Hosts: Jake Lancaster MD, Chief Medical Information Officer and Amanda Comer DNP, System Director, Advanced Practice Providers
Guest: Zachary Nahmias, MD, Dermatologist
Summary:
In this episode of Right Care Baptist, host Dr. Jake Lancaster (Chief Medical Officer, Baptist Medical Group) and Amanda Comer, NP (Chief Advanced Practice Officer) sit down with Dr. Zachary Nahmias, a board-certified dermatologist at NEA Baptist Clinic in Jonesboro, Arkansas, to discuss the most common dermatology referrals from primary care and how to manage them more effectively.
Dr. Nahmias breaks down his top five referral categories — suspicious skin lesions, psoriasis, eczema/contact dermatitis, adult acne, and hard-to-place rashes — and offers practical guidance for each. The conversation covers red flags for skin cancer (flat irregular lesions, bleeding, pain, and the "ugly duckling" that stands out from surrounding spots), when and how to screen patients, and the importance of gathering UV exposure and family history before referring.
The discussion then shifts to rashes, where Dr. Nahmias encourages primary care providers to treat confidently when they recognize common conditions like psoriasis, eczema, and seborrheic dermatitis rather than deferring to a 6-month dermatology wait. He highlights common pitfalls including diagnostic anchoring, the risk of topical steroids masking or feeding fungal infections, the dangers of systemic steroids for psoriasis causing a rebound "whiplash," and misusing high-potency topical steroids in sensitive skin fold areas. He walks through distinguishing tinea from eczema by looking for a leading scale with an erythematous base, and recommends Lotrisone as an underappreciated option when the diagnosis is unclear on the feet and lower legs.
On drug-related rashes, Dr. Nahmias discusses the challenge of identifying culprit medications in patients on multiple drugs, common inpatient offenders like vancomycin and sulfa drugs, and serious reactions including Stevens-Johnson syndrome and DRESS syndrome.
The episode wraps with advice on building relationships with local dermatology offices, taking clinical photos to share with referrals, knowing when to send a patient urgently (vasculitic rashes, sudden whole-body eruptions with systemic symptoms), and how the VisualDx diagnostic platform can help primary care providers narrow differentials and select first-line treatments.
