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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.
4/
Lighting is key. Some tips:
- Don't shine a light on the rash/lesion itself. The glare will be hard to see through (pic 1).
- Normal ambient light is fine (pic 2).
- Usually you shouldn't use flash.

Check out my hand dermatitis from the constant handwashing as an example😬 ImageImage
5/
Take photos from far away (pic 1) & close up (pic 2). That way we can evaluate the distribution of the rash, but also see the primary lesion up close.

Look in the mouth, eyes, & groin. Take a photo (pic3) if there's something! NB: The mouth might need a flash.
pc: @dermnetnz ImageImageImage
6/
Don't forget there are things that we can't tell from a photo. So it's helpful if you can do these physical exam maneuvers to report to us at the time of the consult call:
- blanchability of erythema
- papular (raised) or macular (flat)
- Any tenderness to palpation
7/
And we still like history! When the rash started, symptoms, any associations with medications or situations you might have noticed. Give us all of that information if you can!
8/
We fully understand that we can't do everything via #telederm. We will still come in if a biopsy is necessary, or if it looks to be a serious situation. We are here for you - we just want to do our part in this #COVID19 crisis to save PPE and limit face to face contact.
9/
It's worth noting that the @MedDermSoc & @DermHospitalist are two groups of like minded #dermatologists who care for the sickest derm patients regularly. Best practices on consult practice are constantly being shared and revised. If you have feedback, please let them know.
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