Dermatology in the Primary Care Office – From Principles to Practice Strategies

Day 1

Introduction – Essentials of Dermatology Diagnosis.

Upon completion of this session, the participant should be able to: ^{COMP^}

1. Approach dermatologic disorders with a consistent and logical method.
2. Interpret the role of “color” in the diagnosis of cutaneous lesions.
3. Select the appropriate therapy for common disorders.

Common Problems in Office Dermatology.

Upon completion of this session, the participant should be able to: ^{COMP, GL}

1. Develop a differential diagnosis of common disorders based on lesion morphology and distribution.
2. Differentiate the many manifestations of cutaneous fungal disease.
3. Analyze fungal foot and nail changes and select the appropriate therapy as per the “Choosing Wisely: Am ACAD of Dermatology 2013” guidelines.

Select Principles of Dermatology Diagnosis and Treatment.

Upon completion of this session, the participant should be able to: ^{COMP^}

1. Utilize morphology of skin disease to generate differential diagnoses.
2. Differentiate topical steroids by strength and vehicle.
3. Develop treatment algorithms that are safe and effective using topical steroids.
4. Formulate a strategy to perform a shave biopsy versus a punch biopsy through a case-based approach.
5. Identify treatment regimen for topical steroids that will prevent adverse effects.

Fever and Rash: A Common Sense Approach.

Upon completion of this session, the participant should be able to:^

1. Identify life-threatening skin conditions present with a fever.
2. Generate a differential diagnosis for a fever and rash.
3. Identify a classification scheme for skin diseases associated with fever.

Day 2

The Sun and the Skin: Photoaging, Non-Melanoma Skin Cancer, Photodermatosis and Sunscreens.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Assess clinical signs that distinguish non-melanoma skin cancers and precancerous lesions.
2. Determine appropriate sun protective measures for patients.
3. Design treatment algorithms for common skin cancers, to include the AAD recommendations for African Americans.
4. Recommend proper sunscreen application behavior to decrease rate of development of actinic keratosis.

Common Tumors in the Office Setting.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Formulate treatment algorithms for common epidermal tumors as analyzed in Cochrane Systematic Reviews.
2. Develop treatment algorithms for common vascular tumors.
3. Distinguish skin findings and develop treatment algorithms for common subcutaneous tumors to diagnose common epidermal tumors.

Contact Dermatitis.                                                                     

Upon completion of this session, the participant should be able to: ^{COMP, GL}

1. Plan the testing for identification of allergens in contact dermatitis.
2. Distinguish and treat poison ivy, poison oak, and poison sumac.
3. Detect common contactants seen in the office setting.
4. Develop a treatment plan for various types of contact dermatitis while considering the British Association of Dermatology Tx Guidelines.

Leg Ulcers and the Principles of Wound Care.

Upon completion of this session, using the Wound and Regeneration Guidelines for the Management and Treatment of Venous and Arterial Ulcers (2006), the participant should be able to: ^{EBM, GL, COMP}

1. Differentiate and treat leg ulcers, based upon etiology, and the Guidelines of the American Academy of Dermatology for treating venous, arterial, diabetic associated and pressure ulcers.
2. Apply the basic principles of wound care.
3. Appraise the rationale for various wound dressings.

Day 3

Acne: Pathophysiology and Treatment.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Characterize types of acne lesions and appropriate therapy based on pathophysiology.
2. Differentiate acneiform eruptions from acne vulgaris.
3. Apply appropriate antibiotic recommendations with consideration of patterns of resistance.
4. Employ the use of Isotretinoin as per the AAD recommendations.

Approach to Rosacea and the Red Face.

Upon completion of this session, the participant should be able to:         ^{EBM, COMP}

1. Identify the various types of Rosacea.
2. Distinguish Rosacea from other causes of the “Red Face”.
3. Develop an Evidence-Based treatment plan for Rosacea as per The Cochrane Skin Group Reviews.

Malignant Melanomas, Part I: Melanoma, Birthmarks.

Upon completion of this session, the participant should be able to: ^{EBM, GL, COMP}

1. Utilize the ABCDE approach to the description of pigmented lesions and features of melanoma.
2. Analyze the biology of melanoma.
3. Appraise and employ the AAD Guidelines of Care for the Management of Primary Cutaneous Melanoma.
4. Refer for a surgical approach, as per the NCCN (National Comprehensive Clinical Network) Guidelines for melanoma.

Malignant Melanomas, Part II: Nevi, Dysplastic Nevi.

Upon completion of this session, the participant should be able to: ^{COMP, GL}

1. Appraise “dysplastic nevi” and describe the relationship between dysplastic nevi and melanomas.
2. Develop an approach to examination, testing and follow up of families with dysplastic nevi and melanomas as per the 2013 NCCN guidelines.

Recommend to patients the methods of photoprotection and the relationship of the sun to melanomas as per the 2014 NCCN guidelines for patients.

Day 4

Dermatology Emergencies.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Detect the diagnostic signs of life-threatening skin emergencies secondary to medications.
2. Detect the diagnostic signs of life-threatening skin emergencies secondary to infections.
3. Differentiate the key pathological difference of staphylococcal scalded skin syndrome from toxic epidermal necrolysis.
4. Apply vaccine recommendations as per the CDC/IDSA and AAP.

Clinical Pearls in Dermatology.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Apply diagnostic and treatment pearls for varied cutaneous disorders encountered in the office.
2. Apply a simple diagnostic maneuver to diagnose basal cell skin cancer.
3. Utilize a dermatologist to effectively manage your patients who have pigmented lesion biopsies.
4. Employ the appropriate use of antibiotics using the AAD “Choosing Wisely Campaign” recommendations list.

Psoriasis.

Upon completion of this session, using AAD Guidelines for Psoriasis Therapy, the participant should be able to: ^{EBM, GL, COMP}

1. Evaluate the spectrum of classical and subtle cutaneous changes of psoriasis.
2. Formulate the basic pathophysiology of psoriasis.
3. Approach topical psoriasis therapy with a basic algorithm.
4. Develop a treatment plan based upon the AAD Guidelines for Management of Psoriasis and Psoriatic Arthritis and Use of Biologics, Phototherapy and Chemotherapy.

Herpes Simplex and Zoster; Lichen Planus.

Upon completion of this session, the participant should be able to: ^{COMP, EBM}

1. Differentiate herpes simplex and herpes zoster based on morphology and distribution of lesions and laboratory testing.
2. Analyze the varied manifestations, reactivation complications of herpes zoster as referenced in the 2011 Journal of Infectious Diseases.
3. Determine an appropriate treatment plan for herpes simplex and herpes zoster as per 2011 FDA and Mayo proceedings recommendations.
4. Evaluate the cutaneous spectrum of lichen planus.

Day 5

Hair and Nail Disorders for the Primary Care Provider.

Upon completion of this session, the participant should be able to: ^{GL, COMP}

1. Develop an objective, simplified approach to hair loss.
2. Distinguish the common causes of hair loss.
3. Plan treatment strategies, as per the AAD recommendations, for the common causes of hair loss.
4. Determine the common causes of nail dystrophy in a primary care practice by applying the AAD recommended diagnostic algorithm.
5. Formulate a treatment strategy for nail fold inflammation.

Evidence-Based Case Studies in Dermatology.

Upon completion of this session, the participant should be able to: ^{EBM, COMP}

1. Formulate evidence-based treatment for photo-damaged skin.
2. Formulate evidence-based treatment for common skin diseases, such as: molluscum contagiosum and pityriasis rosea.
3. Assess the one side effect of isotretinoin therapy that predicts higher risk for future hyperlipidemia.

Pathophysiology and Treatment of Diabetic Ischemic and Neuropathic Foot Ulcers.

Upon completion of this session, using the Wound and Regeneration Guidelines for the Treatment of Diabetic Foot Ulcers (2006), the participant should be able to: ^{GL, COMP}

1. Distinguish between ischemic and neuropathic etiologies of diabetic foot ulcers.
2. Treat neuropathic ulcers successfully with debridement and weight-off loading.
3. Recommend selected footwear in the patient with neuropathy.

“Cases That Have Taught Me a Lesson.”

Upon completion of this session, the participant should be able to: ^{COMP^}

1. Detect skin changes that point to specific and varied cutaneous disorders encountered in the office.
2. Appraise and recommend therapy for perioral dermatitis.