Connecting Dermatologic and Podiatric Principles for Improved Outcomes

Hadar Lev-Tov, MD:
Hi, my name is Hadar Lev-Tov, and I'm an associate professor of dermatology. I work at the Department of Dermatology and Cutaneous surgery at the University of Miami. And I suppose what makes me unique is the fact that I'm a dermatologist, so I'm a board certified dermatologist, I went through the whole training process, but then I have a strong interest in wound healing in general, and various entities within that big topic of... But I think that definitely puts me one of few in the country that do this. So it gives me a unique perspective. I dab my toes in both worlds.

I think podiatrists are really uniquely positioned to make diagnoses on the skin of the legs. And there's two elements there. There's the skin, but a lot of people forget there's also the nails, and I think it's very easy to just dismiss everything to be onychomycosis, but actually nail biology is fascinating, and nail disease is even more fascinating. And so really understanding that not everything is onychomycosis, and understanding that nail changes can be subtle, and reaching out for an expert, namely a dermatologist, can really give you good input, and then help your patient. At the same time, looking at the skin of the feet as well. I think all doctors, not just podiatrists, all doctors really look at every rash and say, "It's got to be fungus." If there's a rash, it's a fungus. If it's itchy, it's a fungus.

And it's true. Fungal infections are common on the lower extremity, but a lot of times there's other huge, differential diagnosis that if you are not confident, A, reach out and try to learn more about it, looking at various content sources, but also have a good dermatologist on speed dial so you can always think together. And as you do that, and I think that's really the important thing, you develop a collaboration, and you learn from that. Just like I learn every time I reach out to other specialty, I'm learning, oh, this is a new medication on the field. This is a diagnosis I forgot. I learned about it in medical school, completely forgot about it. There's now new diagnoses that keep coming up. So I think this is a way to stay current, to educate yourself. And it's fun, because you work in a network which is a lot more fun than being a lone wolf in the clinic by yourself.

I think podiatrists do a great job when they need to biopsy. I think the key to biopsy, though, is understanding what is the pathology? What are you actually looking for? And so what we all learned in our training is that you have to have a diagnosis in mind when you run a test, and this will change how you biopsy. There's different ways to biopsy. Where is the pathology? Is it deep? Is it superficial? Based on that, you choose the biopsy. So I think that's something that, again, if podiatrists educate themselves about what the pathology is, then accordingly they can choose the right procedure for a biopsy. Dermoscopy is a really big tool that dermatologists now use routinely. We learn it during our residency, and it's also an evolving field. We learn more and more diagnoses where we can apply dermoscopy.

A dermatoscope is a simple tool. It's not too expensive, everybody can have in their pocket. It's basically a magnifying glass that has polarized light that allows us to see the very superficial layer of the epidermis. And just by doing that, you can learn so much on different pathologies. Now it's very common to use it on pigmented lesions, right? Like moles, trying to understand if it's a melanoma, or other skin cancer. But now we learn more and more that we can do a lot of different things with a dermatoscope, namely different diagnoses. So I think we always need to pick up new tools and expand our knowledge base. I think trying to learn more about dermoscopy can be very helpful, even dermoscopy of the nails.