Dermatologists Release Choosing Wisely Recommendations

Larry Hand

October 30, 2013

The American Academy of Dermatologists (AAD) has released its list of commonly prescribed skin tests and procedures that may not be necessary. The evidence-based recommendations, part of the American Board of Internal Medicine Foundation's Choosing Wisely campaign, are:

1. "Don't prescribe oral antifungal therapy for suspected nail fungus without confirmation of a fungal infection." About half of the suspected cases of fungal infection turn out not to be.

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." Patients with this type of melanoma have a 5-year survival rate of 97% and carry a low risk of the cancer spreading elsewhere.

3. "Don't treat uncomplicated, non-melanoma skin cancer less than one centimetre in size on the trunk and extremities with Mohs micrographic surgery." The risks of this type of surgery are greater than the benefits for some locations.

4. "Don't use oral antibiotics for treatment of atopic dermatitis unless there is clinical evidence of infection." Antibiotics have not been shown to reduce signs, symptoms, or severity of uninfected atopic dermatitis.

5. "Don't routinely use topical antibiotics on a surgical wound." Topical antibiotics have not been shown to reduce the rate of infection for a clean surgical wound more than nonantibiotic ointment or no ointment. However, this recommendation does not apply to nonsurgical wounds such as scraped knees or household cuts or abrasions.

Save Time and Money

"The [AAD] is strongly committed to dermatologists serving as effective stewards of limited health care resources by assisting patients in making informed health care decisions," dermatologist Brett Coldiron, MD, incoming president of AAD, said in a news release.

The AAD's board of directors and its Council on Science and Research approved the Choosing Wisely recommendations after a work group of board-certified dermatologists within AAD identified areas with the greatest potential for overuse or misuse, where there was a need for quality improvement, and where there was strong evidence-based, supportive research.

More than 15 other medical societies have issued Choosing Wisely recommendations as of today, and about 15 others are scheduled to do so during the rest of this year and into 2014. More than 80 national and state medical specialty societies, regional health collaboratives, and consumer partners have been involved in conversations about appropriate care, according to the AAD announcement. As of today, the campaign will have covered more than 2250 tests and procedures.

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