For our longtime readers, you can probably guess that part of what I love about being the Editor in Chief of the Journal of the Dermatology Nurses' Association (JDNA) is that I am able to be intimately involved with the cultivation and development of exceptional educational materials for dermatology nurses. With each issue that we publish, my hope is that you find thoughtfully written articles that help to teach you about a new aspect of dermatology or reinforce your current dermatology knowledge. I am always excited when I learn something new or hear about a commonly encountered dermatology topic in a new way. How many of you were able to join us in Las Vegas, NV, in April 2015 for our annual Dermatology Nurses' Association (DNA) convention? I find that attending this educational opportunity is always professionally stimulating, on many levels. Not only am I able to learn about the latest scientific updates and review new and novel therapies for dermatology conditions, perhaps more importantly, I also have the opportunity to engage with my fellow dermatology nurses and members of our dermatology community. The time I spend talking with my colleagues at this event is always the highlight of the convention. You, as a community of dermatology nurses, are engaged and energetic and passionate for what you do and for the patients you serve. You inspire me and encourage the work we do here at the JDNA.
For those of you who were unable to join us in Las Vegas, I wanted to share with you some of the highlights of the notes I took away from each presentation. Unlike our articles that have multiple references, these are simply great pearls of knowledge that come directly from the presenters at the convention. So, here are some of the best clinical pearls I will remember from the 2015 DNA Convention, and I thought you should know about them, too.
LESSONS FROM LAS VEGAS
* A delusion is a fixed false belief-you can't argue with these patients.
* Delusional patients will present in dermatology, but they are a psychiatric patient.
* Consider having a verbal contract with the patient.
* Do not get into a power struggle with the patient.
* When you have a patient with delusions of parasitosis, make sure you do a toxicity screen to rule out drug use.
* Historically, the treatment of choice for delusions of parasitosis has been pimozide, which is particularly suitable because this medication has no psychiatric indication for patients who "Google" this drug. Start slowly and cautiously with the dosing of this medication; there is no effect until the dose is at 3 mg so please do expectation management with the patient. You should underpromise and overdeliver, not the reverse.
* Try using psychogenic excoriations as a replacement term for neurotic excoriations.
* Look for the Butterfly sign with psychogenic excoriations-the central back, where they can't reach, is clear.
* Anxiety, obsessive compulsive disorder, depression-these all play a role in dermatology.
* Although off label for use, the first-choice treatment for trichotillomania is paroxetine.
* Before you use doxepin, consider an electrocardiogram, especially with elderly patients or if using a large dose.
* Rifampin and griseofulvin do increase the risk for unintended pregnancy.
* Check G6PD enzyme every time a patient is on dapsone.
* Patient response to diphenhydramine for sedation predicts response to doxepin.
* When using immunologic and biologic medications, Days 14-90 is the period of most risk.
* "Methotrexate is never going to go away" (Stephen Wolverton, MD).
* If you see a nail and think it has onychomycosis, but if it's the posterior nail fold that is involved or affected, then think Candida.
* When treating tinea versicolor, consider fluconazole 300 mg Q week x 2 weeks; this has a 94% cure rate.
* Anyone in dermatology: Do not use oral ketoconazole for anything. There is just not a good reason to use this.
* If you see ringworm on the face, it's usually because of a new pet in the home; be sure to check and ask about this.
* When you are looking at tinea, the fungus is always 0.5-1 inch past the red border; the patient must use the medication 1 inch past the borders of the lesions.
* There is no scale seen with granuloma annulare because this is a dermal process.
* If you see tinea capitis in a child, be sure to look at their siblings because 50% will also have this.
* Fifty percent of all dystrophic nails are not because of fungal infections.
* Polymerase chain reaction for T. rubum is coming, and it will be very reliable-it will "revolutionize our diagnosis."
* For cutaneous tinea, consider using naftifine and terbinafine because these will help with itch earlier.
* It takes 8-12 weeks to clear tinea capitis.
* Over-the-counter Lotrimin Ultra works.
* Consider using sublingual Vitamin B12, 1000-mcg QD for aphthous ulcers-it works well.
* If you see multiple pyogenic granulomas, consider the diagnosis of bacillary angiomatosis.
* When you see molluscum contagiosum on the face of an adult, the CD4 count tends to be low.
* If you see pus, you scrape it.
* Purple bumps = Kaposi's sarcoma
* We are stewards of using our few oral antibiotics.
* Don't operate on the face, head, and neck if you are not familiar with the anatomy.
* In neurofibromatosis Type I, you can see Lisch nodules on the iris.
* The ash leaf macules seen in tuberous sclerosis are hypopigmented, not depigmented.
* With Birt-Hogg-Dube syndrome, skin tags will be in 100% of patients, especially in the axillae.
* When a patient has Muir-Torre syndrome, they must be checked for both colon and gentiourinary cancers.
* Petechiae is less than 3 mm, purpura is 3-10 mm, and ecchymosis is >10 mm.
* Petechiae in infants are always concerning.
* Rocky Mountain spotted fever is often fatal in patients with G6PD deficiency; otherwise, mortality is 3%-5%.
* Do not send healthy kids with chicken pox to the emergency room, ever.
* If you confirm a case of Vibrio vulnificus, you need to notify the Centers for Disease Control and Prevention.
* You will see a postive Nikolsky's sign with Staph scalded skin syndrome.
* Consider treating idiopathic guttate hypomelanosis with tacrolimus.
* Vitiligo is associated with autoimmune endocrinopathies.
* There is no cure for vitiligo, but treat with tacrolimus, calcipotriene, and/or topical steroids.
* 2015 Year of Ethics by the American Nurses Association (ANA)-consider looking at the ANA's Code of Ethics at http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNu.
* For psoriasis: "All of our patients need a systemic medication" (Lakshi Aldredge, NP).
* Effectively treating inflammation decreases myocardial infarction risk.
* Five to ten percent of weight loss in 1 year is meaningful and significant.
* Lithium can exacerbate psoriasis.
* Immunosuppressants treat an overactive immune system to normalize the immune system.
* There is a cardioprotective effect with use of biologic medications.
* Sixty percent of melanoma show up de novo.
* Have a good relationship with medical oncology, and know when to consult with them.
What's the most interesting or useful fact you learned in Las Vegas? I'd be interested in hearing from you and sharing your new knowledge and expertise with our readers.
I'd like to introduce two new JDNA Editorial Board members who have volunteered to serve. Brooke Ingram, BSN, RN, has 11 years of experience in dermatology and says she will always have a passion for dermatology. Ms. Ingram says, "I am very excited to contribute a series of articles on the subject of cutaneous manifestations of systemic disease. I was instantly fascinated about this topic when I heard the dermatologist for whom I worked bring this up for the first time, and I am very excited JDNA has provided an outlet for me to share this knowledge with others who are also passionate about dermatology." She dedicates the work she will do with the JDNA to the loving memory of her husband, Don Anderson, DO, who has always been her greatest inspiration and teacher. Hilary Fairbrother, MD, is someone with whom many of you may be familiar with. Not only has she presented several times at annual DNA Conventions, she is also the daughter of DNA's own past president, Karrie Fairbrother, BSN, RN, DNC, CDE. Dr. Fairbrother is in a position to share her dermatology experiences from the perspective of an emergency room physician. She says, "I am honored to be joining the JDNA Editorial Board." We welcome the contributions of both new editorial board members to JDNA.
I would be remiss in this transition period if I didn't mention that one of our JDNA board members, Lakshi Aldredge, MSN, RN, ANP-BC, has decided to step down from her volunteer position on the editorial board. Her valuable vision, input, and contributions have served to guide the JDNA for the past few years, and I celebrate the work she has done with us. Ms. Aldredge leaves the editorial board to focus on other aspects of volunteering within the dermatology nursing community but certainly will continue to represent and advocate for the JDNA. Thank you, Lakshi.
I'd like to make a midyear reminder that our JDNA publisher, Wolters Kluwer-Lippincott Williams & Wilkins, is again sponsoring three JDNA Writing Awards for 2015. Like previous years, there will be awards for both The Best Clinical Article and The Best Research Article, but this year will also feature an award for the article chosen to be the People's Choice. Of course, you as a JDNA reader will be helping to vote on that award next year so keep reading and keep your favorite articles in mind. I am looking forward to presenting the Writing Awards at the annual DNA Convention next year in Indianapolis, IN.
Looking forward to hearing from you.
Angela L. Borger
Editor in Chief
E-mail: [email protected]