Discover and read the best of Twitter Threads about #dermatologia

Most recents (11)

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
1/
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?
2/
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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Read 20 tweets
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
@AADskin Thanks to all! This is what we ended up with the presentation. Appreciate all of #medtwitter's help!
Read 3 tweets
Let's go back to the basics today, and talk about some #morphology in the #dermatology exam.

Today's #tweetorial/#medthread will be about evaluating....

SCALE!

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatologia pc:@dermnetnz
1/
Before we get too far into it, how do we think about #scale? Meaning, which one of the following is it?
2/
When we say "primary lesion," we mean the most basic element of a lesion/rash (papule, macule, patch, plaque etc).

SECONDARY CHANGE (which scale is) means the extra exam element that occurs on top of the primary lesion!

Tertiary/Quaternary isn't a thing. I'm just a jerk.
3/
Read 15 tweets
I had a bit of an “ah ha moment” while attending in our #dermatology resident clinic a month ago.

The way I run this clinic means that when the timing is right, I try to have our senior resident precept the junior resident. I try to stay silent and literally say nothing.

1/
When this happened, we had a brand new senior and a brand new first year. Essentially both residents were settling into their respective roles.

In typical fashion, the junior resident presented the key points to the senior resident as I listened on.

2/
Jr: the patient doesn’t have a rash today, but the pictures look like wheals. He says that pressure causes it. Diphenhydramine doesn’t work that well. He doesn’t have dermatographism.

Sr: what do you think it is?

::both look at me to see what I’m thinking/about to say::

3/
Read 13 tweets
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
1/
#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.
2/
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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Read 14 tweets
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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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.
2/
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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Read 17 tweets
Time for a #tweetorial/#medthread on:

#CALCIPHYLAXIS!

This is a devastating diagnosis often seen in inpatients, so this goes to all the @DermHospitalist & #hospitalists out there!

#FOAMed #MedEd #dermatology #dermatologia #dermtwitter #medtwitter @SHMlive @DermHospitalist
1/
First of all, what is it? The exact mechanism is unknown. What we do know is that there is calcium in the arterioles of the skin, with arterial thrombosis. This interruption of blood flow causes painful ulcers and retiform purpura. Remember this?



2/
That interruption of blood flow causes the clinical picture of calciphylaxis - retiform purpura with a predilection for fatty areas, violaceous borders, necrosis with ulceration, and TERRIBLE PAIN. Without the pain, I really think one needs to reconsider the diagnosis!

3/
Read 17 tweets
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
1/
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?
2/
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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Read 18 tweets
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
1/
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)!
2/
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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Read 12 tweets
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
1/
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)!
2/
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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Read 17 tweets
Thanks to all for the encouragement after my first #tweetorial on SJS/TEN! I thought I'd keep the momentum going with #dermatology emergencies with a new #twearl aka #MedThread on #DRESS Syndrome, Drug Rash with Eosinophilia and Systemic Symptoms! Thanks to @dermnetnz!
1/
DRESS is a life-threatening drug reaction that, as the name implies, can cause systemic/end-organ damage. Although less flashy than SJS/TEN, it's much more common, occurring 10x more frequently! With a mortality estimated to be up to 10%, admission is usually recommended.
2/
Clinically, the name DRESS can be misleading. Let's try a quick poll:

Which of the following features is REQUIRED for the diagnosis to be made?

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Read 14 tweets

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