Lists > Pearls from Great Clinicians

Pearls from Great Clinicians

Top  Previous  Next

Michael Fisher Pearls:

•he has only seen cryptococcal cellulitis in patients who are immunocompromised secondary to glucocorticoids (i.e. vs. chemo or AIDS)
•has never seen the lesions of lepromatous leprosy to involve the midline of the back (M. leprae likes cool places);  stated otherwise:  when presented with a dermal reaction pattern in a patient, you can rule out leprosy if the lesions occur over the spine
•do not see acrosclerosis in sclerodermatous conditions other than PSS;  stated otherwise: absence of acrosclerosis argues strongly against progressive systemic sclerosis
•atrophoderma of  Pasini and Pierini:  classically looks red/brown – most people first think “vascular” --> then think parapsoriasis/MF
•when he sees psoriasiform strange disease, he thinks of erythrokeratoderma variabilis
•"chicken pox" that lingers is PLEVA
•"PR that lingers is small plaque parapsoriasis"
•“BPP with small ulcerations” = cryoglobulinemia
•he has never seen dermatomyositis without periungual telangiectasia

 

Alan Halpern:

•middle aged women don't get Schamberg’s benign pigmented purpura, therefore in women it is cryoglobulinemia until proven otherwise

 

Braverman’s Pearls:

•lupus never has pustules (vs. rosacea)
•Raynaud’s: look for pitted scars on fingertips
•scleroderma (PSS only i.e. not CREST) has even follicular re-pigmentation  (vs. vitiligo)
•LS&A of the vulva: telangiectasias make the diagnosis
•real “targets” almost never go on to TEN
•SJS-TEN will respond to steroids of caught in the first 48hrs
•Paget’s disease has to involve the nipple (i.e. if only areola, then not Paget’s) ducts à nipple à areola

 

AAD Practical Approaches Course:

•t. faceii is photosensitive (and often mistaken for LE or rosacea)
•recurrent keratoacanthoma's on legs after multiple Moh's procedures... consider hypertrophic LP (treat with topical steroids)

 

Miscellaneous:

•Stretch the skin when doing a punch biopsy to leave an ellipse instead of a circle
•Use a needle holder dipped in liquid nitrogen to freeze skin tags (especially close to the eye)
•Inject normal saline into an area of fat atrophy (e.g. after ILK) - seems to speed the resolution