What are the case study prompts for outpatient dermatology?

From the Guidelines

Outpatient dermatology case study prompts should prioritize conditions like acne vulgaris, psoriasis, and atopic dermatitis, focusing on diagnostic reasoning and treatment planning based on the most recent guidelines, such as those from the Journal of the American Academy of Dermatology 1.

Key Conditions to Focus On

• Acne vulgaris: including moderate to severe cases requiring isotretinoin at 0.5-1mg/kg/day for 4-6 months, as per the guidelines of care for the management of acne vulgaris 1
• Psoriasis: particularly plaque type, which may respond to topical steroids like betamethasone dipropionate twice daily for 2 weeks, or biologics for severe cases, as recommended by the joint American Academy of Dermatology-National Psoriasis Foundation guidelines 1
• Atopic dermatitis: requiring stepped care from emollients to topical tacrolimus 0.1% twice daily
• Contact dermatitis: with allergen identification and avoidance strategies
• Melanoma: emphasizing ABCDE criteria and surgical management
• Common fungal infections: treated with topical antifungals like clotrimazole 1% cream twice daily for 2-4 weeks

Developing Effective Prompts

These prompts should include:

• Patient demographics
• Detailed history
• Physical examination findings with specific descriptions of lesions
• Relevant laboratory or biopsy results The prompts should require students to:
• Formulate differential diagnoses
• Recommend appropriate diagnostic tests
• Develop treatment plans with specific medications and durations
• Consider patient education points

Importance of Recent Guidelines

Using the most recent guidelines, such as those from 2024 1, ensures that treatment plans are evidence-based and reflect current best practices in dermatology. This approach helps develop clinical reasoning skills by connecting visual findings with pathophysiology and prepares students for real-world dermatology practice.

From the FDA Drug Label

The individual components of the PASI (induration, erythema and scaling) contributed comparably to the overall treatment-associated improvement in PASI Across all treatment groups, the percentage of subjects who previously received systemic therapy for PsO ranged from 61% to 65% in Study I and 71% to 75% in Study II, and those who previously received phototherapy ranged from 44% to 50% in Study I and 72% to 73% in Study II

• Key Points:
  • The drug label does not provide specific case study prompts for outpatient dermatology.
  • The label discusses the efficacy of etanercept in treating plaque psoriasis, including response rates and maintenance of response.
  • Previous treatments for PsO, including systemic therapy and phototherapy, are mentioned, but no specific case study prompts are provided. 2

From the Research

Case Study Prompts for Outpatient Dermatology

• The following case study prompts can be used to assess outpatient dermatology:
  • Atopic dermatitis (AD) treatment options, such as methotrexate 3, and their effectiveness in improving clinical symptoms
  • Combination therapies, like methotrexate and narrowband UVB phototherapy, for the treatment of chronic plaque-type psoriasis 4
  • Systemic treatments for AD, including their benefits and harms, as well as comparative impact on AD outcomes 5
• When conducting a consultation and clinical assessment of the skin, advanced clinical practitioners should consider the following:
  • Taking a thorough dermatological history 6, 7
  • Performing a systematic examination of the skin 6, 7
  • Being aware of the various skin conditions and their potential diagnoses 7
• The use of methotrexate in the treatment of AD and psoriasis has been studied, with results showing its effectiveness in improving clinical symptoms 3, 4
• Network meta-analyses have been conducted to compare the benefits and harms of different systemic treatments for AD, including methotrexate, and to inform treatment guidelines 5