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  • Presentation

Office Tips 3

Description

In this presentation, Mark Lobwell discusses various office tips related to dermatology and clinical practices, emphasizing the use of Hedgehog inhibitors like sanidegib in patients undergoing Mohs surgery for basal cell carcinoma, highlighting their efficacy in tumor reduction and side effects management. He provides anecdotal evidence of successful patient outcomes through the pre-treatment of muscle cramps with L-carnitine. The talk extends to emerging treatments, including Tricophytin and Tiniae for tinea infections, and specific management strategies for patients on biologic therapies regarding vaccinations and surgery preparations, pointing out essential guidelines and recommendations. Lobwell emphasizes the importance of communication in patient care, sharing humorous anecdotes about effective storytelling with patients to ease their concerns. He also touches on practical tips for managing perioral dermatitis and preventing isotretinone-induced side effects. The session showcases the need for proper knowledge about drug interactions, complications, and patient histories, integrating clinical tips with personal anecdotes to enhance patient-provider interactions. Additionally, he underscores the significance of being selective about reading scientific literature and developing accurate assessments to foster trust with patients.

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Conclusions

  • Hedgehog inhibitors can significantly reduce tumor size in patients with basal cell carcinoma prior to Mohs surgery.
  • Sonidegib may reduce side effects compared to vismodegib, making it a preferable option for patients.
  • L-carnitine can help mitigate muscle cramps caused by hedgehog inhibitors, allowing for better patient tolerance.
  • Patients on biologics can safely receive certain vaccinations, including live vaccines under specific conditions.
  • Management approaches for terbinafine-resistant dermatophytes include itraconazole and avoidance of topical steroids.
  • For patients scheduled for surgery, a perioperative management guideline suggests continuing most psoriasis therapies safely.
  • Patients with prior adverse reactions to COVID vaccinations may require customized vaccination recommendations.
  • Isotretinone is effective for perioral dermatitis with a predictable course and lower doses may reduce side effects.
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  • Gutzmer R, Loquai C, Robert C, Dréno B, Guminski A, Lewis K, Arntz R, Martelli S, Squittieri N, Kheterpal M. Key Clinical Adverse Events in Patients with Advanced Basal Cell Carcinoma Treated with Sonidegib or Vismodegib: A Post Hoc Analysis. Dermatol Ther (Heidelb). 2021 Oct;11(5):1839-1849.
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