#dermJC Transcript
Healthcare social media transcript of the #dermJC hashtag.
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See #dermJC Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | Roxana Daneshjou MD/PhD @RoxanaDaneshjou Roxana, derm resident from Stanford. I consult but it has nothing to do with this topic. #dermjc |
 | Daniel Butler MD @DanielButlerMD I can start things off with a some thoughts. Derm doesn't always come across dementia ( but we certainly see it in clinic) #dermjc |
 | Dermatology Journal Club @DermatologyJC RT @RoxanaDaneshjou: Roxana, derm resident from Stanford. I consult but it has nothing to do with this topic. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: I can start things off with a some thoughts. Derm doesn't always come across dementia ( but we certainly see it in clinic) #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: Thanks to all who are joining, we can sit a few minutes for people to pop in. No pressure to contribute but would love to know who is out there #dermjc @GeriDerm |
| Daniel Butler MD @DanielButlerMD This paper faintly brings together dermatology and dementia ( a well known geriatric condition) by association of anticholinergic meds. NOT TO BE confused with antihistamines which were included in this cohort but did not show an association with dementia. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @DanielButlerMD It’s good to point that out because I have heard people say that we shouldn’t give antihistamines without having done a deep dive into this paper. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: This paper faintly brings together dermatology and dementia ( a well known geriatric condition) by association of anticholinergic meds. NOT TO BE confused with antihistamines which were included in this cohort but did not show an association with dementia. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @RoxanaDaneshjou: @DanielButlerMD It’s good to point that out because I have heard people say that we shouldn’t give antihistamines without having done a deep dive into this paper. #dermjc |
| Daniel Butler MD @DanielButlerMD That's a great point about antihistamines which should be used with caution for other reasons. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @DanielButlerMD Raise your hand if you’re a dermatologist that uses antihistamines in your practice. Lol. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: That's a great point about antihistamines which should be used with caution for other reasons. #dermjc |
| Daniel Butler MD @DanielButlerMD 🖖 #dermjc |
| Daniel Butler MD @DanielButlerMD Antihistamines should be used cautiously in aging adults but beyond that generic statement...we should be using them in situation where they can work. Thats brings up the important fact that data shows itching/pruritus does not respond to antihistamines #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DanielButlerMD: Antihistamines should be used cautiously in aging adults but beyond that generic statement...we should be using them in situation where they can work. Thats brings up the important fact that data shows itching/pruritus does not respond to antihistamines #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: Antihistamines should be used cautiously in aging adults but beyond that generic statement...we should be using them in situation where they can work. Thats brings up the important fact that data shows itching/pruritus does not respond to antihistamines #dermjc |
| Daniel Butler MD @DanielButlerMD The main anticholinergics that were found to possibly contribute to dementia are Doxepin Amitriptyline Carbamazepine #dermjc |
| Daniel Butler MD @DanielButlerMD Meaning that ones we commonly use in dermatology #dermjc |
| Daniel Butler MD @DanielButlerMD My question to the community out there (or any geriatrician listening) is if this will/should change practice of using any of these medication? #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: The main anticholinergics that were found to possibly contribute to dementia are Doxepin Amitriptyline Carbamazepine #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: My question to the community out there (or any geriatrician listening) is if this will/should change practice of using any of these medication? #dermjc |
 | Goran Micevic MD/PhD @gmicevic Putting aside the major caveat of assuming that anticholinergics were actually taken as prescribed, what I found really interesting (?surprising) was the stronger association with vascular dementia than Alzheimer disease. #dermjc |
| Daniel Butler MD @DanielButlerMD My take on this. We use doxepin for stubborn neuropathic itch. It's particularly effective for patient with scalp or genital pruritus as well as those with a possible anxiety component to pruritus. With this, we should be dig in to how much the itch is impacting QOL #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @LoewenthalMd @DanielButlerMD We use doxepin in dermatology. At least we have here. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @gmicevic: Putting aside the major caveat of assuming that anticholinergics were actually taken as prescribed, what I found really interesting (?surprising) was the stronger association with vascular dementia than Alzheimer disease. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @gmicevic: Putting aside the major caveat of assuming that anticholinergics were actually taken as prescribed, what I found really interesting (?surprising) was the stronger association with vascular dementia than Alzheimer disease. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: My take on this. We use doxepin for stubborn neuropathic itch. It's particularly effective for patient with scalp or genital pruritus as well as those with a possible anxiety component to pruritus. With this, we should be dig in to how much the itch is impacting QOL #dermjc |
| Daniel Butler MD @DanielButlerMD That was interesting too. Do you think that association with vascular > AD suggests a contribution to the multiple comorbidities that contribute to vascular? HTN, hyperlipid, PVD, CAD, DM? #dermjc |
 | DermPA @DermPAElizabeth @DanielButlerMD Interesting that for those who participate in MIPS, under measure 238 (use of high risk medications in the elderly) anticholinergics and 1st generation antihistamines are on the list of meds to avoid in patients 65+ #dermjc |
| Dermatology Journal Club @DermatologyJC RT @ElizabethAhlstr: @DanielButlerMD Interesting that for those who participate in MIPS, under measure 238 (use of high risk medications in the elderly) anticholinergics and 1st generation antihistamines are on the list of meds to avoid in patients 65+ #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: That was interesting too. Do you think that association with vascular > AD suggests a contribution to the multiple comorbidities that contribute to vascular? HTN, hyperlipid, PVD, CAD, DM? #dermjc |
| Daniel Butler MD @DanielButlerMD @ElizabethAhlstr Yeah I think it’s a safe blanket to put over these medication, particularly given the lack of efficacy for antihistamines. Now does that mean its an absolute contraindication... I wouldn’t go that far. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: @ElizabethAhlstr Yeah I think it’s a safe blanket to put over these medication, particularly given the lack of efficacy for antihistamines. Now does that mean its an absolute contraindication... I wouldn’t go that far. #dermjc |
| DermPA @DermPAElizabeth I think the biggest question in my mind (still not answered by this study) is at what age do you start to worry about use of anticholinergics? Authors mention middle age. When is that? 😆 #dermjc |
| Daniel Butler MD @DanielButlerMD If I can make a plug for the larger geriatric-dermatology community...I do love that this paper does communicate, in some form, that dermatology as a field should continue to evaluate practices and habits in patients that are aging/geriatric #dermjc |
| Daniel Butler MD @DanielButlerMD @ElizabethAhlstr I get asked the "what age is geriatric" question a lot, and so I'm curious how the geriatrics answer it. I personally don't think it's an age. It's a comorbidity and functionality measure that defines who we should/shouldnt be worried about. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @LoewenthalMd @DanielButlerMD We love having others join! Use the #dermjc so we can see your tweets! |
| Dermatology Journal Club @DermatologyJC RT @ElizabethAhlstr: I think the biggest question in my mind (still not answered by this study) is at what age do you start to worry about use of anticholinergics? Authors mention middle age. When is that? 😆 #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: If I can make a plug for the larger geriatric-dermatology community...I do love that this paper does communicate, in some form, that dermatology as a field should continue to evaluate practices and habits in patients that are aging/geriatric #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: @ElizabethAhlstr I get asked the "what age is geriatric" question a lot, and so I'm curious how the geriatrics answer it. I personally don't think it's an age. It's a comorbidity and functionality measure that defines who we should/shouldnt be worried about. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DanielButlerMD: If I can make a plug for the larger geriatric-dermatology community...I do love that this paper does communicate, in some form, that dermatology as a field should continue to evaluate practices and habits in patients that are aging/geriatric #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DanielButlerMD: My take on this. We use doxepin for stubborn neuropathic itch. It's particularly effective for patient with scalp or genital pruritus as well as those with a possible anxiety component to pruritus. With this, we should be dig in to how much the itch is impacting QOL #dermjc |
| Daniel Butler MD @DanielButlerMD Dermatologists are one of the most common specialist groups that see aging/geriatric adults. #1 is always ophthalmology then derm, ortho, and cardiology are the next most common. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: Dermatologists are one of the most common specialist groups that see aging/geriatric adults. #1 is always ophthalmology then derm, ortho, and cardiology are the next most common. #dermjc |
| Daniel Butler MD @DanielButlerMD #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @DanielButlerMD Will you hold it if the patient already has underlying dementia? #dermjc |
| Daniel Butler MD @DanielButlerMD @RoxanaDaneshjou Great question. That's where it gets sticky. When I'm making a decision about treating older patients with cognitive impairment, I always ask if they are sleeping, if they are able to perform the activities of daily living #dermjc |
| Daniel Butler MD @DanielButlerMD @RoxanaDaneshjou If they are not sleeping or performing ADLs, that is a signal to me that we need to treatment escalate. Depending on the type of pruritus, that may be doxepin or even MTX or other immunosuppressants. It is almost never antihistamines! #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: #dermjc |
| Dermatology Journal Club @DermatologyJC RT @RoxanaDaneshjou: @DanielButlerMD Will you hold it if the patient already has underlying dementia? #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: @RoxanaDaneshjou Great question. That's where it gets sticky. When I'm making a decision about treating older patients with cognitive impairment, I always ask if they are sleeping, if they are able to perform the activities of daily living #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: @RoxanaDaneshjou If they are not sleeping or performing ADLs, that is a signal to me that we need to treatment escalate. Depending on the type of pruritus, that may be doxepin or even MTX or other immunosuppressants. It is almost never antihistamines! #dermjc |
| Daniel Butler MD @DanielButlerMD One treasure the Geriatricians are wonderful about teaching, with older adults, it's never black and white when it comes to risky treatment. It's a shared decision discussion about the risks as well as a thorough dive into the patient's goals. #dermjc |
| Daniel Butler MD @DanielButlerMD I encourage every dermatology practitioner out there on twitter to reach out to your local geriatrician. They are a tremendous resource for complex patients. They can be a life saver for you and the patient. @AmerGeriatrics #dermjc |
| Daniel Butler MD @DanielButlerMD @AmerGeriatrics I am biased as my wife is a geriatrician #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: I encourage every dermatology practitioner out there on twitter to reach out to your local geriatrician. They are a tremendous resource for complex patients. They can be a life saver for you and the patient. @AmerGeriatrics #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: One treasure the Geriatricians are wonderful about teaching, with older adults, it's never black and white when it comes to risky treatment. It's a shared decision discussion about the risks as well as a thorough dive into the patient's goals. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DanielButlerMD: I encourage every dermatology practitioner out there on twitter to reach out to your local geriatrician. They are a tremendous resource for complex patients. They can be a life saver for you and the patient. @AmerGeriatrics #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DanielButlerMD: One treasure the Geriatricians are wonderful about teaching, with older adults, it's never black and white when it comes to risky treatment. It's a shared decision discussion about the risks as well as a thorough dive into the patient's goals. #dermjc |
| DermPA @DermPAElizabeth @DanielButlerMD Does this paper have any bearing on how comfortable you feel using anticholinergics in general, even for much younger patients? Do you worry about long term consequences? (For example in derm, we may use glycopyrrolate for hyperhidrosis.) #dermjc |
| Dermatology Journal Club @DermatologyJC RT @ElizabethAhlstr: @DanielButlerMD Does this paper have any bearing on how comfortable you feel using anticholinergics in general, even for much younger patients? Do you worry about long term consequences? (For example in derm, we may use glycopyrrolate for hyperhidrosis.) #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @DanielButlerMD What are your thoughts on the inpatient setting? Cc: @DrStevenTChen #dermjc |
| Daniel Butler MD @DanielButlerMD @ElizabethAhlstr Looks like glycopyrrolate at its doses used for antimuscarinic bronchodilitation were not shown to increase the risk of dementia in patients over 55 so I don't think it will change my practice too much but it's a great question. Will certainly think about this article.#dermjc |
 | Allison Larson, MD @AllisonLarsonMD Thanks for reviewing this paper @DanielButlerMD and @DermatologyJC! I’m in the thick of application reading so I couldn’t join but enjoyed the article and your insights. I’m going to be carefully thinking about the anticholinergics I give #dermjc |
| Dermatology Journal Club @DermatologyJC RT @AllisonLarsonMD: Thanks for reviewing this paper @DanielButlerMD and @DermatologyJC! I’m in the thick of application reading so I couldn’t join but enjoyed the article and your insights. I’m going to be carefully thinking about the anticholinergics I give #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @AllisonLarsonMD: Thanks for reviewing this paper @DanielButlerMD and @DermatologyJC! I’m in the thick of application reading so I couldn’t join but enjoyed the article and your insights. I’m going to be carefully thinking about the anticholinergics I give #dermjc |
 | Steven Chen 陳持威, MD, MPH, MHPEd @DrStevenTChen @RoxanaDaneshjou @DanielButlerMD Haha, sorry, I’ve been lurking. Same thoughts for inpatient. Usually by the time we as #derm get to the patient, antihistamines have been tried, but agree with @DanielButlerMD that it doesn’t make sense most of the time, so I’m actively recommending they d/c it. #dermjc |
| Steven Chen 陳持威, MD, MPH, MHPEd @DrStevenTChen @RoxanaDaneshjou @DanielButlerMD Only exception to that fact is in urticaria or dermatographism, something that’s actually histamine related. On inpatient, I see most often with narcotic induced. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrStevenTChen: @RoxanaDaneshjou @DanielButlerMD Haha, sorry, I’ve been lurking. Same thoughts for inpatient. Usually by the time we as #derm get to the patient, antihistamines have been tried, but agree with @DanielButlerMD that it doesn’t make sense most of the time, so I’m actively recommending they d/c it. #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DrStevenTChen: @RoxanaDaneshjou @DanielButlerMD Only exception to that fact is in urticaria or dermatographism, something that’s actually histamine related. On inpatient, I see most often with narcotic induced. #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou @DrStevenTChen @DanielButlerMD You gave yourself away by liking a tweet. ;) #dermjc |
| Daniel Butler MD @DanielButlerMD @DrStevenTChen @RoxanaDaneshjou The exception! @DrStevenTChen taught me this. Urticarial itching is the one type responsive to antihistamines #dermjc |
| Roxana Daneshjou MD/PhD @RoxanaDaneshjou RT @DanielButlerMD: @DrStevenTChen @RoxanaDaneshjou The exception! @DrStevenTChen taught me this. Urticarial itching is the one type responsive to antihistamines #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: @DrStevenTChen @RoxanaDaneshjou The exception! @DrStevenTChen taught me this. Urticarial itching is the one type responsive to antihistamines #dermjc |
| Daniel Butler MD @DanielButlerMD Take away points. 1. Use doxepin with caution. 2. While not a/w dementia, antihistamines still don't work for itch 3. Introduce yourself to local geriatrician #dermjc |
| Dermatology Journal Club @DermatologyJC RT @DanielButlerMD: Take away points. 1. Use doxepin with caution. 2. While not a/w dementia, antihistamines still don't work for itch 3. Introduce yourself to local geriatrician #dermjc |
| Dermatology Journal Club @DermatologyJC Thank you @DanielButlerMD for teaching us so much about @GeriDerm!! Feel free to keep comments coming on #dermjc! |
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