The American Academy of Dermatology has recently updated its recommendations on a wide variety of dermatologic tests and treatments that may not be medically necessary. Costly tests are sometimes done on patients with skin diseases that don’t change the outcome of the disease or are felt to be dangerous, among other reasons. This reduction in recommended procedures is part of the American Academy of Dermatology’s Choosing Wisely List, which had a similar list of procedures no longer recommended released back in 2013.
Together, these two lists comprise many procedures currently practiced in dermatology offices throughout the US that may not be helpful patients. Ideally, with the addition of the current list, patients can have practical conversations with their dermatologist about their diagnostic and treatment options.
What is on the current list?
- Skin prick testing and radioallergosorbant testing (RAST testing) is not recommended for the identification of allergens. Instead of using a pin prick test or RAST testing, it is currently recommended to use patch testing of the allergen against the skin to identify which allergens the patient is allergic to.
- Injected or oral use of corticosteroids not recommended for chronic dermatitis. The long term use of systemic corticosteroids in the treatment of long standing dermatitis carries risks that outweigh the benefits of providing treatment.
- Don’t test acne lesions for the presence of specific bacteria. Culturing acne lesions for the presence of bacteria is expensive and does not change the way acne is treated.
- Avoid the use of antibiotics in the treatment of swelling and redness of both lower legs unless infection is obvious. Currently, dermatologists provide antibiotics to patients who have bilateral leg redness and swelling, believing this is represents infection. Unless infection is proven, no antibiotics should be used. Most of these conditions reflect changes in the skin brought about by dermatitis, varicose veins, or redness from lower leg edema.
- Inflamed epidermal cysts generally do not need antibiotics. The infection should be proven whenever encountering an inflamed epidermal cyst before antibiotics are given.
These recommendations were added to those released in 2013 that looked at melanoma and non-melanoma treatments and their necessity. The findings from the 2013 release included the following:
- Dermatologists shouldn’t perform any other diagnostic tests, including sentinel lymph node biopsy on any patients known to have thin, early cases of melanoma. These diagnostic procedures have not been found to improve the rate of melanoma survival, which is already excellent at 97 percent five year survival in patients diagnosed with early cases of melanoma. There is also a low risk that melanoma at this stage is metastatic, negating the reason for doing the sentinel node biopsy in the first place.
- Uncomplicated skin cancers that are not melanoma and are less than a centimeter located on the extremities and trunk should not be treated with the Mohs surgical technique. This technique involves shaving off skin cancer pieces until the shavings are free of cancer. For non-melanoma skin cancers like basal cell cancer or squamous cell cancer, doing such a procedure can be risky and doesn’t offer any benefit over other methods of non-melanoma treatment strategies.
The addition of the 2015 recommendations to the 2013 recommendations should offer patients and dermatologists other choices for care of their skin condition without resorting to treatments and techniques that don’t offer any benefit over less invasive techniques, especially when it comes to the treatment of melanoma skin cancer.
