Palliative care in dermatology: A clinical primer, review of the literature, and needs assessment

Geriatric dermatologic surgery part I: Frailty assessment and palliative treatments in the geriatric dermatology population

Longer life expectancy and increasing keratinocyte carcinoma incidence contribute to an increase in geriatric patients presenting for dermatologic surgery. Unique considerations accompany geriatric patients including goals of care, physiologic changes in medication metabolism, cognitive decline, and frailty. Limited geriatric training in dermatology residency has created a knowledge gap and dermatologic surgeons should be familiar with challenges facing older patients to provide interventions more congruent with goals and avoid overtreatment. Frailty assessments including the Geriatric 8 and Karnofsky Performance Scale are efficient tools to identify patients who are at risk for poor outcomes and complications. When frail patients are identified, goals of care discussions can be aided using structured palliative care frameworks including the 4Ms (what matters, medications, mentation, and mobility), REMAP (reframing, expecting emotion, mapping patient goals, aligning patient goals, and proposing a plan), and Serious Illness Conversation Guide. Most geriatric patients will tolerate standard of care treatments including invasive modalities like Mohs surgery and excision. However, for frail patients, nonstandard treatments including topicals, energy-based devices, and intralesional chemotherapy may be appropriate options to limit patient morbidity while offering reasonable disease control.

Pain management in hidradenitis suppurativa

Pain is the most impactful symptom in hidradenitis suppurativa (HS), contributing to physical limitations, worsened mental health, and impaired social relationships. Some HS-directed therapies ameliorate HS pain; however, these medications provide insufficient relief for many people living with HS. This article reviews what is currently known about HS pain phenotypes and pathophysiology, the effectiveness of HS treatments for pain, and practical suggestions for dermatologists to help patients manage the symptoms of acute and chronic HS pain.