PracticeUpdate: Dermatology - Vol 1 - No.1 - 2017

2017 AAD ANNUAL MEETING 13

• The use of a J-Tip, CO 2 -powered, lidocaine-loaded syringe is reported to greatly reduce injection pain and provide a 2-cm radius of numbing. • Other pearls for pain reduction include use of a Buzzy Bee vibration device and an ice pack. • Reducing fear in a child during a procedure can be done by thorough preparation (tell the child what is being done before it is done), reducing chaos (having only one person in the room talk), and preparing trays outside of the room. The use of iPads or other tablets during the actual procedure are very helpful as well. Lastly, restraining the child leads to fear and anxiety; being held in a comfortable position by a parent proves to be more helpful. Managing hidradenitis suppurativa in the pediatric population – Chris Sayed Dr Sayed reviewed the management of hidradenitis sup- purativa (HS) in pediatric patients, and, like in adults, it is very challenging. Pediatric patients are more likely to have a family history of HS, and disease comorbidities include metabolic syndrome and other inflammatory dis- eases, which are on par with adult disease. • Of note, young children with HS should be evaluated for androgen excess , specifically precocious puberty. Evaluation for metabolic syndrome or other systemic disease is dictated by physical exam and findings. • A treatment algorithm with clindamycin and rifampin, hormonal therapy for women (drospirenone-containing oral contraceptives), laser for follicular destruction, and deroofing vs local excision can be considered. • Immunomodulators such as etanercept, adalimumab, infliximab, and ustekinumab are considered in adults with HS but have limited use in children. • The use of retinoids to treat HS signs and symptoms is not promising in children or adults with HS. References 1. Simpson EL, Chalmers JR, Hanifin JM, T, et al. J Allergy Clin Immunol 2014;134(4):818-823. 2. Craiglow BG, Liu LY, King BA. J Am Acad Dermatol 2017;76(1):29-32.

Acne is themost common dermatologic diagnosis in a homeless shelter clinic Though unexpected, the most common dermatologic diagnosis at a homeless shelter clinic was acne, with approximately one in five patients presenting with the condition, finds a retrospective chart review. M ichael J. Murphy, MD, of the University of Connecticut, Farmington, explained that

The top 10 diagnoses per total number of patients over 8 years were: • Acne, 19.78% • Atopic dermatitis, 9.89% • Tinea pedis, 9.16% • Xerosis, 8.06% • Folliculitis, 5.13% • Post-inflammatory hyperpig- mentation, <5% • Seborrheic dermatitis, <5% • Tinea infection of the body and head, <5% • Psoriasis, <5% • Verruca vulgaris, <5% Surprisingly, only acute cold injury and two foot lacerations were treated. Additionally, the rate of suspected malignancy per total patients seen was 2.6%, with seven patients presenting with lesions concerning for melanoma (n=5) and basal cell carcinoma (n=2). Diagnostic trends were also analysed based on gender, eth- nicity, age, and season of the year. Dr Murphy concluded that though unexpected, the most common diagnosis at the clinic was acne, with approximately one in five patients in the homeless shel- ter clinic presenting with the condition. The most common diagnoses will advise decisions about diagnostic and treatment supplies ordered for future clinics in order to best care for these homeless individ- uals. Results of the study will be published in an upcoming issue of Connecticut Medicine . The studywas limited by the lack of clinics during the summer months and diagnosis variability between attending dermatologists.

among the homeless, dermato- logic conditions are very common due to the exposure of skin to environmental elements and often inadequate clothing and hygiene. The University of Connecticut South Park Dermatology Clinic was founded in 2008 to reduce barriers to care and increase con- venience in these patients. The clinic is part of a general med- ical clinic founded in 1987 by a group of University of Connecti- cut medical students. Their goal was to provide critical health- care services to this underserved population. Dr Murphy and colleagues set out to identify the most common dermatologic diagnoses among all patients seen at the clinic from 2008 to 2016. Particular attention was paid to age, gender, season of the year, and the rate of malig- nancy. The data will be used to generate a robust supply of treat- ment options to best care for homeless patients. Patient charts from 45 derma- tology clinics held at the shelter clinic were reviewed and demo- graphics, diagnosis, and treatment data were recorded. Overall, 273 patients, 1–67 (mean 37, median 39 years of age were seen for dermatologic concerns. Demographically, 54% were male and 46% were female, with 30% identifying as African-American/ black, 29% Hispanic, and 25% Caucasian. Sixteen percent did not disclose their race. A total of 363 diagnoses were recorded, encompassing 90 separate der- matologic conditions, with 26% of patients presenting with more than one complaint.

PracticeUpdate Editorial Team

© 2017 American Academy of Dermatology Association.

VOL. 1 • NO. 1 • 2017