Hello, dear readers of the Journal of the Dermatology Nurses' Association (JDNA)! I am so excited to be writing to you for this issue. Recently, I had the fortunate opportunity to attend the annual Dermatology Nurses' Association (DNA) annual convention in Savannah, GA. What a great experience to reconnect with so many of my friends and colleagues and to meet new dermatology nurses for the first time. To be honest, participation in the DNA's annual convention is always a highlight of my year. I had not been to an in-person DNA meeting since the COVID-19 pandemic started, and it was everything I remembered. There is something to be said for spending extended time, even if just a few days, at a meeting of smart, knowledgeable, and enthusiastic dermatology nurses! I want you to know that you all inspire me with your passion and excitement for dermatology nursing.
During the annual convention in Savannah, Nancy Smail, RN, became the newest DNA president. During her welcome speech at the annual business meeting, she shared, “As President, I believe I can further the goals of the DNA by promoting the need for ongoing education, supported by furthering expanded offerings in the CE Center for dermatology nursing professionals so that they can be confident of their skill levels to provide quality care as well as providing the necessary support in these challenging times.” She then invited attendees to “take some time to discover what committees you'd like to join, the educational offerings available, the authorship possibilities with the JDNA, and the opportunities to promote awareness of issues and concerns in the area of health policy and advocacy. Your involvement is not dependent on the number of degrees or letters after your name but rather what experience and ideas you bring to the table.” Speaking as a representative of the organization, she said, “Our mission is to provide knowledge and expertise as well as practical assistance to make that possible. To that end, my theme for this next year is to expand our vision to further our mission and so I have named the theme ‘Exploring the Scenery.’” I would like you all to take a look around the DNA and prepare yourselves to be challenged, excited, and inspired by what you see. Don't limit your ability to explore and find something that suits you best” (personal communication, February 27, 2023). Will you join us in “Exploring the Scenery” of the world of dermatology nursing?
As usual, I sit in each lecture at the annual convention and try to take notes about important dermatology knowledge. I find the speakers always seem to add something to my knowledge, even if the lecture is on a topic I consider myself to be knowledgeable about! As per annual tradition, here are a few of the learning points I noted during the DNA's 2023 annual convention in Savannah:
- Nurses are agents of change.
- Staphylococcal scalded skin syndrome (SSSS) is the systemic version of bullous impetigo.
- If you see mucositis in the emergency room, be sure to check other mucous membranes as well.
- Reactive infectious mucocutaneous eruption may worsen after virus, for example, after COVID.
- Drug reaction with eosinophilia and systemic symptoms affects internal organs but does present with mucositis.
- Drug reaction with eosinophilia and systemic symptoms typically will be seen ~3–6 weeks after new medications.
- Comorbidities that can been seen with hidradenitis suppurativa (HS) include cardiovascular concerns, inflammatory disease, polycystic ovarian syndrome, inflammatory bowel disease, psychological issues, and arthritis.
- In HS, having the patient use zinc 100 mg with copper 5 mg daily may be helpful.
- In severe HS, consider stacking medication or using more than one medication at a time. For example, use a combination of rifampin, moxifloxacin, and metronidazole, or rifampin, levofloxacin, and metronidazole.
- Consider referring patients with HS to a specialty clinic if their symptoms persist.
- One may see squamous cell carcinoma (SCC) in areas with long-standing HS; be on the lookout for this, and don't hesitate to biopsy these areas, especially if there are lesions in the groin or buttock areas. These SCCs can be very aggressive and have a high mortality rate.
- Pediatric patients absorb Janus kinase inhibitors quicker than adults.
- Alopecia areata (AA) is associated with comorbidities such as metabolic disease, obesity, diabetes, cardiovascular disease, depression, and anxiety.
- There have been reports of growth of hair in patients with AA after fecal transplant.
- Interleukin-17E has had a positive correlation with depression, which has implications for patients with AA, atopic dermatitis, and psoriasis.
- Inverse psoriasis may have a glazed, smooth appearance.
- Six to nine percent of patients with breast cancer will have skin involvement.
- Inflammatory breast carcinoma will present with sudden pain, redness and swelling of the breast, and/or induration/edema (peau d'orange) and, in general, has a poor prognosis.
- After radiation for breast cancer, chronic radiation dermatitis may occur.
- Radiation morphea will present with firm, red to violaceous plaques.
- Angiosarcoma may occur secondary to radiation exposure or to chronic lymphedema, usually about 10 years after radiation.
- Mucous membranes of the vagina and non-hair-bearing sites of the vulva are resistant to steroid-induced atrophy.
- Lichen sclerosis presents with hypopigmentation and is more common in women than men. It presents in prepubertal and perimenopausal ages. Lichen sclerosis will present with atrophy, white parchment skin appearance, and itch; have a figure-8 pattern and a red border; and have erosions and maybe labial fusion and clitoral hooding. These patients are at a high risk for SCC development.
- Lichen simplex chronicus results in accentuated skin markings and has a chronic itch–scratch cycle.
- Cutaneous lupus erythematosus is not a systemic condition.
- Again, remember, a patient can develop SCC in areas of chronic inflammation, including cutaneous lupus.
- The “butterfly rash” of lupus will spare the nasolabial fold.
- Livedo reticularis is a cutaneous pattern that looks like a fishnet and is worse when patients are cold. If the patterns stay on the skin, this is called livedo racemosa and is associated with collagen vascular diseases.
- In a patient with clotting concerns, consider antiphospholipid syndrome and look at labs such as the lupus anticoagulant, beta-2 glycoproteins, and cardiolipin antibodies.
- Tumor necrosis factor inhibitors can cause drug-induced lupus.
- Skin cancer is the most common malignancy after transplant.
- After a transplant, there is a 4:1 presentation of SCC to basal cell carcinoma.
- Forty-four percent of patients with a transplant will develop multiple skin cancers.
- Nicotinamide 500 mg BID (not niacin) may be a good vitamin for patients after a transplant; this may help prevent skin cancers, but always check with the patient's transplant team first.
- Posttransplant, ultraviolet exposure is the only risk factor a patient can control. Ask them to avoid sun exposure, use sun-protective clothing, wear sunscreen, and avoid being outside at times when the ultraviolet index is high.
- Slip, Slap, Slop, and Wrap: Slip on a shirt, slap on a hat, slop on sunscreen, and wrap eyes with glasses.
- For posttransplant patients, consider referral to academic centers for those with a high burden of disease. They need frequent visits, consistent care, education, and multidisciplinary care.
- Educate your patients that pet deaths can occur if they are using Efudex. Have the patient take measure to ensure this does not happen.
- The best sunscreen is the one you are going to use.
- For post-organ-transplant patients with skin of color, the skin of the genital areas is the most common spot for cancer.
- Transplant Recipients International Organization is a good patient support organization; consider encouraging patients to look into this group.
- One definition of an emerging disease is “a disease that is appearing for the first time in a particular population or that existed previously but is now rapidly increasing or presenting in a different population.”
- Emerging diseases do not need to be tropical or communicable, and examples now might include diabetes or foot ulcers.
- A patient needs tyrosine to make melanin.
- More than 100 skin conditions associated with COVID-19 or COVID-19 vaccinations have been documented, for example, COVID toes.
- When taking photographs of a patient's skin, consider getting a consent; this consent should have a clause that allows for the consent to be revoked at any time, and this is an important feature of a patient consent form.
If you are like me, you find the days at a convention to be busy and filled to the brim with dynamic interactions with others who love nursing, and in this case dermatology nursing, as much as you do. I can't say enough to complement the DNA's program planning committee; I know how much work it must take to identify experts on specific dermatology topics and then invite them to be part of the DNA's annual event each year. All members of the program planning committee should be commended. I am sure they are already planning the DNA's 42nd annual convention in San Diego, CA, from March 6 to 9, 2024 (Figure 1). The theme for the event next year will be “Exceeding the Vision,” and I would ask you to consider how you might incorporate this theme in your own dermatology nursing practice over the next year.
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FIGURE 1.: DNA's 42nd annual convention in San Diego, CA.
Please consider setting aside time in your schedule to allow for you to attend this amazing event. I think you will also find this annual event to not only be educational but also offer the chance to reconnect with colleagues and friends and have potential to make new dermatology nurse connections as well! If you have good ideas for future DNA convention topics or speakers, I am sure the program planning committee would love to have your input; be sure to share your ideas with the DNA!
As always, looking forward to hearing from you.
Angela L. Borger
Editor-in-Chief
[email protected]
