Discover and read the best of Twitter Threads about #dermatology

Most recents (24)

Thread on how #inclusion, or lack thereof, affects #Wellbeing:

⚠️: upcoming #vulnerability moment

Do you ever feel Iike you don’t belong in the spaces you occupy?
I do.
The feeling is isolating & discouraging.

The reasons why are complex, complicated. /1
#medtwitter #burnout
I will confess here that being in #dermatology and in #academia magnifies these feelings.

Being courageous, stepping outside comfort zones, making your voice heard... it’s good, necessary, but the way you’re perceived and received matters. It has impact.

It’s complicated.
/2
The cycle of self-confidence can be a positive or negative one, and often starts early in youth, affected by things such as parental upbringing, privilege, etc.

That cycle can build on itself, and have huge implications for one’s professional and personal wellbeing.

/3
Read 14 tweets
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.
3/
Read 20 tweets
“Around 2012 or 2013, researchers identified evidence that gadolinium retention was connected to illness in patients with normal kidney function.” scholar.google.com/scholar_case?c…
“In September 2017, after the FDA voted to add concerns about gadolinium retention on warning labels, [gadolinium-based contrast agent] manufacturers, including Defendants, issued a new joint warning to patients with normal kidney function.” scholar.google.com/scholar_case?c…
“The warning [RE: #gadolinium retention] also directed physicians to advise patients of these concerns.”

Consent: valued in the United States since the Nuremberg trials of 1947 🇺🇸 scholar.google.com/scholar_case?c…

☢️#radiology
🥼#nephrology
🏥#publichealth ⚠️#patientsafety
💉#MRIdye
Read 4 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'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
1/
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?
2/
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…
3/
Read 20 tweets
A #tweetorial/#medthread on…

CONSULT ETIQUETTE – for the consultant!

(This is the 2nd in a series on consult etiquette. See the end of this thread for a link to my other tweetorial for primary teams calling consults).

#MedEd #FOAMEd #dermtwitter #medtwitter #dermatology
1/
So you just got paged for a consult…. What do you do?

2/
Of course we all think #1, yes?! Realistically though, it can be stressful to get consults. They are unpredictable, can come at any time, & the primary team may or may not listen to what you have to say. Here are some tips I’ve come up with from my time on #dermconsults.
3/
Read 12 tweets
I completed medical school 4 years ago. So I would like to discuss how learning cultural competency and advocating for social justice are VERY relevant to my career. And I'm a dermatologist and aspiring physician scientist. THREAD #medtwitter #MedEd
First, this article erroneously assumes we no longer get basic science training. I assure you, we received plenty of basic science classes. I did have to memorize the Krebs cycle, after all. Learning cultural competency and advocacy did not replace basic science. #meded
1) Climate change is very relevant to healthcare. In #dermatology, endemic illnesses have expanded their geographic areas as the climate has changed. See @MishaRosenbach et al: ncbi.nlm.nih.gov/pubmed/27742170
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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!


3/
Read 14 tweets
I hope you brought your appetite and have a strong stomach for...

A TASTING MENU OF DERMATOLOGY

This 5 course menu is a culinary journey through food-named skin signs. Bon appetit!

#prixfixe #tweetorial #MedEd #FOAMEd #dermtwitter #dermatology #medthread h/t @AdamRodmanMD
N.B. The MENU. Skip this tweet if you prefer delightful surprises. If you're one of those people who prefers to know what's ahead, here you go.
BREAKFAST:

CAFE AU LAIT MACULES (CALMs) are light brown patches seen in neurofibromatosis types I and II ("Coast of California"-type edges) and McCune-Albright syndrome ("Coast of Maine").

For NF, a diagnostic criterium is ≥ 6 CALMs of 5mm (prepubertal), 1.5cm (postpubertal).
Read 37 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
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
1/
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!
2/
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).
3/
Read 17 tweets
Excited to share our work on adverse events from immune checkpoint inhibitors (ICI)! We found that having rash improved overall & progression free survival among patients with ICI-induced colitis!

#dermtwitter #medtwitter #dermatology @MGHCancerCenter

jaad.org/inpress#/artic…
@MGHCancerCenter Thanks to @JAADjournals for supporting the work!
Read 3 tweets
Want to hear a joke?

What's bumpy & painful, & "read" all over?

A #tweetorial/#medthread on ERYTHEMA NODOSUM!

Now that I've lost a few hundred followers from that terrible opener😳, let's get started👇👇

#MedEd #FOAMEd #dermatology #dermtwitter #medtwitter pc: @dermnetnz
1/
Why talk about erythema nodosum (EN) in the first place? Well, most medical professional recognize it, will see it, but may need some help past that! If that's you, read on.
1st, exam: As the name implies- red nodules! It's usually on the legs, & they are often ill-defined.
2/
EN is commonly seen in young healthy pts, & women >> men. Of course, the patient's history is critical, as EN is a reactive process to something else! It's inflammation in the subQ fat (a panniculitis). The rash itself isn't dangerous, but should prompt looking for a trigger.
3/
Read 13 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
“Gadolinium-based contrast agents: Stimulators of myeloid-induced renal fibrosis and major metabolic disruptors,“ is now in press—sciencedirect.com/science/articl…

#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
#toxicology
#dermatology
#nephrology
Gadolinium-based “magnetic resonance imaging contrast agent treatment impaired renal function, induced pathologic damage, and increased kidney fibrosis,” sciencedirect.com/science/articl…

#gadolinium
#nephrology
#radiology ☢️
#patientsafety
#publichealth
#toxicology
Read 11 tweets
Per request of @GoodishIntent (and many others!), let’s talk about TOPICAL RETINOIDS.

#dermatology
#dermtwitter
#medtwitter
I’ve briefly discussed some of the mechanisms behind topical retinoids before, so this thread will focus on their practical use.

Topical retinoids are vitamin A derivatives that are commonly used in dermatology for acne, photoaging, and other skin conditions like psoriasis. Today let’s focus on their benefit combatting the damage done by that pesky fireball in the sky.
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/
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“Notably, in recently published rodent studies, complete clearance of the brain took up to 6 months after injection of a large amount of” gadolinium-based contrast agents. journals.lww.com/investigativer… @HrsQuiet
#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
“[S]o it can be assumed that the total clearance—if achieved at all—might also take months in humans,” after gadolinium-based contrast administration— journals.lww.com/investigativer… @HrsQuiet
#gadolinium
#neurology 🧠
#radiology ☢️
#patientsafety
#publichealth
#toxicology
Read 4 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!
3/
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/…
3/
Read 17 tweets
“Despite significant differences in the thermodynamic stability between non-ionic Omniscan and ionic Magnevist, the [#gadolinium ☠️] concentrations were about the same in the brain,” nibib.nih.gov/sites/default/…
#radiology ☢️ #patientsafety #publichealth #neurology 🧠 #dermatology
“Chronic symptoms attributed to [gadolinium-based contrast agent] exposure:” paresthesias, dysesthesias, clouded mentation, skin discoloration, skin changes, skin thickening, bone pain, bone/joint pain, muscle spasms, arthralgia, muscular weakness—nibib.nih.gov/sites/default/…
“Chronic symptoms attributed to [gadolinium-based contrast agent] exposure:” fatigue/asthenia, digestive symptoms, nausea, vomiting, diarrhea. nibib.nih.gov/sites/default/…
#gadolinium #radiology ☢️ #patientsafety #publichealth #neurology 🧠 #dermatology #nephrology #rheumatology
Read 14 tweets

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