SKIN The Journal of Cutaneous Medicine

Uncle Charlie: Dennie-Morgan Lines

Domenica Del Pozo — Mon, 13 May 2024 00:00:00 +0000

No Abstract.

Utilizing Data from Electrical Impedance Spectroscopy Significantly Improves the Decision to Biopsy Pigmented Skin Lesions Beyond Clinical Evaluation and Dermoscopy

Danny Zakria, Nicholas Brownstone, Klaus Fritz, Carmen Salavastru, Darrell Rigel — Mon, 13 May 2024 00:00:00 +0000

Background: Even the most experienced dermatologists may forego a biopsy on as many as one-third of malignant melanomas (MMs). Electrical impedance spectroscopy (EIS) is a noninvasive technology that send a painless, very low voltage electrical current through a pigmented lesion to determine if it is benign or malignant. This study aimed to determine if EIS data can improve the decision to biopsy a pigmented lesion even beyond dermoscopy.

Methods: A survey with 49 images of MMs, severe dysplastic nevi (SDNs), and benign pigmented skin lesions (PSLs) was shown to dermatologists at a national conference. They were asked if they would biopsy the lesion after first seeing the clinical image, then again after seeing the dermoscopic image, and again after receiving the EIS score.

Results: 151 dermatologists completed the survey. Respondents significantly increased correct biopsy decisions (biopsy MMs and SDNs and forego biopsy of benign PSLs) with the addition of dermoscopy versus clinical image alone for MM (78.5% vs. 56.2%, p<0.01) and SDN (62.7% vs. 43.8%, p<0.01). Participants also demonstrated a statistically significant increase in correct biopsy decisions beyond the dermoscopic evaluation when integrating the EIS score for MM (86.2% vs. 78.9%, p<0.01), SDN (68.1% vs. 62.7%, p<0.05) and benign lesions (58.7% vs. 48.0% vs, p<0.01).

Conclusion: EIS was able to further improve the rate of correct biopsy choice for MMs and SDNs even beyond dermoscopic evaluation. While dermoscopy worsened diagnostic accuracy for benign PSLs, EIS results were able to significantly improve decision making for these lesions as well. This study demonstrates the clinical utility of EIS technology for improving melanoma diagnosis.

Merkel cell carcinoma primary sites and overall survival: The prognostic indications of head and neck tumors

Marcus Elias, Joshua Burshtein, Victoria Sharon — Mon, 13 May 2024 00:00:00 +0000

Trend Analysis of Industry Payments to Dermatologists in the United States from 2015-2022

Nicole Hardy, Christian Gronbeck, Hao Feng — Mon, 13 May 2024 00:00:00 +0000

Background: Open Payments, established in 2013 to address concerns about industry-driven healthcare influence, aims to enhance transparency regarding financial relationships between industry and physicians. This study investigates trends in industry payments to dermatologists between 2015 and 2022, a topic that has not been explored since a prior characterization in 2014.

Methods: We conducted a retrospective review of United States dermatologists appearing in the Open Payments database between 2015 and 2022. A Joinpoint analysis was performed to calculate the average annual percentage change (AAPC) across study years. A sensitivity analysis excluding 2020-2021 data was conducted.

Results: This study reviewed 2,616,289 payments totaling $494,271,790 made to dermatologists during the study period. The average annual percentage change (AAPC) across these years for the number of recipient dermatologists, total value of payments, and total number of payments were 1.5%, 5.5%, and 3.9%, respectively, with confirmed positive growth when excluding data from 2020-2021.

Conclusions: Payments per dermatologist have increased over the years, even when adjusting for inflation, but this growth is likely attributed to the overall expansion of the specialty. Most individual payments to dermatologists were less than $50. However, a substantial proportion of dermatologists (60%) received total payments exceeding $1000 during the study period. These findings suggest a longitudinal nature of industry-dermatologist relationships and emphasize the financial significance of payments over time. Notably, the impact of physician-industry relationships on patient care in dermatology remains debated but may influence medical decision-making and engender patient distrust.

Scratching the Surface: A Paraneoplastic Pruritus Phenomenon in a Mediastinal Mass

Mon, 13 May 2024 00:00:00 +0000

Real-World Performance of a Noninvasive Cutaneous Melanoma Rule-Out Test: A Multicenter U.S. Registry Study

Mon, 13 May 2024 00:00:00 +0000

Introduction: Non-invasive adjuncts to visual assessment of pigmented lesions may reduce biopsies of benign lesions without compromising melanoma detection. A non-invasive genomic melanoma rule-out assay analyzes RNA extracted from stratum corneum cells for PRAME and LINC00518, two genes commonly expressed in melanomas but less often in benign lesions. This study sought to characterize performance of this test in a large patient cohort tested in the real-world clinical setting.

Methods: The test was applied to suspicious pigmented skin lesions at 63 U.S. dermatology and primary care practices. Test results (positive / negative) were compared to pathology diagnoses (melanoma / not melanoma) for lesions that were biopsied and to follow-up visual examination for those that were monitored.

Results: Of 19,653 total lesions evaluated, 17,858 (90.87%) tested negative. Biopsy results and / or follow-up examinations were available for 5,096 lesions, with median and mean follow-up duration of 352 and 341 days, respectively. For melanoma, sensitivity was 95.8% and specificity was 69.4%. Positive predictive value (PPV) was 13.4%, and NPV was 99.7%. For melanoma and ‘borderline’ lesions combined, sensitivity was 94.2%, specificity was 71.2%, PPV was 20.8%, and NPV was 99.3%.

Conclusion: The results suggest this noninvasive test can facilitate distinction of melanoma from its benign simulators, increasing the proportion of pigmented lesions that can be safely managed with surveillance rather than biopsy and/or excision.

Unusual Presentation of Marginal Zone Lymphoma

Akash Rau, Anne Opalikhin, Kaitlin Kreuser, Richard Ashack, Kurt Ashack — Mon, 13 May 2024 00:00:00 +0000

Primary cutaneous B-cell lymphomas (pcBCLs) are non-Hodgkin lymphomas that present with exclusive cutaneous disease at the time of diagnosis. The lesions may be indolent, subtle, or waxing and waning, making the diagnosis challenging. The ear is an uncommon location, and its frequency of involvement remains unknown. A retrospective analysis of a single patient with primary cutaneous marginal zone lymphoma of the ear. The patient was a 44-year-old male who presented with erythematous tender nodules on the left superior posterior helix. Shave biopsy revealed mixed dermal lymphoid infiltrate with eosinophils and telangiectasias. The patient was diagnosed with angiolymphoid hyperplasia with eosinophilia. Multiple treatment regiments were trialed but failed due to lack of therapeutic response, relapse, and clinical progression. The patient ultimately underwent Mohs surgery with biopsy findings that demonstrated CD-20 positive cells. Evaluation with B-cell histopathology and gene rearrangement studies confirmed the diagnosis of marginal zone lymphoma. This case report shows a unique presentation of marginal zone lymphoma of the ear, initially diagnosed as angiolymphoid hyperplasia with eosinophilia. Our findings demonstrate a relatively rare presentation for this disease and highlight the challenges in diagnosing primary cutaneous marginal zone lymphoma.

Identifying a Case of an Atenolol-induced Papulosquamous Eruption

Daniel Fischer, Joseph Gofman, Graham Litchman, Sourab Choudhury — Mon, 13 May 2024 00:00:00 +0000

While beta-adrenergic blocking agents (beta blockers) are generally safe, their incidence of medication-induced cutaneous eruptions remain under-recognized in the primary care setting. The adverse dermatologic effects of these medications may arise in the days to years following drug initiation, contributing to its delayed diagnosis and management. Here we report a case of a papulosquamous drug eruption in an older adult due to atenolol. We also discuss pertinent morphologic findings, diagnostic methods, management, and how to distinguish this type of eruption from other papulosquamous disorders.

Incontinentia Pigmenti In a Female Infant: A Case Report

Rebecca Lapides, Hannah Porter, Deborah Cook, Keith Morley — Mon, 13 May 2024 00:00:00 +0000

Incontinentia pigmenti (IP) is an X-linked disorder characterized by a variety of findings that affect different systems, including cutaneous, ophthalmologic, neurologic, and dental. The cutaneous findings occur in 4 consecutive stages, generally referred to as vesicular, verrucous, hyperpigmented, and atrophic. The first stage is often observed in infancy, and this may be the first indication of IP in an infant. Early diagnosis is critical so that interventions can be implemented as soon as possible to monitor for complications and mitigate the effects of IP given the potential for multisystem involvement. Here, we describe a case of IP that was diagnosed in a female infant with no prior family history of IP. Prompt diagnosis and family counseling is critical, as early interventions can help optimize patients’ quality of life and genetic testing may help families make informed future family planning decisions.

Chronic Nonbacterial Osteomyelitis, Hidradenitis Suppurativa, and SAPHO Syndrome

Mon, 13 May 2024 00:00:00 +0000

Introduction: Synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome may represent one side of a spectrum of disease that also includes chronic nonbacterial osteomyelitis.

Case: A 23-year-old male with bone pain in the anterior chest, shoulder, clavicles, left elbow, and left ankle presented to rheumatology clinic after multiple evaluations for infectious osteomyelitis. Imaging and deep bone biopsies of affected areas were consistent with chronic osteomyelitis, with labs notable for elevated erythrocyte sedimentation rate, C-reactive protein, and positivity for HLA-B27. A full skin exam was consistent with hidradenitis suppurativa, and he was started on infliximab and methotrexate with improvement in both his osteoarticular and skin symptoms.

Conclusions: Patients presenting with features of follicular occlusion or neutrophilic dermatoses in conjunction with bone pain should be evaluated for SAPHO/CNO. In patients with SAPHO/CNO with vertebral involvement, bisphosphonates in addition to anti-inflammatory medications (such as methotrexate and TNF-inhibitors) can be effective.

Eruptive Epidermal Inclusion Cysts in a Renal Transplant Patient on Tacrolimus

Meredith Burns, Hoang Ho-Pham, Lauren Kole — Mon, 13 May 2024 00:00:00 +0000

Epidermal inclusion cysts are common cutaneous lesions that can develop anywhere on the body. While benign, these cysts can become inflamed and symptomatic. Symptomatic epidermal inclusion cysts can be treated with intralesional steroid injections or antibiotics, but surgical excision is often necessary for definitive treatment. We present a unique case of tacrolimus-induced eruptive epidermal inclusion cysts on the head and trunk of an adult male post-renal transplantation. Physicians should be familiar with this potential adverse effect, especially due to the difficulty of obtaining definitive treatment for a multitude of epidermal inclusion cysts.

Epithelioid Angiosarcoma: A Diagnostic Dilemma with Clinically and Histopathologically Overlapping Features

Mon, 13 May 2024 00:00:00 +0000

Cutaneous angiosarcoma is a rare malignancy of endothelial cell origin that commonly presents in the head and neck region of elderly individuals and is known for high rates of lymph node metastasis and mortality. There is significant variability in the histopathologic features, and immunohistochemistry is necessary to help differentiate epithelioid angiosarcoma from lesions it may clinically mimic. Here, we report a rare case of poorly differentiated epithelioid angiosarcoma on the trunk initially diagnosed as poorly differentiated squamous cell carcinoma (SCC) on shave biopsy. A 56-year-old man presented for a full-body skin examination significant for a 5.6 x 2.8 mm brown-black macule on the left superomedial posterior trunk and a 5.0 x 2.7 mm pink, ulcerated papule on the right inferior posterior trunk. On histopathology, one lesion was found to be melanoma in situ, and the other showed ulcerated and infiltrative, poorly differentiated SCC. Post-excision histologic analysis of the right inferior back lesion revealed tumor cells immunoreactive to vimentin, ERG, and CD31 (PECAM-1). These findings suggested that the lesion previously diagnosed as SCC was an invasive, poorly differentiated epithelioid angiosarcoma. The patient underwent 40 sessions of radiotherapy. Epithelioid angiosarcoma occurring outside of the conventional epidemiologic profile is believed to portend higher mortality rates. This case highlights the importance of thorough clinical evaluation and appropriate histopathologic diagnosis of an aggressive neoplasm unlikely to present in this location. Further studies are required to explore potential risk factors, effective treatments, and long-term outcomes in patients with epithelioid angiosarcoma.

Intralesional Kenalog Injections for Recurrent Cutaneous Rosai-Dorfman Disease (RDD) in the Lower Extremity

Victoria Jiminez, Lawangeen Zeb, Lauren Graham, Anna Gray — Mon, 13 May 2024 00:00:00 +0000

Rosai-Dorfman disease (RDD) is a rare disorder of histiocytic origin with nodal, extranodal, and cutaneous classifications often presenting as eruptive rashes, most commonly affecting the face, trunk, and thigh. Due to its rarity, no consensus exists regarding standard of care for these lesions, as most knowledge regarding treatment is provided by case reports. To our knowledge, we report the first case of a patient with a recurrent lower extremity mass consistent with cutaneous RDD, despite surgical excision and topical steroids treatment. A 51-year-old female presented with recurrent RDD after failed treatment with clobetasol ointment and surgical excision at an outside practice. Examination revealed violaceous plaques with overlying scale, without lymphadenopathy. With the failure of the previous excision, the patient was prescribed 5 mg/ml intralesional Kenalog (ILK) injections to suppress inflammation of the lesion. She experienced improved clinical response to treatment and remission of active disease with residual post-inflammatory hyperpigmentation at 10 months after two rounds of injections, although the patient reported vast improvement at 5 months as well. Treatment of RDD is difficult due to its rarity, hindering clinical trial development. Therapeutics reported to be efficacious include topical, intralesional, and systemic steroids, retinoids, methotrexate, chemotherapy, cryotherapy, phototherapy, and radiation. Clinical management is variable and often requires multiple forms of treatment on a case-to-case basis, highlighting the need for larger clinical studies to establish a standard of care. Our case poses interest in the use of ILK for RDD and should be considered in recurrent cases after prior surgical excision.

Type I Collagen Matrix with Polyhexylmethylene Biguanide in a Chronic Lower Extremity Wound

Kawaiola Aoki, Simona Bartos — Mon, 13 May 2024 00:00:00 +0000

Chronic wounds pose a significant healthcare challenge, affecting millions of individuals and incurring substantial healthcare costs. In this case study, we present the successful treatment of a chronic lower extremity wound in an 80-year-old female using PuraPly™, a Type I collagen matrix embedded with polyhexylmethylene biguanide (PHMB). The patient initially sustained the injury, which had become infected and resistant to conventional treatments. After applying PuraPly™, the wound showed rapid improvement, ultimately resulting in complete closure. Our findings highlight the utility of PuraPly™ as an effective intervention for chronic wounds, thereby improving treatment outcomes and the quality of life for these patients.

Safety and Efficacy of Combination Therapy of Upadacitinib and Biologic Agents for Treatment-Resistant Psoriasis and Psoriatic Arthritis

Shivkar Amara, Aarav Patel, Mark Lebwohl — Mon, 13 May 2024 00:00:00 +0000

Importance: Although there are many available treatments for psoriasis and psoriatic arthritis (PsA), there are patients resistant to standard conventional therapy. For these patients, combination therapy of biologic agents and upadacitinib may be a viable alternative option; however, there is limited data on concomitant usage.

Objective: To evaluate the safety and efficacy of combination therapy of upadacitinib and biologic agents for the treatment of refractory psoriasis and psoriatic arthritis.

Design: We report the results of a retrospective chart review of 3 patients in a single practice treated with a combination of upadacitinib and biologics for psoriasis and PsA. The risks, benefits, and safety warnings of combination therapy of upadacitinib and biologic agents were discussed before initiation. After shared decision-making with the provider, patients were placed on a trial of combination therapy.

Results: All three patients, previously refractory to monotherapy, experienced significant improvement of their symptoms while on combination therapy. No adverse reactions (malignancy, cardiovascular events, venous thromboembolism) occurred during treatment. However, one patient experienced a shingles outbreak and diverticulitis while on combination treatment. Further studies are needed to determine long-term efficacy with a larger sample size.

Coexisting Psoriasis and Anti-P200 Pemphigoid: A Case Report

Samantha Hunt — Mon, 13 May 2024 00:00:00 +0000

Psoriasis and autoimmune bullous diseases have been shown to coexist in certain patients. Notably, anti-p200 pemphigoid has been associated with psoriasis. We present a case of a patient who presented with psoriasis and was also found to have anti-p200 pemphigoid. This case highlights the importance of recognizing this association, which may aid in diagnosis but also poses an interesting challenge in co-managing these two entities.

Pulse Dosing Vismodegib Therapy as an Effective Treatment of Basal Cell Carcinoma: A Case Report

Marisa Tandy, Caroline Kruithoff, Michael Noparstak — Mon, 13 May 2024 00:00:00 +0000

Basal cell carcinoma (BCC) is a common nonmelanoma skin cancer, frequently present on the face and head. BCC is linked to the Sonic Hedgehog (Shh) signaling pathway. Mutations within the Shh signaling pathway, involving the activation of the ligand-independent pathway by the Smoothened (Smo) protein, can lead to unregulated proliferation of basal cells, resulting in BCC. Vismodegib, a hedgehog pathway inhibitor, is a chemotherapy drug approved for targeting the Shh signaling pathway. We herein report a presentation of nodular BCC in a Caucasian female who was treated with Vismodegib. This case highlights the effectiveness of pulse dosing treatment to minimize side effects.

Primary Cutaneous Apocrine Carcinoma: Diagnostic and Management Difficulties of an Uncommon Neoplasm

Mon, 13 May 2024 00:00:00 +0000

Primary cutaneous apocrine carcinoma (PCAC) is a rare adnexal neoplasm. Due to its clinical presentation, it can mimic other tumors, especially metastasis. We present a case of primary apocrine carcinoma of the axilla mimicking breast carcinoma metastasis in a 54-year-old woman. The patient presented with a painless, lobed, and erythematous nodule in the left axilla of one year duration. We suspected an adnexal neoplasm but also considered metastasis from breast carcinoma. Histological examination revealed apocrine proliferation. Immunohistochemistry stains of tumor cells were positive for AE1/AE3, and negative for CK7, CK20, p63 and GATA3. Radiological explorations did not reveal any signs of malignancy. Considering all these features, the conclusive diagnosis was primary cutaneous apocrine carcinoma. Treatment was wide excision without adjuvant therapy, and no recurrence was noted. Due to the rarity of this carcinoma, its various clinical presentations, and histological overlaps with breast cancer metastasis, making the diagnosis may be challenging. A comprehensive evaluation of all findings is necessary to rule out other tumors. There is any consensus on the management strategy. The standard treatment is surgical excision, but adjuvant therapies such as radiotherapy or chemotherapy can be proposed in advanced stage disease.

A Case of Refractory Cutaneous Sarcoidosis Successfully Treated with Infliximab

Roudha Jassim Al-Dehneem — Mon, 13 May 2024 00:00:00 +0000

Sarcoidosis is an inflammatory granulomatous disease affecting multiple organs with cutaneous sarcoidosis occurring in 25% of patients. There are several treatment options available, but alternative therapies should be considered in patients with refractory disease to standard intervention. Though they are not been FDA-approved for sarcoidosis, TNF-a inhibitors have demonstrated significant therapeutic intervention targeting proinflammatory cytokines involves in pathogenesis of sarcoidosis. Herein, we present a case of refractory cutaneous sarcoidosis successfully treated with infliximab therapy with significant hair regrowth on the scalp.

Sealing the Deal: Embracing Hydrocolloid Dressings for Post Procedure Dermatologic Care

Justin W Marson, Rebecca M. Chen, Michelle Schwartz, Daniel M. Siegel — Mon, 13 May 2024 00:00:00 +0000

Hydrocolloid dressings provide a maintenance-free method of post-procedural wound care. Commercially available hydrocolloid dressing, however, may not be accessible or affordable for all procedural patients. Here we report a case of a patient with a fibroepithelioma of pinkus treated with electrodessication and curettage with post-procedural wound care managed with an over-the-counter hydrocolloid “pimple” patch.

Lymphocytoma Cutis - A Case Report

Grace Hingtgen, Rafael Mojica, Douglas Robins — Mon, 13 May 2024 00:00:00 +0000

Without tissue biopsy and holistic review of presentation, histology, and immunohistochemistry, lymphocytoma cutis (LC) can often be misdiagnosed as other benign conditions or malignant pathologies such as cutaneous B cell lymphoma (CBCL). A 36-year-old female presented with a two-year history of a progressive indurated, edematous plaque in the preauricular area. At presentation, the patient also had labs significant for thrombocytopenia and eosinophilia. Original treatment with topical steroids did not lead to clinical improvement of the lesions. Punch biopsy revealed reactive lymphoid hyperplasia with polyclonal lymphoid infiltrates of small lymphocytes, histiocytes, eosinophils, and plasma cells. Diagnosis of LC was made and our patient was treated with serial 5 mg intralesional triamcinolone injections. Clinical improvement was seen beginning at 2 months. Diagnosing LC can be particularly difficult as the clinical presentation is ubiquitous and can resemble several other conditions such as CBCL, cutaneous lupus erythematosus, sarcoid, or hypersensitivity reactions. Recognition of the typical histologic findings of top-heavy dermal mixed-cellular infiltrates along with polyclonal kappa and lambda hybridization on immunohistochemistry is often essential in arriving at the correct diagnosis. Following diagnosis of LC, long-term surveillance is recommended as malignant transformation is a possibility.

A Review of Therapeutic Options for Linear Porokeratosis

Kritin K. Verma, Mojahed M. K. Shalabi, Aubrey C. Hartmann, Daniel P. Friedmann — Mon, 13 May 2024 00:00:00 +0000

Linear porokeratosis (LP) is a rare and uncommon variant of porokeratosis presenting as linear annular papules or plaques along Blaschko’s lines. It may arise spontaneously, although evidence of genetic predisposition exists via point mutations in the mevalonate pathway of cholesterol biosynthesis. Malignant transformation is the most serious complication of this chronic, progressive dyskeratosis. We review the currently available treatment options for LP, including topical, systemic, laser, photodynamic, and surgical therapies.

Acquired Congenital Malalignment of the Great Toenails: A Case Series

Mon, 13 May 2024 00:00:00 +0000

Congenital malalignment of the great toenail is a dystrophic disorder that is characterized by lateral deviation of the nail plates. It is usually present at birth and diagnosed very early in life. Late onset of this condition, often referred to as, “acquired,” is very uncommon. Mechanical stress and repeated microtraumas to the nail can cause complications that can worsen the appearance of the nail and make the condition more obvious in older individuals, however, there are other triggers for this condition as well, such as drugs that can cause nail changes. Properly diagnosing this condition can prevent patients from undergoing unnecessary treatments and also facilitate the efficient initiation of the correct treatment in patients. Here, we discuss 3 cases of acquired congenital malalignment of the great toenail in patients during their 5^th, 8^th, and 7^th decades of life.

The Role of Field Cancerization in Selecting Therapies for Actinic Keratosis: An Expert Consensus Panel

Mon, 13 May 2024 00:00:00 +0000

Background: Actinic keratosis is a very common disease that affects over 40 million people in the United States. In addition to the clinically visible lesion, patients may present with surrounding field cancerization based on their history of ultraviolet exposure. While lesion-directed therapy such as cryosurgery can effectively treat individual actinic keratoses it does not treat subclinical lesions or field cancerization.

Objective: To create consensus recommendations on the role of field cancerization in selecting appropriate therapy for actinic keratoses.

Methods: A comprehensive literature search of PubMed, Google Scholar, and Embase was conducted using the keywords “actinic keratos*,” “treatment,” and “field cancerization” for English-language original research articles without date restrictions. Articles were included that either discussed the role of FC in treating AKs or compared various AK field therapies. The relevant articles were then distributed to a panel of nine dermatologists with significant expertise in managing AKs. Each panelist reviewed the articles and assigned them a level of evidence based on Strength of Recommendation Taxonomy (SORT) criteria. The panel then convened on to discuss the studies and develop consensus statements on the role of FC in selecting AK therapy. The panel utilized a modified Delphi process to approve the adoption of each statement and gave each one a strength of recommendation based on SORT criteria.

Results: The initial literature search produced 243 articles that met search criteria. After a thorough screening of these articles for relevance to the research question, 21 articles were chosen to be reviewed by the panel and assigned a level of evidence. Of the 21 articles that were reviewed, the panel assigned level 1 evidence to three articles, level 2 evidence to six articles, and level 3 evidence to twelve articles. The panel created seven consensus statements related to AK management and FC. All seven statements received a unanimous (9/9) vote for adoption. Each of the statements was given a strength of recommendation according to sort criteria

Conclusion: Field cancerization due to chronic ultraviolet exposure leads to subclinical AK lesions in addition to lesions that are clinically apparent. In order to address these lesions, field therapy is an important component of an adequate regimen and can be used in conjunction with lesion-directed therapy for optimal results.

Application of Lean Six Sigma in Dermatology Practice

Kaycee Nguyen, Parneet Dhaliwal, DO, Clay J. Cockerell MD, MBA, JD — Mon, 13 May 2024 00:00:00 +0000

The Lean Six Sigma (LSS) methodology integrates two quality improvement techniques to enhance efficiency, reduce waste, and improve the quality of processes and products within an organization. While it has found application in various healthcare settings, to the best of our knowledge, there is currently no literature addressing its utilization in a community dermatology clinic. This study aimed to identify efficiency issues within a local dermatology clinic and implement targeted strategies to bolster collaboration, streamline processes, reduce wait times, augment patient volume, and enhance clinical outcomes and the quality of care. Five areas for improvement were identified: the building complex, front office, EMA system, medical assistants, and general improvements. The executed changes effectively standardized multiple processes, mitigated the potential for errors, and minimized task duration. These findings underscore the efficacy of LSS as a potent tool for enhancing efficiency and reducing waste. Efforts should be directed toward the incorporation of LSS techniques for quality improvement within healthcare systems, both internally and across interconnected entities.