What Tests, Txs May Be Unnecessary in Dermatology?

The American Academy of Dermatology has issued new recommendations regarding potentially unnecessary dermatologic tests and treatments as part of the Choosing Wisely campaign. The list has been released in conjunction with the 2015 Summer Academy Meeting.

The new recommendations join those included on the Academy’s first Choosing Wisely list, released in 2013, to identify procedures that may not be necessary. The final list was reviewed and approved by the Academy’s Council on Science and Research and the Academy’s Board of Directors. The recommendations include:

• Don’t use systemic (oral or injected) corticosteroids as a long-term treatment for dermatitis. The potential complications of long-term treatment with oral or injected corticosteroids outweigh the potential benefits.
• Don’t use skin prick tests or blood tests such as the radioallergosorbent test (RAST) for the routine evaluation of eczema. When testing for suspected allergies is deemed necessary in patients with dermatitis or eczema, it is better to conduct patch testing with ingredients of products that come in contact with the patient’s skin.
• Don’t 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 generally unnecessary because it does not affect the management of typical acne patients.
• Don’t routinely use antibiotics to treat bilateral swelling and redness of the lower leg unless there is clear evidence of infection. Research has suggested that 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.
• Don’t routinely prescribe antibiotics for inflamed epidermal cysts. It is important to confirm infection before treating these cysts with antibiotics.