5 dermatology interventions doctors should stop doing

By Michael Woodhead

 

 

 

 

 

 

 

 

 

 

 

 

 

Doctors are being advised to question whether they need to perform five interventions around dermatology as part of the Choosing Wisely campaign.

The Australasian College of Dermatologists has nominated five areas where tests, treatments and procedures should be questioned.

Here are the 5 'do-not-dos' for doctors:

1. Do not assume that lower leg bilateral redness and swelling is due to infection. Do not prescribe antibiotics unless there is clinical evidence of sepsis or microbiological confirmation of infection.

Rationale: Bilateral lower leg cellulitis is very rare. Most commonly the bilateral inflammation is due to underlying skin disease such as venous eczema, dry skin, irritant or allergic contact dermatitis, or lymphoedema. A careful history and physical examination should be undertaken and swabs taken from both legs for microbiology to confirm whether infection is present.

Don't miss our Dermatology Academy event coming up on 28 May: Click here to find out more!

2. Do not routinely prescribe antibiotics for inflamed epidermal cysts of the skin evaluated in the first 3-4 days of appearance unless infection is confirmed microbiologically.

Rationale: The initial inflammation with epidermal cysts is secondary to an intense foreign body reaction to the cyst contents leaking into dermis and subcutaneous tissues and will respond to incision and drainage plus/minus intralesional corticosteroids that will reduce the inflammatory response. Bacterial infection is a secondary complication.

3. Do not investigate episodes of acute urticaria of fewer than six weeks' duration unless the clinical history or examination reveals a likely infective, inflammatory or neoplastic trigger or swelling and skin changes persist longer than 24 hours.

Rationale: The causes of acute urticaria are many and are rarely identified by blood investigations. The individual weals of acute urticaria and angioedema can be widespread and variable in appearance, resolving in 24 hours, leaving normal skin.

4. Do not prescribe topical or systemic antifungal medication for patients with thickened, distorted toenails unless microbiological confirmation of a dermatophyte infection has been obtained.

Rationale: Some 50% of thickened distorted toenails are caused by pressure from footwear (onychogryphosis) or other trauma, disorders such as psoriasis, lichen planus, or congenital pachyonychia, and are not due to fungal nail infection.

5. Monotherapy for acne with either topical or systemic antibiotics should be avoided. Combine with topical antiseptics such as benzoyl peroxide to reduce antibiotic resistance. 

Rationale: Acne is a very common disorder in adolescence, often persisting into the early 20s. Treatment may be necessary over many years. Current evidence suggests the antibiotics effective in acne exert an anti-inflammatory effect, rather than a bactericidal effect.

Don't miss our Dermatology Academy event coming up on 28 May: Click here to find out more!

More information:

Australasian College of Dermatologists: tests, treatments and procedures clinicians and consumers should question

This article first appeared in Australian Doctor on the 16th of May, 2016

                          Doctors are being advised to question whether they need to perform five interventions around dermatology as part of

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