AAD Releases Second Set of Choosing Wisely Recommendations

The American Academy of Dermatology (AAD) released its second set of recommendations regarding dermatologic tests and treatments that are not always necessary. These recommendations were developed as part of the Choosing Wisely® campaign, an ABIM Foundation initiative designed to help patients avoid care that may be unnecessary for them. The first set of recommendations was released in 2013.

“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,” says board-certified dermatologist Mark Lebwohl, MD, FAAD, president of the Academy. “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 AAD’s new Choosing Wisely® list includes the following recommendations:

• 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.

The items on the Choosing Wisely® list were selected by a workgroup composed of board-certified dermatologists, who identified areas with the greatest potential for overuse/misuse, a need for quality improvement and the availability of strong evidence-based research to support the recommendation. The final list was reviewed and approved by the AAD’s Council on Science and Research and its Board of Directors.

To date, nearly 100 national and state medical specialty societies, regional health collaboratives and consumer partners have joined the conversations about appropriate care. With the release of these lists, the campaign will have covered more than 400 tests and procedures that the specialty society partners say are overused and inappropriate, and that physicians and patients should discuss. For more information on the campaign, visit www.ChoosingWisely.org.

—Stefanie Tuleya