Pearls from the ODAC Dermatology Conference

Patients with itch on the palms without a rash, especially in females, should spark consideration of primary biliary cirrhosis or cholestatic itch. Adam Friedman, MD

A major take home point regarding perioral rhytides is that fillers and toxins are not the primary treatment for this condition — and patients with etched-lines on the upper lip really need laser resurfacing. Joel Cohen, MD

When treating the orbicularis oris muscle with toxin, Dr. Cohen recommends 5-10 units of botulinum toxin total (Botox, Xeomin units) or 12-20 units of Dysport. Joel Cohen, MD

Perifollicular scaling and fibrotic white dots are seen in lichen planopilaris. Orthogonal white streaks can be seen in melanoma. Glomerular vessels are often seen in Bowen’s disease. Sima Jain, MD Dermoscopy

A direct neck lift in an aging woman will create a visible scar. The scar can be modulated by combining the use of lasers and injectables. The improved scar is a trade-off to the turkey gobbler neck that many older women are happy to accept. - Deborah Sarnoff, MD

SLNBx is not proven but may be useful for patients with ulcerated melanomas to identify stage III B patients who would qualify for immunotherapy - John Zitelli, MD

Long-horned ticks, which carry phleboviruses have been recently imported from east Asia into at least 7 U.S. states. - Justin Finch, MD

The presence of vascular polymorphism, milky-red areas, crystalline structures, and blue-gray dots are highly suggestive of amelanotic melanoma. - Sima Jain, MD

When performing skin tightening procedures, it is advisable to perform a procedure that reduces red and brown dyschromias in the same session; that way the patient sees some short term skin enhancement while waiting for the skin tightening effect to take hold (which often might take 1-4 months). - E. Vic Ross, MD

Modifying a Rosacea patient's skincare regime can be just as important as the medication prescribed. Substitute gentile cleanser, moisturizer and sunscreen for harsh astringents and scrubs. - Linda Stein Gold, MD

The debate on diet and acne has come full circle and there is some evidence that certain foods, especially those with a high glycemic index, can exacerbate acne. - Linda Stein Gold, MD

Treatment of the male glabellar complex and lateral canthi often requires higher doses of neuromodulators, which creates the potential for diffusion to adjacent musculature, and consequently an opportunity for the unopposed lateral fibers of the frontalis to pull the eyebrow superiorly. To prevent this from happening, place very small aliquots of neuromodulator (0.5 units, for example) where you do not want the eyebrow to peak, even if you aren't treating the forehead. Terrence Keaney, MD

BTX-A can be helpful to pretreat anticipated areas of large Mohs repairs, especially in high tension areas. The forehead, glabella, and crow’s feet are good anatomic locations for this treatment before Mohs or before repair of larger skin cancer defects on the face. Joel Cohen, MD

White streaks can be seen in melanoma and basal cell carcinoma. Telangiectasias, leaf-like areas and spoke wheel pigmentation are seen in basal cell carcinomas. The delta wing jet with contrail is specific for scabies. Sima Jain, MD - Dermoscopy

Non-surgical rhinoplasty is an extremely valuable procedure for male and female patients who are self conscious about the appearance of their nose. It can be performed safely and inexpensively in an office setting with no down time. Many patients may require a touch up at 6 weeks. - Susan Weinkle, MD

Benzoyl peroxide is a crucial part of acne therapy for every patient. Spironolactone and earlier use of isotretinoin should be considered instead of oral antibiotics. Hilary Baldwin, MD

Alpha-gal syndrome is a red meat hypersensitivity caused by tick bites. The classic measles triad is classic triad of conjunctivitis, cough, and coryza – The Three C’s. Koplik spots are one of the earliest dermatologic manifestations. Justin Finch, MD

Presence of 'jet with contrail' sign' and 'mini triangles' sign are specific for scabies. - Sima Jain, MD

Psoriasis is associated with systemic diseases including a risk of metabolic syndrome and cardiovascular disease. Management of psoriasis with systemic therapies might reduce the risk of cardiovascular disease. - Jeffrey Callen, MD

The new paradigm of onychomycosis and fungal infection treatment includes compatibility with nail polish, treatment of the entire disease and reservoir of fungus, and most importantly, treating the marathon not the sprint. - Neal Bhatia, MD

We often combine the (1) IPL and (2) KTP/pulsed dye/Q-alexandrite lasers in the same session. We use the IPL over broad flatter regions of dyschromia and then use the lasers with smaller spots to treat discrete lesions around the nose and other areas where the skin topography is a bit irregular. - E. Vic Ross, MD