Diagnosing dermatologic conditions on the lower extremities can be challenging because many conditions look alike. Two speakers at Thursday’s Breakfast Symposium will explain their tips for diagnosing and managing a variety of common and unusual conditions and explore new technology for an old problem.
Dock Dockery, DPM, and Evan Rieder, MD, will discuss common conditions, such as dry skin, skin tags, melanonychia and onychomycosis, as well as the role of biopsies, biopsy techniques, when to refer patients, and the use of lasers to treat fungus of the nail.
Dr. Dockery, director of the International Foot & Ankle Foundation, will use a case-presentation format to explore management of dry skin conditions, pediatric skin issues such as eczema and warts, problems related to repetitive scratching and itching, dermatofibromas, and common conditions that often are misdiagnosed.
“I will have images of each case with examples of other cases of the same condition,” he said. “It helps the practitioner not to get in the mode of guessing what something looks like. A lot of these things look similar to other things, and they can range from benign to malignant lesions.”
An important part of diagnosis is using the correct type of biopsy procedure, so Dr. Dockery also will review the use of punch and shave biopsies, as well as biopsy-related issues, such as margins and the need for consent forms.
Dr. Rieder, an assistant professor of dermatology at the Ronald O. Perelman Department of Dermatology, NYU Langone, will discuss the importance of observing characteristics of skin rashes and when to refer patients to specialists, as well as treating pigmented spots on nails and using lasers to treat onychomycosis.
“One of the things I am passionate about is the ability to hone your observational skills—the art of observation, looking at subtlety and details to help people distinguish common skin rashes,” he said. “They all look similar, but there are subtleties and differences that allow clinicians to be able distinguish between eczema, psoriasis, fungus and some of the less common diagnoses that should be referred for medical management by a dermatologist or internal medicine doctor.”
When managing melanonychia, Dr. Rieder follows an algorithmic approach. The majority of pigmented spots on nails are benign, but clinicians often are overly concerned about cancers, he said. He will explain when a biopsy is needed, when a patient should be referred to a specialist, and when spots can just be monitored.
Finally, he will explore the growing interest in using lasers to treat onychomycosis.
“We will go through what the evidence shows, explaining to your patients the pros and cons of this type of treatment, and where the field should be going in terms of using lasers to treat nail disease,” Dr. Rieder said.