"20 Tips in 20 Minutes" Offers Practical Pearls at Fall Clinical

Five dermatologists shared rapid-fire clinical, procedural, and practice-management advice, ranging from alopecia photography and nail examination to infantile hemangiomas, reimbursement, and patient communication at the 2026 Fall Clinical Dermatology Conference.

The fast-moving "20 Tips in 20 Minutes" session brought together Boni E. Elewski, MD; Lawrence J. Green, MD; Jonathan S. Weiss, MD; Adelaide Hebert, MD; and Leon H. Kircik, MD, for five rounds of practical advice designed to make everyday dermatology more effective and efficient.

1. Photograph alopecia consistently

Standardized serial photographs can reveal hair regrowth that patients may not notice. Dr. Elewski described parting hair at the midline, aligning the part with the nose, measuring its width and photographing the scalp at successive visits. In one case, a patient who felt unchanged after a year of treatment had substantially greater density on comparison images.

“Patients forget; cameras do not,” Dr. Elewski said.

2. Consider short-course IL-23 inhibition for guttate psoriasis flares

Dr. Green described his experience with short courses of targeted biologics in difficult-to-manage cutaneous psoriasis and discussed the possibility of prolonged benefit after relatively few doses.

“A much simpler treatment is like a Vegas knockout blow,” Dr. Green said.

3. Build excellence through continuing education

Dr. Weiss argued that clinical quality is the foundation of patient loyalty. He recommended attending meetings, following journals and news updates, joining in-person or virtual journal clubs, maintaining certification, and using evidence resources and podcasts to stay current.

“The key to getting your patients to come back all the time and to appreciate you is to practice good medicine first,” Dr. Weiss said.

4. Give hyperhidrosis patients a reliable resource

Dr. Hebert recommended the International Hyperhidrosis Society’s sweathealth.org as a resource for clinicians and families. She noted its educational information, treatment updates, medical-necessity letter templates, physician directory and practical suggestions for clothing and other products.

“It really is an excellent resource, not only for you, but also for your patients and their families,” Dr. Hebert said.

5. Place the examination chair diagonally in small rooms

A diagonal chair arrangement can give clinicians access to both sides of the patient even in a cramped examination room. Dr. Kircik warned that pushing the chair against a wall can make procedures awkward and strain the clinician’s back.

“Please put that chair in diagonally at this, so you can approach on both sides if you have a small room,” Dr. Kircik said.

6. Inspect the lunula when nail changes are puzzling

Dr. Elewski described a patient repeatedly treated with antifungals who instead had traumatic nail changes consistent with onychotillomania. Enlarged lunulae, hemorrhage, ragged cuticles, transverse ridging and asymmetry can provide clues to repetitive picking.

“When in doubt, inspect the lunula of the nail,” Dr. Elewski said.

7. Consider tacrolimus with or without bimatoprost for postcryotherapy hypopigmentation

Dr. Green discussed topical tacrolimus and a melanosome-based product as approaches he uses for postinflammatory hypopigmentation after freezing lesions. He also mentioned combining topical agents for pigmentary disorders. These were presented as practice suggestions, not as trial-proven regimens; the transcript contains potentially inaccurate mechanistic descriptions.

“There are things we can do about it that we just don’t think about,” Dr. Green said.

8. Practice in your clinical sweet spot

Dr. Weiss advised physicians to concentrate on work that matches their strengths, whether medical, surgical, cosmetic or procedural dermatology. Referring appropriate procedures to a faster or more specialized colleague can improve productivity, professional satisfaction and patient experience.

“My billings and collections went up because I was practicing in my sweet spot,” Dr. Weiss said.

9. Recognize early infantile hemangiomas

Dr. Hebert urged clinicians not to overlook a large telangiectatic patch in an infant, especially one with a pale halo, because it may precede proliferative hemangioma growth. She discussed topical timolol for selected superficial lesions and oral propranolol for higher-risk lesions, while emphasizing systemic absorption risks with ulcerated skin and toxicity concerns when using topical anesthetics in infants.

“This doesn’t look like anything that is that ominous, but let me share with you what walked in,” Dr. Hebert said before showing a dramatic subsequent photograph. "It is heartbreaking that this was not treated while the child was in the hospital because this easily could have been managed and the aggressive growth that you see here prevented."

10. Document lesion destruction accurately

Dr. Kircik distinguished cryosurgical destruction of actinic keratoses from cryotherapy as a more general treatment term, urging clinicians to align procedural documentation with the service billed. Coding requirements should be verified against current payer and CPT guidance rather than relying on terminology alone, he said.

“When you freeze an AK, it’s cryosurgery, not cryotherapy,” Dr. Kircik said.

11. Take a solitary abnormal nail seriously

Dr. Elewski urged a broader differential when only one nail is affected, including benign nail-unit tumors, melanoma, and bone-associated lesions. She discussed longitudinal bands, distal V-shaped onycholysis, splinter hemorrhages, and the importance of imaging when a bony tumor is suspected. A single-nail change is not diagnostic of tumor, and biopsy decisions require full clinical assessment.

“If that's all they have, one lousy nail, it’s probably a tumor,” Dr. Elewski said.

12. Improve suture visibility during scalp biopsies

For scalp punch biopsies in dark hair, Dr. Green suggested using a light-colored latex glove as a contrasting background for dark suture material and leaving sufficient suture length to make handling easier. He also reminded the audience of the value of horizontal and vertical sections in hair-loss evaluation.

“Put the suture on the latex glove so you can see it really easily,” Dr. Green said.

13. Be therapeutically proactive—and patient-centered

Dr. Weiss encouraged dermatologists to embrace effective new treatments while remaining within their clinical comfort and expertise. He also described a “platinum rule” of care: adapt treatment to patients’ preferences and priorities rather than assuming everyone wants the same approach.

“They want to be treated how they want to be treated,” Dr. Weiss said.

14. Reduce friction in patients prone to blisters and calluses

Dr. Hebert suggested cushioned socks and friction-reducing products as supportive measures for patients with recurrent calluses, friction blisters and fragile skin. She cited her wound-care center’s experience and cautioned that thicker socks may require larger shoes. Such products supplement, rather than replace, evidence-based offloading and diabetic foot care.

“These can really reduce those calluses,” Dr. Hebert said.

15. Remember the modifier 51-exempt code for 15 or more AKs

Dr. Kircik highlighted the actinic keratosis destruction code used for more than 15 lesions and discussed its treatment under multiple-procedure payment rules.

“This is the best kept secret in dermatology,” Dr. Kircik said, joking that it needed to be kept in that room.

16. Reassure patients who bring bags of shed hair

Dr. Elewski described using a patient’s collected hairs as a starting point for a calm discussion of telogen shedding, rather than dismissing their concerns. She suggested considering thyroid and iron evaluation when indicated, reviewing recent weight loss and medication changes, assessing nutrition, and identifying concomitant androgenetic alopecia. She also mentioned low-dose minoxidil in selected cases.

“You sit calmly," Dr. Elewski said. "You open the bag. You start looking at them and admire their hair. 'Oh, good news. Wow, you have club hairs. Oh, is this great? These are hairs that grow back. You're not losing the bad hairs, the androgen hairs. You are going to be so lucky with your future.'"

17. Consider G2211 for longitudinal dermatologic care

Dr. Green encouraged clinicians to consider the Medicare add-on code G2211 for qualifying visits involving ongoing management of serious or complex conditions, including psoriasis and atopic dermatitis.

“You’re providing the same thing, long-term care,” Dr. Green said.

18. Make each visit count

Dr. Weiss advised clinicians to address additional appropriate concerns or procedures during an existing visit when feasible, rather than automatically booking a return appointment. Doing so can save patients another trip and preserve scarce appointment capacity, while still requiring appropriate consent, time, and documentation.

“You’re using two slots for one patient,” Dr. Weiss said.

19. Try a practical barrier for habitual lip licking

Dr. Hebert recommended an inexpensive zinc oxide diaper-rash product such as Desitin at bedtime for children with lip-licking dermatitis. The thick barrier can protect irritated skin and may discourage repeated licking; families should use a suitable formulation and avoid application when ingredients cause irritation.

“It will quickly deter that child from continuing to lick their lips,” Dr. Hebert said.

20. Protect practice finances with separate Medicare deposit accounts

Dr. Kircik shared a practice-management strategy of directing Medicare electronic deposits into a dedicated account and transferring receipts regularly into a separate operating account. He framed the approach as a way to limit exposure of routine operating funds, although banking and Medicare enrollment requirements should be checked with financial and compliance advisers.

“We opened two accounts, one just for Medicare deposits, and then one was all the other money,” Dr. Kircik said.