Clinical Tips: Practice Management Pearls and Biopsies

 Tips 1 and 2: Two Diagnostic Pearls

 1. Persistent hyperkeratosis of heels may be the first sign of psoriasis. 

 2. Tinea unguium is only one of 12 causes if onychodystrophy. Think broadly.

 Dr Richard Lewis
 Kamloops, BC, Canada

Tips 3 and 4: Practice Management

1. Do not have too many signs all over the place for patients to read as to what to do and what not to do. It makes the office look messy and cluttered.
2. For medical practices, do not have any advertisements or medical information floating around on a computer or TV screen. It is too commercial and shows that you are financially driven.

Dr Ron Vender
Hamilton, ON, Canada

 Tip 5: Biopsy Inflammatory Skin Disease

We all know the saying, "if it walks like a duck, quacks like a duck”—you get the gist. In line with this, if a dermatologic disease does not respond to therapy the way a duck should, that is a good signal to revisit the differential diagnosis board. A biopsy might be helpful but be mindful of the following when it comes to inflammatory skin diseases: (1) only biopsy an area that has not been treated for 2 to 3 weeks and (2) try not to biopsy from the elbows or knees as it is almost guaranteed to yield the most hated histopathologic read: spongiotic psoriasiform dermatitis. Choose your site wisely, and sometimes it needs to be multiple sites.

 Dr Adam Friedman
 Washington, DC