Discover and read the best of Twitter Threads about #dermatologists

With Memorial Day behind us, we're getting into the summer months, so time for a #tweetorial on:

SUNSCREEN!

While #dermatologists are the usual ones who are making these recommendations, I hope this #dermtwitter/#medtwitter 🧵can help everyone!

#MedEd #FOAMEd #sunscreen
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First of all, I have no COIs with any makers of sunscreen! Even so, I'm going to avoid talking about any brands. Instead, we'll focus on the different factors you should consider when picking your favorite.

What is your current preference for sun protection (if any)?
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There's debate in the field right now about whether everyone even needs sunscreen. For this #tweetorial, I'm going to focus on those who've decided they need sun protection.

So 1st rec: The best sunscreen is one you'll actually put on. Doesn't matter if you won't use it!
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Steven Chen 陳持威

אילן שיינפלד. "הנזיר היהודי". עכשו בכנרת זמורה. 🌈

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Hi #dermtwitter/#medtwitter! Our last (for now!) #tweetorial/#medthread on nails! This time it’s...

PEDIATRIC NAIL CONDITIONS!

Education from @naildisorders and the @jmervak team!

@societypedsderm @PeDRAResearch #medstudenttwitter #medtwitter #meded #FOAMed

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Beau’s lines (transverse ridge) and onychomadesis (nail shedding) common in kids! Often seen in a post-viral setting.

Common culprit = hand foot mouth disease!

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Congenital malalignment of the great toenails – lateral deviation of the first toenails. More common than you think. Start looking at more toes and you’ll see it! Can improve with time or persist. Risk for nail thickening or ingrown nails.

pc: sciencedirect.com/science/articl…

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@ilanshpr

1/ החיים, ההורות, הספרות ומה שביניהם (14)

מזה כשבועיים שאני סובל מתופעת עור מטרידה. על ידי השמאלית ועל צד החזה הימני שלי התפתחה אדמומית, מלווה בפצעונים ובגרד. זה קשה מנשוא.

2/ לכן, בשבוע שעבר חיפשתי בנרות את רופא העור הקבוע שלי, ומשלא מצאתי אצלו תור פנוי נסעתי לרופאת עור אחרת של 'מכבי' בכרמיאל.
היא הציצה בזה, ושאלה מיד אם סבלתי אי פעם מאסטמה של העור. אמרתי לה שלא. אבל שאני אלרגי מאד לחילופי העונות, ואולי זו תגובה לזה.

3/ היא הנהנה, רשמה לי שתי משחות למריחה פעמיים ביום, קרם גוף וסבון טיפולי ושלחה אותי לדרכי. עברתי כמה בתי מרקחת. באף אחד מהם לא נמצאה אחת המשחות שרשמה. לבסוף הזמנתי אותה מבית מרקחת בדיר אל אסד. עלותה היא 250 שקלים. לא פחות.
אני מתמרח במשחות ובקרמים האלה כבר שבוע.

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@dermnetnz

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As promised, here's the second installment of my #Derm101 series on the #dermatology physical exam and #morphology. A #tweetorial on:

THE SECONDARY LESION!

#MedEd #FOAMEd #dermtwitter #medtwitter #medstudenttwitter pc:@dermnetnz

https://twitter.com/DrStevenTChen/status/1295033541349093376?s=20

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First off, if you haven't gone through the primary lesion #tweetorial yet, it's a good idea to start there. Here's the link:

https://twitter.com/DrStevenTChen/status/1295033541349093376?s=20

As review, these are the different primary lesions👇

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Secondary lesions are the changes that affect the primary lesion.

Say what? If a papule is scaly, the SCALE is the secondary lesion. If a plaque is crusty, the CRUST is the secondary lesion.

A question: What was the secondary lesion seen in the pic from the 1st tweet?

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@dermnetnz

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Let's get back to the basics. A #dermtwitter #tweetorial on:

THE PRIMARY LESION!

My plan is to make a #Derm101 series on #morphology and the #skin exam, so this will be the first in that series of #medthreads.

#MedEd #FOAMEd #medtwitter #medstudenttwitter pc:@dermnetnz

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Why are #dermatologists so obsessed with description?

Well, for us, morphology is everything. We start with the exam and take the history afterward based on the possible differential we've come up with!

So let's start simple. What was that lesion in the prior tweet?

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That was a PATCH of vitiligo.

PATCHES are flat lesions >1 cm wide, whereas MACULES are flat lesions <1 cm wide! Check out photo #1 of perioral vitiligo where macules are coalescing into patches!

In #2, you can see both macules and patches in these Cafe au lait lesions.

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Hello #medtwitter & #dermtwitter, time for another #dermatology #tweetorial! Let’s go back to the basics and talk about:

#ACNE!

Hopefully this #meded/#foamed moment is helpful for all the #maskne in the #covid19 era!

Let’s start with a simple question:
What causes acne?

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All of the above! Often, every one of these factors plays some role. What’s important is knowing what treatment to emphasize based on what factor seems to be the biggest influencer.

For example:
-Retinoids for cell turnover
-Ocps for hormones
-Antibiotics for bacteria!

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Let’s talk exam. When I see an acne patient, I’m looking for what lesion I see most: comedones (white/blackheads), inflammatory papules, or cysts.

I’m also looking at distribution (where on the body) and the severity.

It’s critical to ask if it’s a good, typical, or bad day!

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@MedDermSoc

All right #dermtwitter & #medtwitter, it's time for the...

@MedDermSoc & @DermHospitalist Mini-Symposium on #COVID19 & #dermatology!!

I will be attempting to #livetweet the Zoom meeting!

Join along if you'd like. I will be using the h/t #COVIDDerm!

@RoxanaDaneshjou @dschless

@MishaRosenbach

Let's get started!!!!

Your cohosts are super excited to have you join. To give a little background, this meeting was planned in ~1 week, and we have over 500 RSVPs!

@MishaRosenbach now kicking us off with #COVIDDerm!

@DrEstherFreeman

.@DrEstherFreeman is speaking and reminding us all to register our #COVID19 #dermatology cases in the @AADskin #COVID registry!

Reminder to do so here:
aad.org/covidregistry

#COVIDDerm

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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

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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

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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.

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STAPHYLOCOCCAL SCALDED SKIN SYNDROME - A #dermatology/#dermtwitter #tweetorial!

Let's start with a question: You are seeing a new patient with a rash you suspect of being SSSS, but aren't sure if it might be bullous impetigo.

What test will help you differentiate the two?

@dermnetnz

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The correct answer is wound culture! SSSS should be sterile or skin flora; bullous impetigo will have lots of staph grow out. Keep reading to find out why! 👇

But before we get there, let's talk about the SSSS exam. The pic is a good example of "sad facies." pc:@dermnetnz

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The other great clue you are dealing with SSSS is the predilection for skin folds. This eruption can cause a high BSA of erythema --> desquamation.

SSSS is more common in the #pediatrics population, especially in kids <5 years of age (for all the #tweetiatricians out there!)

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@dermnetnz

SWEET SYNDROME - a #tweetorial/#medthread!

Join me for a discussion of this confusing eruption that we more commonly see on the inpatient side.

Bonus: a discussion on pathergy versus koebner phenomenon!

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatology pc: @dermnetnz
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It helps to start by using the other name for Sweet Syndrome: Acute Febrile Neutrophilic Dermatosis. This pretty much sums up the whole syndrome.

Relatively sudden onset? ✅
Fever? ✅
Skin stuff? ✅

But what makes this diagnosis confusing is the differential diagnosis!
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If a patient presents with a fever + rash, we often start to consider infectious processes first, which is totally reasonable. What helps though, is the exam.

The rash in Sweet Syndrome is usually described as "juicy edematous papules and plaques."
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@dermnetnz

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.
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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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@dermnetnz

Hello new followers!👋 In honor of your joining me on Twitter, I thought I'd put together a new #dermatology #tweetorial/#medthread. This time, on a topic near and dear to my own clinical practice:

MYCOSIS FUNGOIDES!

#MedEd #FOAMEd #Dermtwitter #Medtwitter pc: @dermnetnz
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@MGHCancerCenter

Let's start w/ caveats:
1-#MycosisFungoides (MF) isn't the same as Cutaneous T-cell Lymphoma. MF is a subtype of #CTCL; there are many other types of CTCL that aren't MF.
2-I co-direct the Skin Lymphoma Program @MGHCancerCenter, so some of this is institutional preference.
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There are roughly 80,000 new cases of #lymphoma a year in the US, and only 3% are primary cutaneous. Within that ~2500 cases, MF makes up almost half (~44%)! The overall classification schema for these diseases was recently updated by the WHO:
bloodjournal.org/content/133/16…
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@dermnetnz

All right #medtwitter, you asked, & I'm going to try to deliver. Here's a #tweetorial/#medthread on...

#ALOPECIA!

***I'm not a hair expert, but hopefully this will just provide a framework to think about this problem***
#dermtwitter #MedEd #FOAMEd #dermatology pc:@dermnetnz
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Let's say a patient complains of his/her hair falling out. In the spirit of examining first as #dermatologists tend to do, let's start with the exam. This is the easiest way to differentiate between the two types of alopecia: scarring and non-scarring. What do you look for?
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While all the above options can help with the ultimate diagnosis, it's the preservation of follicular ostia (or loss of said finding) that helps point you in the right direction. Whether it's scarring or non-scarring can really help narrow your differential.
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@DermHospitalist

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
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https://twitter.com/DrStevenTChen/status/1099828893656252416

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?

https://twitter.com/DrStevenTChen/status/1099828893656252416

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!

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@dermnetnz

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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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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@dermnetnz

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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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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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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@healourskin

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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

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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.

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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.

@dermnetnz

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

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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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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