Tip 1: Managing Your Online Image
Although most of our patients are happy with the care we provide, it is often the disgruntled patients that go out of their way to rate you online on a variety of physician rating websites that now exist. Encourage your happy patients to post comments about their positive experience on rating websites. You need to be an active participant in your online image.
Benjamin Barankin, MD
Toronto, ON
Tip 2: Stimulate Healing of Ulcers
To help stimulate epithelialization of small, slowly healing ulcers, have patients dab the ulcer with a 10% aqueous silver nitrate solution via a cotton-tipped applicator two or three times daily. Dispense in amber bottle.
Jerry Litt, MD
Beachwood, OH
Tip 3: What To Do When You Do Not Know
I think that all of us have a different way to approach the unknown. I ask myself three questions:
• What can this be?
• What is it certainly not?
• What would I be most worried about?
If I suspect a malignancy, I do my best to convince the patient to have a biopsy now (like the lady with a melanoma on eyebrow who wasn’t at the appointment for that). If I think it’s inflammatory, I will use a topical steroid for a limited area or an intramuscular if it is widespread and the patient has no contraindications. If I’m not sure whether something is inflammatory or neoplastic, but my suspicion level is low, I take a chance and prescribe the patient a strong topical steroid for 2 weeks. After 2 weeks, I re-check and biopsy if it’s not better. It is rare that I use an antibiotic without knowing what exactly it is for.
Now to reveal the big secret truth — a few times a year, if a patient presents with a scaly, inflamed eruption on the hands or feet and I am not sure what is going on, I do a fungal culture and use Lotrisone (this drug should be used by dermatologists only).
Jo Herzog, MD
Vestavia, AL
Tip 4: Managing Irritation Fibromas
Irritation fibroma (oral) is caused by repetitive, non-destructive, trauma to local mucosa or gingiva. This chronic inflammation results in isolated tissue fibrosis producing pedunculated lesions that may grow to sizes greater than 3 cm in diameter. There is no gender or age predilection and the manifestation is based entirely upon the extent of trauma and cellular reactivity in the oral tissue. There have been no reported cases of malignant transformation in documented studies of irritation fibroma.
Treatment in the case illustrated above was surgical excision. The fibroma was anesthesized. We used a chalazion clamp to achieve hemostasis and isolate the fibroma (see image above right). A skin hook was then applied for buccal retraction. The fibroma was excised with tissue scissors and the mucosa was electro-dissected with excellent results. Recurrence is unlikely unless the inciting trauma is repeated.
Rob Norman, MD
Tampa, FL
---------------------------
Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of six books in dermatology and is widely published in the dermatology and humanities literature. He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
Tip 1: Managing Your Online Image
Although most of our patients are happy with the care we provide, it is often the disgruntled patients that go out of their way to rate you online on a variety of physician rating websites that now exist. Encourage your happy patients to post comments about their positive experience on rating websites. You need to be an active participant in your online image.
Benjamin Barankin, MD
Toronto, ON
Tip 2: Stimulate Healing of Ulcers
To help stimulate epithelialization of small, slowly healing ulcers, have patients dab the ulcer with a 10% aqueous silver nitrate solution via a cotton-tipped applicator two or three times daily. Dispense in amber bottle.
Jerry Litt, MD
Beachwood, OH
Tip 3: What To Do When You Do Not Know
I think that all of us have a different way to approach the unknown. I ask myself three questions:
• What can this be?
• What is it certainly not?
• What would I be most worried about?
If I suspect a malignancy, I do my best to convince the patient to have a biopsy now (like the lady with a melanoma on eyebrow who wasn’t at the appointment for that). If I think it’s inflammatory, I will use a topical steroid for a limited area or an intramuscular if it is widespread and the patient has no contraindications. If I’m not sure whether something is inflammatory or neoplastic, but my suspicion level is low, I take a chance and prescribe the patient a strong topical steroid for 2 weeks. After 2 weeks, I re-check and biopsy if it’s not better. It is rare that I use an antibiotic without knowing what exactly it is for.
Now to reveal the big secret truth — a few times a year, if a patient presents with a scaly, inflamed eruption on the hands or feet and I am not sure what is going on, I do a fungal culture and use Lotrisone (this drug should be used by dermatologists only).
Jo Herzog, MD
Vestavia, AL
Tip 4: Managing Irritation Fibromas
Irritation fibroma (oral) is caused by repetitive, non-destructive, trauma to local mucosa or gingiva. This chronic inflammation results in isolated tissue fibrosis producing pedunculated lesions that may grow to sizes greater than 3 cm in diameter. There is no gender or age predilection and the manifestation is based entirely upon the extent of trauma and cellular reactivity in the oral tissue. There have been no reported cases of malignant transformation in documented studies of irritation fibroma.
Treatment in the case illustrated above was surgical excision. The fibroma was anesthesized. We used a chalazion clamp to achieve hemostasis and isolate the fibroma (see image above right). A skin hook was then applied for buccal retraction. The fibroma was excised with tissue scissors and the mucosa was electro-dissected with excellent results. Recurrence is unlikely unless the inciting trauma is repeated.
Rob Norman, MD
Tampa, FL
---------------------------
Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of six books in dermatology and is widely published in the dermatology and humanities literature. He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
Tip 1: Managing Your Online Image
Although most of our patients are happy with the care we provide, it is often the disgruntled patients that go out of their way to rate you online on a variety of physician rating websites that now exist. Encourage your happy patients to post comments about their positive experience on rating websites. You need to be an active participant in your online image.
Benjamin Barankin, MD
Toronto, ON
Tip 2: Stimulate Healing of Ulcers
To help stimulate epithelialization of small, slowly healing ulcers, have patients dab the ulcer with a 10% aqueous silver nitrate solution via a cotton-tipped applicator two or three times daily. Dispense in amber bottle.
Jerry Litt, MD
Beachwood, OH
Tip 3: What To Do When You Do Not Know
I think that all of us have a different way to approach the unknown. I ask myself three questions:
• What can this be?
• What is it certainly not?
• What would I be most worried about?
If I suspect a malignancy, I do my best to convince the patient to have a biopsy now (like the lady with a melanoma on eyebrow who wasn’t at the appointment for that). If I think it’s inflammatory, I will use a topical steroid for a limited area or an intramuscular if it is widespread and the patient has no contraindications. If I’m not sure whether something is inflammatory or neoplastic, but my suspicion level is low, I take a chance and prescribe the patient a strong topical steroid for 2 weeks. After 2 weeks, I re-check and biopsy if it’s not better. It is rare that I use an antibiotic without knowing what exactly it is for.
Now to reveal the big secret truth — a few times a year, if a patient presents with a scaly, inflamed eruption on the hands or feet and I am not sure what is going on, I do a fungal culture and use Lotrisone (this drug should be used by dermatologists only).
Jo Herzog, MD
Vestavia, AL
Tip 4: Managing Irritation Fibromas
Irritation fibroma (oral) is caused by repetitive, non-destructive, trauma to local mucosa or gingiva. This chronic inflammation results in isolated tissue fibrosis producing pedunculated lesions that may grow to sizes greater than 3 cm in diameter. There is no gender or age predilection and the manifestation is based entirely upon the extent of trauma and cellular reactivity in the oral tissue. There have been no reported cases of malignant transformation in documented studies of irritation fibroma.
Treatment in the case illustrated above was surgical excision. The fibroma was anesthesized. We used a chalazion clamp to achieve hemostasis and isolate the fibroma (see image above right). A skin hook was then applied for buccal retraction. The fibroma was excised with tissue scissors and the mucosa was electro-dissected with excellent results. Recurrence is unlikely unless the inciting trauma is repeated.
Rob Norman, MD
Tampa, FL
---------------------------
Dr. Barankin is a dermatologist based in Toronto, Canada. He is author-editor of six books in dermatology and is widely published in the dermatology and humanities literature. He is also co-editor of Dermanities (dermanities.com), an online journal devoted to the humanities as they relate to dermatology.
Tip 1: Managing Your Online Image
Irritation fibroma (oral) is caused by repetitive, non-destructive, trauma to local mucosa or gingiva. This chronic inflammation results in isolated tissue fibrosis producing pedunculated lesions that may grow to sizes greater than 3 cm in diameter. There is no gender or age predilection and the manifestation is based entirely upon the extent of trauma and cellular reactivity in the oral tissue. There have been no reported cases of malignant transformation in documented studies of irritation fibroma.
