What do syphilis and Rocky Mountain Spotted Fever have in common?
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, December 1, 2024
Besides the fact that both cause skin rashes, syphilis and spotted fever rickettsiosis (of which RMSF is one), are reportable to local/state health departments and are followed by the CDC’s National Notifiable Diseases Surveillance System. So are quite a few other infections that dermatologists may see at some point in their practice, including (but not limited to): anthrax, chancroid, coccidiomycosis, cryptococcus, gonorrhea, viral hepatitis, Lyme disease, measles, meningococcal disease, mpox, rubella, streptococcal and other toxic shock syndrome, tuberculosis and non-tuberculosis mycobacterial infections, vibrio, and in some states, varicella. Many infectious diseases with public health significance have prominent skin manifestations, placing dermatologists in a strategic position to recognize changing disease trends.
Early in my career, having never seen syphilis, I diagnosed my first case of secondary lues, soon to be followed by several other cases. Sure enough, the number of national syphilis cases spiked that year, mirroring what I was seeing in the clinic. A decade later, we started seeing Lyme in Vermont in patients with no history of travel to areas in which it was known to be endemic. It soon became clear that Lyme had made its way into the local deer (and deer tick) population. My experience with Lyme helped me better understand the importance of our role as reporters. I encourage you to become familiar with your state’s list of reportable diseases. Remember that even though the laboratory who performs the diagnostic/confirmatory test will report, clinicians must ALSO report. Some diseases, including measles (and, yes, it is back) must be reported immediately, even prior to lab confirmation. Reporting is required by law, but it’s also the right thing to do.
My residents know that I am a big advocate for safety in the clinic, so I’m sure our article this month on patient safety will be no surprise to them! I grew up in a family of aviators and became a pilot before I learned to drive a car. Checklists were part of the process then, and I still use at least mental checklists to minimize errors in clinical practice, especially when doing procedures. Assistant Managing Editor Allison Evans reviews best practices for avoiding common procedural errors in our feature article “A near miss.” It may be human to err, but relatively simple — and consistent — processes can help minimize this risk.
Am I the only one who didn’t understand what Medicare Advantage is? Thanks to Assistant Editor Emily Margosian, I now have a better understanding of this growing trend in which private insurance companies contract with CMS to provide Medicare-covered services to enrollees. Those of us providing care to enrolled patients may face the downside of this arrangement, including added administrative burden, reimbursement challenges, and difficulties accessing the network. Our feature article may help you better understand the challenges.
2025 is just around the corner and staff has offered us a sneak preview of the upcoming Annual Meeting! I offer a big shout-out for the onsite childcare for those planning to bring young children to the meeting. If you have not committed to coming, now is the time. This meeting offers an outstanding curriculum, Orlando fun at Universal CityWalk, and puppies! You won’t want to miss it.
