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New Recommendations In Dermatology & Skin Cancer
As part of the Royal Australasian College of Physicians’ EVOLVE initiative, the New Zealand Dermatological Society has produced five recommendations concerning oral antifungal therapy, sentinel lymph node biopsies, Mohs micrographic surgery, antibiotics for atopic dermatitis, and topical antibiotics for surgical wounds. The recommendations were recently published in the Dermatology Practice Review.
Don’t prescribe oral antifungal therapy for suspected nail fungus without confirmation of fungal infection, because about half of nails with suspected fungus do not have a fungal infection. Other nail conditions may look similar, so it is important to ensure accurate diagnosis of nail disease before beginning treatment.
Don’t perform sentinel lymph node biopsy for the evaluation of early, thin melanoma because they do not improve survival. Patients with thin melanomas have a very low risk of the cancer spreading to the lymph nodes or other parts of the body, so sentinel lymph node biopsy is unnecessary.
Don’t treat non-melanoma skin cancer less than 1cm in size on the trunk and extremities with Mohs micrographic surgery. The use of Mohs micrographic surgery for low-risk, small, superficial or non-aggressive squamous cell carcinomas and basal cell carcinomas is inappropriate for skin cancers on the trunk and extremities because the risks exceed the benefits.
Don’t use oral antibiotics for the treatment of atopic dermatitis unless there is evidence of infection. The presence of high numbers of staphylococcus aureus on the skin of people with atopic dermatitis is common. The routine use of oral antibiotic therapy to decrease the amount of bacteria on the skin has not been definitively shown to reduce the signs, symptoms or severity of atopic dermatitis. If antibiotics are used when there is not an infection, it may lead to the development of antibiotic resistance.
Don’t routinely use topical antibiotics on a surgical wound. The use of topical antibiotics on clean surgical wounds has not been shown to reduce the rate of infection compared to the use of non-antibiotic ointment or no ointment. Topical antibiotics can aggravate open wounds. When topical antibiotics are used, there is a significant risk of developing contact dermatitis, along with the potential for developing antibiotic resistance.
Read more latest research on the management of dermatological conditions.
Release of new recommendations by RACP’s EVOLVE initiative. 2017. Dermatology Research Review. Issue 5, page 2.
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