Clinical Tips: Visual Tools to Assist Skin Exams, Free Botox, and More

tip 1

Tip 1: Tools for Assisting the Eye

Patients frequently ask for evaluation of very small lesions and subtle inflammatory skin findings. A standard, unassisted skin exam can result in nonspecific findings. 

Thus, in addition to my dermatoscope, I use a 2x or larger viewing lens magnifying glass with polarizing light (3Gen) to examine all lesions, rashes, hair loss, and nail deformity. I also have a dermatoscope camera with an iPhone viewing screen (Canfield Veos) that I can use to show patients’ lesions with magnified texture and color not otherwise visible. The camera is also good for showing patients’ lesions that are on their back and scalp, or that they otherwise cannot see. 

Patients are generally impressed that they are getting a very high-tech, accurate clinical exam. In addition, the photographed dermatoscope image can be emailed to the patient and the dermatopathologist reading the slide. This assisted exam is especially good for confirming follicular inflammatory conditions, clearly distinguish purpura from melanin pigment, help establish presence of eczematous vesicles in an otherwise nonspecific dermatitis, identify early verrucous skin changes, in addition to the traditional use in evaluating seborrheic keratoses, atypical nevi, and basal cell carcinomas. You will need a lab coat with large enough pockets to carry the equipment from room to room. These devices equate to the internist’s stethoscope. 

Wayne Fujita, MD

Aiea, HI

tip 2

Tip 2: Free Botox

I had a patient who I had suggested could improve several areas of his face with Botox. I misunderstood his request and, by mistake, gave him Botox for his forehead when he only wanted to continue receiving Botox for crow’s feet. I apologized and gave him the Botox for his forehead for free. 

He returned 4 months later and said he liked the results and has since continued treating both the crow’s feet and forehead areas. Should we offer free Botox to more patients?

Benjamin Barankin, MD, FRCPC

Toronto, Ontario, Canada

tip 3

Tip 3: Teaching Patients to Use Self-Injectable Therapies

With more self-injectable medications available, you may find yourself demonstrating to patients how to administer an injection. Some dermatologists will demonstrate the technique using an orange as a surrogate for the patient. But occasionally, patients misunderstand these instructions and instead, consume an orange that they have injected with their medication. If you are using any props in the office, make sure to be clear with patients that these are only substitutes and they will be using the needle on themselves. 

Patients can forget anywhere between 40% to 80% of the information they receive in the office, which can make administering injectables at home more difficult and scarier for those with needle phobias.1 It may also help to encourage patients to use their smartphone to record the demonstration so they can review the instructions later, which improves retention.2 

Steven R. Feldman, MD, PhD

Winston-Salem, NC

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.

References

1. Barr PJ, Bonasia K, Verma K, et al. Audio-/videorecording clinic visits for patient’s personal use in the United States: Cross-sectional survey. J Med Internet Res. 2018;20(9):e11308.

2. Kessels RPC. Patients’ memory for medical information. J R Soc Med. 2003;95(5):219-222.