Resident perspectives on hidradenitis suppurativa, plus AD and food allergies, and isotretinoin in transgender patients

In this resident takeover of the podcast, three dermatology residents—Dr. Elisabeth Tracey, Dr. Julie Croley, and Dr. Daniel Mazori—discuss how to talk with patients about hidradenitis suppurativa (HS) myths, tobacco use, and weight loss. They also provide strategies for managing flares and weigh medical vs. surgical treatment of HS. We bring you the latest in dermatology news and research: 1. Atopic dermatitis in egg-, milk-allergic kids may up anaphylaxis risk Egg- and milk-allergic patients with atopic dermatitis had more incidents of anaphylaxis; no impact seen in cases of peanut allergies. 2: iPLEDGE vexes dermatologists treating transgender patientsIn a survey, half of dermatologists report uncertainties when registering transgender patients in iPLEDGE. *   *   * Things you will learn in this episode: Dispel the myths of HS. Some patients may worry that HS is contagious or infectious, sexually transmitted, or a result of poor hygiene. "I think this often stems from misinterpretation of the fact that HS is multifactorial and may implicate skin flora in part of the pathogenesis," Dr. Croley says. "I think this really highlights the importance of patient education." When recommending smoking cessation, avoid sounding accusatory and discuss how tobacco use has been correlated with HS. "I like to follow this by asking about the patient's personal smoking status," Dr. Croley explains. "I find the strategy useful in making the patient feel comfortable about talking about this topic." Suggest weight-loss strategies to address obesity in HS, such as diet, exercise, and referral to a nutritionist, to give patients strategies to achieve that goal. Adopt a policy that allows patients who experience a flare to visit the clinic without an appointment. "I think part of it is giving them the anticipatory guidance that flares may happen, probably will happen," says Dr. Mazori. Consider prescribing short courses of either oral antibiotics or oral steroids in the event that patients with HS experience a flare. Reserve surgery for severe or refractory disease. Laser hair removal (eg, with the Nd:YAG laser) is helpful for mild to moderate disease. Evidence supports using this intervention for treating affected areas and the pilosebaceous unit. For patients who cannot afford laser treatment, suggest cosmetic clinics that are affiliated with a residency program, "because I think in general those tend to make it more accessible," Dr. Mazori suggests. *   *   * Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation, Ohio); Julie Ann Amthor Croley, MD (The University of Texas Medical Branch at Galveston); Daniel R. Mazori, MD (State University of New York Downstate Medical Center, Brooklyn) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: [email protected] Interact with us on Twitter: @MDedgeDerm

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