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Steven Chen 陳持威, MD, MPH, MHPEd Profile picture
Steven Chen 陳持威, MD, MPH, MHPEd
@DrStevenTChen
Dermatologist/internist @ MGH- Love complex/onco-dermatology & MedEd | Harvard Derm APD | Dad | Husband | Recovering a cappella nerd. Tweets are mine & ≠ advice
11 subscribers
Apr 8 • 9 tweets • 3 min read
Hi #medtwitter and #dermtwitter! Since I'm giving a talk at the upcoming @SocietyHospMed Converge meeting, I thought I'd put together a brief #tweetorial on:

DIFFERENTIATING PEMPHIGUS AND PEMPHIGOID!

Follow along for a reminder on how to tell them apart!
1/ Image Reminder that Pemphigus is from an antibody targeting the Desmosome - which holds skin cells (keratinocytes) together.

Pemphigoid is from an antibody targeting the Hemidesmosome, which holds keratinocytes to the basement membrane.
pc:
2/ bookdown.org/jcog196013/BS2…
Image
Oct 23, 2023 • 15 tweets • 5 min read
If everyone could just humor me for a little, here's a #dermtwitter/#medtwitter/#pharmtwitter #tweetorial on...

AZATHIOPRINE

Did you know that dermatologists use this medication too? Read on to see all the ins and outs of safety and dosing, from a #dermatology point of view!
1/ Image Did you notice those two rings above? That's how it works.

Azathioprine is a purine (see figure) analogue, so it gets in the way of RNA/DNA synthesis (making transcription and replication and all that downstream goodness more difficult).
2/ Image
Jul 18, 2023 • 16 tweets • 6 min read
Time for a #dermtwitter/#medtwitter #tweetorial on...

LYME DISEASE

#Meded #FOAMEd

PC:
1/ https://t.co/E9DgXHQDFNphil.cdc.gov
Image Let's start with the basics. What causes Lyme?

The spirochete Borrelia burgdorferi is the most common cause. It is transmitted via tick bite, and so, certain areas of the country have higher rates based on endemicity of the organism.

What tick classically transmits lyme?
2/
Jun 9, 2023 • 12 tweets • 6 min read
We're seeing more consult questions for this, and it's also garnering national attention, so let's take a brief moment in #tweetorial format to talk about:

XYLAZINE SKIN ULCERS!

#xylazine #MedEd #FOAMEd #dermtwitter #medtwitter

1/ What is Xylazine? It was created in the 70s as a veterinary anesthetic. As an analog of clonidine, it has similar effects as an alpha-2 agonist, leading to sedation, anesthesia, and euphoria in the CNS.
2/ Image
May 16, 2023 • 16 tweets • 7 min read
A #dermtwitter #tweetorial on the skin manifestations of:

SYPHILIS!

#MedEd #FOAMEd #medtwitter #syphilis @VisualDx

pc: en.wikipedia.org/wiki/Treponema…
1/ Image Let's go back to the basics. Syphilis is from an infection by the bacterium Treponema pallidum. Usually spread by sexual means, syphilis has three main stages of disease.

Primary infection usually presents as a papule that turns into a painless ulcer called a chancre.
2/ Image
Jan 31, 2023 • 19 tweets • 8 min read
DERMATOMYOSITIS (DM)

Let’s spend some time in this #tweetorial on the dermatologic manifestations of this potentially paraneoplastic disease!

First, a question: What is necessary to make a diagnosis of DM?
1/ None of the above! DM is a clinical diagnosis, which is why getting the exam right is super important! That said a biopsy CAN help with getting to a diagnosis, but it’s not necessary.

So let’s start! Heliotrope rash! This poikilodermatous erythema occurs around the eyes.
2/
Jan 17, 2023 • 12 tweets • 6 min read
It's been ages since I've put out a #dermtwitter #tweetorial, so I thought what better way than to share a diagnosis that was the original motivator for me to become a dermatologist! A 🧵 on:

PEMPHIGUS VEGETANS!

#MedEd #dermatology #medtwitter #FOAMEd @healourskin #pemphigus
1/ Image What is Pemphigus Vegetans? This is where breaking down the terms can be super helpful. It's the diagnosis we give when pemphigus has the morphology of vegetative plaques.

A #tweetorial on pemphigus if you need it👇

2/
Dec 7, 2022 • 10 tweets • 5 min read
A brief #dermtwitter #tweetorial on the importance of context and patient/host characteristics on your diagnosis.

let's use UMBILICATED PAPULES as an example. Take a look here. What's your diagnosis?

Thanks to @visualdx for the photos!
1/ A: Skin colored papules with central umbilication in hair beB: Umbilicated papules, some with hemorrhagic crust, on leftC: Purple papules, some with central dellD: Skin colored to yellow papules with umbilication on right Well, the correct answer should be, "it depends."

Let's start with an easy question. When you hear "umbilicated papule," what is your inclination for diagnosis?

I'd guess you're thinking of molluscum contagiosum (MC), amirite?

Well, which one of those photos is molluscum?
2/
Aug 24, 2022 • 11 tweets • 5 min read
You've seen rashes and called them all "maculopapular," because, why not?

Does describing something accurately really make a difference?

9 words to improve your life... when calling a derm consult. Macules are flat lesions, less than 1 cm in diameter.

If you closed your eyes and ran your finger over it, you wouldn't feel where it starts and stops.

👀Idiopathic guttate hypomelanosis Shins with hypopigmented maculesHypopigmented macules on the arm
Jun 27, 2022 • 4 tweets • 2 min read
Reminder for our new resident peers:

If you find yourself in the role of a consultant, be kind. The person paging you is asking for help from you, the expert. It's an opportunity to help & educate.

Remember how nervous you might've been the 1st time you called a consult!
1/ Yes, all those "silly consults" add up to be more work. But remember, you are the expert now, and what is "silly" to you may be truly confounding to the primary team. Something that might seem so simple to you is only that way because of your training, and that's pretty great.
2/
Jun 22, 2022 • 17 tweets • 8 min read
It's overdue. Time for a #dermtwitter #tweetorial on...

SEZARY SYNDROME!

We're going to focus on presentation and work up!

#sezary #ctcl #medtwitter #onctwitter #meded #FOAMEd
1/ Just a few years ago, Sezary Syndrome (SS) was thought to be the leukemic variant of Mycosis Fungoides (MF). We basically thought people had MF, it would keep getting worse, and then it would turn into SS.

Check out my old #tweetorial on MF here👇
2/
Jun 1, 2022 • 11 tweets • 5 min read
I learned an interesting #clinicalpearl today!

Did you know that in Wilson Disease, despite high ALT/AST/bilirubin, Alkaline Phosphatase (AP) stays normal or low?

It made me ask "why," & so, I present the answers I found in #tweetorial form.

A rare non-derm, #medtwitter 🧵
1/ Let's start by establishing that Wilson Disease is a multisystem process wherein copper deposits in various tissues (liver, brain, eyes) because of improper transport.

A mutation in ATP7B causes this, and the depositional process leads to disease manifestations.
2/
May 31, 2022 • 18 tweets • 9 min read
With Memorial Day behind us, we're getting into the summer months, so time for a #tweetorial on:

SUNSCREEN!

While #dermatologists are the usual ones who are making these recommendations, I hope this #dermtwitter/#medtwitter 🧵can help everyone!

#MedEd #FOAMEd #sunscreen
1/ First of all, I have no COIs with any makers of sunscreen! Even so, I'm going to avoid talking about any brands. Instead, we'll focus on the different factors you should consider when picking your favorite.

What is your current preference for sun protection (if any)?
2/
May 22, 2022 • 10 tweets • 6 min read
A brief thread on the #dermatologic exam for #monkeypox!

Caveat: I myself have not seen a MPX patient, but am piecing information together for my #dermtwitter and #medtwitter colleagues!

#MedEd #FOAMEd #tweetorial

PC:npr.org/sections/goats…
1/ Since #Monkeypox seems to transition from:

Macules ➡️ Papules ➡️ Vesicles ➡️ Pustules

The primary lesion isn't enough to make the diagnosis. You're going to need the primary lesion AND time from rash onset to know what you should be expecting to see.
2/
Apr 19, 2022 • 10 tweets • 4 min read
1/
A #dermtwitter and #MedEd #tweetorial on...

LINEAR IGA!

This is an autoimmune blistering disorder that can be triggered by drugs!

Hey #medtwitter, what do you think is one of common culprits for causing this eruption? 2/
 You'd be correct if you said vancomycin!

Vanco triggers IgA to attack proteins in the hemidesmosome that holds epidermis to the basement membrane. That means this is a part of the PEMPHIGOID group.

So you get TENSE blisters with a NEGATIVE NIKOLSKY.
Feb 8, 2022 • 18 tweets • 9 min read
1/
 PEMPHIGUS FOLIACEOUS (PF), a #dermtwitter/#medtwitter #tweetorial!

How is this different than Pemphigus Vulgaris (PV)? Why do we not see blisters often? What's the desmoglein compensation theory?!

Read this #MedEd/#FOAMEd #thread & get your learn on! 2/
 The "pemphigus" part of the name means we are similarly dealing with an EPIDERMAL blistering disease, much like it's better known cousin, "pemphigus vulgaris" (PV).

If you haven't had a chance yet, take a look at my prior #tweetorial on PV:

Jan 21, 2022 • 17 tweets • 9 min read
1/
 A #dermtwitter #tweetorial on...

#PEMPHIGUS VULGARIS!

Join me for a quick #thread on this autoimmune blistering disorder!

#MedEd #FOAMEd #medtwitter #MedStudentTwitter 2/
 Pemphigus vulgaris is where the patient's own antibodies target a Desmosomal protein, which leads to the keratinocytes coming apart.

I describe this to patients as a brick wall, where the mortar holding things together is getting dissolved.

Remember this?👇
Jan 14, 2022 • 17 tweets • 10 min read
1/
 WHY ARE SOME RASHES ACRAL?

I'm channeling my "Curious Clinician" today for this different type of #dermtwitter #tweetorial.

Let's start with a question. What does acral mean?

#MedEd #FOAMEd #medtwitter #medstudenttwitter 2/
 If you answered, "hands, feet, and ears," you're correct! This is tricky, and it wasn’t until dermatology residency that I learned it’s not palms and soles!

If you haven't yet, take a look at my old #tweetorial on acral rashes as a primer.

Dec 31, 2021 • 11 tweets • 6 min read
1/
 A #dermtwitter #tweetorial on:

NXG (necrobiotic xanthogranuloma)

This #meded #foamed #medtwitter moment brought to you by episode 11 of @TheDermConsult!

What color do you expect to see when you hear NXG? 2/
 Yes, yellow! Whenever you hear something is “xanthomatous,” expect to see something yellow on exam! Kudos to all of you who guessed some form of a xanthomatous process on our prior mystery diagnosis tweet!👇
Dec 12, 2021 • 7 tweets • 4 min read
Hi #dermtwitter/#medtwitter! Recently, I partnered with @jmervak's & @NailDisorders to make #MedEd/#FOAMEd on nails more accessible! Please consider filling out this ANONYMOUS & SHORT survey👇!

unc.az1.qualtrics.com/jfe/form/SV_af…

If you need a refresher, #tweetorial links below!
1/ 2/
 Nails and underlying systemic disease!

Nov 24, 2021 • 12 tweets • 7 min read
1/
 Join me for a #dermtwitter #tweetorial on:

SCARS AND KELOIDS!

#MedEd #FOAMEd #medstudenttwitter #MedTwitter

Let's start ourselves off with a question: Which one of the following conditions will lead to scarring? 2/
 The correct answer is Pyoderma Gangrenosum! This illustrates a quick first point - scarring only occurs if you damage the skin into dermis and beyond. Epidermal damage heals without scarring, which is why the first 3 don't lead to scarring!