Spilling the Tea: Important Observations to Help Clinicians

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, delivers a solo “Spilling the Tea” segment exploring clinical observations that may warrant a closer look. He examines dermatomyositis findings that can mimic more common conditions, nuances in prescribing language, the importance of a thorough hidradenitis suppurativa (HS) examination, and an unexpected case of rhabdomyolysis, highlighting details that can change how clinicians approach diagnosis and patient management.

Dr Del Rosso begins with scalp pruritus as a potential manifestation of dermatomyositis. He reviews images showing how scalp involvement may resemble seborrheic dermatitis or psoriasis, with findings such as erythema, scaling, and hair thinning. He also examines nailfold changes, including prominent capillaries, capillary dropout, and abnormal cuticles, that can provide additional diagnostic clues. Recognizing these findings is particularly important given the potential systemic implications of dermatomyositis.

The discussion then turns to limitations of use in prescribing information stating that certain therapies are “not recommended” in combination with other agents. Dr Del Rosso distinguishes this language from a formal contraindication and discusses the importance of understanding the evidence behind labeling when making treatment decisions.

In HS, he emphasizes the value of a complete skin examination, including areas patients may initially be reluctant to expose. Assessing and palpating lesions can help distinguish active inflammatory findings, including abscesses, nodules, and draining tunnels, from established fibrotic or scarred disease.

Finally, Dr Del Rosso shares the case of a 42-year-old woman receiving JAK inhibitor therapy who developed markedly elevated creatine kinase and rhabdomyolysis. Although her medication presented one possible explanation, further investigation revealed that she had gone several weeks without levothyroxine for hypothyroidism, another potential contributor. The case illustrates the importance of considering the full clinical picture when evaluating an unexpected finding or adverse event.

Tune in to the episode for clinical observations that encourage a closer look at what may initially seem straightforward, from recognizing less familiar disease presentations and interpreting prescribing information precisely to conducting a thorough examination and considering multiple explanations for an unexpected finding.