From avoiding the long-term use of systemic steroids for dermatitis to skipping routine microbiologic testing in the evaluation and management of acne, the American Academy of Dermatology released new recommendations regarding tests and treatments that are not always necessary.
This marks the Academy’s second list developed as part of the Choosing Wisely® campaign, an ABIM Foundation initiative designed to help patients avoid care that may be unnecessary for them.
The Academy’s new Choosing Wisely® list, released in conjunction with the 2015 Summer Academy Meeting in New York, includes the following recommendations:
- Don’t use systemic (oral or injected) corticosteroids as a long-term treatment for dermatitis. The potential complications of long-term treatment with oral or injected corticosteroids outweigh the potential benefits.
- Don’t use skin prick tests or blood tests such as the radioallergosorbent test (RAST) for the routine evaluation of eczema. When testing for suspected allergies is deemed necessary in patients with dermatitis or eczema, it is better to conduct patch testing with ingredients of products that come in contact with the patient’s skin.
- Don’t routinely use microbiologic testing in the evaluation and management of acne. Microbiologic testing, used to determine the type of bacteria present in an acne lesion, is generally unnecessary because it does not affect the management of typical acne patients.
- Don’t routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection. Research has suggested that bilateral lower leg cellulitis is very rare. Patients with swelling and redness of both legs most likely have another condition, such as dermatitis resulting from leg swelling, varicose veins, or contact allergies.
- Don’t routinely prescribe antibiotics for inflamed epidermal cysts. It is important to confirm infection before treating these cysts with antibiotics.
These recommendations join those included on the Academy’s first Choosing Wisely® list, released in 2013:
- 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.
- 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 5-year survival rate for patients with these types of melanoma is 97%, and there is a low risk of the cancer spreading to other parts of the body.
- Don’t treat uncomplicated, nonmelanoma skin cancer less than 1 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.
- 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.
- 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 nonantibiotic ointment or no ointment. This recommendation does not apply to wounds received outside a surgical office, such as scraped knees or household accidents resulting in a cut or abrasion.
The items on the Academy’s Choosing Wisely® list were selected by a workgroup composed 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, nearly 100 national and state medical specialty societies, regional health collaboratives, and consumer partners have joined the conversations about appropriate care. With the release of these lists, the campaign will have covered more than 400 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss.
