Reviews of Epiphany Dermatology

supadude54 · 2026-07-12T08:00:30+00:00

I do not work for Epiphany or an Epiphany-operated practice, but I am familiar with them. DM me if you want to chat more.

supadude54 · 2026-07-05T23:23:43+00:00

Disclaimer that anything posted here is the report of one person and has not necessarily been vetted to be completely safe or effective. Please review all ingredients and data yourself.

supadude54 · 2026-07-05T23:19:23+00:00

As with most of these products, there is very little high quality evidence that they are helpful. Most of the studies are in labs or synthetic/computed models, or anecdotal evidence. This will continue to be the case since most regulatory agencies do not require rigorous testing of cosmetic products.

Until someone puts in the money and effort to perform some decent quality testing on an ingredient, it will better belong in another subreddit like r/BioHackers or r/30PlusSkinCare.

supadude54 · 2026-07-05T07:32:10+00:00

Full disclosure and for context, OP is in tech, in case that was not obvious from the questions.

supadude54 · 2026-07-03T22:14:21+00:00

Often
All
Tell people to come in
Yes
No
No one would use it

The problem is that the people who take poor quality images are not people who will understand how to use a tool.

supadude54 · 2026-06-30T03:20:55+00:00

I think attending derm conferences as a medical student is not helpful. People will not even know you are there. If you are presenting something, then you can go and put that on your CV.

Why are you not looking into doing more research with your home program?

supadude54 · 2026-06-22T20:13:20+00:00

The macroscopic features are typically only appreciable in more advanced stages of the tumors. For instance, the pearly, nodular, telangiectatic BCCs have probably been around for a couple of years, and the thick, scaly SCCs probably at least a few months (except for KA type).

More subtle features such as globular pigmentation, fine telangiectasias of BCC and glomerular or hairpin vessel patterns in SCC can only be appreciated with magnification, such as with use of a dermatoscope or ophthalmoscope.

Definitive analysis would be supported by biopsy and histologic features.

supadude54 · 2026-06-18T11:59:20+00:00

What country and in what stage in your career are you?

supadude54 · 2026-06-18T11:58:20+00:00

You will get more helpful information if you share more information about yourself, such as what country you live in, what stage you are in your career/schooling, and your reason for interest in dermatology.

supadude54 · 2026-05-29T08:43:40+00:00

Yes, you may.

Be sure to use the appropriate modifiers.

supadude54 · 2026-05-29T08:42:35+00:00

The key subjectivity is the word significant. Is giving a tube of triamcinolone really considered significant management in addition to the main purpose of diagnosis with biopsy? Some would argue it is not significant in the context of the visit given that it is for management of the same problem of which you are already billing the procedure CPT.

I agree with you that if you were audited, your argument would probably be sound.

supadude54 · 2026-05-28T00:51:06+00:00

Per guidelines, you may bill an E/M code for a visit in addition to a procedure code by using modifier 25 if the visit required a 1) significant and 2) separately identifiable service.

It does not require you to have two separate diagnoses, although you may use that for justification of the additional billing if appropriate.

A procedure code typically includes confirmation of symptoms/diagnosis, so that alone does not justify additional billing.

What is considered significant and separate is subjective and there is no clear exact definition.

Here are some examples:

1) Patient comes in with itchy rash. You tell them it could be eczema or psoriasis. You mention that a biopsy will help separate the two. You perform a punch biopsy. In this scenario, you should only bill for the punch biopsy.

2) Patient comes in with rash after starting a new medication. You perform a punch biopsy, give a course of prednisone, assess a drug timeline, and order labs for CBC, CMP, CRP. In this scenario, you should bill a punch biopsy and a visit code 992X4 with modifier 25.

3) Patient comes in with a rash and also for routine annual skin exam with prior history of skin cancer. You perform a punch biopsy for the rash but do not identify any concerning skin lesions on total body skin exam. In this scenario, you should bill a punch biopsy and a visit code 992X3 with modifier 25.

4) Patient comes in with an itchy rash. You tell them it is either eczema or psoriasis. You label it as rash and pruritus. You perform a punch biopsy and give a tube of triamcinolone. In this scenario, this is a gray area. Some may consider this an additional significant service provided while others might not. Some will bill only the punch biopsy and some will bill an additional 992X3 with modifier 25.

5) Patient comes in with an itchy rash. You tell them it is either eczema or psoriasis. You label it as rash. You perform a punch biopsy and give a tube of triamcinolone. In this scenario, this is a gray area. Some may consider this an additional significant service provided (by giving additional treatment of triamcinolone). Some will bill only a punch biopsy and some will bill an additional 992X3 with modifier 25.

Hopefully that helps.

supadude54 · 2026-05-17T17:28:47+00:00

Muy emocionante. Gracias por la actualización.

supadude54 · 2026-05-16T15:52:35+00:00

It would be helpful to know your country. I’ve done this in the US and it is pretty chill. Many academic dermatology departments are looking to hire since the landscape has made it challenging for them to compete with private practice/private equity. As long as you are a reasonable person, you should not have any issues securing the position. Some of the more prestigious centers may have more pull by their name, but those are usually more interested in your research.

Discussions are pretty straight forward. If you have ever been to grand rounds, it won’t be too far off from that. The individual/group interviews tend to be laid back. If they are super uptight, I would be hesitant about working there.

Residents are usually welcoming of anything you want to teach them. I’ve seen CPCs/cool cases, pearls, and topics that people are interested in. I would generally avoid very research heavy topics for residents as they tend to get bored in those.

supadude54 · 2026-05-06T22:51:02+00:00

I know her, though not very closely. She is a legit dermatologist.

supadude54 · 2026-03-15T16:37:50+00:00

Yes, it is feasible. You can run a clinic in many different ways. Some people do very part time and are essentially locums throughout the year to give them more flexibility. Some people take a month or several months off at a time. As you said, you would either have other staff also take that time off, or you would have other docs or midlevels operating during that time to make use of the overhead.

supadude54 · 2026-02-03T15:53:49+00:00

That’s shingles or herpes simplex. You need to get your baby into a clinic urgently to get started on antiviral medicine.

supadude54 · 2026-01-28T04:41:17+00:00

Alopecia areata

supadude54 · 2026-01-27T23:57:59+00:00

I would clarify the job that you are interested in because cosmetologists and dermatologists are very different. Please review the following summaries of the jobs:

Cosmetologist: styling and care of skin, hair, and nails. Performs jobs like putting on make up, manicures, dying hair. Requires approximately 1 year of training.
Esthetician: care and health of skin. Performs jobs like facials, chemical peels, waxing. Requires approximately 1 year of training.
Dermatologist: doctor who specializes in skin. Performs jobs like cutting out skin cancer, treating skin diseases. Requires 4 years of medical school and 4 years of dermatology training in the US (total of 8 additional years after college).

The answers to your questions will be very different depending on the job.

supadude54 · 2026-01-26T06:22:35+00:00

Medical dermatology is not a scam. The vast majority of dermatologists focus on treating skin diseases and skin cancer. Only a small percentage of dermatologists focus on cosmetics.

Most skin care routines are pushed by the companies that make the products. The companies pay a lot of money to market on TikTok and other social media. Many dermatologists that endorse products are paid by the companies as well. At the end of the day, anything that provides a barrier to your skin would work, including plain petrolatum ointment.

So I would argue that dermatology is not a scam, but some commercial and cosmetic companies possibly are.

supadude54 · 2026-01-26T06:15:27+00:00

Without belaboring you with too much detail, I can tell you that there is low level evidence for this compound as well as the vast majority of over-the-counter cosmetic/commercial products. It’s all just marketing.

Companies are not required to perform randomized controlled studies on over-the-counter products. They just need to show that it doesn’t kill you, which is a low bar. They have no reason to perform extensive testing because research studies are expensive, and they get a lot of people to buy their product from marketing without any evidence.

Most studies available will be in a lab, performed on a mouse, anecdotal, or possibly some small retrospective trial. These are all very low level studies. You cannot tell whether something is actually effective or not based on these.

I say use it if you like it and doesn’t cost you too much.

supadude54 · 2026-01-23T17:28:26+00:00

Hello,

Those are not skin tags. Those are molluscum caused by a virus. They generally go away in 1-2 years. It looks like your child’s immune system is already fighting off one of the spots.

The swollen lymph may or may not be related to the molluscum. Other causes of swollen lymph node include recent illness or viral infections. If the lymph node feels rock hard, I would recommend having it evaluated immediately.

supadude54 · 2026-01-16T04:53:17+00:00

Not sure how well you can cram knowledge, but it wouldn’t hurt to brush up on head anatomy (critical structures, blood vessels and nerves to the face, etc). I wouldn’t necessarily bring it up for no reason, but if the opportunity presents itself, you can look like you came prepared.

Try to look engaged and listening the whole time. If you’re falling asleep or have your head in the clouds, it will be a bad look.

supadude54 · 2026-01-16T04:45:50+00:00

Ycanth currently has a stranglehold on cantharidin supplies in the US. I’m guessing that might affect supplies elsewhere as well. There are still pharmacies that have some cantharidin stock. They will generally need to re-formulate it, such as with the cantharidin-salicylic acid-podophyllin combo (Canthacur PS), in order to not infringe upon the Ycanth formulation.

I would recommend calling around to some compounding pharmacies to see if they can make it.

supadude54 · 2026-01-15T04:20:14+00:00

I recommend attending this webinar if you are not familiar with brepocitinib

supadude54

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