By SARAH SHMERLING | Editor-in-Chief
Dr. Joshua Wieder, board certified in both dermatology and internal medicine, and Dr. Kathy Kim Langevin, board certified in dermatology and pediatric dermatology, answer questions about when an in-person visit is required, what skin issues should not be ignored and sun safety tips for parents with kids spending more time outdoors.
Post: Due to the pandemic, patients may skip going to see a doctor, both on a regular basis and in response to something new that comes up. What are some skin issues that should not be ignored and looked at by a professional in a short amount of time, even throughout the pandemic?
Wieder: I think the most important skin condition that should not be ignored is a possible skin cancer. Skin cancer is the most common cancer in the U.S.
Currently, one in every five Americans are predicted to develop skin cancer in their lifetime. The good news is that 99% of all cases are curable if they are diagnosed and treated early enough.
So, during this pandemic, any new or changing growth should be looked at promptly by a board-certified dermatologist, especially a growth that changes in shape, color or size, becomes fragile, or bleeds easily.
Other conditions to be examined promptly include possible skin infections, unusual skin rashes, or rashes created by mask wearing and hand washing that do not respond to over-the-counter remedies.
Post: What are some of the reasons to bring children to the office for an in-person dermatology appointment at this time?
Langevin: Anything requiring a procedure would necessitate an in-person visit. For instance, a changing mole that is concerning for a malignancy, though rare in children, needs a biopsy sooner rather than later.
If there is an infection or an abscess, an in-person visit would be needed for culture or possible I and D (incision and drainage). Ideally, any pigmented lesion such as moles (including birthmarks) are better visualized in-office where we have special tools to help identify any concerning features.
Post: What can people do to combat some of the skin issues that come along with preventing COVID-19, like dry hands from hand washing and hand sanitizer, or rashes that are triggered by wearing a mask?
Wieder: The Centers for Disease Control and Prevention (CDC) recommendations for frequent hand washing, use of hand sanitizer and mask wearing have helped reduce the spread of the coronavirus. However, these recommendations may also contribute to skin irritation, rashes and facial acne.
Be gentle on your hands. Use gentle cleansers and cool or lukewarm water to wash with. Hot water isn’t necessary to clean your hands. Avoid antibacterial cleansers, which can be harsh on the skin.
Moisturize: After washing and gently drying your hands, apply a fragrance-free moisturizer until they no longer feel dry. Even if your hands are not dried out, applying a moisturizer regularly is a good way to prevent skin irritation.
Wear gloves: When you are out of your home, wearing disposable gloves is a reasonable alternative to frequent use of hand sanitizer, especially if your hands are already getting dried out. Wearing gloves while using household cleansers and disinfectants will also protect your hands.
Frequent mask use can lead to irritation of the skin on your nose, chin, cheeks and even behind the ears. Moist conditions under the mask can lead to acne breakouts and other skin concerns. To ease these complications of mask wearing during the COVID-19 pandemic:
Develop a regular skin care routine. After removing your mask, try to get in the habit of cleansing your skin with a gentle cleanser and then applying a lightweight moisturizer. If you develop friction points from the mask, apply a thin barrier cream such as zinc oxide or even a fragrance-free moisturizer to soothe and protect the skin. Alternatively, using a small band aid on the friction points can be helpful without interfering with the mask’s effectiveness.
Treat acne. If you develop acne, cleanse your skin regularly. Use a light, oil-free moisturizer. Over-the-counter products containing benzoyl peroxide or salicylic acid may be helpful for mask-triggered acne.
If these simple remedies are not helpful, an office visit or telehealth visit with your dermatologist would be the appropriate next step.
Post: What, in your experience, are the pros and cons of telemedicine appointments?
Wieder: The obvious advantage is accessibility. No matter where the patient is or how far from a medical office they may be, if someone has a smartphone or computer with a camera, they can access their dermatologist.
Skin conditions most amenable to telehealth care are those that are easily visible on a computer screen and the evaluation of which doesn’t require fine detail. For example, acne, body rashes etc. can readily be assessed via telehealth visits.
The biggest disadvantage is that dermatology often requires visual assessment of close detail to evaluate small moles and possible skin cancers. These conditions are hard to see on a video screen, especially if someone has slow internet speeds at home.
We may need to have the patient email us high-resolution photos prior to the telehealth visit so that we can see the fine detail not available on the video screen.
Additionally, dermatologists use many senses to evaluate skin conditions—we often need to feel the texture of skin growths, use various lighting angles and employ hand-held dermatoscopes to see close detail. Obviously, none of this can easily be done via telehealth.
Post: What are some of the things you are able to diagnose and treat through telemedicine appointments?
Langevin: Acne in general can be treated through tele-medicine. Other conditions like eczema or psoriasis, especially if an established patient, can also be treated fairly well.
Certain infections, such as warts and molluscum, can usually be diagnosed via tele-medicine, and treated with topical or oral medications though obviously, the removal of such lesions can require an in-person visit. Some rashes can be visualized and diagnosed on a tele-medicine visit but can sometimes require follow up in person.
Post: What COVID-19 protocols is your team enforcing when patients do come into the office?
Wieder: We have instituted a very extensive protocol to ensure the safety of our patients and staff. First, at the time of making an appointment, every patient is screened by questionnaire to assess any risk of exposure.
Upon arrival, we ask that all our patients wait in their car until the waiting room is empty of other patients and they can be escorted directly into the exam room—of course, after their temperature is taken.
We have installed plexiglass barriers throughout the office and follow all CDC guidelines re: wiping down all surfaces that might be touched before and after every patient visit. All of our staff wear masks and eye protection, and the back-office staff wear face shields. We are also using special HEPA filters in our exam rooms.
Langevin: Dr. Wieder has done an incredible job of keeping our office safe and has been following all local COVID protocols with regards to PPE and safe office practices.
We have been limiting the number of patients we see to make sure that there is no to minimal overlap of patients inside the clinic or waiting room. We require all staff, physicians and patients to wear masks at all times during their visits (briefly removing masks for any exam of the area if needed), screen patients before their visits, and screen the doctors and staff daily. Our staff has been cleaning each room thoroughly between visits, as well as rotating the exam rooms used so that each room has at least a full hour to “air out” between patients.
That being said, for any patients nervous about seeking medical care in-person, tele-medicine is still an option.
Post: We’ve read that some of the signs that a child has COVID-19 are visible on their skin. What are some things to look out for?
Langevin: I wouldn’t want to alarm families that “COVID-toes” or a viral rash are signs their child is infected with COVID, as many viruses can be the cause of a rash. If your child is sick appearing, the best bet is to reach out to your pediatrician.
If only a rash is visible, you can try to see if dermatology tele-medicine is an option, but not as concerning if your child is otherwise well and the rash is asymptomatic.
Post: With indoor activities largely shut down, many kids are spending more time than ever in the outdoors. Even though a mask can block some of the face, what are some of the steps parents should be doing to ensure protection from the sun?
Langevin: That’s a great question as most patients I have been examining have definitely been getting more sun! I think outdoor, socially distanced activities are great, and critical for you and your child’s well-being.
Ideally, I would avoid prolonged outdoor time during peak sun hours (in California, that’s really 9 a.m. to 4 p.m.). Sun protective clothing (rash guards, wide-brimmed hats) are an easy way to protect the skin, and applying an SPF 30 or greater sunscreen every 90 minutes or so, more frequently if in the water or sweating.
Kids tend to rub their eyes after removing their goggles, so I love the sunscreen sticks that can be applied more frequently and easily.
Post: What else would you like the community to know about you or your practice?
Wieder: We are an adult and pediatric dermatology practice located in West Los Angeles. We focus on general adult and pediatric skin conditions as well as cosmetic dermatology with an emphasis on non-invasive rejuvenation. We are happy to see all ages of patients, ranging from newborns to centenarians!
Wieder Dermatology & Laser Center is open for in-person and telehealth visits, with a goal of ensuring safety for all patients and staff. For more information, visit wiederderm.com or call 310-207-8900.
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