AT THE SUMMER MEETING OF THE AMERICAN ACADEMY OF DERMATOLOGY
NEW YORK – Five new Choosing Wisely recommendations have been issued by the American Academy of Dermatology.
The five new recommendations are:
Don’t use oral or injected corticosteroids as a long-term treatment for dermatitis.
Don’t use skin prick tests or blood tests such as the radioallergosorbet test (RAST) for the routine evaluation of eczema.
Don’t routinely use microbiologic testing in the evaluation and management of acne.
Don’t routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection.
The release of the list provides evidence that the AAD is “committed to serving as good stewards of limited healthcare resources,” according to AAD President Dr. Mark Lebwohl. who is also chair of the department of dermatology at Icahn School of Medicine at Mount Sinai, New York.
These diagnostic tests and treatments are often performed but are not necessarily appropriate. Some of the procedures may be reasonable in specific situations, he said, and this list “can help patients with skin, hair, and nail conditions start a conversation with their dermatologists about what tests and treatments are right for them.”
The five Choosing Wisely recommendations join the five recommendations issued in 2013 by the AAD. The Choosing Wisely campaign was launched by the American Board of Internal Medicine Foundation in 2012 and now has participation from more than 70 professional healthcare organizations.
Each of the recommendations from the AAD was issued with a background explanation. For example, it was specified that the adverse effects of long-term systemic corticosteroids make a favorable benefit-to-risk ratio unlikely in patients with chronic dermatitis. Also, determining the type of bacteria in an acne lesion has little value because it would be unlikely to change management decisions.
The five recommendations from 2103 were to avoid oral antifungal therapy for suspected nail fungus until infection has been confirmed; to refrain from further staging studies, such as sentinel lymph node biopsy, in early stage, localized melanoma; to refrain from Mohs micrographic surgery in non-melanoma skin cancer of less than 1 cm in size; to avoid oral antibiotics for atopic dermatitis in the absence of clinical evidence of infection, and to avoid topical antibiotics for infection prophylaxis for clean surgical wounds.
All 10 of the Choosing Wisely recommendations from the AAD were selected by an AAD-organized workgroup of board-certified dermatologists seeking to identify practices that are common but impose a strong potential for poor use of healthcare resources. In some cases, there is evidence that the opportunity for harm exceeds the likelihood of benefit. In others, no added value is expected from procedures that add cost.
The AAD list of 10 recommendations is part of more than 400 tests and procedures now identified in the Choosing Wisely campaign by the participating professional organizations. Importantly, this list is not just distributed to those delivering care but is expressly made available to patients to encourage them to discuss options with their physicians and to participate in determining which care is unnecessary to them.
The goal of providing patients with information that can help them participate in decisions about appropriate care is consistent with the full transparency that the AAD endorses, Dr. Lebwohl said. “We want to empower our patients to make informed healthcare decisions.”