Recommendations Released About Potentially Unnecessary Treatments and Procedures

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The American Academy of Dermatology recently released new recommendations about treatments and tests that may not be necessary. These can include seeking routine testing for the evaluation and/or management of acne to avoiding the long-term use of systemic steroids for dermatitis.   This is the second list from the Academy, which represents part of the organization's “Choosing Wisely” campaign. This is an initiative from the ABIM Foundation that is designed to help people avoid unnecessary treatments.   The new Choosing Wisely list includes the following recommendations:

  • -Don’t use prick or blood tests such as the RAST (radioallergosorbent) for routine evaluations of eczema.

 

  • -Don’t routinely use microbiologic test for the management / evaluation of acne

 

  • -Routine use of antibiotics to treat bilateral swelling and redness of the lower leg should be avoided unless there is evidence of infection.

 

  • -Prescribed antibiotics should not be routinely used for inflamed epidermal cysts.

 

These new recommendations joined the first Choosing Wisely list (released in 2013), which includes:

 

  • -Prescribed oral antifungal therapy for nail fungus should not be used without confirmation of a fungal infection.

 

  • -Sentinel lymph node biopsies or other similar diagnostic test should not be performed for the evaluation of early melanoma, as they do not improve survival.

 

  • -Uncomplicated, non-melanoma skin cancers less than one centimeter in size on the trunk and extremities should not be treated using Mohs micrographic surgery.

 

  • -Oral antibiotics should not be used for the treatment of atopic dermatitis, unless there is evidence of infection.

 

Topical antibiotics should not be routinely used on surgical wounds. The items on this list were selected through a workgroup comprising board-certified dermatologists. This group identified areas that had the greatest potential for overuse or misuse, the need for quality improvement, along with evidence based research that would support the recommendations. The final list was approved be the Academy’s Board of Directors and its Council on Science and Research.   The campaign has covered and studied more than 400 tests that the specialty society partners indicated are overused and inappropriate. Says Dr. Thomas Wright, medical director of Laser Lipo and Vein Center, “These findings indicate that it is very important for both physicians and patients to discuss any procedure or treatment, so each feels comfortable with the treatment prescribed. This will help provide the best results for both the patient and the doctor.”