The ethical foundation on which my medical practice is based was recently shaken by an episode involving the intrusion of managed care into my practice. With the patient's informed consent, I prescribed a medication that I knew would not work.
As we approach the 21st century, specialty training programs in dermatology are feeling increasing pressures that have begun to erode clinical teaching. Full-time faculty members are being asked to spend more time in patient care to support an…
BACKGROUND: The explosion of medical knowledge, the influence of communications technology, and the pressures for health care reform challenge dermatologists to learn efficiently and teach effectively. OBSERVATIONS: The vast body of material on…
Inadvertent drug substitution occurred in several instances in our practices due to the combination of the physician's illegible handwriting on prescriptions and the pharmacist's misinterpretation of subtle clues, which might have prevented the…
BACKGROUND: Despite anecdotal evidence of a possibility of decreased effectiveness of oral contraceptives (OCs) with some antibiotics, it is not known whether antibiotic use in dermatologic practices engenders any increased risk of accidental…
BACKGROUND: The treatment of palmar and plantar warts is difficult and often frustrating. The need for multiple destructive treatments and recurrences after apparent cure are common. OBJECTIVE: The purpose of this study was to determine if…
A healthy 10-year-old boy presented with a widespread, nonpruritic, pustular rash of 3 days' duration. He reported having no fever, chills, or other systemic symptoms. Physical examination revealed perifollicular pustules concentrated in the swimsuit…
Whether a vesicobullous disease is intraepidermal or subepidermal is often difficult to determine from the clinical examination. The Tzanck preparation can provide clues that aid in the diagnosis of a number of diseases. It is particularly helpful in…
Patients with scabies may present with urticarial, eczematous or excoriated papules, eczematous patches or, occasionally, nodules. It is often difficult to differentiate scabies from eczema, folliculitis, drug eruption or lichen planus. The…
A potassium hydroxide preparation is used to confirm the diagnosis of a superficial fungal skin infection. Adding black or blue-black ink to the potassium hydroxide solution highlights fungal organisms and distinguishes them from surrounding cellular…
Stump pemphigoid is a localized variant of bullous pemphigoid characterized by specific clinical, pathological, and immunofluorescent characteristics. The early diagnosis of this entity guides treatment toward this specific immunologically mediated…
Tinea versicolor is a common superficial fungal infection that typically affects young adults in warm, humid climates. We describe two young black children in the temperate northeastern Ohio area with tinea versicolor limited to the face. The…
Acne vulgaris is a common skin disease that is most effectively treated with a combination of topical products and, in some cases, systemic antibiotics. While it is important to treat papules, pustules, nodules, and cysts with topical or systemic…
Superficial fungal infections are easily managed once the proper diagnosis is made. However, misdiagnosis is not uncommon, and many standard approaches to treatment popular just a few years ago are now out of date or in need of refinement. Through…
A 52-year-old man was referred for evaluation of three mildly pruritic patches on his right lateral upper arm, left shoulder, and right posterior thigh. The lesions had been present for 4 years, and although itching had decreased, they had failed to…
The use of drug samples in a dermatology clinic is controversial. Drug samples are associated with influencing physician prescribing patterns often toward costlier drugs, increasing health care costs, increasing waste, inducing potential conflicts of…
Sebaceous hyperplasia is a benign lesion that occurs commonly on the face of older individuals. A variety of treatment options have been described, including oral isotretinoin, electrodesiccation, CO2 laser surgery, cryosurgery, and shave excision…
