Blog | Thursday, April 23, 2009

Warts and all

General internists must see a lot of crusty, itchy, oozing patients.

Today's "Essential Dermatology for the Practicing Internist" session was packed to the gills, with audience members consuming all available floor and wall space. Speaker Julia Nunley, ACP Member, even encouraged folks to sit down front in the area before the podium, "like little children at church."

Once settled in, we all enjoyed a pre-lunch earful and eyeful of scaly patches, inflamed sores, engorged pustules--and juicy clinical tidbits. Among them:

--Be sure to tell patients you treat for acne that it can take 2-3 months to clear up, and that the acne may not disappear completely. Many will quit treatment after three weeks if they don't see results.

--When female patients come in with acne, always ask about their menstrual cycles. "You don't want to miss PCOS," Dr. Nunley said. "When I'm checking out faces, I tuck my finger under the chin so I can feel to see if she's shaving. Often she won't tell you."

--Ask older patients with acne about flushing and blushing; you don't want to miss a diagnosis of rosacea. is a good site for patients to learn about things that can cause rosacea flair-ups. "You won't see this in any dermatology textbook, but rosacea flairs with menses," Dr. Nunley said. "For me personally, it flairs when I fly."

--Sun protection is the single most important treatment for rosacea. People are born with rosacea, and it gets worse with age-- but it can be stemmed if one is careful in the sun.

--Treatment for dandruff (Seborrheic Dermatitis) varies with ethnic background. African- Americans typically wash their scalps once per week, so shampoo treatments are of limited benefit. Ointments (fluocinonide) and oils (fluocinolone) should be used instead. For Asians and Caucasians, solutions (clobetasol) and lotions (triamcinolone) work well.

...and finally, the one that caused some gasps and murmurs to ripple through the crowd..

--HPV can actually live in liquid nitrogen. Never, ever double dip when performing back-to-back cryosurgery on warts.