Time Out for Medical Ethics in Dermatology - Please Vote!

A 17y.o. presents to the office with an enlarging abscess on his back. He's a foreign exchange student and claims to have no access to a parent or legal guardian. No one whom he can reach by phone/email in a small town in Upper Mongolia. Your staff tries to reach his exchange program supervisor without success. Federal law prohibits seeing a patient under 18 without parental/guardian consent - typically we require a note from parents in order to see an unaccompanied minor. However, the law also permits physicians to act in an emergency in the patient's best interests, regardless of parental consent. The patient has no fever or evidence of bacteria in the bloodstream. His vital signs and medical hisotry are otherwise unremarkable.

You're the dermatologist...Do you:
A) Practice standard of care and drain the enlarging abscess - this isn't an emergency but may quickly become one if untreated.
B) Take the hard line and refuse to see the patient.
C) Not my problem - send this patient to the ER across the street.
D) Take the middle road and prescribe antibiotics. While not the standard of care for an abscess, maybe this will work and its alot less invasive than incision and drainage.

...Retweet or comment with your answer!...Follow Up to Come.

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Acne Keloidalis Nuchae

Acne Keloidalis Nuchae. A chronic and sometimes very painful condition, this severe follicular inflammation can lead to permanent scarring. We use antibiotics like doxycycline to keep this condition at bay. Intralesional injections of steroids can hep with excess inflammation. For very severe cases, isotretinoin and even surgical intervention has been shown to have remarkable, long-term clearence results.

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Henoch Schonlein Purpura

Henoch Schonlein Purpura - a small vessel "vasculitis" (inflammation of small blood vessels) more common in children, but seen at all ages. These bruise-like lesions are clasically located on the legs and are associated with abdominal and joint pain.  

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Melanoma in situ

This mole is as irregular as they come - note the lack of distinct edges and the variegate color. A biopsy of this lesion revealed a Melanoma in situ.



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Dissecting Cellulitis of the Scalp/Folliculitis Decalvans

http://emedicine.medscape.com/article/1071957-overview
A challenging, chronic condition to treat. Oral antibiotics are inconsistently effective, probably because bacterial cultures are usually negative for known pathogens. Isotretinoin usually has the best track record in my experience.

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