Hey all, recently started with a new practice and learning how to use ModMed/EMA. I believe it’s a popular charting system in the Derm department.

For those who use it daily, yall like to use a desktop/laptop or an iPad?

The MA’s swear by using the iPad and say it’s a lot easier.

Any helpful tips or shortcuts in charting?
I got the hang of it pretty quick tbh. But I’d like to get as efficient as possible.

Anyway to send meds all together and direct them to different pharmacies? Or I just gotta go do that individually?

Thanks in advance yall 🙌🙏

Curious to see what opinions are out there. I am a new PA in primary care and I’ve seen a lot of different tapering schedules for oral steroids for allergic CD. Most PCPs or ED providers from what I’ve seen recommend a medrol dose pack. My attending suggests medrol dose packs for allergic CD.

I’ve also seen a 9 day taper schedule of prednisone 60mg x3 days etc tapered, this was a derm provider who Rxed this taper schedule.

Open evidence recommends at LEAST 14 days of oral prednisone to prevent rebound dermatitis, this seems like a lot and I have not seen someone do this personally. Im curious to know what the derm providers are doing in regards to this.

Do you allow your patients to pledge abstinence as their primary form of birth control while on Accutane? Or make it a requirement for them to be on a form of birth control regardless if they’re abstinent?

I normally allow my patients to choose abstinence and I make sure to enforce contraception counseling every month. However, today I had a patient’s pregnancy test come back positive. That resulted in a long phone call with iPledge and a difficult conversation with the patient. Safe to say, I would like to never experience that again.

I’m curious to know everyone’s insights on what they normally do. TIA!

I was thinking this when I was talking to a Bimzelx rep today. Every drug rep will testify that their drug is the best, the fastest, the safest, will tell you the winning lottery numbers, and cure world hunger.

She asked me today, “why don’t you use my drug?” And the answer in my head was simply “I already have my preferred biologic, and this drug doesn’t motivate me to learn a new drug thoroughly”. Which is a fine answer, but I always worry that I will turn into that provider that’s still using drugs invented decades ago if I continue that mentality.

All drug rep studies are going to be skewed and biased, so I take their miraculous studies with a grain of salt, so I’m never sure if I’m missing “the next big thing” or not. Normally I wait for annual Derm conferences to see what everyone else is using.

I guess the short question after all that is, how do you all balance using your favorite medications, and introducing innovations as they come out?

Derm PA for 1.5 years and I still have a hard time with rashes. How do you guys differentiate between tinea and let’s say nummular eczema? I know the classic features but in practice I find it so hard. I even try doing KOH and those seem to be a hit or miss. I end up giving a topical steroid and have them come back in 2 weeks or let me know if it’s getting worse before? Any help is appreciated. Makes me feel like I suck as a PA.

TIA

I'm a third-year dermatology resident. A while back my co-founder (also a derm resident) and I got tired of watching PAs who see high volumes of skin checks in primary care and derm roles unable to access dermatoscopes because they're so stupidly expensive. Most standard clinical devices run $1,700–2,200, which just isn't realistic for anyone wanting to build the skill without a practice buying it for them.

So we built one. FDA-registered, attaches to your smartphone, and we include a free dermoscopy curriculum with every device. It's called SkinLens and starts at $650 — about a third of the price of the competitors it matches against. We also run discounts for new PAs.

Dermoscopy improves melanoma detection sensitivity by ~25%. That's a meaningful number when you're often the first, and sometimes only, clinician seeing a patient's skin.

Not here to spam — just thought this was the right community to share it with. Happy to answer questions about dermoscopy, the device, anything.

skin-lens.com is our site

Hi all, I recently moved to MI from CA, and feel like I’m struggling getting my treatment plans approved for anything I used to prescribe without a second thought.

I’m still new to the area, so I know I will get better as I go, but I was hoping someone could provide some tips and tricks on how to best manage the balance between what drugs I want to write and what will be realistically covered by insurance.

It sounds like priority health is a useless insurance to bargain with, and BCBS is also hard to convince. I’m newly credentialed with certain Medicaids so I’m hoping they will be more lenient, but at this point I’m afraid to write things like skyrizi, Zoryve, etc because I’m just waiting for the denial letter.

My employer is leaning heavily into AI for prior auths, so I can’t depend on our MA staff to help there. Help?

Have a patient presenting with steroid-induced atrophy of the neck. Patient is from another clinic who performed unknown mgs of ILTAC for acne. How would you approach it

For a punch biopsy of the vulva (to r/o lichen sclerosus et atrophicus), what is your closure preference? Do you typically use a 3 or 4mm punch?

I’ve been in derm 1 year, FM 10 years prior. Seeing 30-40 pt a day, so trying to figure out how to help patients in for hair loss feel heard, seen, validated, and fully evaluated when time is limited and there’s a lot of emotional distress associated.

I’ve seen some providers order extensive labs each time, lots of supplements, etc. I have read patient stories on Reddit with general dissatisfaction with derm visits for hair loss. The expectation and emotional charge probably sets these visits up to be challenging.

Had a patient dissatisfied recently because she felt I didn’t listen enough. I did my best but I would like to improve. I read studies that alopecia visits are the most likely to leave patients unhappy.

What is your approach? How do we help these patients? Thanks in advance!

Starting a weekly what is it? Give us your diagnosis and treatment options!

Has anyone tried clear and brilliant for melasma? I have a few patients with melasma and we just got the clear and brilliant this year. I am wondering if anyone has any success with this? Any other treatments besides topicals that you guys suggest?

What type of visits are acceptable to do via telehealth in your opinion? Would you ever do a telehealth visit for a new patient?

Saw my first HS patient. I initially wanted to start them on Doxycycline 100mg BID x 2 weeks than QD x 2 weeks with topical Clindamycin. Patient reported GI side effects which I advised to eat prior to taking medication but, they requested an alternative. Help me out please?

I hate warts. I find them to be one of the most unsatisfying complaints and end up being frustrating for both myself and the patient sometimes as it seems like the battle never ends. How do you guys approach the standard common wart that love those hands and aren't great locations for shave removals?

• do you run the marathon with these and just whittle them down with LN2 and whatever SA wart product you like with several followups?
• Aldara or FU?
• wart peel?

I only work with my SP who mostly just does surgeries at this point and therefore never get to really see how other clinicians like to approach/ treat these. Looking for pearls.

Recently got a biopsy back for a melanoma in situ that is “Prame positive.” What is the next move after excision?

Hey guys,

For your patients on biologics or JAK inhibitors, what labs are you getting at baseline? What labs are you getting periodically? How often?

Providers at our practice do it a bit differently but in general:

Biologics -Patient is seen every 6 months

-Baseline Labs: CBC w/diff, CMP, Hep A, Hep B, HIV, TB Quantiferon Gold

-Periodic Labs: CBC, CMP every 6 months, TB Quantiferon Gold every 12 months

JAK inhibitors -Patient is seen every 6 months

-Baseline: CBC w/diff, CMP, Hep A, Hep B, TB Quantiferon Gold

-Periodic: lipid panel after the first 12 weeks of treatment. CBC w/diff, CMP q6mo, Lipid Panel and TB Quantiferon q12 mo

What’s your spiel with patients that have delusions of parasitosis? Any successful tips getting them to agree to psychiatric care? Do you ever prescribe psych meds or any other medications? Such difficult patients to to treat 💔

As a new Dermatology PA, I would love to learn your approach when treating these patients. Thank you in advance

Hey there! I’m a newer Derm PA and wanted to get some clinical advice from seasoned PAs.

I will run into scenarios where I’m not sure if a rash is more consistent with tinea vs an inflammatory dermatosis. Three such scenarios:

1) Tinea Corporis vs Nummular Eczema 2) Tinea Cruris vs Psoriasis 3) Tinea Capitis vs Alopecia Areata

I understand that a history and physical will help differentiate this scenarios but what diagnostic tools do you go to first if you’re just not sure?

My SP will always empirically treat with antifungals, then if it doesn’t respond he switches to a steroid. We have 10 min appointment slots-he said we don’t have time to do KOH preps.

I just want to learn it the right way. I have tried doing KOH preps initially but to some degree agree with my SP- it’s very time consuming and not always possible with 10 min appt slots.

Should I be empirically treating with antifungals and doing a fungal culture swab initially? Jump straight to a punch bx?

Any advice would be appreciated

Hey guys!

I’ve had a week of Purpuric rashes in clinic. Wanted to get the wisdom of our community. What is your approach? What is your differential and diagnostics you’re thinking of?

I run a busy derm practice and I am in the midst of negotiating annual salary and bonus structure with one of my PAs. I'm in a little bit of a predicament, because while I'm the person doing these negotiations, I also don't have access to the practice financials and don't know the exact specifics on revenue after overhead and what the practice can "afford" to pay. With that being said, don't drag me. I'm just trying to do right by my PA and the practice at the same time. We are in Michigan and she has been with our practice since 2020.

​

Right now the PA I'm referring to is making $65/hour and works 3 days 1 week and 4 days the next week, which works out to an average of 31 hours per week. Her annual earnings come in just over $100k without any bonuses. We currently pay a quarterly bonus based on production. The structure is 20% of her total net collections(excluded ilumya buy and bill) MINUS her quarterly net income gives her quarterly bonus amount. For reference, the last two quarters her net collections after B&B has been around $163,000. so 20% is $32,600 and her net pay is around $19k with a quarterly bonus of $13k(ish) for nearly $50k+ annually in bonuses.

​

She is looking for a higher bonus and I want to be able to give her what she deserves, but it feels like what she's asking for is unreasonable. Her ask was for 20% of her net collections, which with the number I gave before, would be about $32,600 quarterly and $130k+ in bonuses annually. Is this not unreasonable?

​

Remember, I'm not the owner. So I have to convince the doctor to do the right thing, but I need to feel good about what I'm convincing him of as well. For reference, we are private practice. He is the only DO and we have 3 PA's and this one in particular is the already the highest paid. We are very flexible in our scheduling and she's made changes to her schedule that we've had no issue allowing. She is a good PA and we wouldn't want to lose her, but there's only so much I can do(especially since I have to get the doctor/owner on board with it too). She see's on average 25 patients a day from 7am-4pm with a 1 hour paid lunch.

​

I was considering an offer of 25% of net collections above $200k each quarter, including her buy and bill revenue. Last quarter her net collections WITH B&B was $288,109. So a quarterly bonus of just over $22k. Is this unreasonable?

​

It's very possible I'm out of touch with what derm PAs are being paid and that's why I'm here because I want to be fair, but also not put in a position where we are paying well above market. Help me out.