The American Academy of Dermatology (AAD) released new recommendations regarding dermatologic tests and treatments that are not always necessary. The list was developed as part of the Choosing Wisely campaign, an ABIM Foundation initiative designed to help patients avoid potentially unnecessary care. Items were selected by a workgroup of board-certified dermatologists who identified: areas with the greatest potential for overuse/misuse, a need for quality improvement and the availability of strong evidence-based research to support the recommendation. The final list was reviewed and approved by the AAD Council on Science and Research as well as the AAD Board of Directors.
The new recommendations have been added to the Academy’s first Choosing Wisely list that was released in 2013 and includes recommendations for dealing with nail fungus, skin cancer, dermatitis and surgical wounds.
The new recommendations include:
- Don’t use systemic (oral or injected) corticosteroids as a long-term treatment for dermatitis. The potential complications of long-term treatment with oral or injected corticosteroids outweigh the potential benefits.
- Don’t use skin prick tests or blood tests, such as the radioallergosorbent test (RAST), for the routine evaluation of eczema. When testing for suspected allergies is deemed necessary in patients with dermatitis or eczema, it is better to conduct patch testing with ingredients of products that come in contact with the patient’s skin.
- Don’t routinely use microbiologic testing in the evaluation and management of acne. Microbiologic testing to determine the type of bacteria present in an acne lesion generally does not affect the management of typical acne patients.
- Don’t routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection. Research has suggested that bilateral lower leg cellulitis is very rare—patients with swelling and redness of both legs most likely have another condition, such as dermatitis resulting from leg swelling, varicose veins or contact allergies.
- Don’t routinely prescribe antibiotics for inflamed epidermal cysts. Confirm infection before treating these cysts with antibiotics.
“The American Academy of Dermatology and its members are committed to serving as good stewards of limited healthcare resources, and we want to empower our patients to make informed health care decisions,” says Mark Lebwohl, MD, FAAD, president of the AAD. “By identifying procedures that may not be necessary, the Academy’s new Choosing Wisely list can help patients with skin, hair and nail conditions start a conversation with their dermatologist about what tests and treatments are right for them.”
For more information, visit www.choosingwisely.org.
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