Prime Time is a blog by Chris Kaiser for those interested in primary care.
The American Academy of Dermatology (AAD) has joined more than 80 other medical societies in the naming five treatments or procedures that may not be necessary.
The Choosing Wisely campaign was started in 2011 by the . The aim is to encourage patients and physicians to follow evidence-based guidelines and to support conversations about treatments, tests, and procedures that may not be needed.
"These recommendations serve as a great reminder to physicians so that the best care can be given to patients in the most cost-efficient way," Emmy Graber, MD, director of the Boston University Cosmetic and Laser Center and a dermatologist at Boston Medical Center, told ѻý.
"In a quickly evolving medical world, it is important for physicians to be kept up to date with the most recent, best-practice recommendations. As we become bombarded with this ever-changing information, it is helpful for societies such as the AAD to present this information in a concise manner to physicians," she added.
Here are the 5 recommended "don'ts" from the AAD:
- Don't prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection. The AAD says that about half of the nails with suspected fungus do not have fungal infections.
- Don't perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma because they do not improve survival. In its rationale, the AAD says that smaller than 0.5 mm has a very low risk of spreading to the lymph nodes or other parts of the body.
- Don't treat uncomplicated, nonmelanoma skin cancer less than 1 cm in size on the trunk and extremities with Mohs micrographic surgery. This procedure is best left for skin cancers on the hands, feet, ankles, shins, nipples, face, and genitals, according to the AAD
- Don't use oral antibiotics for treatment of atopic dermatitis unless there is clinical evidence of infection. The AAD notes that oral antibiotics should only be used to treat patients with evidence of bacterial infection in conjunction with other standard treatments.
- Don't routinely use topical antibiotics on a surgical wound. Their use has not been shown to reduce the rate of infection compared with non-antibiotic ointment or no oinment, the AAD says.
"So many times I've seen topical antibiotics applied to a sutured wound or an open wound where it develops an allergic reaction and then I can't tell if it is the antibiotic ointment or a true infection that I'm treating," commented AAD president-elect Brett Coldiron, MD, in .
He said it's best to "use some type of bland, topical emollient instead of an expensive topical antibiotic."
Previous coverage by ѻý of the Choosing Wisely program can be found here and here.