Tip 1: Obessive-Compulsive Disorder Management
One must understand that patients who consult us for treatment of problems such as skin-picking disorder (neurotic excoriations) or trichotillomania do not want to hear “stop it.” This is undoubtedly what the patient has been told by family and friends for years, and if the patient could stop it, of course they would have done so, long ago.
Problems such as these fall into the spectrum of the obsessive-compulsive disorders. The patient usually has little understanding of just why it is happening, and the lack of control in addition to the visible lesions, leads the patient to feel frustrated, angry, ashamed, and humiliated.
To help these patients, it is important to empathize with the negative feelings of frustration and humiliation, and proceed with open-ended questions. The goal is to get a feel for what is going on in the patient’s life. This may enable one gradually to help the patient to understand the triggers that set the compulsion in motion, and even to employ less destructive solutions such as worry beads.
Because the skin is the focus of attention for the patient, it is helpful to prescribe intensive topical treatments, hoping to replace the patient’s negative activity with measures that may encourage healing.
If trust can be established, a psychiatric referral may also be considered. Currently, the treatments of choice are one of the selective serotonin reuptake inhibitor (SSRI) antidepressant medications or cognitive-behavioral psychotherapy. If the patient has already unsuccessfully consulted other physicians, the dermatologist may certainly prescribe an SSRI.
Caroline Koblenzer, MD
Moorestown, NJ
Tip 2: Sharing Published Articles in the Reception Room
If you publish articles or research, or are quoted by the media, put your articles in a binder to be placed in the reception room for your patients to see. Your patients will be able to see the breadth of your abilities or interests, and it often leads to interesting conversations.
A binder full of comics and tasteful jokes, perhaps medically related, is also fun for the reception room. This is more fun reading than old magazines.
Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada
Tip 3: Plantar Wart Treatment
For plantar warts, I do not aggressively treat because of the morbidity and high recurrence rate. Instead, I pare the wart down and dip a Q-tip in phenol and another in nitric acid. I touch the wart with the phenol first then the nitric acid; it makes smoke and sizzles, and gets a “wow” reaction. Although, it is generally not strong enough to get rid of the wart, there is no downtime.
Normally, I then dispense 5-fluorouracil (5-FU) either straight from the bottle or generally mix some in a small tube of moisturizer as I do for actinic keratosis and have them apply it daily under occlusion with duct tape or bandage. After they remove the bandage, they scrape the surface with an abrasive corn or callus file that they can purchase at any pharmacy. They reapply the 5-FU and occlude it, and continue this for a month. If the wart is not gone, I treat again with phenol and nitric acid and continue the 5-FU.
Most patients with plantar warts give up too soon. It can take several months to get rid of it, but if they follow the scrape and apply regimen, it will be painless and eventually be gone. Make sure you pare it when you first see them, as a wart and corn can be confused.
Barry Ginsburg, MD
Birmingham, AL
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: Obessive-Compulsive Disorder Management
One must understand that patients who consult us for treatment of problems such as skin-picking disorder (neurotic excoriations) or trichotillomania do not want to hear “stop it.” This is undoubtedly what the patient has been told by family and friends for years, and if the patient could stop it, of course they would have done so, long ago.
Problems such as these fall into the spectrum of the obsessive-compulsive disorders. The patient usually has little understanding of just why it is happening, and the lack of control in addition to the visible lesions, leads the patient to feel frustrated, angry, ashamed, and humiliated.
To help these patients, it is important to empathize with the negative feelings of frustration and humiliation, and proceed with open-ended questions. The goal is to get a feel for what is going on in the patient’s life. This may enable one gradually to help the patient to understand the triggers that set the compulsion in motion, and even to employ less destructive solutions such as worry beads.
Because the skin is the focus of attention for the patient, it is helpful to prescribe intensive topical treatments, hoping to replace the patient’s negative activity with measures that may encourage healing.
If trust can be established, a psychiatric referral may also be considered. Currently, the treatments of choice are one of the selective serotonin reuptake inhibitor (SSRI) antidepressant medications or cognitive-behavioral psychotherapy. If the patient has already unsuccessfully consulted other physicians, the dermatologist may certainly prescribe an SSRI.
Caroline Koblenzer, MD
Moorestown, NJ
Tip 2: Sharing Published Articles in the Reception Room
If you publish articles or research, or are quoted by the media, put your articles in a binder to be placed in the reception room for your patients to see. Your patients will be able to see the breadth of your abilities or interests, and it often leads to interesting conversations.
A binder full of comics and tasteful jokes, perhaps medically related, is also fun for the reception room. This is more fun reading than old magazines.
Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada
Tip 3: Plantar Wart Treatment
For plantar warts, I do not aggressively treat because of the morbidity and high recurrence rate. Instead, I pare the wart down and dip a Q-tip in phenol and another in nitric acid. I touch the wart with the phenol first then the nitric acid; it makes smoke and sizzles, and gets a “wow” reaction. Although, it is generally not strong enough to get rid of the wart, there is no downtime.
Normally, I then dispense 5-fluorouracil (5-FU) either straight from the bottle or generally mix some in a small tube of moisturizer as I do for actinic keratosis and have them apply it daily under occlusion with duct tape or bandage. After they remove the bandage, they scrape the surface with an abrasive corn or callus file that they can purchase at any pharmacy. They reapply the 5-FU and occlude it, and continue this for a month. If the wart is not gone, I treat again with phenol and nitric acid and continue the 5-FU.
Most patients with plantar warts give up too soon. It can take several months to get rid of it, but if they follow the scrape and apply regimen, it will be painless and eventually be gone. Make sure you pare it when you first see them, as a wart and corn can be confused.
Barry Ginsburg, MD
Birmingham, AL
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: Obessive-Compulsive Disorder Management
One must understand that patients who consult us for treatment of problems such as skin-picking disorder (neurotic excoriations) or trichotillomania do not want to hear “stop it.” This is undoubtedly what the patient has been told by family and friends for years, and if the patient could stop it, of course they would have done so, long ago.
Problems such as these fall into the spectrum of the obsessive-compulsive disorders. The patient usually has little understanding of just why it is happening, and the lack of control in addition to the visible lesions, leads the patient to feel frustrated, angry, ashamed, and humiliated.
To help these patients, it is important to empathize with the negative feelings of frustration and humiliation, and proceed with open-ended questions. The goal is to get a feel for what is going on in the patient’s life. This may enable one gradually to help the patient to understand the triggers that set the compulsion in motion, and even to employ less destructive solutions such as worry beads.
Because the skin is the focus of attention for the patient, it is helpful to prescribe intensive topical treatments, hoping to replace the patient’s negative activity with measures that may encourage healing.
If trust can be established, a psychiatric referral may also be considered. Currently, the treatments of choice are one of the selective serotonin reuptake inhibitor (SSRI) antidepressant medications or cognitive-behavioral psychotherapy. If the patient has already unsuccessfully consulted other physicians, the dermatologist may certainly prescribe an SSRI.
Caroline Koblenzer, MD
Moorestown, NJ
Tip 2: Sharing Published Articles in the Reception Room
If you publish articles or research, or are quoted by the media, put your articles in a binder to be placed in the reception room for your patients to see. Your patients will be able to see the breadth of your abilities or interests, and it often leads to interesting conversations.
A binder full of comics and tasteful jokes, perhaps medically related, is also fun for the reception room. This is more fun reading than old magazines.
Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada
Tip 3: Plantar Wart Treatment
For plantar warts, I do not aggressively treat because of the morbidity and high recurrence rate. Instead, I pare the wart down and dip a Q-tip in phenol and another in nitric acid. I touch the wart with the phenol first then the nitric acid; it makes smoke and sizzles, and gets a “wow” reaction. Although, it is generally not strong enough to get rid of the wart, there is no downtime.
Normally, I then dispense 5-fluorouracil (5-FU) either straight from the bottle or generally mix some in a small tube of moisturizer as I do for actinic keratosis and have them apply it daily under occlusion with duct tape or bandage. After they remove the bandage, they scrape the surface with an abrasive corn or callus file that they can purchase at any pharmacy. They reapply the 5-FU and occlude it, and continue this for a month. If the wart is not gone, I treat again with phenol and nitric acid and continue the 5-FU.
Most patients with plantar warts give up too soon. It can take several months to get rid of it, but if they follow the scrape and apply regimen, it will be painless and eventually be gone. Make sure you pare it when you first see them, as a wart and corn can be confused.
Barry Ginsburg, MD
Birmingham, AL
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.
