PracticeUpdate Dermatology May 2019

AAD 2019 25

Dr. Ashish Bhatia’s Take-Aways

By Ashish C. Bhatia MD, FAAD P earls from the session Optimize Your Prac- tice: Getting It Right and Loving Your Job . These are tips to avoid burnout, have more joy at work, and

optimize your practice. • It's impossible to be grateful and depressed at the same time... try it! • You can’t "yoga" yourself out of burnout; so, work on practices in your daily life that will keep you from burning out like... yoga! • Keep a gratitude journal. • Try "laughter yoga." It’s a real thing; watch the videos on YouTube. More info can be had at laughteryoga.org. • The AMA has a great resource for prac- tice improvement and preventing burnout called STEPS Forward: edhub.ama-assn.org/ steps-forward. • Think BIG ― ― B ond and Belong – it can get lonely in medicine. You have to commit to con- necting with peers, friends, colleagues and family. ― ― I mpact – know that you are making a difference in your practice, with your patients, and in your community. Try to engage in activities where you are making an impact. Pick something you like; for example, clubs and groups, the state medical society, advocacy groups, volunteer programs. ― ― G ratitude – practice gratitude daily. Make it part of your routine. • Have a “blue ocean” mentality when it comes to business. There is plenty (of patients) to go around. Focus on improving yourself, your practice, and the patient experience. Practice is not a zero-sum game. • Have a daily huddle with your team every morning. Go over the schedule and come together to figure out how to tackle hurdles before you encounter them. Everyone will feel more prepared to have a great day. • Have your team pick a quote of the day... your mantra for the day. • Use more checklists. This is especially helpful for mission-critical tasks with changing guide- lines such as melanoma. Checklists will also help new staff become oriented more quickly

• When treating a patient with pityriasis rubra pilaris, it is important to ensure that it is not drug-induced (for example, by sorafenib, insulin, imatinib, telaprevir, and vaccinations). Eczematous presentation (vs psoriasiform) in adults and ichthyo- siform presentation in children portend a more chronic course of disease. Best treatments include systemic retinoids, etanercept, and ustekinumab, based on literature reviewed and the UCLA cohort data presented. Hot topics: hair loss • Prophylactic fexofenadine (Allegra) can be used to address seasonal flaring described in alopecia areata. • There have been cases of incidental hair regrowth in alopecia areata (AA) patients treated with dupilumab for their atopic dermatitis. There have also been 4 cases of AA developing while on dupilumab. However, dupilumab is a reasonable option in patients with AA and concomitant atopic dermatitis. • More studies are needed to determine true efficacy of platelet-rich plasma for various types of hair loss; however, for patients eager to try this therapy, a rec- ommended platelet-rich plasma treatment regimen for treating hair loss included three treatments, each 1 month apart, followed by a “booster” every 3 to 6 months. Therapeutic and diagnostic pearls • Dermatologists should recommend the SHINGRIX shingles vaccine in healthy adults over the age of 50. This vaccine is given in two doses 2 to 6 months apart. • Treatment options discussed for molluscum contagiosum included 10% KOH once to twice daily or compounded 16.7% salicylic acid/16.7% lactic acid. New therapies on the horizon include nitric oxide and a novel delivery system for cantharidin. • The maximum clinical cure rate for onychomycosis is approximately 30% regardless of the treatment regimen chosen, although oral therapy is slightly better than topical therapy. • Topical antibiotics do not decrease wound infection but do increase the risk of allergic contact dermatitis, cost of medical care, and antimicrobial resistance. • Some general tips for care in patients with desquamative gingivitis include: ― ― Use of a water pick ― ― Diligent management of Candida with fluconazole acutely and daily clotrimazole troche chronically, and 1-mg tacrolimus capsule dissolved in half a liter of water used to swish and spit for 2 minutes. ― ― Additionally, topical/intralesional steroids and oral methotrexate/mycophenolate may be warranted due to risk of aggressive squamous cell carcinoma with poor control of inflammation. www.practiceupdate.com/c/80853

and feel comfortable faster. www.practiceupdate.com/c/80905

VOL. 3 • NO. 2 • 2019