Dermatologists provide list of specific treatments, procedures not required for medical care

American Academy of DermatologyOct 29 2013

The American Academy of Dermatology (Academy) today released its list of specific treatments and procedures related to skin health and care that are not always necessary. The Academy developed its list as part of Choosing Wisely®, an initiative of the ABIM Foundation to help patients talk with their doctors about medical tests and treatments that may be unnecessary to effectively care for their condition.

"The American Academy of Dermatology is strongly committed to dermatologists serving as effective stewards of limited health care resources by assisting patients in making informed health care decisions," said dermatologist Brett M. Coldiron, MD, FAAD, incoming president of the Academy. "It is important for patients with skin, hair or nails concerns to talk with and ask questions of their dermatologist about medical care they may not need. This Choosing Wisely® list can help patients save time and money by avoiding medical treatments and tests their condition may not require."

Dermatologists made the following recommendations:

1.Don't prescribe oral antifungal therapy for suspected nail fungus without confirmation of a fungal infection. Approximately half of all patients with suspected nail fungus do not have a fungal infection.

2.Don't perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma because they do not improve survival. The five-year survival rate for patients with these types of melanoma is 97 percent and there is a low risk of the cancer spreading to other parts of the body.

3.Don't treat uncomplicated, non-melanoma skin cancer less than one centimeter in size on the trunk and extremities with Mohs micrographic surgery. In patients with skin cancer on certain parts of the body, the risks of this specialized surgical procedure outweigh the benefits.

4.Don't use oral antibiotics for treatment of atopic dermatitis unless there is clinical evidence of infection. Antibiotic therapy has not been shown to reduce the signs, symptoms or severity of atopic dermatitis that is not infected.

5.Don't routinely use topical antibiotics on a surgical wound. The use of topical antibiotics on a clean surgical wound has not been shown to reduce the rate of infection compared to the use of non-antibiotic ointment or no ointment. This recommendation does not apply to wounds received outside a surgical office, for example, scraped knees or household accidents resulting in a cut or abrasion.

The items on the Choosing Wisely® list were selected by an Academy workgroup comprised of board-certified dermatologists who identified areas with the greatest potential for overuse/misuse, a need for quality improvement and the availability of strong evidence-based research to support the recommendation. The final list was reviewed and approved by the Academy's Council on Science and Research and the Academy's Board of Directors.

To date, more than 80 national and state medical specialty societies, regional health collaborative and consumer partners have joined the conversations about appropriate care. With the release of these new lists, the campaign will have covered more than 250 tests and procedures that the specialty society partners say are overused and inappropriate and that physicians and patients should discuss.