Discover and read the best of Twitter Threads about #dermatologists

Most recents (15)

1/
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?
2/
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!
3/
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!
Read 16 tweets
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
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! Image
.@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
Read 39 tweets
Alright y'all, whose hands are taking a beating from #COVID hand-washing, or face acting up with breakouts?

BC if you’re like me, your skin might be needing some extra TLC right now.

Here's a fun tweetorial on some tried & true, dermatologist-recommended skin care tips:
/1
So, why can I tweet about this & why am I tweeting about this?

✅Well, it’s what I do for a living. I'm a board-certified dermatologist, 10 years in. Dermatology isn’t just skin care & acne, but it’s a lot of skin care and acne, so us #dermatologists are really good at it./2
✅I know you probably can’t get easy access to your doctor right now. Between #SocialDistance & doctors’ offices in essential-care-only mode (& much of this is not "essential care"), access is harder. I want you to have the information you need right now but can’t get as easily.
Read 48 tweets
1/
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
2/
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
3/
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.
Read 9 tweets
1/
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?
2/
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
3/
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!)
Read 14 tweets
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
1/
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!
2/
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."
3/
Read 15 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
1/
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…
3/
Read 17 tweets
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
1/
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.
2/
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…
3/
Read 15 tweets
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
1/
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?
2/
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.
3/
Read 21 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
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
1/
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....
2/
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.
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.
3/
Read 18 tweets
1/
#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
2/
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.
3/
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.
Read 17 tweets
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!

1/
#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.

2/
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
3/
Read 13 tweets
In preparation of my upcoming talk on #dermatology emergencies for the @SHMlive conference, I thought I'd put together my first #tweetorial on Stevens Johnson Syndrome (SJS). Having never done this, apologies in advance for subpar tweeting! Here we go!
1/
#medtwitter #dermtwitter
SJS and its more severe cousin, Toxic Epidermal Necrolysis (TEN), are life-threatening dermatologic toxicities, usually caused by a drug trigger. In rare cases, they can be triggered by infection (more commonly seen in the #pediatric population).

2/
#SJS usually presents with an atypical targetoid macular (flat) eruption with +nikolsky. This is in contrast to another entity on the ddx, erythema multiforme, which has classic target papular (raised) lesions. See the difference? (hands are EM, back is SJS). CC @dermnetnz!

3/
Read 11 tweets

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