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Dr Eliot Mostow discusses herpes
zoster and the Dermatology
Teachers Exchange Group
Eliot N Mostow MD, MPH, is Professor and Head of the
Dermatology Section at Northeast Ohio Medical University,
and an Editorial Board Member of
PracticeUpdate
Dermatology.
FRM F015 – Herpes zoster: controversies and conundrums in treatment and prevention.
Lorraine L. Rosamilia
This was an excellent case-based session moderated by Dr Lorraine Rosamilia. She did a
great job framing the “real world” questions related to herpes zoster as an effective set-up
and closure to covering reviews on diagnostics given by:
•
Dr Whitney High – While Tzanck preps can still play a role, newer diagnostics such
as polymerase chain reaction (PCR) are not too expensive and are relatively quick and
accurate. The options for these will vary with locale.
•
Dr Vikash Oza – In paediatric cases, zoster can occur post vaccination, but it is often
attenuated compared with wild-type cases except in the immunocompromised.
•
Dr Stephen Tyring – Vaccine is safe, and “moderately” effective in adults, although
vaccination, once someone’s had shingles, is likely of minimal benefit.
•
Dr Ken Tomecki – Reviewed drug options and data.
Searching for zoster in the AAD program shows that this was the only mention of it, although
I hope there were lectures in other sessions that covered some of this material!
FRM F029 – Dermatology Teachers Exchange Group.
Tammie C. Ferringer, Roy Mitchell Colven
I loved the overall session known as the Dermatology Teachers Exchange Group. I always
leave inspired to think about new ways to advance the teaching of dermatology. This year,
I’m going to use ideas proposed to “force” students to use accurate terms by filling in the
blanks (sort of like a Mad Libs) of a script I’m going to compose…something like, “This
patient has a___________(primary lesion) that is_________(descriptor of color, texture,
etc) on the_________(location)…” with additional scripts that will help them improve their
communication with me and to enter the medical record in a more defined fashion.
I also liked the lecture by Allison Cruse from the University of Mississippi Medical Center.
She talked about efforts to increase hand hygiene in outpatient clinics by having medical
students, residents, nurses, and faculty make a single knock on the desk or wall if anyone
enters a patient room without
using hand hygiene within 20
seconds. Their centre went
from about 40% hand hygiene
to 80% in 6 months and 90%
a year later. Nonthreatening
immediate feedback can have
dramatic results in improving
behaviour, even when in-
grained in faculty over decades!
Time and space do not permit
more comments on this ses-
sion; but, if you like teaching,
this is a great session every
year.
tests are indicated. First, test for muscle
strength and order creatine kinase (CK) and
aldolase to showmuscle damage. In patients
with clear-cut dermatomyositis, further
diagnostic tests are often not warranted.
However, in patients in whom the diagnosis
is considered, but not at all certain, a panel
of myositis antibodies in the patient’s serum
can now be ordered at certain reference labs
(eg, Oklahoma Medical Research Founda-
tion Clinical Immunology Laboratory and the
Mayo Clinic). Be prepared for the results
to take up to 2 months since the tests are
batched before they are run. Also, the panel
may detect 70% to 80% of cases, but not all.
The panels include:
•
Mi2 – Patients with this antibody
commonly have skin findings including
the “shawl” sign, less muscle weakness,
and generally a good prognosis.
•
Anti-tRNA synthetase (Jo 1 and others
are in this class) – These patients
commonly have interstitial lung disease
and Raynaud’s phenomenon, but this
antibody is rare.
•
MDA-5 (10–20% of DM patients) –
These patients have rapidly progressive
interstitial lung disease, painful palmar
papules, and ulcerations in place of
Gottron’s papules, although they are in
the same locations.
•
TIF1-gamma (13–20% of DM patients)
– This can be malignancy-associated.
Extensive skin disease is present, including
psoriatic lesions and hyperkeratotic lesions
of the palms and soles.
•
NXP2 (2–30% of DMpatients) – This can
be malignancy-associated and is seen in
juvenile DM.
An approximate 20% of patients with DM
have interstitial lung disease. Three ap-
proaches can be taken to assess for this in
DM patients.
•
Pulmonary function tests.
•
High-resolution CT; often read as
interstitial pneumonia. This has the added
benefit of screening for lung cancer (DM
is associated with a threefold increased
risk of internal malignancy).
•
Refer to pulmonary physician.
With regard to the question does smoking
decrease the effectiveness of antimalarial
agents in patients treated for discoid lupus?
•
One study said “yes.”
•
Three retrospective studies said “no.”
•
Recent JAAD meta-analysis suggested a
two-fold decrease in disease response in
patients who smoke.
© 2016 AMERICAN ACADEMY OF DERMATOLOGY
DECEMBER 2016
AAD 2016
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