Discover and read the best of Twitter Threads about #dermatology

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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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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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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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#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.
Read 17 tweets
This particular thread is for everyone. Especially the eczema diagnosing people.
#dermatology.
Have you ever seen this before?
Let me say it like 10 times maybe it will get to the people behind.
This is not eczema
This is not eczema
This is not eczema.
Eczema is not a diagnosis. Eczema can be caused by so many different things. This is a fungal infection of the skin called Pityriasis versicolor
Commonly affects the areas where you have oil (sebum) because the organism causing it loves sebum. So you'll find it most of the time on the face, chest, back, shoulders.
It is not uncommon to treat it and it shows itself again months later. O stubborn gan.
Read 15 tweets
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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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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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!

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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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Read 13 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!
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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.
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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
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!
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#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).

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#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!

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Read 11 tweets

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