Life is not always pretty.
From the Editor
Dr. Schwarzenberger is the former physician editor of DermWorld.
By Kathryn Schwarzenberger, MD, FAAD, May 1, 2024
I have been a doctor for more than 30 years and have practiced in a wide variety of regions, ranging from a small rural community to a larger urban city. Illicit drugs have, unfortunately, found their way into every setting, and I, as I suspect most of us, have cared for patients with problems related to their use. Many of them have shown up with skin problems related to their drugs of choice, and as the popularity and availability of certain drugs have changed over time, so have the skin findings. This month, Assistant Editor Emily Margosian speaks with colleagues familiar with some of the newer skin reactions we may be seeing these days, including xylazine-induced skin ulcers, kratom-associated photosensitive hyperpigmentation, and methamphetamine “mites.” Recognition of these conditions requires a high index of suspicion, and it can be easy to miss these diagnoses at first. Hopefully, our article will help you recognize these conditions if — or perhaps I should say when — you see them. We offer helpful suggestions for approaching patients about suspected illicit drug use; this conversation can be difficult, but building a trusting, nonjudgmental relationship with your patient may be lifesaving.
It’s tough being a kid and coming to the doctor’s office can be a scary experience, especially when procedures are involved. Unfortunately, sometimes a biopsy or other procedure is necessary and ensuring safe and adequate anesthesia can be more complicated than providing the same care in adults. Can we do anything to make it less scary? And how can we use anesthesia safely in children? The nuance of doing procedures in children reminds us yet again that children are not just little adults. Our feature article this month “Alleviate the Ouch” calls on experts in both pediatric dermatology and pediatric anesthesiology to review best practices for using anesthesia in children. Concerns raised about potential neurotoxic effects of anesthesia in young children led the FDA in 2017 to issue a drug safety communication warning about potential risks when used in children under age three. Fortunately, subsequent studies over the past seven years have been reassuring, allowing us to feel more comfortable using general anesthesia when needed. Whether or not you provide direct care to children, I hope you find this insightful article useful for you and your patients!
Dealing with the administrative side of medicine is never easy, but several of our articles this month will hopefully help! Our annual MIPS update reviews all the necessary activities for 2024. This month’s Coding Consult clarifies the use of the visit complexity add-on code G2211. While some of our visits will not likely qualify, this code can be used when providing longitudinal care related to a patient’s single, serious, or complex condition. And, on a brighter note, we can share excitement about the Academy’s advocacy wins with the iPLEDGE program, which promises to be less onerous in the near future as a result of changes in the program prompted by the efforts of our very dedicated members and leaders!
It’s hard to believe it’s already May. May is a great month, with Cinco de Mayo, Mother’s Day, and Memorial Day. Melanoma Monday is May 6 this year. It’s always been one of my favorite months, offering all the beauty of spring with the promise of summer to come. Kind of like Friday night before the weekend! I hope you take some time to enjoy the beauty that surrounds you.
