Dermatology Weekly

How is dermatology handling this change in practice toward telehealth? Guest host Dr. Candrice Heath talks with Dr. George Han about how dermatologists can adapt their clinical practice to conduct quality teledermatology visits with their patients. "Last year ... I think overall in the health system we probably had about 2,000-3,000 telehealth visits ... by the end of March [this year], I think the numbers I saw [were] around 30,000, so it's absolutely just kind of been a huge change in the way we practice medicine," Dr. Han explained. They discuss potential use cases for teledermatology during the current health crisis and beyond as well as how to address technological barriers to care.

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We also bring you the latest in dermatology news and research:

1. Novel inflammatory syndrome in children possibly linked to COVID-19

2. Case reports illustrate heterogeneity of skin manifestations in COVID patients

3. COVID-19 Dermatology Registry

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Things you will learn in this episode:

• Despite recent HIPAA relaxations, dermatologists still should be aware of privacy and security issues when conducting telehealth visits with patients.
• Existing resources -- such as noninvasive tests that can be self-administered by patients -- may be useful for concerning lesions that are difficult to diagnose during video visits. "There's this genomic test for melanoma. ... I hadn't used it very much before the COVID pandemic because we could biopsy patients in the office. ... But now that the whole paradigm has changed, I've actually used it more than I ever did before," Dr. Han explained.
• Common conditions such as psoriasis, acne, and eczema are relatively easy to triage via telemedicine. "We're going to have to do a lot more experimentation, certainly, if there's a lesion that's scaly and erythematous. ... But I think as long as you're up front with the patients, they understand it, too," Dr. Han said.
• In most cases, total-body skin examinations and evaluation of pigmented or potentially cancerous lesions still warrant an in-person visit.
• Biologics often can be started in patients with psoriasis or atopic dermatitis without first seeing them in person. "If it's a pretty clear case of psoriasis, I would say that your treatment options are not limited by the fact that we're handling over telemedicine, and I think that's really nice for our patients. There are a number of treatments out there that you don't need laboratory screening for, so those are helpful to have on hand," Dr. Han said.
• For older patients who may not have the necessary technology skills or devices to participate in video consultations, the Centers for Medicare & Medicaid Services recently issued a guidance that telephone visits will now be paid at the level of an established visit (levels 2–4). "The recognition is there that we're still doing important work for our patients and you don't necessarily need that video signal to be able to do this, and we certainly don't want to create any artificial barriers to access to care," Dr. Han said.
• Prior to COVID-19, telehealth services use was low because patients did not think of it as a legitimate option, but the marketplace will demand these services moving forward now that they are seeing the benefits. "I think it's important as we go ahead in the next phase ... we use the lessons we've learned during this pandemic of just large numbers of people utilizing teledermatology services to help map out what makes sense for our specialty ... as well as technical requirements that we should be asking of our vendors providing these services," Dr. Han advised.
• Beyond the parameters of the COVID-19 pandemic, teledermatology also provides access to care for patients in parts of the country with limited access to dermatologists, such as in rural areas.
• Dermatologists can use telehealth services for short hands-off visits, such as to counsel patients, check in before titrating doses, or follow-up after a cosmetic procedure. "Those are situations where you actually might improve your show rate by offering telemedicine services," Dr. Han noted.
• A tip sheet is available online that provides information to help dermatologists adopt telehealth in their practice. It describes what you need, how to select a software platform, and how to monitor workflow.
• Patients should be asked to provide high-quality photographs before the visit via a HIPAA-secured chat or email. "We always recommend that you get a HIPAA-secured email server account if you can if you're asking for patients to send in photos, because what happens is that once they send those photos to you, you are responsible for the safety and security of that photo," Dr. Han explains.
• Set expectations for patients up front and be realistic about what you think is reasonable for implementing telehealth services in your practice. "If you're not comfortable seeing concerning lesions, suspicious moles, those things, you should make it very clear to your schedulers that patients should be told that if it is one of those problems, they cannot be seen by this methodology," Dr. Han recommended.

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Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia)

Guest: George Z. Han, MD, PhD (Icahn School of Medicine, New York)

Disclosures: Dr. Heath and Dr. Han report no conflicts of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Transparency about industry-supported interactions among physicians was the goal of the online Open Payments database created by the Centers for Medicare & Medicaid Services. Dr. Vincent DeLeo talks to Dr. Allen F. Shih about a retrospective review of how accurately dermatologists presenting at a major medical meeting disclosed industry conflicts of interest, compared with the OP database. They discuss possible reasons for data discrepancies and provide tips for dermatologists to ensure their COIs are disclosed appropriately. "I think it's very important for dermatologists to continue to review industry-reported interactions listed on the online Open Payments database and to make sure it is as accurate as possible," recommends Dr. Shih.

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We also bring you the latest in dermatology news and research:

Private equity: Salvation or death sentence? Depending on whom you ask, the continuing growth of private equity purchases of dermatology practices is either a death sentence -- or salvation -- of the specialty.

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Things you will learn in this episode:

• All U.S. companies that produce or purchase drugs or devices that are reimbursable by a government-run health care program are required by the Physician Payments Sunshine Act to announce all payments to physicians using the online OP database: "Once a year, the government gives the companies a particular time frame to establish these payments. ... and list the physician, the amount, and the type of payment that they are giving out," Dr. Shih explains.
• Speakers at meetings of the American Academy of Dermatology must publicly disclose a full list of industry COIs in the meeting program, including the company name and type of interaction.
• A comparison of industry interactions disclosed at the AAD 73rd Annual Meeting in March 2015 vs. the 2014 OP database showed a discrepancy between the two sets of data for about 30% of dermatologists.
• The most commonly reported industry relationships among dermatologists were investigator, followed by consultant and advisory board member. "Specifically, among these three roles, the form of payments that dermatologists reported were, number one and number two, honoraria and grants and research funding," Dr. Shih notes.
• Overall, 66% of interactions were accurately and fully disclosed by dermatologists when the AAD and OP data were compared. "It looks like [dermatologists] are in line with what other specialists are seeing from other specialties," Dr. Shih said.
• Data discrepancies could be industry-reporting inaccuracies, which are not audited. "If you have a payment that you see, you can check it online to make sure it's not something that was entered under your name erroneously, which has happened before," Dr. Shih advised.
• Dermatologists speaking at meetings may fail to report industry payments they feel are outside the scope of their presentation topic. "For example, a dermatologist who goes to AAD to speak about psoriasis may not feel the need ... to disclose items that may be related to a laser," Dr. Shih explained.
• Patients can search the Centers for Medicare & Medicaid Services website for a list of all interactions and type of payments received by any physician by calendar year. "One of the reasons that Congress decided to include Open Payments [in the Affordable Care Act] was to include the transparency and objectivity ... so that patients and providers and the general public alike would be able to find if there were particular biases that physicians were having based on financial interactions that were yet to be revealed," Dr. Shih explained.
• Every year, CMS gives physicians a 45-day period to review reported industry interactions for the previous calendar year. For 2019, the review period started on April 1, 2020, and goes until May 15, 2020, during which time physicians can submit corrections to CMS if an error is noted.

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Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guests: Allen F. Shih, MD, MBA (Boston University)

Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Dr. Shih reports no conflict of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Dermatologists play an important role in disease management for patients with Muir-Torre syndrome (MTS). In this resident takeover, Dr. Daniel Mazori talks to Dr. Mohammed Dany about the pathogenesis of MTS and its associated malignancies. "We are the ones who usually make the diagnosis, and we should know that these patients are at risk for developing several visceral malignancies and thus require screening," Dr. Dany explained. They also review diagnostic clues and tools for dermatologists when treating patients with solitary sebaceous tumors.

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We also bring you the latest in dermatology news and research:

1. COVID-19 spurs telemedicine, furloughs, retirement

2. Evidence on spironolactone safety, COVID-19 reassuring for acne patients

3. COVID-19 decimates outpatient visits

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Things you will learn in this episode:

• Muir-Torre syndrome is an autosomal-dominant genetic disorder that predisposes patients to both cutaneous neoplasms and visceral malignancies.
• Sebaceous tumors are the hallmark of MTS and are rarely seen outside of this condition: "All three types of sebaceous tumors can be present in these patients: the adenomas, the epitheliomas, and the carcinomas," Dr. Dany explains. Nonsebaceous skin tumors also can present in MTS, including rapidly growing keratoacanthomas and basal cell carcinomas.
• Patients with MTS should be further screened for colorectal, endometrial, ovarian, breast, lung, genitourinary, hematobiliary, hematopoietic, and central nervous system cancers. "Every Muir-Torre syndrome patient [also] should definitely see a dermatologist at least once a year for skin cancer screening," Dr. Dany advises.
• In MTS, germline mutations in DNA mismatch repair genes lead to microsatellite instability, which drives the formation of tumors; however, MTS is not always genetic and is not always inherited. More research is needed on whether specific mutations put MTS patients at higher or lower risk for developing certain kinds of tumors.
• All patients presenting with a solitary sebaceous tumor should be worked up for MTS. Tumor location can be a helpful diagnostic indicator. "A sebaceous tumor that is inferior to the neck is most likely associated with Muir-Torre syndrome; on the other hand, sebaceous tumors on the head and neck can be either a manifestation of Muir-Torre but can also be spontaneous," Dr. Dany advises.
• The Mayo MTS score is a helpful tool for risk stratification in MTS patients. "The score ranges from 0 to 5, and then a risk of 2 or more has 100% sensitivity for Muir-Torre syndrome and has an 81% specificity for predicting a germline mutation in the [DNA mismatch repair] genes," Dr. Dany explains. Molecular testing should be performed to confirm the diagnosis.
• Solitary sebaceous tumors in patients with low Mayo scores may be sporadic; therefore, further laboratory work-up is recommended to avoid misdiagnosis of MTS.
• Muir-Torre syndrome type 2, also known as autosomal-recessive colorectal adenomatous polyposis, is a new subtype of MTS that demonstrates an autosomal-recessive pattern of inheritance and microsatellite stability.
• Future research is needed to delineate pathways for targeted therapies that can shut down the formation of new sebaceous tumors, particularly sebaceous carcinomas. "If we are able to find a way to prevent the formation of those sebaceous tumors from showing up, then we will end up with less follow-up, [fewer] biopsies, and less concern from our end," Dr. Dany explains.

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Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn)

Guests: Mohammed Dany, MD, PhD (University of Pennsylvania, Philadelphia)

Disclosures: Dr. Mazori reports no conflict of interest. Dr. Dany reports no conflict of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Hosts of the dermatology podcast Dermasphere, Luke Johnson, MD, and Michelle Tarbox, MD, join MDedge host Nick Andrews to talk about COVID-19 and dermatology as well as how their podcast works.

Dr. Johnson is assistant professor of dermatology at the University of Utah School of Medicine in Salt Lake City, and Dr. Tarbox is assistant professor of dermatology at Texas Tech University Health Science Center in Lubbock.

You can find Dermasphere on Apple Podcasts, Google Podcasts, Spotify, and wherever podcasts are found.

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Hair salon closures during the coronavirus pandemic have left women of African descent to care for their own hair -- whether natural, processed, or synthetic -- at home. Dr. Lynn McKinley-Grant, president of the Skin of Color Society, talks to Dr. Susan C. Taylor about hair care products these patients can use so that dermatologists can help African American women take care of their hair and manage dermatologic conditions. "With COVID-19, many women are at home -- me included -- and it's important for women to understand that they have to continue to groom their hair. Just because no one sees you doesn't mean that you don't regularly shampoo and condition as well as comb and style your hair," says Dr. Taylor.

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Key takeaways from this episode:

• Dermatologists should know how to recognize and differentiate between natural, processed, and synthetic hair in women of African descent to inform diagnosis and treatment recommendations.
• Regardless of hairstyle, it is important for all African American patients to shampoo, condition, detangle, and style their hair with products that contain appropriate ingredients.
• Shampoos with sodium lauryl sulfate contain the harshest detergents that can dry out the hair and scalp. "For our skin of color patients, or African American patients, we suggest shampoos that contain sodium laureth sulfate, which is a much milder detergent to clean the hair, and it helps to leave the hair moisturized," Dr. Taylor explains.
• Social distancing provides an opportunity for African American women to concentrate on conditioning the hair while taking a break from damaging hair care practices. "I personally think this is a great time to minimize what you do to your hair in regard to heat from blow-dryers and flat irons and curling irons. I also think it's a great time if you have a weave or braids and extensions to take them out to really give your hair a rest," Dr. Taylor recommends.
• Many patients seek to avoid products containing controversial ingredients such as parabens, mineral oil, and tetrasodium EDTA because of concerns that they may be carcinogens or endocrine disruptors. "I think the jury is still out. There are a whole host of products that do not contain those particular ingredients, so I think our patients have to have choices," Dr. Taylor says.
• Prescription shampoos for seborrheic dermatitis in people of African descent can dry out the scalp. "What I suggest to my patients is that they apply the shampoo directly to the scalp with a 4- to 5-minute contact time and then rinse the shampoo out of the scalp, followed by the use of a conditioning shampoo to actually shampoo their strands of hair. That way they're minimizing the contact time with the prescription shampoo," Dr. Taylor advises.
• Although daily shampooing typically is not recommended for individuals of African descent, health care workers and first responders will need to wash their hair more frequently during the coronavirus pandemic. "I think rinsing the hair with water, not necessarily doing a full shampoo every day, could be helpful. [Also] putting in a leave-in conditioner and reapplying the leave-in conditioner every day I think can really help combat potential dryness they can experience," Dr. Taylor suggests. It also is important to thoroughly dry the hair after each wash so it doesn't stay damp, which could lead to infection.

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Hosts: Nick Andrews; Lynn McKinley-Grant, MD (Howard University, Washington)

Guest: Susan C. Taylor, MD (University of Pennsylvania, Philadelphia)

Disclosures: Dr. Taylor reports no conflict of interest. Dr. McKinley-Grant reports no conflict of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Patients, medical students, residents, and even attendings often seek reliable information about nail biopsy procedures on the Internet. Dr. Vincent DeLeo talks with Dr. Shari Lipner about the quality and credibility of nail biopsy videos on YouTube. "There is a need for reliable information for dermatologists and students and residents to learn more about this, and I do think we have the resources to put together a good instructional video," Dr. Lipner says.

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We also bring you the latest in dermatology news and research:

1. COVID-19: What Now?

2. Presymptomatic or asymptomatic? ID experts on shifting terminology

3. Cardiology groups push back on hydroxychloroquine, azithromycin for COVID-19

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Key takeaways from this episode:

• Not all nail biopsy videos on YouTube are produced by reliable sources.
• In a recent analysis, the top 10 most relevant nail biopsy videos on YouTube were associated with a number of shortcomings.
• Medical students, residents, and dermatologists are advised to seek other more reliable opportunities to learn about nail biopsy procedures: "Probably the best would be to learn in person how to do a biopsy from a nail specialist or a Mohs surgeon," Dr. Lipner suggests. She also recommends didactic sessions in which physicians can practice biopsy procedures on cadaver nails.
• The American Academy of Dermatology offers a hands-on nail surgery course at its annual meetings, where dermatologists can work on cadaver nails under the direction of at least 10 nail specialists.
• The most reliable resource for patients on nail biopsies is education from a board-certified dermatologist. There is a need for more patient education materials that explain the procedure in detail.

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Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guest: Shari R. Lipner, MD, PhD (Weill Cornell Medicine, New York)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Lipner reports no conflict of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

Body lice present an important public health concern due to the potential spread of infectious diseases. Dr. Vincent DeLeo talks with Dr. Dirk Elston about how to identify and manage human body lice infestations.

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We also bring you the latest in dermatology news and research:

1. Skin manifestations are emerging in the coronavirus pandemic 2. NCCN panel: Defer nonurgent skin cancer care during pandemic 3. iPLEDGE allows at-home pregnancy tests during pandemic

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Key takeaways from this episode:

• Human body lice are similar in appearance to head lice but can be differentiated based on the location of the infestation: "Body lice tend to lay their eggs in seams of clothing and on the fibers of hair in clothing rather than on the hairs on the head," Dr. Elston notes.
• Body lice are transmitted through prolonged person-to-person contact associated with mass crowding, refugees, poverty, and homelessness.
• Patients with body lice typically present with generalized pruritus, maculated ceruleae, and hemosiderin deposits in the skin where the lice have fed, as well as lice and nits in the clothing.
• Body lice can be treated entirely with treatment of the clothing. "Pharmacologic intervention in the case of body lice is more for disease that the body louse may have spread," Dr. Elston explains.
• Clinical signs and symptoms of body lice infestation include sepsis or more serious infection, typhus, eschar associated with other rickettsial-type diseases, endocarditis, cat scratch fever, acral splinter hemorrhages, and Osler-type nodes. "Most of these patients won't present to us in clinic but more likely to [the] emergency department," says Dr. Elston.
• Unlike body lice, head lice can be treated by shaving the head or other topical treatments. Combing through the hair has shown low efficacy rates. "Head lice are widespread. They know no economic or social boundaries. ... Fortunately, they are not known to be significant vectors of disease, but they are certainly a nuisance and something that carries a significant social stigma," advises Dr. Elston.
• Transmission of lice is highly preventable. "[The] simple separation of clothing is the greatest intervention that we can do to prevent spread among schoolchildren, and it's really a very simple and common-sense thing to do," Dr. Elston says.
• If a patient has very coarse curly hair, pubic lice are more likely to infest the scalp than head lice. Pubic lice also are common in body hair, particularly in males, and are not just restricted to the pubic region.

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Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles)

Guest: Dirk M. Elston, MD (Medical University of South Carolina, Charleston)

Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Elston reports no conflicts of interest.

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

As the nation's health care system braces for COVID-19 cases, physicians who've faced the pandemic first have critical lessons for everyone.

In this bonus episode of Dermatology Weekly, two Seattle-area critical care leaders explain how their medical centers are preparing for and responding to their region's early outbreaks. And they share some creative approaches that are uniting Seattle's critical care departments.

Patients with severe psoriasis may be at higher risk for infection because of increased inflammation in the body. Dr. Lawrence Green discusses how to counsel patients who are taking biologics to control their psoriasis during the COVID-19 pandemic. "What I recommend [is to] stay on your biologic as long as you can unless you have exposure [or] you start to feel feverish," Dr. Green advises.

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We also bring you the latest in dermatology news and research:

1. CMS implements temporary regulatory changes to aid COVID-19 response

2. FDA issues EUA allowing hydroxychloroquine sulfate, chloroquine phosphate treatment in COVID-19

3. FDA okays emergency use of convalescent plasma for seriously ill COVID-19 patients

4. Physician couples draft wills, face tough questions amid COVID-19

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Key takeaways from this episode:

• Patients with uncontrolled psoriasis symptoms are at higher risk for developing infection and other comorbidities. "In general, I have told patients that if they stop the biologic for some time and the psoriasis comes back so that it's severe again, I think that it's significantly more risky for getting COVID-19 than if they continue to take their biologic," says Dr. Green.
• There currently are no data on whether biologics help or harm patients with COVID-19.
• Anti–tumor necrosis factor (anti-TNF) agents may be useful in helping control pneumonia, but they also are associated with an increased risk for infection, compared with other biologic agents. It may be safer for patients to switch to or continue treatment with anti–IL-17 or anti–IL-23 agents during the COVID-19 pandemic.
• Patients should stop biologic treatment if they have exposure to someone with COVID-19 or start to show symptoms. "Stopping a biologic for a few weeks will not bring your psoriasis back. ... [but] a few months off can make a difference," Dr. Green explains.
• Patients currently on biologics should take extra precautions to practice social distancing, stay at home when possible, wash hands, use hand sanitizer, and avoid touching the face, as recommended by the Centers for Disease Control and Prevention.
• For additional resources, dermatologists can consult the American Academy of Dermatology or the National Psoriasis Foundation guidelines on psoriasis treatment during the COVID-19 pandemic.

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Host: Nick Andrews

Guest: Lawrence J. Green, MD (George Washington University, Washington)

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

In residency, transitioning care to different providers can be a complicated process. Dr. Vincent DeLeo talks to Dr. Sophie Greenberg about strategies to improve patient handoffs among dermatology trainees. Dr. Greenberg identifies key issues that may hinder patient handoffs and poses evidence-based solutions that can help keep dermatology residents organized.

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We also bring you the latest in dermatology news and research:

1. Coronavirus resources from AAD target safe office practices, new telemedicine guidanceAAD President George J. Hruza, MD, assured members that AAD will maintain updated resource pages in a situation that's changing by the day.

2. How to ramp up teledermatology in the age of COVID-19Dr. Adam Friedman discusses the steps his institution is taking to prepare for more virtual visits.

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Things you will learn in this episode:

• Handoff problems are one of the top issues that are more prevalent in malpractice cases involving medical trainees vs nontrainees.
• Issues with handoffs occur between trainees as well as between trainees and attendings. "Communication skills may be underemphasized in residency, with lack of formal teaching on this matter," Dr. Greenberg notes.
• Many electronic medical records have built-in functions to assist with patient handoffs, and there also are several HIPAA-compliant electronic apps that can help providers collaborate and stay organized.
• Mnemonics and other standardized tools that have proven effective in internal medicine inpatient settings may be easily implemented in the dermatology setting. "I also keep a notebook with stickers of each patient I see and jot down things to follow up. At the end of each day, I double check and periodically update my electronic handoff," Dr. Greenberg explains.

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Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles)

Guests: Sophie A. Greenberg, MD (Columbia University Medical Center, New York); Adam Friedman, MD (George Washington University, Washington)

Show notes by: Alicia Sonners, Melissa Sears

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm

The Fitzpatrick skin type (FST) often is used as a proxy for constitutive skin color, which can lead to confusion. Dr. DeLeo speaks with Dr. Susan Taylor and her colleagues Olivia Ware and Jessica Dawson about the racial limitations of FST in clinical practice. They discuss other classification systems for assessment of skin type and highlight the challenges of creating one system to classify an infinite number of skin tones.

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We also bring you the latest in dermatology news and research:

1. Paper from Wuhan on dermatology and coronavirus

2. Patients accept artificial intelligence in skin cancer screening 3. Dermatologists best at finding work satisfaction in the office

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Things you will learn in this episode:

• In its early stages, the Fitzpatrick scale was designed to guide dosage for patients undergoing phototherapy by determining who burned and who tanned on exposure to UV light.
• The Fitzpatrick skin type has been incorrectly associated with visual stereotypical skin color cues, most likely because there is no other widely adopted classification system for skin color that can be applied to all skin.
• In clinical practice, many providers inappropriately use the FST to describe patients' constitutive skin color or race/ethnicity rather than their propensity to burn.
• The FST is automatically included in the physical examination portion of many standardized note templates, even for patients without phototherapy needs.
• Providers who do not identify as having skin of color may be more likely to use FST to describe constitutive skin color, compared with providers with skin of color.
• A more detailed and diverse system to describe constitutive skin color in clinical practice is needed. "The world is becoming so diverse, and there are so many different hues, races, ethnicities, and as dermatologists in the forefront we need to be able to identify pigmentary disorders, identify who will have adverse reactions to a variety of procedures, and thinking about how to do that is really the first step in accomplishing our goal," explains Dr. Taylor.

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Hosts: Nick Andrews; Vincent A. DeLeo, MD (University of Southern California, Los Angeles)

Guests: Susan C. Taylor, MD (University of Pennsylvania, Philadelphia); Olivia R. Ware (Howard University, Washington); Jessica E. Dawson (University of Washington, Seattle)

Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie

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You can find more of our podcasts at http://www.mdedge.com/podcasts

Email the show: [email protected]

Interact with us on Twitter: @MDedgeDerm