Dermatology for Advanced Practice Clinicians 2014.pdf

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Dermatology for
Advanced Practice
Clinicians
FIRST EDITION
Margaret A. Bobonich, DNP, FNP-C,
DCNP, FAANP
Assistant Professor
Case Western Reserve University School of Medicine
and Frances Payne Bolton School of Nursing
Director, Dermatology NP Residency
Department of Dermatology
University Hospitals Case Medical Center
Cleveland, Ohio
Mary E. Nolen, MS, ANP-BC, DCNP
Director, Dermatology NP Fellowship
Lahey Hospital and Medical Center
Department of Dermatology
Burlington, Massachusetts
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Copyright © 2015 Wolters Kluwer.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced or
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9 8 7 6 5 4 3 2 1
Printed in China
Library of Congress Cataloging-in-Publication Data
Bobonich, Margaret A., author.
Dermatology for advanced practice clinicians / Margaret A. Bobonich, Mary E. Nolen.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4511-9197-4 (alk. paper)
I. Nolen, Mary E., author. II. Title.
[DNLM: 1. Skin Diseases. WR 140]
RL74
616.5—dc23
2014023342
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,
including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based on health care professionals’ ex-
amination of each patient and consideration of, among other things, age, weight, gender, current or
prior medical conditions, medication history, laboratory data, and other factors unique to the patient.
The publisher does not provide medical advice or guidance, and this work is merely a reference tool.
Health care professionals, and not the publisher, are solely responsible for the use of this work, in-
cluding all medical judgments, and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent profes-
sional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dos-
ages, and treatment options should be made and health care professionals should consult a variety
of sources. When prescribing medication, health care professionals are advised to consult the prod-
uct information sheet (the manufacturer’s package insert) accompanying each drug to verify, among
other things, conditions of use, warnings, and side effects and to identify any changes in dosage
schedule or contraindications, particularly if the medication to be administered is new, infrequently
used, or has a narrow therapeutic range. To the maximum extent permitted under applicable law,
no responsibility is assumed by the publisher for any injury and/or damage to persons or property,
as a matter of products liability, negligence law or otherwise, or from any reference to or use by any
person of this work.
LWW.com
CONTRIBUTORS
Lakshi M. Aldredge, MSN, ANP-BC
Nurse Practitioner
Portland VA Medical Center
Portland, Oregon
Victoria Garcia-Albea, MSN, PNP, DCNP
Nurse Practitioner
Mystic Valley Dermatology
Stoneham, Massachusetts
Lahey Hospital and Medical Center
Department of Dermatology
Burlington, Massachusetts
Glen Blair, RN, MSN, ANP-C, DCNP
Associate Nurse Leader
Harvard Vanguard Medical Associates
West Roxbury, Massachusetts
Victoria Griffin, RN, MSN, ANP-BC, DCNP
Nurse Practitioner
Harvard Vanguard Medical Associates
Wellesley, Massachusetts
Margaret A. Bobonich, DNP, FNP-C, DCNP, FAANP
Assistant Professor
Case Western Reserve University School of Medicine and
Frances Payne Bolton School of Nursing
Director, Dermatology NP Residency
Department of Dermatology
University Hospitals Case Medical Center
Cleveland, Ohio
Diane Hanna, MSN, DNP
Regional Medical Liaison
Celgene
Overland Park, Kansas
Director of Clinical Research and Nurse Practitioner
Modern Dermatology
Shawnee, Kansas
Niki Bryn, APRN, GNP-BC, NP-C, DCNP
Nurse Practitioner
Dermatology and Skin Health
Dover, New Hampshire
Linda Hansen-Rodier, MS, WHNP-BC
Nurse Practitioner
Northeast Dermatology
North Andover, Massachusetts
Susan Busch, MSN, ANP-BC
Nurse Practitioner
Lahey Hospital and Medical Center
Department of Dermatology
Burlington, Massachusetts
Kathleen E. Dunbar Haycraft, DNP,
FNP/PNP-BC, DCNP, FAANP
Nurse Practitioner
Riverside Dermatology
Hannibal, Missouri
Cathleen K. Case, MS, ANP, DCNP
Nurse Practitioner
Reliant Medical Group
Worcester and Leominster, Massachusetts
Dea J. Kent, MSN, RN, NP-C, CWOCN, DNP-C
Director of Quality Assurance, Long Term Care
Nursing Home Oversight, Community Health Network
Indianapolis, Indiana
Janice T. Chussil, MSN, ANP-C, DCNP
Nurse Practitioner
Klein Dermatology & Associates
Portland, Oregon
Victoria Lazareth, MA, MSN, NP-C, DCNP
Nurse Practitioner
UMass Memorial Medical Center
Worcester, Massachusetts
Melissa E. Cyr, MSN, ANP-BC, FNP-BC
Nurse Practitioner
Lahey Hospital and Medical Center
Department of Dermatology
Burlington, Massachusetts
Gail Batissa Lenahan, APRN, DCNP
Nurse Practitioner
Foundation Skin Surgery and Dermatology at Foundation
Medical Partners
Nashua, New Hampshire
Pamela K. Fletcher, DNP, RN, FNP-BC, DCNP
Assistant Professor
Northern Kentucky University College of Health Professions
Highland Heights, Kentucky
UC Health Dermatology
Southgate, Kentucky
Mary E. Nolen, MS, ANP-BC, DCNP
Director, Dermatology NP Fellowship
Lahey Hospital and Medical Center
Department of Dermatology
Burlington, Massachusetts
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CONTRIBUTORS
Kelly Noska, RN, MSN, ANP-BC
Nurse Practitioner
Lahey Hospital and Medical Center
Department of Dermatology
Burlington, Massachusetts
Dorothy Sullivan, MSN, APRN-BC, NP-C
Nurse Practitioner
Lahey Hospital and Medical Center
Department of Dermatology
Burlington, Massachusetts
Katie Brouillard O’Brien, MSN, ANP-BC
Nurse Practitioner
Mystic Valley Dermatology
Stoneham, Massachusetts
Jane Tallent, ANP-BC
Nurse Practitioner
Harvard Vanguard Medical Associates
Medford and Somerville, Massachusetts
Theodore D. Scott, RN, MSN, FNP-C, DCNP
Nurse Practitioner
Southern California Permanente Medical Group
San Marcos, California
Susan J. Tofte, MS, BSN, FNP
Nurse Practitioner and Assistant Professor
Oregon Health & Science University
Portland, Oregon
Diane Solderitsch, MSN, FNP
Nurse Practitioner
University Hospitals Case Medical Center
Cleveland, Ohio
Susan Thompson Voss, APRN, DNP, FNP-BC, DCNP
Nurse Practitioner
Riverside Dermatology
Hannibal, Missouri
P R E FA C E
“The eye sees only what the mind is prepared to comprehend.”
. . . . Henri Bergson, French philosopher and educator
For centuries, educators have emphasized the importance of
knowledge and its impact on how we view or interpret the world.
This is particularly relevant as we proceed through the twenty-first
century, with increasing demand for health care and limited access
to specialties such as dermatology. As a result, primary care pro-
viders shoulder a significant burden for the care of patients with
dermatologic complaints. Advanced practice clinicians (APCs) are
uniquely positioned to help satisfy this growing demand, and will
likely encounter one out of every three patients with a dermato-
logic complaint. For that reason, APCs are responsible to ensure
that they have the knowledge and skills to develop competency in
evaluating skin conditions.
For most of us, there was minimal education and clinical experi-
ence in dermatology during our master’s programs. Acquiring this
knowledge and clinical acumen is challenging, especially for those
interested in pursuing a career in dermatology. We have seen, first-
hand, the educational gaps that exist between APC education and
practice, and have endeavored to develop structured, interprofes-
sional post-master’s education for dermatology NPs. So after years
of teaching, mentoring, and lecturing health care professionals in
both nursing and medicine, we set out to create a dermatology text
dedicated to APCs.
The content of this book focuses on skin diseases that are high
volume (most common conditions seen in practice); high mor-
bidity (causing disability or high impact on the community); and
high mortality (life- or limb-threatening). Our aim was to create a
practical approach to learning dermatology that can impact clinical
practice with an emphasis on recognition, diagnosis, management,
and collaboration. This book outlines the essential dermatology
knowledge and skills for APCs in primary care and provides a
strong foundation for new clinicians specializing in dermatology.
The chapters have been designed in an orderly and user-friendly
manner, offering tables, algorithms, and lists that we have found
to be the most beneficial for the busy clinician. Common pitfalls,
clinical pearls, and guidelines for referral and consultation are rec-
ommended on the basis of the scope of practice for our professions
and specialty practice. Given the visual nature of dermatology spe-
cialty, more than 600 photographs are included to guide APCs to
a prompt and accurate diagnosis—helping the mind understand
what one’s eyes are seeing.
It is our hope that this will become an everyday reference that
will be your “go to” book for skin-related patient complaints. We
encourage you to start at the beginning to master the basic concepts
outlined in the first two chapters. Understanding the structure and
function of the skin is key to distinguishing normal from abnor-
mal, and for making clinicopathologic correlations. Algorithms can
guide you from the primary morphology of a lesion to differential
diagnosis groups with easy reference to chapter content.
This text is ideal for new and experienced APCs alike. Students
can utilize this text to learn more about dermatology during their
master’s programs, enabling them to be more prepared to evaluate
and treat patients with dermatologic complaints. A greater knowl-
edge of dermatology gained through this user-friendly text can
enhance your professionalism, decrease anxiety about treating pa-
tients with unknown rashes, and most importantly, produce better
patient outcomes.
Enjoy!
Margaret A. Bobonich, DNP, FNP-C, DCNP, FAANP
Mary E. Nolen, MS, ANP-BC, DCNP
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