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AAD Updates its List on Unnecessary Care

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The American Academy of Dermatology (AAD) released a second list of recommendations of dermatology tests and treatments found unnecessary, as part of the Choosing Wisely campaign.

The Choosing Wisely campaign is an American Board of Internal Medicine Foundation initiative designed to help patients avoid unnecessary care.

 “The American Academy of Dermatology and its members are committed to serving as good stewards of limited health care resources and we want to empower our patients to make informed health care decisions,” said Mark Lebwohl, M.D., FAAD, board-certified dermatologist, president of the AAD. “By identifying procedures that may not be necessary, the Academy’s new Choosing Wisely list can help patients with skin, hair and nail conditions start a conversation with their dermatologist about what tests and treatments are right for them.”

The items on the list were selected by a workgroup, composed of board-certified dermatologists who identify areas with the greatest potential for overuse and misuse care. The final list was reviewed and approved by the AAD’s Council on Science and Research and the AAD’s Board of Directors.

The Newest List

The recently updated list from AAD for the Choosing Wisely campaign was released in conjunction with the 2015 Summer Academy Meeting in New York.

  • Do not use systemic—oral or injected—corticosteroids as a long-term treatment for dermatitis. 
    • Potential benefits become outweighed with potential complications of long-term treatment of oral or injected corticosteroids.
  • Do not use skin prick tests or blood tests such as the radioallergosorbent test for the routine evaluation of eczema
    • It is better to conduct patch testing with ingredients of products that come in contact with the patient’s skin when testing for suspected allergies is deemed necessary in patients with dermatitis or eczema.
  • Do not routinely use microbiologic testing in the evaluation and management of acne
    • Microbiologic testing—used to determine the type of bacteria present in an acne lesion—is unnecessary because it does not affect the management of typical acne patients.
  • Do not routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection.
    • Research suggests bilateral lower leg cellulitis is very rare. Patients with swelling and redness of both legs most likely have another condition, such as dermatitis resulting from leg swelling, varicose veins or contact allergies.
  • Do not routinely prescribe antibiotics for inflamed epidermal cysts.
    • It is important to confirm infection before treating these cysts with antibiotics.

The Original List

In 2013, the AAD released its first list for Choosing Wisely.

  • Do not prescribe oral antifungal therapy for suspected nail fungus without confirmation of a fungal infection. 
    • Approximately half of all patients with suspected nail fungus do not have a fungal infection.
  • Do not perform sentinel lymph node biopsy or other diagnostic tests for the evaluation of early, thin melanoma because they do not improve survival.
    • The five-year survival rate for patients with these types of melanoma is 97% and there is a low risk of the cancer spreading to other parts of the body.
  • Do not treat uncomplicated, nonmelanoma skin cancer less than one centimeter in size on the trunk and extremities with Mohs micrographic surgery.
    • In patients with skin cancer on certain parts of the body, the risks of this specialized surgical procedure outweigh the benefits. 
  • Do not use oral antibiotics for treatment of atopic dermatitis unless there is clinical evidence of infection.
    • Antibiotic therapy has not show signs to reduce the symptoms or severity of atopic dermatitis that is not infected. 
  • Do not routinely use topical antibiotics on a surgical wound.
    • The use of topical antibiotics on a clean surgical wound has not been shown to reduce the rate of infection compared to the use of nonantibiotic ointment or no ointment. This recommendation does not apply to wounds received outside a surgical office, such as scraped knees or household accidents resulting in a cut or abrasion.

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