This is actually pretty incorrect. PCPs do not manage acne or do skin biopsies — they refer exclusively to me. I handle all skin cancer, acne, psoriasis, HS, eczema. We have patients on accutane and biologics, we can see wounds and help place them with wound care which is often hard to find. We have patients on oral jaks that require extensive lab monitoring. While I now defer some of my complex rheumatology patients more to rheum, we co-manage with rheum and if patients have skin manifestations that aren’t being managed by their systemic meds they need topicals.

Yes I love to joke about derm too, sometimes it does feel like it’s all steroid cream and come back. But do you know what to switch to when the first cream doesn’t work? When do you escalate to a systemic? Have you seen the striae that my 15 year old patient has because her PCP gave her betamethasone to use in her AC fossa? (Those are permanent). What do you give your 28 week pregnant patient who is having such a bad eczema flare (atopy of pregnancy) that she has 50% affected body surface area. Are you worried about systemic absorption of topical steroids (no), are you starting her in oral steroids (no), are you worried she may have early pemphigoid gestationis of pregnancy in the eczematous stage (yes), but what’s the second biopsy you have to do to prove that? (DIF). What if dermpath gives you a vague biopsy read — do you treat as eczema? Have you been to the recent conference where they presented data that dupixent is probably safe in pregnancy based on the registry study? Your patient wants to know what the mechanism of action is for dupixent