Discover and read the best of Twitter Threads about #dermtwitter

Most recents (24)

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ERYTHEMA MULTIFORME – a #dermatology #tweetorial/#medthread!

#MedEd #FOAMEd #dermatologia #dermtwitter #medtwitter #derm pc: @dermnetnz

Let's warm up with a question for all y'all tweeps out there!

What is the most common trigger for erythema multiforme (EM) in adults?
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EM is an immunologic syndrome usually triggered by infection in adults. We usually consider HSV and mycoplasma. A simple history for cold sores or genital ulcers can be telling, but mycoplasma can go undetected symptomatically.

What primary lesions do you expect in EM?
3/
EM is usually made up of papular (raised) targets. Pic1 is of EM; you can see the 3 zones in a typical target (red rim, then white, then red center). Versus SJS/TEN (pic2), where macular targetoid (2 zones of red rim, dusky center & flat).

2nd photo: my.clevelandclinic.org/health/disease…
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VENOUS STASIS LEG ULCERS!!!

A #tweetorial for the #dermtwitter, #medtwitter, #medstudenttwitter, and #hospitalist crowd. 📸:@dermnetnz #medthread

Let's start with a question - What percentage of leg ulcers do you think is caused by venous stasis?
2/
Roughly half (40-50%) of all leg ulcers are the result of venous stasis! Since 1% of the population will get stasis ulcers at some point, it's quite common, both in the inpatient & outpatient settings!

While some say they aren't painful, many of my patients would disagree....
3/
Let's talk exam. These ulcers are predominantly on the lower legs, and often near the medial malleolus. They're usually chronic, so they may have a base covered by yellow fibrinous debris. They tend to be shallow, and given the pathophysiology, quite exudative.
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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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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?
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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/
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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
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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?
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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…
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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?

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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
Bit of a different #tweetorial today, on:

CONSULT ETIQUETTE!

- TIPS for the PRIMARY TEAM calling the consult.

Caveat: Some examples are a little #dermconsult specific, but can be extrapolated to others!

#medthread #dermtwitter #medtwitter #meded #FOAMEd #tipsfornewdocs
1/
As both a #dermatologist & a #hospitalist, I have the pleasure of being on both ends of the #consult game.

So, your team has decided to call a consult, and you are the intern or student who has been tasked with contacting the team. Don't be nervous! Try these tips!👇👇👇
2/
First of all:

1)Have a consult question

Asking a consultant to see a pt w/o a ? is like having a pt see you w/o a chief complaint! The ? helps the consultant frame the note in a way that is most helpful for you & your team. Otherwise, I'm guessing at what you want to know.
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Derm/Rheum Consult 1: 82yoW w/ HTN, breast can, new annular rash. Skin bx eosinophilic lymphocytic infiltrate. Gave 1mg/kg steroids.
ANA+ with centromere pattern, CREST?
==>#UnmaskSx with Steroids when tapering steroids.
==>Deep perivascular infiltrate on bx = Derm IDK!

1/
Derm/Rheum Case 2: 78yoF MGUS,HFpEF, rash on legs. ?purpura. w/u Cryocrit normal , RF+ skin bx C3 in vessel walls, LCV.
Dx: Type II Cryo
Learning Pearl: Retiform purpura "angular stellate rash" pic below and diagram -> VASCULITIS or VASCULOPATHY

#dermtwitter #rheumatology
2/
Derm/Rheum 3: Bullous Rash? DDx: Bullous Lupus vs. Epidermal Bullous Acquisita (EBA) vs. Bullous Pemphigoid
Learning Pearl:
Minimal trauma w/ blisters = EBA, treat with dapsone +/- prednisone
Consult Derm!

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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/
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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
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#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/
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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/
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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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There are many guides on how to write a personal statement. I thought I’d share my own thoughts for all those #premed & #medstudenttwitter folks. This is just my opinion, but it’s served me well.

So here goes: a #tweetorial on the PERSONAL STATEMENT!

#meded #medtwitter
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Unlike another recent #medthread on the PS, I don’t think we should be using it to scare our applicants or to expect that they entertain us. Applying for the next level be it med school, residency, or whatever is stressful enough! Let’s support our applicants through it!
2/
First of all, I think the PS when poorly written can definitely lose you an interview. When written in a super compelling way, it may tip you toward getting an interview, but in the vast majority of cases, it doesn’t move the needle much. So first rule: don’t get weird.
3/
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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
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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).
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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/
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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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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!

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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.
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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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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)!
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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#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.
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.
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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!

2/
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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