PracticeUpdate: Dermatology & Rheumatology

AAD 2016 7

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.

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.

© 2016 AMERICAN ACADEMY OF DERMATOLOGY

DECEMBER 2016