Monday, July 15, 2019

IJWD July 2019 Issue Now Available

The July issue of the International Journal of Women's Dermatology is now available online. Review the full table of contents, access the Women's Health Highlight and Art of Prevention signature articles, and download the Patient Page resources on the new IJWD website: www.wdsijwd.org.

WOMEN'S HEALTH HIGHLIGHT 

Clinical considerations for the management of psoriasis in womenAlice B. Gottlieb, Caitriona Ryan, Jenny E. Murase


Read all Women's Health Highlights






PATIENT PAGE


The Patient Page is a concise, informative sheet that Health Care Providers can download, print and provide to their patients to prompt them to ask relevant questions and begin focused doctor/ patient dialog. 

Psoriasis Management in Women
Alice B.Gottlie, Caitriona Ryan, Jenny E.Murase







FULL TABLE OF CONTENTS

Clinical considerations for the management of psoriasis in women
Alice B. Gottlieb, Caitriona Ryan, Jenny E. Murase

Introduction to The Art of Prevention series
Jenny E. Murase, Dedee F. Murrell


Hyperkalemia in women with acne exposed to oral spironolactone: A retrospective study from the RADAR (Research on Adverse Drug Events and Reports) program
Rebecca M. Thiede, Supriya Rastogi, Beatrice Nardone, Lauren M. Sadowsky, ... Bethanee J. Schlosser

Cutaneous leishmaniasis: A neglected disfiguring disease for women
Asli Bilgic-Temel, Dedee F. Murrell, Soner Uzun

Autoimmune bullous diseases during pregnancy: Solving common and uncommon issues
Aikaterini Patsatsi, Branka Marinovic, Dedee Murrell

Serum homocysteine level, vitamin B12 levels, and erythrocyte folate in psoriasis: A case-control study
Robabeh Abedini, Azadeh Goodarzi, V. Saeidi, Seyedeh H. Hosseini, ... Vahide Lajevardi

Dermatology residents in the era of #MeToo: Ethical considerations of appropriate responses to inappropriate patient behavior
S. Mattessich, A. Chiaravalloti, A. Y.-Y. Chen

Gender workforce disparities - an ethical imperative
Allison R. Larson

Successful management of bullous pemphigoid with dimethyl fumarate therapy: A case report
Aslı Bilgic-Temel, Shilpa Das, Dedee F. Murrell

Keratinocytic epidermal nevus with ipsilateral breast hypoplasia
Eric Chen, Anthony J. Chiaravalloti, Justin Finch

Malignant acanthosis nigricans as a paraneoplastic manifestation of metastatic breast cancer
Javier Arellano, Pamela Iglesias, Claudia Suarez, Yamile Corredoira, Katty Schnettler

Cutaneous myiasis in an elderly woman in Somaliland
Mukhtar A. Yusuf, Bobbi S. Pritt, Josette R. McMichael

Sophie Spitz: A woman ahead of her time
K. Spitz, M. Piliang, E. Mostow

The legacy between the Women's Dermatological Society and leadership in the American Academy of Dermatology
Linda Susan Marcus

International WDS Forum Abstracts 

Wednesday, July 10, 2019

Photography in the Clinic #PACPearls


The WDS Practice Advisory Committee (PAC) shares dermatology photography tips including how to take quality photos and save time, before and after photography, dermoscopy and more.



Dermoscopic Photography



I find it very helpful to monitor pigmented lesions for changes using dermoscopic photography. In order to do this quickly, I have a phone case that is magnetized to hold my dermatoscope in place. Both my dermatoscope and the case are from DermLite. Using an app for EPIC, my photographs can be directly uploaded into the patient's chart for future use. I find this system to be very quick and efficient. 

Taking dermoscopic photographs of things that I biopsy has also improved my own knowledge. I review photographs when dermpath comes back to see if there are any features that I can learn from for a particular diagnosis. For anyone who teaches residents, having a library of dermoscopic images can also improve residency training.

- Lori Fiessinger, MD


Obtain Post Procedure Photographs



Baseline photographs before cosmetic procedures can easily be taken when patients come in for treatments, but obtaining post procedure photographs can be more difficult. To encourage patients to come in for photographs after their treatments, try offering follow-up appointments 2 weeks after a cosmetic procedure for possible touch-ups and photographs. This will help to motivate patients to come in at an ideal time for post procedure photographs in addition to improving patient satisfaction.

- Jeanette Black, MD


Photographing Nails



Routinely examine and photograph nails from their surface and free margin views. In this way you will document the source of a nail disorder (nail bed and distal matrix as depicted in this onychopapilloma) and document progress in response to medical or surgical treatment.

- Molly Hinshaw, MD



Create Consistency



If not ready for a more sophisticated photography setup in your practice, consider choosing a white wall in the same space, mark out on the floor a consistent distance and review with your staff the different angles using anatomical features as landmarks to lineup before and after photos.

The American Society for Dermatologic Surgery (ASDS) has a poster on photographic standards that can be put up on the wall in the photography-designated room. This can help to remind staff of face and body positioning to get greater consistency with photos (poster can be purchased online through the ASDS).

- Monica Li, MD


Not all practices have the resources and space for a sophisticated photography room. You can incorporate inexpensive techniques for photography standardization such as using black or white backdrops made of thick cardboard cut into desired sizes. These can be kept in each patient room, easily accessed and placed behind the patient to efficiently capture photos without having to move the patient. You can also place these behind the doors in patient exam rooms, again for easy access.

- Mona Sadeghpour, MD


Good before and after photos are hard to do- one must reproduce the exact lighting and position of the patient. Using the same room and buying a few lights inexpensive on amazon such as this with a dedicated space is best.

- Margo Weishar, MD 


Useful Apps



Use a program that allows “ghosting.” Overlaying the new photo with the old photo can really improve your accuracy. We use RxPhoto which is a paid program but there are free apps to try as well. iPhone 10 photos are very high quality for everyday use. For publishable quality, you will probably need a higher end camera.

- Margo Weishar, MD


In trying to keep follow-up photos uniform, I would look into an app called Imagine (NFI).

- Mark Kaufmann, MD



*Please note, all products and apps mentioned are included as examples and are not endorsed by WDS.



Thursday, June 20, 2019

Avoiding the MIPS Penalty in 2019 #PACPearls

By Dr. Mark Kaufmann

The bar has been raised.

The amount of MIPS points required to be exempted from the 7% penalty in 2021 (for performance year 2019), is DOUBLE what it was last year. Instead of 15 MIPS points, you now need to get 30 MIPS points. With a little more effort, there is still a way to avoid the MIPS penalty in 2019, and while it’s still possible to do this without using a registry OR an EHR, both of them would make it a lot easier.

Here’s how to get it done:


  • If you are a small (fewer than 15 clinicians) practice, each clinician needs to complete five measures on at least one patient. I still recommend that each clinician complete five measures on more than one patient. Any combination of measures will do, and five will give you 15.75 points.
  • In order to get up to 30 MIPS points, you will also need to do a High Weighted Improvement Activity (IA).
  • You can choose any of the high weighted IAs from the 2019 Improvement Activities List, and if you want to do it without a registry or EHR, I would recommend doing the Complete CDC Training in Antibiotic Stewardship.
  • Without a registry, you would have to attest to completing the IA by using the CMS QPP website, which is probably more difficult than doing the IA itself!
  • If you use a registry, like DataDerm, they will attest for you…and by the way, it’s probably the right time to consider getting DataDerm, as this will probably be the last year that I will be able to write this type of cheat sheet.
  • Starting next year, you will have to choose between getting “in the game” or, taking a 9% penalty every year moving forward.


Food for thought.


Friday, May 31, 2019

Milan Travel Tips for the World Congress



WDS Editorial Highlight
By Jennifer Sorrell, MD

The World Congress of Dermatology is fast approaching, taking place June 10-15, 2019 in Milan, Italy. We would be remiss to not take a moment to discuss some of the wonders of this breathtaking portion of Europe.

Milan
Milan is one of the fashion capitals of the world, however there are some fantastic historical sites to take in as well including da Vinci’s “The Last Supper” and the Duomo. Visits to The Last Supper are very limited in availability and should be booked well in advance. Tours of the Duomo are not possible on Sundays or religious holidays. I would suggest a walking tour, as these always provide such amazing information in the moment and make the sites so memorable. Usually, these tours also allow you to “skip the lines”, so that you aren’t wasting valuable sightseeing time waiting. One tidbit I have found after doing lots of walking tours in different European cities is to arrive at the meeting site at least 15 minutes early to account for potential delays.

Switzerland
A day trip option is to take a quick (1 hour) train ride into Switzerland and the town of Lugano is an easy choice. I did note that Lugano was a bit pricey. I highly recommend taking the funicular to the top of Monte San Salvatore.

Lakes District of Italy
If you will have a bit of extra time, the Lakes District of Italy is a must see. Lake Como is an ideal place to “reset” and simply take in the most picturesque surroundings and the cleanest air without a preset agenda.

If you enjoy a more modern hotel experience, I can personally recommend Avenue hotel and Como Luxury Rooms. The Avenue hotel had free bicycle rental allowing us to bike the area with ease, though I felt that Como in general was very walkable. The latter hotel was unique in that it only has 2 rooms and has more of a studio apartment feel in the middle of town. If you stay for dinner, there is a lovely, authentic family run restaurant called Osteria del Gallo. They serve an appetizer of a light cheese stuffed focaccia with thinly sliced prosciutto on top that I could literally eat everyday. Using Lake Como as your base camp, it is quite easy to take the ferry to several of the towns that surround the lakes like Bellagio, which is equally lovely and provides some unforgettable views.

We would love to see the fun times you had at these meetings! Please submit your travel photos to wds@womensderm.org as we will be posting a few members’ travel experiences in an upcoming newsletter. Bon Voyage!

Wednesday, May 15, 2019

Tips and Pearls on Consent Forms for Surgical and Cosmetic Procedures in Dermatology #PACPearls

The WDS Practice Advisory Committee (PAC) shares tips and advice for optimizing consent forms for surgical and cosmetic procedures in dermatology.

Include Patient Discussions in Office Notes

Don’t forget that a form may not always protect you. It is just as important, if not more, to include the discussion you had with the patient in your office note. The patient can always claim that they didn’t read a form that was put in front of them.
- Mark Kaufmann, MD


Focus on Patient Dialogue

More important than a signed consent form, is a dialogue with the patient to convey the risks, benefits and alternatives of a procedure or intervention, and determining that the patient understands the dialogue as it is pertinent to them.
Also, consider having a witness print their name and sign as well as the patient on the consent form.
- Monica Li, MD, FRCPC, FAAD


Increase Patient Compliance after a New Procedure

Give patients a follow up call the day after a new procedure. This can be delegated out to office staff if needed. Patients usually have questions or concerns the day after experiencing a new procedure and they always really appreciate the call. This simple step increases patient compliance with post procedure instructions, decreases incoming patient calls to the office and patient complaints, improves outcomes, and sets you apart from other providers that wouldn’t take the time to do this.
- Jeanette Black, MD


Use Simple Consistent Phrasing

Phrase in simple language with the patient in first person and divide out into two categories: 
“I will have ...” and “I may experience ...”
Add the exact same phrasing to patient after visit summary/after care instructions and the notes to keep things consistent. 
- Lori Fiessinger, MD

Wednesday, April 10, 2019

Going the Extra Mile for Customer Service #PACPearls

The WDS Practice Advisory Committee (PAC) shares ways to go the extra mile to ensure patient satisfaction.



Patient Appreciation Day

We organize a ‘Patient Appreciation Day’ once a year where existing patients have access to exclusive treatment packages, discounts on non-physician services and discounts on skin care products.

The event is in open house format - patients are served snacks and juice, and can tour the clinic further. Our patients LOVE the annual event!
- Monica Li, MD, FRCPC, FAAD


Neutralize the Hangry Patient

On busy clinic days when we get behind schedule, we offer snacks and soft drinks in addition to our standard coffee and water service.
- Elizabeth Long, MD




Acknowledge Life’s Joys and Sorrows

We keep a stash of custom thank you cards on hand to swiftly thank those who bring us gifts of food, tokens of friendship, or souvenirs from exciting travels abroad. We also reach out with condolence cards when we hear of the death of a patient.
- Elizabeth Long, MD

VIP Check Out

For the cosmetic patient that does not want to risk being seen at the check out desk, we offer in room check out. Our aesthetic consultant handles the transaction and the patient can exit discretely.
- Elizabeth Long, MD

Personal Follow Up

Whenever I excise a skin cancer, I call my patient that evening to see how they’re doing. We often forget that our patients tend to be very anxious when diagnosed with a ‘cancer’ of any kind, and they are usually shocked- and very appreciative- for the call.
- Mark Kaufmann, MD




Monday, April 8, 2019

The Power of Analogies in Dermatology




WDS Editorial Highlight
By Nicole Rogers, MD




I love analogies. I try to use them every day in my private practice, multiple times if I can. I use them with my patients. I use them with my nurses. I even try to use them with the cleaning people if they let me.

My practice is devoted to treating hair loss. We offer both medical hair loss and hair transplantation (surgery). And, living in New Orleans, we have lots of colorful expressions to use. Watching the trends over the years as new devices enter the market is not as exciting as using lasers in dermatology but for me the fun is educating my patients about the nuances of the hair follicle cycle, learning new FUE (follicular unit extractions) techniques, and seeing how we can optimize the role of PRP (platelet rich plasma) in treating hair loss.

I love it when patients say things like, “I started that new hair supplement and immediately my hair felt different all over!” Really? Do they really think that an over the counter supplement taken for 2 weeks will alter the quality of their hair 12 inches away from their scalp? But alas, I try not to roll my eyes. Instead, I patiently try to educate them. One of my first analogies was explaining how making changes to your hair was like driving a big ship down the Mississippi River. We may make a small turn at the helm but it often takes 3 or more months to slowly turn the boat in the right direction.


When explaining male and female pattern hair loss, I show patients the variation in hair caliber and explain how it is a “dirty trick on God’s part” because they are getting “less bang for their buck.” Not only are the hairs coming in finer and thinner, but they are also growing for a shorter period of time. They laugh when I say, “You know how hard you are working at your job/school/etc?  Well this is what your follicles are doing.” And then I lean back in my stool and put my feet up on the counter. “Your follicles are getting lazy! So you need to tell them who’s boss!”

Telogen effluvium can often unmask an underlying male or female pattern hair loss. When they first present with such massive shedding I liken their situation to a plane crashing. “Imagine,” I say, “the plane is losing altitude, your hairs are coming out, flames are coming out, and so the first thing we have to do is stabilize the plane (halt the hair loss) and then we can work on regaining some altitude (regrowing some hair). We can’t get that hair to come back overnight.

My favorite is when they say, “But Doc! If I keep going at the same rate I am I am going to be BALD!” and I try to remind them that their hair is like the stock market. They are going to have good days, and they are going to have bad days. But so long as they are on some kind of medical therapy it will continue to hopefully trend upwards in the right direction (toward regrowth).

Recently we operated on a gentleman who was in the crawfish business. For those of you outside Louisiana, this is a fragile business because they only harvest once per year and people like to buy them live for their weekend crawfish boils. He asked, “How do you keep those grafts live while they are out of the body?” And I said, “Well, just like you have to worry about minimizing the time your crawfish are out of water, we have to minimize the time your grafts are out of the body. Those follicles don’t like drying out, or getting pinched, or sitting in sun.  We keep them moist and well-hydrated, just like your crawfish!”

Read more Editorial Highlights on the WDS Website