One-minute Pearls for Your Clinical Practice

At the 2020 Winter Clinical Dermatology Conference, a panel of experts opened the day with quick tips and helpful hints for acne, psoriasis, eczema, office management, and more. The session, titled 60 Tips in 60 Minutes, was led by James Q. Del Rosso, DO, and featured Dee Anna Glaser, MD; Mark Lebwohl, MD; Seemal R. Desai, MD; Neal D. Bhatia, MD; and Boni E. Elewski, MD. In several rounds, these clinicians shared their one-minute pearls for a dermatology practice, as noted below:

• Dr Del Rosso suggested using anatomic terminology consistently, from the dermatologist to their staff and paperwork. This can help avoid ambiguity and confusion in the future. Additionally, it can help assure accuracy in a biopsy location, particularly when photodocumentation is necessary. Staff should be sure to include a ruler for measurement and landmarks in photos.
• Dr Bhatia warned attendees to not freak out over a bad online review. If your practice receives a negative review, take a moment to determine the authenticity of the review and note possible causes, such as bedside manner, honesty, office staff, and results. Have a staff member kindly and professionally respond directly to the review to help keep your reputation positive online.
• Dr Desai recommended that a new onset vascular nodule that presents in the craniofacial and neck region receives a biopsy. These are the most common sites for renal cell carcinoma to metastasize, and differential diagnosis is important for infectious causes, pyogenic granuloma, Kaposi sarcoma, among others.
• Dr Desai also noted that attendees should review if their office is compliant with Occupational Safety and Health Administration (OSHA) regulations. Visit the OSHA website to review laws and make sure to have their posters clearly posted in a visible area, such as a break room. Make sure staff know of important OSHA requirements, such as eye wash station location and fire exit routes, and have lab work (ie, immunizations and hepatitis B and tuberculosis testing) on all new hires. 
• Dr Elewski advised to avoid long-term topical treatment with corticosteroids for nail psoriasis, as atrophy of the digit has been reported. Instead, rotational therapy with topical corticosteroids on weekends and Vitamin D derivatives on weekdays can be an effective alternative.
• Dr Glaser shared that nursing and medical assistant engagement can be improved with frequent team huddles. Consider adding a daily team huddle with the in-office physician as well as appointing a spokesperson who can act as a voice for all staff.
• Dr Glaser also mentioned that attendees should remember the chemical peel as a treatment for recalcitrant acne. It can even be reimbursed with the code CPT 17360, chemical exfoliation for acne.
• Dr Lebwohl added to be mindful of patient characteristics for deciding treatment plans. Patients who cannot easily self-inject, such as children, require an oral medication or a therapy that requires infrequent injections. Also, patients who cannot afford copays may be able to receive a drug to be administered in an office or hospital as part of their medical benefits.

Reference
Del Rosso JQ, Bhatia ND, Desai SR, Elewski BE, Glaser DA, Lebwohl M. 60 Tips in 60 minutes: acne, psoriasis, eczema and office management. Presented at: 2020 Winter Clinical Dermatology Conference; Kohala Coast, HI; January 18, 2020.