The American Academy of Dermatology releases ‘Choosing Wisely’ list of treatments physicians and patients should question


The American Academy of Dermatology has released a list of treatments and screenings that may not always be necessary in dermatologic medicine.

The list of recommendations is part of the American Board of Internal Medicine Foundation’s "Choosing Wisely" campaign, which aims to educate patients and physicians about unnecessary and potentially harmful testing and treatment.

The AAD’s list was created by members of the its Board of Directors; Council on Science and Research, Health Policy and Practice; Council on Government Affairs, Health Policy & Practice; Research Agenda Committee; Clinical Guidelines Committee; Access to Dermatologic Care Committee; Patient Safety and Quality Committee; Resource-Based Relative Value Scale Committee; and the Workgroup on Innovative Payment and Delivery Reform.

The AAD’s Choose Wisely recommendations are as follows:

• Do not prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection. About half of nails with suspected fungus do not actually have a fungal infection. Other nail conditions such as dystrophies may look similar in appearance, so it is important to first confirm the presence of nail disease before starting treatment.

• Do not perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma. These tests do not improve survival. Patients with early, thin melanomas have a very low risk of the cancer spreading to the lymph nodes and other parts of the body, and a 97% 5-year survival rate. Also, baseline blood tests and radiographic scans have high false-positive rates and are not the most accurate for detecting cancer that is spreading.

• Do not treat uncomplicated, nonmelanoma skin cancer less than 1 centimeter in size on the trunk and extremities with Mohs micrographic surgery. The use of Mohs micrographic surgery in healthy individuals with low-risk, small, superficial, or nonaggressive squamous cell carcinomas and basal cell carcinomas is not appropriate for skin cancers on the trunk and extremities, as the benefits do not outweigh the risks on these parts of the body. However, Mohs micrographic surgery may be called for in skin cancers on the hands, feet, ankles, shins, nipples, or genitals, as they have a higher risk for recurrence and may require additional surgical considerations.

• Do not use oral antibiotics for treatment of atopic dermatitis unless there is clinical evidence of infection. The presence of Staphylococcus bacteria on the skin of children and adults with atopic dermatitis is common. Though it is widely believed that Staphylococcus bacteria may contribute to skin inflammation, oral antibiotics have not been shown to reduce the symptoms or severity of atopic dermatitis. The use of antibiotics may also lead to antibiotic resistance and cause side effects such as hypersensitivity reactions.

• Do not routinely use topical antibiotics on a surgical wound. This practice has not been shown to reduce the rate of infection, compared with using nonantibiotic ointment or no ointment. Topical antibiotics can aggravate open wounds, thus delaying the healing process. Also, topical antibiotic use carries a significant risk of developing contact dermatitis. Antibiotics should only be used when wounds show symptoms of infection.

For more information about the campaign, visit the AAD website.

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