS/TEN (pic2), where macular targetoid (2 zones of red rim, dusky center & flat).
2nd photo: my.clevelandclinic.org/health/disease…
EM is usually made up of papular (raised) targets. Pic1 is of EM; you can see the 3 zones in a typical target (red rim, then white, then red center). Versus SJS/TEN (pic2), where macular targetoid (2 zones of red rim, dusky center & flat).
2nd photo: my.clevelandclinic.org/health/disease…
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VENOUS STASIS LEG ULCERS!!!
A #tweetorial for the #dermtwitter, #medtwitter, #medstudenttwitter, and #hospitalist crowd. 📸:@dermnetnz #medthread
Let's start with a question - What percentage of leg ulcers do you think is caused by venous stasis?
VENOUS STASIS LEG ULCERS!!!
A #tweetorial for the #dermtwitter, #medtwitter, #medstudenttwitter, and #hospitalist crowd. 📸:@dermnetnz #medthread
Let's start with a question - What percentage of leg ulcers do you think is caused by venous stasis?
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Roughly half (40-50%) of all leg ulcers are the result of venous stasis! Since 1% of the population will get stasis ulcers at some point, it's quite common, both in the inpatient & outpatient settings!
While some say they aren't painful, many of my patients would disagree....
Roughly half (40-50%) of all leg ulcers are the result of venous stasis! Since 1% of the population will get stasis ulcers at some point, it's quite common, both in the inpatient & outpatient settings!
While some say they aren't painful, many of my patients would disagree....
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Let's talk exam. These ulcers are predominantly on the lower legs, and often near the medial malleolus. They're usually chronic, so they may have a base covered by yellow fibrinous debris. They tend to be shallow, and given the pathophysiology, quite exudative.
Let's talk exam. These ulcers are predominantly on the lower legs, and often near the medial malleolus. They're usually chronic, so they may have a base covered by yellow fibrinous debris. They tend to be shallow, and given the pathophysiology, quite exudative.
Syphilis! RMSF! Hand-foot mouth!
Slow down there, Tiger! Let's dive deeper into:
ACRAL RASHES - a #tweetorial/#medthread
(aka rashes on the "palms and soles" - kind of 😉).
#MedEd #FOAMEd #medtwitter #dermtwitter #dermatology #dermatologia pc:@dermnetnz
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Slow down there, Tiger! Let's dive deeper into:
ACRAL RASHES - a #tweetorial/#medthread
(aka rashes on the "palms and soles" - kind of 😉).
#MedEd #FOAMEd #medtwitter #dermtwitter #dermatology #dermatologia pc:@dermnetnz
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No where else on the body does a rash evoke more of a knee-jerk differential. That's not wrong per se, as we all learn this in med school, but it's more complicated then starting doxycycline and checking an RPR!
Let's start with a definition - what does "acral" actually mean?
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Let's start with a definition - what does "acral" actually mean?
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Technically, "acral" just means our distal body parts. So while we often think of palms and soles, it's actually inclusive of the whole hand, the whole foot, ears, and some include even the nose!
I actually didn't learn this until #derm residency, which was shocking to me.
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I actually didn't learn this until #derm residency, which was shocking to me.
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Hey #medtwitter, can you help me?
I’m leading a session today for the Ohio #derm association/@AADskin career launch Bootcamp on...
THE POWER OF TWITTER!
Could you help RT & like to help me prove the reach of this platform!
Thank you!
#dermtwitter #dermatology #dermatologia
I’m leading a session today for the Ohio #derm association/@AADskin career launch Bootcamp on...
THE POWER OF TWITTER!
Could you help RT & like to help me prove the reach of this platform!
Thank you!
#dermtwitter #dermatology #dermatologia
@medpedshosp @tony_breu @aoglasser @AdamRodmanMD @WrayCharles @ETSshow @AdeAdamson @HarkerDavid @RoxanaDaneshjou @SBowersMD @DxRxEdu @sargsyanz @AADmember @SuzanneOlbricht @ebtapper @OgunyemiMD @DrGaellon @GIMaPreceptor
@AADskin Thanks to all! This is what we ended up with the presentation. Appreciate all of #medtwitter's help!
I'm going to go outside of my regular comfort zone a bit today, and try out a #tweetorial/#medthread a bit more applicable to #medtwitter in general. So here goes....
A beginner's guide to the use of #PREDNISONE!
#MedEd #FOAMEd #dermtwitter #dermatology PC:@dermnetnz
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A beginner's guide to the use of #PREDNISONE!
#MedEd #FOAMEd #dermtwitter #dermatology PC:@dermnetnz
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Ah, prednisone. One of the most frequently used drugs in our specialty, and in many across the board in medicine. Useful for quick suppression of an overactive immune system, whether that be because of autoimmunity, or acute infection. But how does it work?
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The point is that there are so many potential mechanisms, that it's hard to point at one particular enzyme or pathway to explain all its effects. This paper address many of them, but my main takeaway is that we don't know everything! ncbi.nlm.nih.gov/pmc/articles/P…
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PYODERMA GANGRENOSUM – a #tweetorial/#medthread
After my recent #thread on Sweet Syndrome, I thought we’d continue our discussion of neutrophilic dermatoses with a focus on PG this time! Join me below!👇👇👇
#dermtwitter #medtwitter #dermatology #dermatologia pc: @dermnetnz
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After my recent #thread on Sweet Syndrome, I thought we’d continue our discussion of neutrophilic dermatoses with a focus on PG this time! Join me below!👇👇👇
#dermtwitter #medtwitter #dermatology #dermatologia pc: @dermnetnz
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#Pyodermagagrenosum is a rare ulcerating skin condition that most of us think of in conjunction with IBD. PG can be associated with other things too, so if there’s no IBD, we should also consider other triggers, like the possibility of paraneoplastic processes.
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PG is a neutrophilic dermatosis, so like Sweet Syndrome, it starts as a pustule, & ulcerates from there. Remember pathergy is a classic associated finding with neutrophilic derms. See my #tweetorial on sweet syndrome for a discussion of pathergy!
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CUTANEOUS LUPUS – a #tweetorial/#medthread!!
We all learn about Systemic Lupus Erythematosus (SLE) in medical school, but did you know there are multiple forms #lupus can take in the #skin?
#Meded #FOAMed #dermtwitter #medtwitter #rheumtwitter #dermatologia pc: @dermnetnz
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We all learn about Systemic Lupus Erythematosus (SLE) in medical school, but did you know there are multiple forms #lupus can take in the #skin?
#Meded #FOAMed #dermtwitter #medtwitter #rheumtwitter #dermatologia pc: @dermnetnz
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It wasn’t until #dermatology residency I learned about all the subtypes of cutaneous lupus (CLE)! I thought it was all just one disease: SLE. But in reality there are many forms of CLE, each with its own implications on systemic involvement and effect on the patient.
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Let’s start with the 3 subtypes:
Acute, Subacute, and Chronic Cutaneous Lupus Erythematosus (ACLE, SCLE, CCLE). CCLE is aka Discoid.
Each subtype "overlaps" with SLE in a different way.
Eg: ACLE overlaps completely with SLE, so they all have SLE! 👇
onlinelibrary.wiley.com/doi/abs/10.111…
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Acute, Subacute, and Chronic Cutaneous Lupus Erythematosus (ACLE, SCLE, CCLE). CCLE is aka Discoid.
Each subtype "overlaps" with SLE in a different way.
Eg: ACLE overlaps completely with SLE, so they all have SLE! 👇
onlinelibrary.wiley.com/doi/abs/10.111…
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All right #medtwitter, ready to feel itchy? Get your Sarna ready and read on for a #tweetorial/#medthread on....
SCABIES!!!
#dermtwitter #dermatology #MedEd #FOAMEd pc: @dermnetnz #derm #itch #pruritus
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SCABIES!!!
#dermtwitter #dermatology #MedEd #FOAMEd pc: @dermnetnz #derm #itch #pruritus
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What exactly is scabies? Sarcoptes scabiei var. hominis is the technical name of this parasitic mite that burrows into the skin (itchy yet?😆). It is notoriously difficult to diagnose, and has humbled many a #dermatologist.
It has a very characteristic look under the scope!
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It has a very characteristic look under the scope!
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On exam, most know the classic distribution: interdigital spaces (pic1). However, other places to look include the areola, axilla, and umbilicus. In kids, the lesions tend to be all over the place (perhaps because they aren't as good at scratching them off! - pic2).
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In honor of my recent trip to Taiwan, where I was eaten alive by mosquitoes, I thought I'd put together a #tweetorial/#medthread on...
BUGBITES and STINGS!
#dermtwitter #dermatology #dermatologia #medtwitter #MedEd #FOAMEd pc:@dermnetnz
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BUGBITES and STINGS!
#dermtwitter #dermatology #dermatologia #medtwitter #MedEd #FOAMEd pc:@dermnetnz
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First of all, did you know that #dermatologists refer to bug bites and stings as an "arthropod assault?" In case you ever wanted to throw that into your next conversation....
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While there are some rashes that can be classic for certain types of bites/stings, many are rather nondescript. So when you see a #dermatologist with what looks like bug bites, we are often making an educated guess. Classically, you see pink edematous papules/plaques.
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In honor of #skin #cancer awareness month, here's a #tweetorial on #SKINCANCER!
There is SO much we could talk about, so I'm going to keep it basic. #Dermtwitter, please add more!
#MedEd #FOAMed #dermatology #medtwitter @aadmember #dermatologia pc: @dermnetnz & @aadskin
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There is SO much we could talk about, so I'm going to keep it basic. #Dermtwitter, please add more!
#MedEd #FOAMed #dermatology #medtwitter @aadmember #dermatologia pc: @dermnetnz & @aadskin
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There are many types of skin cancer, but we'll focus on the big 3 in this #thread. We'll discuss basal cell carcinoma (BCC), Squamous cell carcinoma (SCC) & melanoma. The first two are types of "non-melanoma skin cancer (NMSC)," or more aptly named "keratinocytic carcinomas."
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BCCs are the most common cancer diagnosed. Classically described as "pink pearly papules," they often have "arborizing" (tree-like) telangiectasias. But, they don't always have to look classic. The 1st pic is the classic, but the others are also BCCs (superficial & pigmented)!
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Get your #dermatology jokes out now, because this is a #tweetorial/#medthread on....
TOPICAL STEROIDS!
Read on for tips on how to prescribe them, which one to choose, when does it matter, etc.
#MedEd #FOAMed #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
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TOPICAL STEROIDS!
Read on for tips on how to prescribe them, which one to choose, when does it matter, etc.
#MedEd #FOAMed #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
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Truly the workhorse of the #dermatologist's medicine chest, topical steroids are great for a multitude of reasons:
- Delivery straight to the organ of interest
- Systemic absorption is usually minimal
- Can be cheap (usually)
What on skin exam best suggests steroids may work?
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- Delivery straight to the organ of interest
- Systemic absorption is usually minimal
- Can be cheap (usually)
What on skin exam best suggests steroids may work?
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Erythema is a great indicator that there is inflammation. As such, topical steroids may be a good treatment option. However, there are some reasons NOT to use topical steroids. For example, if the rash is infectious (eg: tinea in photo1, herpes in photo2), steroids = no bueno.
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Thanks, @MelBreggs for the mention, and thank you to @gopiastik for a great #tweetorial on #AGEP (acute generalized exanthematous pustulosis). I would add a couple thoughts here. Please read on!
#MedEd #FOAMEd #derm #dermatology #dermatologia #medthread PC: @dermnetnz
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#MedEd #FOAMEd #derm #dermatology #dermatologia #medthread PC: @dermnetnz
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First of all, the name AGEP can be confusing, but really all it is a description (we dermatologists just like to sound #fancy). If you break it down, Acute (really quick onset) generalized (everywhere), exanthematous (rash-y), pustulosis (pustules)!
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The exam is red plaques studded with pustules (see photo). These pustules can coalesce and become "lakes of pus!" The 2nd picture doesn't have pustules b/c all of them came together, lifted off, and left the "collarette" of scale (which means there's a footprint leftover!
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Just wrapped up 2 weeks on the @MGHMedicine service! Let's celebrate with....
#CELLULITIS - a #tweetorial/#medthread!
#MedEd #FOAMEd #dermtwitter #medtwitter #derm #dermatologia #dermatology PC:@dermnetnz
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#CELLULITIS - a #tweetorial/#medthread!
#MedEd #FOAMEd #dermtwitter #medtwitter #derm #dermatologia #dermatology PC:@dermnetnz
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What is cellulitis? It's a bacterial infection of the deep dermis & subcutis. Every year, there are ~ 14.5 million cases diagnosed in the US, leading to >600,000 admissions! What does it usually look like? Remember: Tumor, rubor, color, dolor (swelling, red, warm, painful)!
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Most likely organisms are staph or strep. Abx choice targets those organisms. For a non-purulent cellulitis in a non-sick pt (1 or fewer SIRS criteria), oral abx are good. IV for non-responders or those with 2 or >SIRS. Check out the algorithm from: jamanetwork.com/journals/jama/…
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#Dermatology #tweetorial time! Let's spend some time on the autoimmune blistering diseases. There are many, so this will be a broad overview of the approach to a the bullous disease patient.
#dermtwitter #FOAMed #medtwitter #medstudenttwitter #MedEd @healourskin pc:@dermnetnz
#Dermatology #tweetorial time! Let's spend some time on the autoimmune blistering diseases. There are many, so this will be a broad overview of the approach to a the bullous disease patient.
#dermtwitter #FOAMed #medtwitter #medstudenttwitter #MedEd @healourskin pc:@dermnetnz
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The first ? we usually ask: "What is the level of the split?" That helps to distinguish between the #pemphigus group of diseases where the desmosome is involved in the epidermis, and the #pemphigoid group where the hemi-desmosome is involved at the basement membrane zone.
The first ? we usually ask: "What is the level of the split?" That helps to distinguish between the #pemphigus group of diseases where the desmosome is involved in the epidermis, and the #pemphigoid group where the hemi-desmosome is involved at the basement membrane zone.
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This correlates with the exam! Higher up in the epidermis means a thinner walled blister that's more fragile. So these are usually flaccid bullae. Deeper down means tense bullae. Photo 1 is pemphigus - see how droopy the bulla is? Vs photo 2 of pemphigoid, which stands up.
This correlates with the exam! Higher up in the epidermis means a thinner walled blister that's more fragile. So these are usually flaccid bullae. Deeper down means tense bullae. Photo 1 is pemphigus - see how droopy the bulla is? Vs photo 2 of pemphigoid, which stands up.
OK #hospmed19, I had told myself I wasn't going to make another #tweetorial until next week to give myself a break, but I can't help but be motivated by all the amazing #tweeps at this meeting. Long story short, here's a #medthread on #PSORIASIS!
#MedEd #FOAMed PC:@dermnetnz
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#MedEd #FOAMed PC:@dermnetnz
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More and more, we are recognizing psoriasis to be a systemic disease. Aside from the psoriatic #arthritis we all know and love, there is more convincing evidence that psoriasis is linked with #cardiovascular disease and risk. As such, #multidisciplinary care is important!
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There are many different variants of psoriasis. The most classic is plaque psoriasis, described commonly as "salmon colored plaques with micaceous scale."
Q: Ever notice how psoriasis doesn't really get impetiginized/superinfected but eczema does? Why do you think that is?
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Q: Ever notice how psoriasis doesn't really get impetiginized/superinfected but eczema does? Why do you think that is?
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#hospmed19 is here, and I'm excited to join up with all my @SHMlive colleagues soon! In honor of the momentous occasion, I put together one last inpatient #tweetorial before the conference!
Let's chat about RED MAN SYNDROME (RMS)!
#MedEd #FOAMed #medthread #dermatology
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Let's chat about RED MAN SYNDROME (RMS)!
#MedEd #FOAMed #medthread #dermatology
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What is RMS? It's a hypersensitivity reaction, most commonly reported to vancomycin. However, it's been reported with other anti-infectives too (including cipro, rifampin, amphotericin, etc). What is the usual distribution seen clinically with RMS?
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RMS usually occurs around the head and neck and upper torso. That's why it's other name is "Red Neck Syndrome." The clinical exam is described as flushing & erythema. Patients complain of pruritus, & can also get pain, spasms, and even hypotension!
pc: aac.asm.org/content/56/12/…
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pc: aac.asm.org/content/56/12/…
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I've always thought #dermatology's great because of the ability to understand what might be happening underneath the skin. Let's chat today about all things #paraneoplastic! Time to get our #tweetorial/#medthread on!
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#MedEd #FOAMed #dermtwitter #medtwitter #derm pc:@dermnetnz
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#MedEd #FOAMed #dermtwitter #medtwitter #derm pc:@dermnetnz
Caveats:
- I can't cover ALL the paraneoplastic syndrome of the skin, so apologies if I miss your favorite!
- Management of these syndromes is variable, so I'm presenting what I've learned.
- Lots of one-off case reports. I'll focus on the more common paraneoplastic stuff.
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- I can't cover ALL the paraneoplastic syndrome of the skin, so apologies if I miss your favorite!
- Management of these syndromes is variable, so I'm presenting what I've learned.
- Lots of one-off case reports. I'll focus on the more common paraneoplastic stuff.
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Let's start with one we tend to think of first - #dermatomyositis (DM)! This could be it's own tweetorial, so I'll be brief here. DM is a clinical diagnosis, no biopsies are necessary! If the skin exam is classic, that's all we need.
✅heliotrope
✅shawl sign
✅gottron papule
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✅heliotrope
✅shawl sign
✅gottron papule
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