Eczema – Testing

Woolf and Harris, family medicine practitioners from Virginia and North Carolina, wrote an article on the harms of screening tests in the Journal of the AMA in 2012. I now quote their first two paragraphs to make a point about so many tests that the RSS patients unnecessarily go through.

Medicine is a science, the practice of it is an art.

Anonymous

“Americans are enthusiastic about screening; especially cancer screening. What could be wrong with screening, especially if it can detect a life threatening condition at an earlier stage? Trials show that early detection, colorectal, and other cancers can reduce cause-specific mortality rates, and the same could apply to other conditions. With presumably little to lose and much to gain from early detection, why recommend against screening unless the concern is costs? Are lives being lost to save money?”

“But costs are rarely the reason that guidelines set limits on screening. Most screening controversies turn on how to balance potential harms relative to potential benefits. Harms from screening programs are real; the burden of these harms can be disputed, but their existence cannot. Screening can produce iatrogenic complications (eg. perforation from colonoscopy), anxiety over abnormal results, and a cascade of follow up tests and treatments. Screening can also precipitate over-diagnosis, the workup and treatment of conditions that qualify as disease but pose little threat to patient’s health).”

The TSA (topical steroid addicted patients) so often undergo an immense amount of unnecessary tests searching for an array of reasons for skin redness. Food allergies, environmental exposures, lupus tests, vascular testing are among the many tests that are inappropriately performed. No diagnosis is forthcoming with these tests and the patients panic believing they have some horrific disease.

About the Author: Dr Marvin Rapaport, MD

In 1978 I initiated and set up the contact and photo dermatitis clinic at UCLA. There was a need to evaluate a large group of patients who exhibited severe eczematoid rashes, especially on the face. Patients were referred from all over Southern California. All patients underwent a lengthy history and examination. Further evaluations included blood studies, allergy patch testing, special sunlight (photo) testing and skin biopsies. From the start it was apparent that most patients experienced a mild dermatitis on various parts of the body that progressively worsened. Their histories always included numerous doctor visits, multiple physicians, and therapy consisting of an increasing amount of corticosteroids. My testing failed to reveal any specific culprit chemicals, cosmetics, perfumes, workplace or recreational exposures. It became increasingly clear that the physician’s therapy, the corticosteroids, was invariably causing the problem. I wrote 7 scientific articles that were published in the most august peer-reviewed dermatologic journals and I gave many lectures at various dermatology meetings. To this day an unfortunate reluctance exists on the part of most physicians to accept this simple concept.