October clinical considerations for NPs, PAs

Joe Gorelick, NPDear Colleagues,

This month we take a look at how to recognize Zika virus in a patient, a new therapeutic option for atopic dermatitis, as well as the concept of field cancerization in treating actinic keratosis.

Zika virus is upon us. Many of our fellow PA and NP colleagues in the Florida region are making the initial diagnoses for affected patients. We need to familiarize ourselves with presenting signs, symptoms, and cutaneous manifestations so that we can adeptly identify infected patients.

“BREAKTHROUGH THERAPY” designation for Dupilumab, a biologic systemic therapy, for Atopic Dermatitis (AD) was granted by the FDA. This therapeutic option represents a first-in-class therapeutic agent for the difficult to manage patients with moderate-to-severe AD. Promising initial study results show significant efficacy, and safety without evidence of immunosuppressive side effects associated with current systemic agents. As a first-in-class injectable biologic therapy for AD, dupilumab represents a  therapeutic asset to help us address the unmet needs of the AD patient population. 

Do you treat the Field? Areas of sun damaged skin can be represented by an individual or group of  actinic keratoses acting as beacons. These actinic keratoses(AK’s) are signals alerting us to surrounding fields of sun damage. The treatment of an individual AK with liquid nitrogen (LN2) does not address these surrounding fields of potentially precancerous skin. Numerous studies and articles demonstrate that you can effectively treat the entire field of sun damaged skin using combination therapy. Combination therapy may include regimes of LN2, topical, and office based light procedures. What is your go-to combination routine to treat the field?

Best,

Joe Gorelick, MSN, FNP-C, Dermatology Education Foundation Founder and Chairman