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Choosing the Best Medication, Managing Pityriasis Rosea, and More

June 2017

Tip 1: Choosing the Best Medication for Each Patient
With many patients having to bear a greater part of the cost of prescription medications, clinicians would do well to examine their prescribing habits by taking the appropriate STEPS—consider the Safety, Tolerability, Efficacy, Price, and Simplicity of use. This mnemonic prods providers to choose the best medication for each individual patient. Both patient and provider benefit—a win-win solution for all.
Brian T. Maurer, PA-C
Enfiled, CT

Tip 2: Managing Pityriasis Rosea
For patients with pityriasis rosea, intramuscular triamcinolone (Kenalog) works well. If early and evolving, treatment might require more than one 40-mg injection. I give 40 mg initially, and I check back at 2 weeks. Another helpful option that can be used is UV-B light therapy. Patients with severe pityriasis rosea require 3 shots at 2-week intervals, but most clear with 1 or 2 shots.
Barry Ginsburg, MD
Birmingham, AL

 
Tip 3: Punch Biopsy Modification
When doing a punch biopsy there is less bleeding if you stay more superficial. If you are deep enough to capture the pathology, you can withdraw the punch after making the outline of the biopsy you want. Then taking the same needle you used to anaesthetize the patient, you can skewer the specimen by applying gentle traction and use a 15 blade or iris scissors to undercut your biopsy. This results in a less invasive biopsy, which heals faster with better aesthetics.
David Adam, MD, FRCPC
Toronto, Ontario, Canada

Tip 4: Rosacea Treatment
Oral polypodium leucotomos (Heliocare) is very effective in treating rosacea. The treatment mostly impacts the vascular part of rosacea. One capsule should be taken before breakfast. I prescribe it daily regardless of sun exposure or temperature.
Mauricio Goihman-Yahr MD, PhD
Caracas, Venezuela

Tip 5: Be Aware of Generational Differences
In your daily practice, it is important to be aware of the generational differences among the patients you are treating. Keep the following 3 tips in mind:1. Married patient with kids—around age 55—may be more interested in safety and may have more patience when it comes to results, while a young man with new onset psoriasis wants immediate results and is likely willing to take on more risk.
2. For elderly patients, I never call them by their first name, but rather Mr Smith for instance. Perhaps once one has more gray hairs or has known the patient for some time, then the first name can be used.
3. Older patients like a handshake or pat on the back, while some young patients enjoy the fist bump.
Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada

Dr. Barankin is a dermatologist in Toronto,    Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.

Tip 1: Choosing the Best Medication for Each Patient
With many patients having to bear a greater part of the cost of prescription medications, clinicians would do well to examine their prescribing habits by taking the appropriate STEPS—consider the Safety, Tolerability, Efficacy, Price, and Simplicity of use. This mnemonic prods providers to choose the best medication for each individual patient. Both patient and provider benefit—a win-win solution for all.
Brian T. Maurer, PA-C
Enfiled, CT

Tip 2: Managing Pityriasis Rosea
For patients with pityriasis rosea, intramuscular triamcinolone (Kenalog) works well. If early and evolving, treatment might require more than one 40-mg injection. I give 40 mg initially, and I check back at 2 weeks. Another helpful option that can be used is UV-B light therapy. Patients with severe pityriasis rosea require 3 shots at 2-week intervals, but most clear with 1 or 2 shots.
Barry Ginsburg, MD
Birmingham, AL

 
Tip 3: Punch Biopsy Modification
When doing a punch biopsy there is less bleeding if you stay more superficial. If you are deep enough to capture the pathology, you can withdraw the punch after making the outline of the biopsy you want. Then taking the same needle you used to anaesthetize the patient, you can skewer the specimen by applying gentle traction and use a 15 blade or iris scissors to undercut your biopsy. This results in a less invasive biopsy, which heals faster with better aesthetics.
David Adam, MD, FRCPC
Toronto, Ontario, Canada

Tip 4: Rosacea Treatment
Oral polypodium leucotomos (Heliocare) is very effective in treating rosacea. The treatment mostly impacts the vascular part of rosacea. One capsule should be taken before breakfast. I prescribe it daily regardless of sun exposure or temperature.
Mauricio Goihman-Yahr MD, PhD
Caracas, Venezuela

Tip 5: Be Aware of Generational Differences
In your daily practice, it is important to be aware of the generational differences among the patients you are treating. Keep the following 3 tips in mind:1. Married patient with kids—around age 55—may be more interested in safety and may have more patience when it comes to results, while a young man with new onset psoriasis wants immediate results and is likely willing to take on more risk.
2. For elderly patients, I never call them by their first name, but rather Mr Smith for instance. Perhaps once one has more gray hairs or has known the patient for some time, then the first name can be used.
3. Older patients like a handshake or pat on the back, while some young patients enjoy the fist bump.
Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada

Dr. Barankin is a dermatologist in Toronto,    Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.

Tip 1: Choosing the Best Medication for Each Patient
With many patients having to bear a greater part of the cost of prescription medications, clinicians would do well to examine their prescribing habits by taking the appropriate STEPS—consider the Safety, Tolerability, Efficacy, Price, and Simplicity of use. This mnemonic prods providers to choose the best medication for each individual patient. Both patient and provider benefit—a win-win solution for all.
Brian T. Maurer, PA-C
Enfiled, CT

Tip 2: Managing Pityriasis Rosea
For patients with pityriasis rosea, intramuscular triamcinolone (Kenalog) works well. If early and evolving, treatment might require more than one 40-mg injection. I give 40 mg initially, and I check back at 2 weeks. Another helpful option that can be used is UV-B light therapy. Patients with severe pityriasis rosea require 3 shots at 2-week intervals, but most clear with 1 or 2 shots.
Barry Ginsburg, MD
Birmingham, AL

 
Tip 3: Punch Biopsy Modification
When doing a punch biopsy there is less bleeding if you stay more superficial. If you are deep enough to capture the pathology, you can withdraw the punch after making the outline of the biopsy you want. Then taking the same needle you used to anaesthetize the patient, you can skewer the specimen by applying gentle traction and use a 15 blade or iris scissors to undercut your biopsy. This results in a less invasive biopsy, which heals faster with better aesthetics.
David Adam, MD, FRCPC
Toronto, Ontario, Canada

Tip 4: Rosacea Treatment
Oral polypodium leucotomos (Heliocare) is very effective in treating rosacea. The treatment mostly impacts the vascular part of rosacea. One capsule should be taken before breakfast. I prescribe it daily regardless of sun exposure or temperature.
Mauricio Goihman-Yahr MD, PhD
Caracas, Venezuela

Tip 5: Be Aware of Generational Differences
In your daily practice, it is important to be aware of the generational differences among the patients you are treating. Keep the following 3 tips in mind:1. Married patient with kids—around age 55—may be more interested in safety and may have more patience when it comes to results, while a young man with new onset psoriasis wants immediate results and is likely willing to take on more risk.
2. For elderly patients, I never call them by their first name, but rather Mr Smith for instance. Perhaps once one has more gray hairs or has known the patient for some time, then the first name can be used.
3. Older patients like a handshake or pat on the back, while some young patients enjoy the fist bump.
Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada

Dr. Barankin is a dermatologist in Toronto,    Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.