In this time of sheltering in place, clinics are trying to help #flattenthecurve by only being available to see patients with urgent/essential or severe needs (including ours, I'm happy to report).

How does this impact dermatology and your skin concerns?

A 2 part series:
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Part 1: I'll share some conditions we consider urgent and/or severe in dermatology, and we want to see you for in clinic.

I know how everyone is trying hard to #socialdistance, so it's important to know we still want you to seek care for the important stuff that needs care.
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There are several conditions in dermatology which necessitate urgency. I'll do my best to keep this brief and to the point:

1) Reactions to medications:
Many types of rashes that can occur with medications, but severe rashes can cover large areas or even the entire body.
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Almost any medicine can --> an allergic rash, and there are numerous ways this can look.

Often it looks like many small red bumps and patches, or hives, but sometimes more severe drug rashes can have blisters, erosions, painful peeling skin, red eyes, or sore lips/tongue.

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Some drug rashes are not severe and can be treated with simple medications to ease your symptoms & we stop the culprit drug.

Other rashes can be more severe and may necessitate more workup & require hospitalization.

Bottom line: You should be seen for drug rashes; call us!
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2) Infections:
Another incredibly broad category, so going to keep it super brief.
-Shingles (formal term is Herpes Zoster). A reactivation of the chicken pox virus, esp in times of stress (um, hello #COVID19). If it involves forehead, tip of nose, can signal eye involvement.
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Shingles, aka Zoster, should be treated with antivirals as soon as possible, preferably within 1st 72 hours, to prevent long term complications of damage and ongoing pain to the nerves it involves.

This is most urgent if it involves the eye.
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We often get called for something that is worrisome for shingles and it isn't. But I'd rather err on the side of caution and give someone good news than risk the diagnosis being missed.

Clue is one-sided painful rash. Shingles is almost never both sides (rare cases)

So call us!

Other infections include deeper infections in the skin, such as cellulitis, and deeper infection of the muscle and deep tissues.

A red, hot, painful swollen and expanding patch, one-sided, is suspicious for cellulitis, and this is definitely urgent.
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If you have an expanding rash, and are feeling unwell, such as fever, chills, fatigue, these are further clues to the rash being infectious and possibly severe. This should NOT wait at home and this definitely warrants an immediate phone call to your doctor, or even an ED trip.

More common infections we see are abscesses (often called "boils"), and these are localized areas of pus & bacterial infection.

Sometimes what seems like an abscess is just an inflamed cyst, but it can be hard to tell the difference.

Left is an abscess, right is a cyst.
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So if you have a swollen, hot, tender bump, though this may not end up being an abscess, we can discern this and get you treated either way.

And if it is an abscess, early intervention is key to preventing deeper infection.

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3) Blistering rashes:

These can be from drugs, from bug bites, from infections, from autoimmune conditions, from allergic reactions, and on and on.

There are too many photos to even share, so let me cut to the chase:
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If you have a blistering rash, ESPECIALLY if they are painful, and/or widespread, we WANT TO SEE YOU!

The list of possibilities extend from a simple eczema reaction of the hands and feet to severe autoimmune conditions, so we need to see you to figure it out and get you treated

4) "Red all over"

There is a rash called "erythroderma", which literally means red skin.

This can happen as the end result of a variety of underlying causes, and when the body is covered in this amount of rash, you can feel cold and unwell.

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If you are red all over, especially if you are feeling cold and shaking, and generally don't feel well, we need to see you. This should not wait.

We will likely take a biopsy and do further workup to get to the bottom of it, and decide how best to treat you.

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5) Changing or bleeding mole:

This is probably the urgent reason that brings in most of our patients, and rightfully so.

If a mole is changing or bleeding, the first question people ask is "Is it skin cancer?"
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This is the right question to ask, and generally speaking, we advise all patients to call us if they notice either a new or old mole that changes in any of these ways:

-Size
-Shape
-Color
-Overall symmetry
-New symptoms, especially bleeding

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Of course, the most worrisome type of skin cancer is melanoma, and though we diagnose many melanomas, we most often are diagnosing non-melanoma skin cancers, which are far more common than melanoma, and in many cases, not nearly as aggressive.
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Melanoma can honestly look like anything, but the classic appearance is an irregular mole with multiple colors:
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The 2 more common types of skin cancer are basal cell carcinoma (left) and squamous cell carcinoma (right):

The basal cell carcinomas often present as slowly growing bumps that bleed easily, and the squamous cell carcinomas tend to grow a little quicker, can also bleed easily, but often have a thicker scale or crust, and usually grow quicker.

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Any lesions that are concerning for skin cancer are appropriate to be seen, but particularly quickly growing lesions, lesions that are changing color or appearance in some way, bleeding lesions, or if you have a history of prior skin cancer (esp melanoma) or immune suppression.

I'll stop here for tonight.
I hope this helped shed light on some of the things we want you to be seen for in the clinic.

In part 2, I'll review conditions that we can see as telehealth vs delayed, and some things you can do at home to take care of your skin in the meantime.
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I know what I shared with you tonight was a whirlwind, and it barely scraped the surface, but I hope you have a little more insight into when you shouldn't wait to see your dermatologist.

Stay tuned for Part 2, bc this will likely be more relevant to most of you!

And I will end with the disclaimer that none of these tweets are medical advise or take the place of calling your doctor.

Drop me a line if you found this helpful or if there are questions you may have or other skin topics you'd like to learn about!

#StaySafeEveryone !

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