As many of you long-time readers may know, attending the annual Dermatology Nurses’ Association’s (DNA’s) annual meeting is one of my favorite events of the year. The chance to spend a few days with my dermatology nurse friends and colleagues, in a robust learning environment, is always welcome. I have come to value sincerely both the social and academic nature of this event. I think a riff on the old trope, “come for the X and stay for the Y,” is appropriate. In this case, I come for the education and knowledge and stay for the friendships and connections. When I was a newer, and younger, nurse, I am not sure I could have qualified or quantified the importance my friendships with dermatology nurses would take on in my life. Don’t get me wrong; the education one gets at a DNA Annual Convention is out of this world, and I can’t say enough superlatives about the topics and presenters each year. However, each year, I most look forward to revisiting and rekindling the friendships that have been most enduring and supportive. In most cases, these are friends who I only see in-person this 1 week a year. The remainder of our friendship is supported and enhanced through calls, texts, and emails, which, I guess, is only a testament of the truly large reach of the connections of our organization. So, for those readers who are new to dermatology nursing or new to the DNA, I invite you to make plans to attend our next annual convention in 2020. I can guarantee you won’t be disappointed by the educational offerings, and I am willing to bet, if you are interested, you’ll likely make some new friends along the way.
Each year, I share with readers some of my notes from the annual convention. My usual disclaimer, that these points are not referenced in the usual style of journals but that they are just my notes taken from annual convention lectures, still applies. Please read this with the understanding that I have taken the best effort to provide you with accurate information, but if you find a bullet point that raises intrigue or further question, don’t hesitate to reach out to me. Please find a list below of the items I recently learned/relearned at the 2019 Annual DNA Convention:
- Pyoderma gangrenosum will present with nipple sparing.
- If you see bullous edges to pyoderma gangrenosum, consider acute myelogenous leukemia.
- With dermatomyositis, you will see joint erythema, joint papules, and ragged cuticles.
- When you see severe seborrheic dermatitis, you should think of neurological problems, Parkinson’s disease, or malignancies.
- If you see rapid-onset seborrheic dermatitis, consider ordering labs; would want to rule out infectious etiologies and malignancies.
- Consider using fillers to help patients with linear scleroderma.
- Men can have frontal fibrosing alopecia.
- When someone presents with severe dermatitis, be sure to check for crusted scabies.
- Nail pitting with alopecia universalis will be uniform.
- When you encounter alopecia areata that is disseminated, check for syphilis.
- Incontinentia pigmenti is almost always fatal for men.
- Hidradenitis suppurativa is more common in women.
- Patients with hidradenitis suppurativa often have quality of life scores that are worse than patients with psoriasis.
- Hidradenitis suppurativa will often present with a double open comedone.
- Gluteal hidradenitis suppurativa is often seen in patients who are thin, male, and smokers.
- Hidradenitis suppurativa has several known comorbidities including cardiovascular disease, inflammatory bowel disease, and squamous cell carcinoma.
- Patients with hidradenitis suppurativa are three times more likely to have carotid plaques, be obese, use tobacco, have elevated systolic blood pressure, have lower high-density lipoprotein, have higher triglyceride levels, have higher erythrocyte sedimentation rate and C-reactive protein levels, and have higher fasting serum glucose levels. Laboratory testing to check these factors should be done routinely.
- Lesions of Crohn’s disease can mimic hidradenitis suppurativa.
- Some patients with hidradenitis suppurativa may develop a rare type of squamous cell carcinoma called Marjolin’s ulcer. The patients who develop this feature are more likely to have had hidradenitis suppurativa for an extended time (20 years or more), have lesions to the buttocks, and be heavy smokers.
- Patients with hidradenitis suppurativa need to be offered medical and surgical management, wound care, psychosocial support, and lifestyle modifications.
- Antimicrobial therapies for hidradenitis suppurativa aim to reduce microbial burden, decrease odor, and reduce inflammation.
- Treatments for hidradenitis suppurativa may include clindamycin, doxycycline, minocycline, finasteride, spironolactone, metformin, acitretin, and adalimumab.
- When using adalimumab in hidradenitis suppurativa, use dosing that is twice of that used for psoriatic arthritis; it may take 6 months to see effect.
- Pregnancy makes hidradenitis suppurativa improve.
- The goal of wound care in hidradenitis suppurativa is to manage exudate, control bioburden, promote healing, decrease pain, improve quality of life, and decrease odor.
- For patient resources about hidradenitis suppurativa, see https://www.nobsabouths.com/ and https://www.hs-foundation.org/.
- In White patients, one in 38 will develop melanoma.
- The sweat of a hippopotamus is red and absorbs ultraviolet radiation, acting as a self-made sunscreen.
- In skin cancer, earlier detection results in finding a smaller tumor, which is often lifesaving. A 1-cm tumor has 50 million cancer cells, a 2-cm tumor has 420 million cancer cells, a 4-cm tumor has 3.4 billion cancer cells, and a 5-cm tumor has 6.5 billion cancer cells.
- To help track moles, you may consider MoleMapper, which is a cellphone application for iPhones: https://www.ohsu.edu/xd/health/services/dermatology/war-on-melanoma/mole-mapper.cfm.
- Hansen’s disease, leprosy, was first detected in 1879.
- Leprosy is, with rare exceptions, a human disease.
- Leprosy is spread by armadillos, although transmission is poorly understood.
- Leprosy affects men more than women, with a 1.5–2:1 occurrence.
- Mycobacterium leprae (M. leprae) is a bacterium that causes leprosy.
- M. leprae likes cooler temperatures and does not grow well in cultures.
- A biopsy or polymerase chain reaction is needed to confirm M. leprae.
- The first cases of leprosy were seen in 1500 BC.
- Ninety percent of leprosy infection is asymptomatic.
- Leprosy is not very contagious; one of 10 close contacts will also get the disease.
- Postexposure prophylaxis for prevention of leprosy is controversial.
- Leprosy will present with a red patch of skin with decreased sensation.
- There may be anesthesia of the hands and feet; may notice foot drop or neuropathy.
- Leprosy may also present with swelling of the face and earlobes as well as coarsened features.
- Leprosy treatment involves a combination of dapsone, rifampin, and clofazimine.
- Use of dapsone in patients with glucose-6-phosphate dehydrogenase deficiency may cause hemolytic anemia. Be sure to check glucose-6-phosphate dehydrogenase levels before use.
- When treating leprosy, reversal reactions are frequent.
- Erythema nodosum leprosum (ENL) is a Type 2 reaction in leprosy and is caused by an immune response to M. leprae.
- ENL flares can continue for years after cessation of mycobacteria antibiotic.
- ENL is treated with thalidomide, which works well to control symptoms.
- Patients with leprosy will often need rehabilitation medicine to help with hand neuropathy.
- A good Web site to use for more information about leprosy is https://www.hrsa.gov/hansens-disease.
- Leprosy is a reportable disease.
- Checking IgE levels in atopic dermatitis is not routinely recommended.
- “There is no such thing as a nonallergenic product.”
- For patients with atopic dermatitis, lotion formulations have a lot of alcohol in them so stick to use of cream formulations.
- There is no role for antihistamines in the treatment of itch from eczema.
- There is no evidence for food avoidance in patients with atopic dermatitis.
- Dupilumab can decrease pruritis in patients with atopic dermatitis.
- IL-31 is known as the “itch interleukin.”
- For acne fulminans treatment, don’t start right away with isotretinoin; start first with oral steroids × 1 month. Start the taper off the oral steroid only once the patient has started the isotretinoin.
- If left untreated, molluscum contagiosum will be 50% better in 12 months and 70% better in 18 months.
- There are no treatments approved by the U.S. Food and Drug Administration for molluscum contagiosum.
- Vitiligo treatments to consider include topical steroids, tacrolimus, ultraviolet light treatments, steroid injections, and surgery therapies including punch biopsies.
If you were at the meeting in Washington, DC, this year, what lessons were you able to learn while in attendance? What tidbit of knowledge have you been able to apply to your practice? Please feel free to share your answers with me at firstname.lastname@example.org, on JDNA Twitter at @JournaloftheDNA, or on our Facebook page at https://www.facebook.com/JournaloftheDNA/. We’d love to hear what you took away from the lectures. If you were not able to be in attendance at the annual convention this year, please consider joining us next year for the DNA’s 38th Annual Convention, which will be on March 18–21, 2020, in Denver, CO. Jane Glaze, our current DNA president, invites you all to mark your calendars to join the excitement of this annual event. She states, “Our talented 2020 Program Planning Committee is putting together a convention with speakers and networking events that will inspire and engage you in learning and leading in dermatology nursing. Locals Peggy Vernon, DCNP and Diana Pencheva, DCNP co-chair this committee and are excited to host YOU in their hometown of Denver. The American Academy of Dermatology Convention will also be in Denver following the DNA Convention. Now is a good time to coordinate your work schedules and save the date for these exciting educational and networking opportunities. I hope to see you in Denver!”
As always, I am looking forward to hearing from you,
Angela L. Borger
Editor in Chief