Missed but not forgotten
Diagnostic pitfalls and practical treatment pearls in routine clinical practice.
S064 – Therapeutic and Diagnostic Pearls
8-10 a.m. | Tuesday, March 31
Four Seasons 1
In Tuesday’s session, S064 – Therapeutic and Diagnostic Pearls, peer-reviewed literature and personal experience will intersect as dermatologists explore practical lessons, unexpected diagnoses, and accessible treatment strategies for everyday dermatologic challenges, including contact dermatitis, pediatric dermatology, dermatologic surgery, medical dermatology, and skin of color.
Among the deep dives at the session are two medical dermatology topics: commonly misdiagnosed scaling patches of the scalp in older adults and a simple, low-cost method for treating xanthelasma and sebaceous hyperplasia using dichloroacetic acid (DCA). Session presenter Robert T. Brodell, MD, FAAD, a professor of dermatology at the University of Mississippi Medical Center in Jackson, will lead the discussion for both, which he said is rooted in real-world misses and realistic solutions.
“My inspiration for the first topic came from personal experience — specifically, cases in which I initially misdiagnosed elderly patients with persistent scalp scaling,” Dr. Brodell said. “We think about seborrheic dermatitis, psoriasis, maybe allergic contact dermatitis. What we don’t often think about is tinea capitis in older patients.”
Lessons learned
Although tinea capitis is commonly considered a childhood condition, Dr. Brodell emphasized that overlooking it in adults, especially seniors, can delay proper treatment. He recounted his misdiagnosis in which a biopsy unexpectedly confirmed a fungal infection that a simple in-office potassium hydroxide (KOH) test could have revealed earlier.
His presentation will walk dermatologists through clinical reasoning, biopsy clues, and reminders to maintain a broader differential diagnosis — particularly when standard treatments fail. He will also spotlight an underutilized treatment method: the application of dichloroacetic acid (DCA) for xanthelasma and sebaceous hyperplasia.
“I’m not a cosmetic dermatologist,” Dr. Brodell said, “but DCA is something any dermatology practice can use. It’s simple, quick, inexpensive, and gets uniformly good results.”
Dr. Brodell cautioned, however, that physicians must be mindful of skin type. Patients with Fitzpatrick types IV and V may experience long-lasting, post inflammatory dyspigmentation, making DCA a poor choice for darker skin tones. He advises starting with one or two lesions to understand healing patterns before treating multiple areas.
Finally, Dr. Brodell will discuss another topic he said all dermatologists should be aware of: supporting the Rural Access to Dermatology (RAD) Society, an initiative aimed at improving care in underserved regions across the United States.
“Whether you live in the city or the country, there are ways you can help raise the level of care for everyone,” he said.
Is it contact dermatitis or …?
Salma Faghri de la Feld, MD, FAAD, an associate professor of dermatology at Emory University School of Medicine in Atlanta, will review misdiagnosis of allergic contact dermatitis (ACD). She said her primary goal is to help dermatologists feel more confident recognizing and managing this often misunderstood condition.
Dr. de la Feld will offer diagnostic pearls, common clinical pitfalls, and real world management strategies, particularly those relevant to today’s increasingly complex therapeutic landscape, that can guide colleagues in differentiating ACD from other skin disorders.
“One of the core challenges with allergic contact dermatitis is that it can mimic other skin conditions,” she said. “Rashes often overlap with disorders such as atopic dermatitis or psoriasis, and sometimes patients have more than one process occurring simultaneously.”
In cases of uncertainty, she said to consider the following clues:
- New or worsening rashes in patients with known atopic dermatitis
- Persistent facial dermatitis in patients on dupilumab
- New eczematous rashes in patients previously diagnosed with psoriasis and undergoing biologic therapy
“All three of those scenarios could point to allergic contact dermatitis,” she said. “This is how easily ACD can be overlooked without a high index of suspicion.”
Although dermatologists may be accustomed to rapid advances in therapeutics for conditions such as psoriasis or eczema, Dr. de la Feld said the cornerstone of treatment for allergic contact dermatitis is allergen avoidance.
Effective avoidance requires patient education, said Dr. de la Feld, who will supply tips on how to counsel patients on avoiding common allergens, including preservatives (such as isothiazolinones) and fragrances. She will also review the 2026 Contact Allergen of the Year and provide patient resources, including the use of tools such as the American Contact Dermatitis Society’s free ACDS CAMP app, which helps patients navigate safe product recommendations after patch testing.
And more!
The jam-packed session will also explore how systemic immunosuppressive therapies affect patch testing. With the surge in biologics and JAK inhibitors for inflammatory skin disease, Dr. de la Feld said dermatologists frequently wonder whether these medications must be stopped before testing. She will outline practical guidance for:
- When patch testing can still be performed
- When systemic therapies interfere with results
- How to approach referrals and follow-up
“It can be overwhelming for physicians who don’t think about allergens every day,” Dr. de la Feld said. “I want them to feel comfortable handling these patients when they return after patch testing.”
The session will also include presentations from Andrew F. Alexis, MD, MPH, FAAD, Jerry D. Brewer, MD, MS, FAAD, and Thy Nhat Huynh, MD, FAAD.
