Clinical Tips: Retinoids and Room Details

Tip 1: Lichenoid Dermatoses & Retinoids

Ready the systemic retinoids for lichenoid dermatoses. Both acitretin and isotretinoin can be valuable tools for the management of moderate to severe lichen planus and its entourage of lichen diseases, from erythema dyschromicum perstans to lichenoid eruption of programmed cell death 1 inhibitors. I typically start low (isotretinoin: 0.5 mg/kg/day; acitretin: 17.5 mg/day), unlike with my heavy-hitting approach to acne, and work up if needed. Also, unlike with acne (when used correctly), remission is not permanent, and often patients will go on vacations from drug to only return to “work” at some point.

Dr Adam Friedman

Washington, DC

Tip 2: Dilated Pupil from Anesthetic

A bit of topical anesthetic (as seen when my nurse probably rubbed her eye after applying the product to a patient) can dilate a pupil and be very frightening to see unless you realize what the cause was, especially with blue eyes. So, if it happens, think before you panic.

Dr Jo Herzog

Birmingham, AL

Tip 3: Lose the Mirror and the Clock

Do not have a clock in the room, because this makes patients aware of time if you are running late. Additionally, in your medical practice, do not have a mirror in the room. While the patient is waiting, they will just find things to ask you that they never thought of asking about before.

Dr Ron Vender

Hamilton, ON, Canada