In vitro diagnostics for the medical dermatologist. Part II: Hypercoagulability tests.

The skin often provides initial clues of hypercoagulability with features such as livedo reticularis, livedo racemosa, retiform purpura, necrosis, and ulcerations. Because these cutaneous manifestations are nonspecific, laboratory testing is often needed to evaluate for underlying causes of hypercoagulability. Importantly, these disorders are reported to be the most common mimicker, resulting in an erroneous diagnosis of pyoderma gangrenosum. Understanding inherent properties of, and indications for, available tests is necessary for appropriate ordering and interpretation of results. Additionally, ordering of these tests in an indiscriminate manner may lead to inaccurate results, complicating the interpretation and approach to management. This second article in this continuing medical education series summarizes information on methodology, test characteristics, and limitations of several in vitro laboratory tests used for the work up of hypercoagulability and vasculopathic disease as it pertains to dermatologic disease.

Dermatologic therapy in pregnancy.

Patients present during pregnancy with a variety of dermatologic conditions, most of which can be treated conservatively with topical medication by a primary obstetrician if he or she is familiar with common treatment options. Patients with moderate to severe forms of dermatologic disease or those requiring systemic therapy should be treated in consultation with a dermatologist. Dermatologic surgery can be performed safely in the second trimester using local anesthesia if needed.

Physiological skin changes during pregnancy.

Physicians may often mistake normal physiological skin changes in pregnancy for pathologic changes, so being able to recognize the skin manifestations unique to pregnancy is of the utmost importance to avoid unnecessary testing and stress for the obstetric patient. Most physiological skin changes will resolve postpartum, so reassurance and expectant management is indicated in almost all cases.

Pregnancy and dermatologic therapy.

Dermatologists should be familiar with medication safety in pregnancy to be able to prescribe safely and confidently to pregnant women or women who may become pregnant during the course of treatment for dermatologic conditions. Topical medications should be considered first-line therapy for pregnant women, but certain systemic medications are safe to use in pregnancy and may be prescribed if necessary. Dermatologic surgery may be performed during the second trimester of pregnancy with proper positioning, but elective procedures should be delayed until the postpartum period.

Contraception and the dermatologist.

Contraceptives are pertinent to dermatologists in 3 major instances: (1) prescribing combined oral contraceptives for the treatment of acne; (2) ensuring that women being treated with potential teratogens are on adequate contraception; and (3) counseling female patients regarding contraceptives that can worsen acne. Most modern combined oral contraceptives will benefit acne; however, there are some agents that may be more effective than others, primarily because of the progestin used in the agent. Long-acting reversible contraceptives should be first line for women on teratogenic medications, but some of these agents can worsen acne because they release progestins.

The Role of an Integrated Multidisciplinary Clinic in the Management of Patients with Cutaneous Lymphoma.

The clinical benefit of a multidisciplinary clinic practice model has been well described in a variety of medical specialties and cancer types. It proves particularly valuable when an integrated team is needed to optimally manage patients with rare or complex neoplasms. However, the ideal implementation of an integrated multidisciplinary care program for translational research and education has not been well reported. Herein, we propose how a multimodality cutaneous lymphoma (CL) clinic model can optimally manage CL patients. We offer our perspective on this model as an efficient means for delivering patient care, a continuing education resource for referring physicians, a conduit for translational and clinical research, and an educational tool for medical students, house staff, and fellows.

Is decreased ultraviolet exposure during childhood the cause of the increased prevalence of atopic dermatitis?

There is a recent accumulation of data suggesting that decreased exposure to ultraviolet light in childhood could be a major factor contributing to the increasing rates of atopic dermatitis in children and adolescents. It would be worthwhile to study the relationship between vigilant sun protective behaviors in children and the incidence of atopic dermatitis.