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Clinical Tips: Clearing Warts, Another Use for Hyaluronidase, and More

Clinical Tips: Clearing Warts, Another Use for Hyaluronidase, and More

warts on foot

Tip 1: Clearing Warts 

Dinitrochlorobenzene 2% topical (DNCB) is the best treatment for patients with widespread warts or big planter warts. In patients who do not heal with DNCB alone (15%) or who may be immunosuppressed, using a combination of DNCB and imiquimod is great. Sensitize patients with DNCB 2% for 5 days under occlusion, then wait 5 days before starting patients on imiquimod 5% under occlusion every night for 2 weeks. Repeat this process as needed.

Mauricio Goihman-Yahr, MD

Caracas, Venezuela

handwashing

Tip 2: Applying Disinfectant For All To See

When applying disinfectant to your hands before examining patients, make sure you draw attention to your actions. For example, you might say “I have to put this on before I even shake your hand to protect you from (pick 2: flesh-eating bacteria/Ebola virus/Zika virus/babesiosis/bubonic plague).” Making it memorable is important because you want patients to remember you cleaned your hands when, 2 weeks later, they hear a story on the radio about doctors who do not wash their hands or when they receive a patient satisfaction survey asking if their doctor washed their hands or not.

Steve Feldman, MD, PhD

Winston-Salem, NC  

Tip 3: Scheduling Your Holiday Party

Every year we have a holiday party, which is typically on a Friday afternoon close to Christmas. What we have now realized is that we should have asked our staff about the holiday party date and time (which made sense to us). It turns out our staff did not want to lose money by having the party from 1 to 3 pm during working hours and instead, preferred to have it during the evening instead. It only took us 7 years to learn this. 

Benjamin Barankin, MD 

Toronto, Ontario, Canada

infections

 

Tip 4: Another Use for Hyaluronidase

I inject hyaluronic acid fillers cosmetically and need to keep hyaluronidase in the office. Usually, these expensive vials of hyaluronidase never get used, expire, and I have to reorder a box of 4 as the minimum purchase order. 

I had a patient with pretibial myxedema who was bothered by the bumps on his lower legs. I treated them with my unused hyaluronidase and had good results. The volume injected was small. After dosing one leg with hyaluronidase and the other with Kenalog 2.5 mg/cc intralesionally, the hyaluronidase injected side seemed to clear better, according to both the dermatologist and the patient. 

Wayne Fujita, MD 

Aiea, HI

rosacea

Tip 5: Treating Rosacea With Ivermectin

Ivermectin works well in most patients with rosacea. Generally, I prescribe 4 to 6 tablets at 3 mg and repeat in one week. I have patients use topical ivermectin paste, which they can purchase for $6 on Amazon. It is a horse-worming product but has a pleasant apple smell, good texture, and works well for maintenance. I have never had a complaint and it does not require prior authorization. 

Barry Ginsberg, MD

Birmingham, AL

Dr. Barankin

Dr. Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.

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