Steven Chen 陳持威, MD, MPH, MHPEd Profile picture
Dermatologist/internist @ MGH- Love complex/onco-dermatology & MedEd | Harvard Derm APD | Dad | Husband | Recovering a cappella nerd. Tweets are mine & ≠ advice
Reza Hosseini, MD Profile picture medicalmoe Profile picture Misth_l Profile picture Sofía de Dios Profile picture Sudeep Bansal Profile picture 7 added to My Authors
Jun 27 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!
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.
Jun 22 17 tweets 8 min read
It's overdue. Time for a #dermtwitter #tweetorial on...


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👇
Jun 1 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 🧵
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.
May 31 18 tweets 9 min read
With Memorial Day behind us, we're getting into the summer months, so time for a #tweetorial on:


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)?
May 22 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…
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.
Apr 19 10 tweets 4 min read
A #dermtwitter and #MedEd #tweetorial on...


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 18 tweets 9 min read
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 17 tweets 9 min read
A #dermtwitter #tweetorial on...


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 17 tweets 10 min read

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
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👇!…

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

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


#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!
Nov 7, 2021 12 tweets 10 min read
Hi #dermtwitter/#medtwitter! Our last (for now!) #tweetorial/#medthread on nails! This time it’s...


Education from @naildisorders and the @jmervak team!

@societypedsderm @PeDRAResearch #medstudenttwitter #medtwitter #meded #FOAMed 2/
Beau’s lines (transverse ridge) and onychomadesis (nail shedding) common in kids! Often seen in a post-viral setting.

Common culprit = hand foot mouth disease!
Oct 27, 2021 10 tweets 6 min read
Join me for a quick #tweetorial/#medthread on:

Pearls for the #Dermatology Exam!

#MedEd #dermtwitter #medtwitter #medstudenttwitter #FOAMed

First a question - What do you think when someone asks for your help with a rash? 2/
Regardless how you answered, I hope to teach you something today! Let's start!

"In #dermatology, we don't do an H+P, we do a P+H."

The exam is perhaps most important. You can use it to narrow down your ddx! Then, you use your history to further work toward the right dx.
Oct 24, 2021 14 tweets 9 min read
Hi #dermtwitter! Back for another #tweetorial/#medthread on nails! Today we’re learning about:

ONYCHOMYCOSIS- nail fungus!
This is THE most common nail condition- so follow along!
Education from @naildisorders
#medstudenttwitter #medtwitter #meded #FOAMed 2/
Onychomycosis is more common in adults than kids.
Trauma, diabetes, immunosuppression, tinea pedis, psoriasis, and family history are some risk factors

Pro tip- check the feet for tinea pedis if you suspect onychomycosis!

Oct 3, 2021 16 tweets 8 min read
Hi #dermtwitter! I'm working with @jmervak et al, who put together this amazing #tweetorial on


Specifically, findings in the setting of systemic diseases: let nails help your diagnosis!

Coordinated with @naildisorders

#medstudenttwitter #medtwitter #meded #FOAMed 2/
First things first, do you mind telling us who you are?
Feb 6, 2021 16 tweets 9 min read
Let's spend some time on a #dermtwitter #tweetorial on all things....


Even though there are 8 herpesviruses that infect humans, I'm going to focus on HSV1 and HSV2 today.

#medtwitter #medstudenttwitter #meded #FOAMEd 2/
You know how we say that everything could be sarcoid? Well, HSV-1/HSV-2 (which I'll refer to as herpes for this #thread) would be a close 2nd, ESPECIALLY on the inpatient service.

While HSV-1 is usually thought to be oral and HSV-2 genital, this certainly is NOT always true.
Jan 2, 2021 18 tweets 10 min read
Let's kick off the new year with a #dermatology #tweetorial! I put together some tweets on


#MedEd #FOAMEd #medtwitter #dermtwitter #onctwitter

Let's start with a poll:

Among BOTH males and females in the US, how common is melanoma? 2/
Melanoma is the 6th most common malignancy (that's tracked) for BOTH men & women. Basal cell carcinoma is actually the MOST common cancer in the US, but we don't track it.

While melanomas are 6th, in certain groups (eg: women age 25-30), it is the #1 cause of cancer death! Image
Nov 1, 2020 16 tweets 10 min read
While we're all doom-scrolling through Twitter, I thought I could help provide some distraction for #medtwitter, #dermtwitter & #medstudenttwitter.

A #Derm101 #tweetorial on the #dermatology exam:


AKA: "How a dermatologist approaches a rash!"
pc:@AADskin 2/
So what exactly is a reaction pattern? It's an organizational way to think about rashes so that we can bucket them. There are FIVE main reaction patterns:

1) Papapulosquamous
2) Eczematous
3) Dermal
4) Vascular
5) Vesicobullous

Which reaction pattern was that last photo?👆
Sep 22, 2020 18 tweets 12 min read
Time for another #morphology #Derm101 series #tweetorial on the skin exam. Today, we'll cover:


How the location a rash occupies on the body might help us with the differential diagnosis!

#FOAMEd #MedEd #medtwitter #dermtwitter #medstudenttwitter #dermatology 2/
An important point to start:
Distribution is LEAST important in the skin exam. Primary & secondary lesions, configuration & scale are all better in informing our DDx.

I tell my learners that if confused about a rash, pretend it's elsewhere on the body & see if that helps.
Aug 29, 2020 20 tweets 12 min read
OK team, #tweetorial #3 in our #Derm101 series on the #dermatology exam. Today, let's discuss:


How primary lesions are grouped or shaped. Read on to learn more!

#dermtwitter #medtwitter #medstudentwitter #meded #FOAMEd pc:@dermnetnz @BrwnSkinMatters 2/
Since this is the 3rd installment in the #Derm101 series, remember that if you haven't already, you might want to check out the first two #tweetorials on skin morphology.

Primary Lesion:

Secondary Lesion: