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Marie Bosslett is the assistant editor of 

 and joined the MJH Life Sciences team in October 2024. She attended Loyola University Maryland in Baltimore and earned a Bachelor of Arts in Communication with minors in marketing and writing. When she’s not writing, Marie enjoys going to concerts, reading on the beach, and spending time with friends and family.

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and joined the MJH Life Sciences team in February 2023. She attended Kent State University and earned a Bachelor of Science degree in journalism with minors in public relations and creative writing. She enjoys making and listening to music, reading, and spending time with her cats, Astrid and Marceline.

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George Washington University recently earned a Skin Smart Campus designation, championing skin cancer prevention through education, free sunscreen, and UV safety measures.

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Panelists offer concluding insights and emphasize the critical role of comparative studies in advancing atopic dermatitis treatment strategies.

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In this interview, Andrew Blauvelt, MD, MBA, explains how nurse practitioners (NPs) can better counsel psoriasis patients and why its important that NPs have the top knowledge on current dermatologic treatments. 

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The Importance of Dermatology Nurse Practitioners

Telehealth may offer a range of new opportunities for nurse practitioners (NPs) looking to provide accessible, affordable dermatologic services and grow their practice. However, that potential comes with certain risks. Susan Kendig, WHNP, JD, outlined key issues that need to be addressed to optimize this service platform in her session on legal issues presented at the 3rd annual Society of Dermatology Nurse Practitioners Symposium, held April 23 to 24, in Nashville, Tennessee.

“Face-to-face consults are still the gold standard for consultations, but telehealth really does work,” said Kendig, a women’s health integration specialist at SSM Health-St. Mary’s Hospital, St. Louis, Missouri, and director of policy for the National Association of Nurse Practitioners in Women’s Health in Washington, DC. “The caveat is that you have to be careful with it [telehealth].”

. First, determine whether your state scope of practice regulations allows NPs to be telemedicine providers. If so, get a clear understanding of the rules and regulations that define how NPs can practice as telehealth providers. Update your knowledge regularly. For example, some states are now reviewing the scope of practice in terms of where the provider is practicing (at home vs in a practice setting) as well as what NPs are allowed to do. Federal requirements are also in flux. During the pandemic, Medicare allowed medical professionals to use telephonic communications. Now, it generally requires a way to visualize the patient, Kendig noted.

Review state licensure requirements before launching a telehealth service that crosses state lines

. “There are different rules and regulations about how NPs engage in telemedicine across state lines,” Kendig said. “These are really important because many malpractice insurance plans will not cover you if you are engaged in unlicensed activities. You also may have to have a rider to add coverage for telemedicine.” She also pointed to some best-practices to mitigate risk of unlicensed practice—including stopping patients from sending photos across state lines.

“You need to communicate each step of the treatment plan in writing as well as verbally,” Kendig said. “You also need to document that you have done so. You cannot guarantee that the patient will understand completely, but the documentation is important—many of the lawsuits I examined had a complaint that the patient was not aware of what might happen.

Kendig cautioned against anchoring biases and diagnosing based on prior experience. She warned not to jump to conclusions that a patient may have an unusual condition, but to watch for these signs to consider a different diagnosis.

This is not a best practice specific to telehealth, but Kendig pointed out that it is not enough to learn new skills. It is worth documenting the method of training—mentorship, certification—and the number of procedures performed.

Kendig S. Legal considerations for dermatology NPs. Presented at: 3rd annual Society of Dermatology Nurse Practitioners Symposium; held April 23-24, 2022, in Nashville, TN.

Telehealth presents opportunities for nurse practitioners (NPs) to expand dermatologic services, but it also introduces legal and regulatory challenges. Susan Kendig emphasized the importance of understanding state and federal regulations, especially regarding scope of practice and cross-state licensure. Proper documentation of patient interactions and treatment plans is crucial to mitigate legal risks. NPs should avoid diagnostic biases and remain open to alternative diagnoses. Additionally, documenting training and skills acquisition is essential for maintaining professional standards and ensuring quality care in telehealth settings.

Susan Kendig, WHNP, JD, detailed how nurse practitioners working in telehealth can limit their liability and protect their practices in her session on legal issues.

NPs Role in Telehealth Protection

Malpractice claims against dermatologists are lesson common than those filed against physicians in other specialties, said Susan Kendig, WHNP, JD, a women’s health integration specialist at SSM Health-St. Mary’s Hospital in St. Louis, Missouri, and director of policy for the National Association of Nurse Practitioners in Women’s Health in Washington, DC.

 While that is good news for dermatology practices and providers, it does not diminish the importance of strategies that increase patients’ safety while limiting practice and provider liability.

In her presentation at the 3rd annual Society of Dermatology Nurse Practitioners Symposium,

 Kendig pointed out that many of the errors that, tragically, did lead to patient mortality could likely have been prevented simply by the better utilization of tools every practice has at its disposal to track patient history and ensure follow up care where needed.

Clinical photographs are only one key component in a patient’s electronic medical records (EMR), but they demand a rigorous set of evidence-based practices. “These images serve a medical and legal purpose,” Kendig said.

To that end, management of these files goes beyond the basics of using a high-quality camera, confining photos to the lesion in question, labeling said lesion with an arrow or mark, and protecting the patient’s identity. “Photos should show close-ups of the lesions and images taken at a distance for context,” Kendig said.

Make sure the lesion is documented in multiple ways, she added.

Photograph it next to a ruler for measurements and make sure the documentation matches the photos.

Always identify images by written-note observations and be as thorough as possible. “If there is inflammation around a lesion, note that,” Kendig said, adding that such information is helpful for the pathologist.

Integrate images into a patients’ EMR and keep them there. Kendig also noted that practices should ensure all images are deleted from the device on which they were taken and from any other storage locations except the EMR.

Do not purge records without careful consideration, as preserving a thorough patient history can help prevent critical information—such as growth in a suspicious lesion—from falling through the cracks if patients change providers or are under the care of multiple providers.

Improving Follow-Ups with Patients and Colleagues

Creating the treatment regime and protecting patients’ records are just 2 aspects of patient safety. Physicians also should focus on follow-up to deliver optimized outcomes. “It is never a case of, ‘We tried 3 times [to reach the patient] and that was enough,’” said Kendig, of ensuring patients act on appointments and referrals. If patients are not coming back for follow-up, a broader range of outreach—from phone to certified letters, so that the practice can track whether reminders reached the patient—can help practices get them back in the door of the same practice for necessary procedures or monitoring. If the next appointment is with a different provider, she advised that patients be asked if they have been seen for the condition before and for a health history, even if they were previously seen by another provider in the same practice.

While some larger medical systems have EMRs in place for closed-loop referrals—an approach that Kendig said works fairly well for tracking whether patients show up to appointments—she cautioned even these proactive measures are not infallible. “In some EMRs, the alert to follow up on a referral disappears if clicked on instead of making the provider actually follow up.” For practices without this kind of tracking, Kendig suggested setting up follow-up appointments with the original provider after they have seen the provider they were referred to.

If the dermatology practice is the one to whom patients are being referred, Kendig advised that they impress the urgency of that referral on the referring provider, citing that melanoma is second only to breast cancer among pathology-related malpractice claims. The provider also needs to review the patient history, including any previous pathology reports, to scan for potential issues.

Having covered best practices for preventing poor outcomes, Kendig touched on patient consent for image release—an aspect of practice that, while not typically connected to health outcomes, has become more complex as imagery is distributed in more varied ways.

A catchall consent form is inadequate as legal protection. Patients need to sign off on the specific intended use of images, whether that is educational or promotional, and the language on consent forms must accurately reflect that. “Remember that while images are essentially owned by the practice, it is the patient who controls the information and how it is used—and for images in EMR, HIPAA rules apply,” Kendig said.

Kornmehl H, Singh S, Adler BL, Wolf AE, Bochner DA, Armstrong AW. Characteristics of Medical Liability Claims Against Dermatologists From 1991 Through 2015. 

. 2018 Feb 1;154(2):160-166. doi: 10.1001/jamadermatol.2017.3713. PMID: 29214284; PMCID: PMC5839273.

Kendig S. Legal Considerations for Dermatology NPs. Presented at: The Society of Dermatology Nurse Practitioners Annual Symposium; April 22-23, 2022; Nashville, TN.

Malpractice claims against dermatologists are less frequent compared to other specialties, yet patient safety and liability management remain crucial. Effective utilization of electronic medical records (EMR), including clinical photographs, is essential for both medical and legal purposes. Thorough documentation, including detailed image management and follow-up protocols, can prevent errors leading to patient mortality. Practices should ensure comprehensive patient history retention and implement robust follow-up systems. Additionally, patient consent for image use must be specific and compliant with HIPAA regulations to mitigate legal risks.

At the Society of Dermatology Nurse Practitioners Annual Symposium, Susan Kendig, WHNP, JD, shared insights to lead to better outcomes and decreased liability throughout the patient journey, from diagnosis and follow-up to EMRs.

Analog, Digital Documentation to Safeguard Patients, Practices

Hair loss continues to be a hot topic in dermatology, especially considering best practices in the diagnosis of subtypes and treatment. In a session on hair loss at the 3rd Annual Society of Dermatology Nurse Practitioners Symposium, held April 22-23, 2022, in Nashville, Tennessee, Veronica Richardson, MSN, ANP-BC, DCNP, reviewed the key clinical features and historical clues for subtype diagnosis.

Richardson, who is nurse practitioner (NP), medical dermatology, at the Ruth & Raymond Perelman Center for Advanced Medicine at the University of Pennsylvania in Philadelphia, outlined the key features of central centrifugal cicatricial alopecia (CCCA). She noted it is almost exclusively seen in Black women and has a prevalence rate that varies from 2.7% to 16%.

Premature loss of inner root sheath, follicular rupture, and follicular degeneration are some of the proposed causes of this hair loss. Other causes include fibroproliferative disorder and persistent low-grade inflammation that results in end stage fibrosis of the follicular unit. Hair care practices also can contribute to the pathogenesis of the disease, according to Richardson.

CCCA manifests as scarring patches or loss of follicular openings beginning on the crown of the head and spreading outward. Additionally, it is characterized by early stage hair breakage, follicular papules, pustules, erythema, scaling, and possibly an absence of overt inflammation, Richardson said.

To help in diagnosis, she recommended a 4mm punch biopsy from an area of active inflammation, and testing for any vitamin D, ferritin, erythrocyte sedimentation rate (ESR), and zinc deficiencies. Also, she recommended doing a complete blood count (CBC) if anemia is suspected.

Discussing female pattern hair loss (FPHL), Richardson emphasized looking for gradual, increased scalp visibility, widening midline part, decreased ponytail size, and preservation of frontal hairline. Other symptom to watch include increased miniaturized follicles (T:V ratio < 4:1), a shorter anagen phase, and a longer telogen phase.

She recommended a patient work-up checking:

Micronutrients: Vitamin D, ferritin, ESR, zinc

Hormones or hormonal levels/: Thyroid-stimulating hormone (TSH), testosterone free/total, dehydroepiandrosterone sulfate (DHEAS)

Richardson suggested a biopsy only if there are concerns for concomitant scarring alopecia.

For frontal fibrosing alopecia (FFA), look for a band-like recession of the frontal hairline, loss of eyebrows, lonely hairs, forehead vein prominence, and perifollicular papules and pustules. Additionally, facial papules and occipital scalp may be involved. Itching may be absent in FFA, according to Richardson.

Histological features of FFA include lymphocyte predominant inflammatory infiltrate, and scarring. She recommended biopsy of the affected area, along with testing TSH to determinewhether the patient is prothrombin time (PT) dependent.

Finally, Richardson described the characteristics of alopecia areata (AA). These characteristics are single or multiple round/oval hairless patches with visible follicular ostia, hairpull, exclamation point hairs, and possible nail dystrophy.

For acute AA, histological features of disease include peribulbar inflammation, melanin incontinence, increased catagen and telogen, miniaturization, and residual inflammatory cells in follicular stalae. Chronic disease features include having most follicles in the telogen phase and miniaturization.

For diagnosing AA, Richardson recommended checking:

If anemia is suspected, check CBC. If there is a celiac/gluten sensitivity, check TTG Ab (transglutaminase IgA).

Baseline labs if systemic therapy is planned. 

Richardson serves on the advisory boards for Boehringer Ingelheim, Bristol Myers Squibb, and Eli Lilly and Company.

Richardson V. Getting to the Roots of Hair Loss. Presented at: The Society of Dermatology Nurse Practitioners Annual Symposium; April 22-23, 2022; Nashville, Tennessee.

Lawson CN, Bakayoko A, Callender VD. Central Centrifugal Cicatricial Alopecia: Challenges and Treatments. 

. 2021;39(3):389-405. doi:10.1016/j.det.2021.03.004

Hair loss remains a significant focus in dermatology, with emphasis on diagnosing subtypes and treatment strategies. Central centrifugal cicatricial alopecia (CCCA) predominantly affects Black women, with causes including follicular degeneration and hair care practices. Female pattern hair loss (FPHL) involves gradual scalp visibility and hormonal influences. Frontal fibrosing alopecia (FFA) is marked by frontal hairline recession and scarring. Alopecia areata (AA) presents with round hairless patches and potential nail dystrophy. Diagnostic recommendations include biopsies and tests for vitamin deficiencies, hormonal levels, and inflammatory markers.

Veronica Richardson, MSN, ANP-BC, DCNP, discussed how she diagnoses hair loss subtypes in her session at the 3rd Annual Society of Dermatology Nurse Practitioners Symposium.

Diagnosing Hair Loss Subtypes

Established in 2015 to support dermatology physician assistants’ leadership experiences and foster their contributions to the field of dermatology, the 

Dermatology Physician Assistant Foundation 

(DPAF) is an educational and charitable arm of the Society for Dermatology Physician Assistants (SDPA).

SDPA Annual Summer Dermatology Conference

editorial board member Renata Block, MMS, PA-C, spoke with incoming chair Faseeha Raza, PA-C, about giving back, leading and inspiring others, and supporting patients.

DPAF Raza and Block

“As we know, DPAF is the philanthropic arm of the SDPA, and my passion is to give back to the community,” Raza told Block. “And that's the only thing I think I felt that I would contribute to the community, being part of DPAF and encourage all the MPs to do the same, if that's their passion, if that's the mission that they want to accomplish.”

Block asked Raza about her goals as incoming chair. “My No. 1 goal would be to cause brand awareness, and letting people know why DPAF exists,” Raza said. “So my goal would be to promote our programming, such as Medical Mission Academy, talks in a box, professional development, and research. And knowing all these, I'm very confident a lot of PAs would be interested in becoming part of it and volunteer for it. The other big goal that I have is to bring in grants for the organization so we can also support great causes, like SCAN—the project that Renata actually helped—and it made a huge difference.”

 in Ohio. “This is a free clinic where I was given an opportunity to run some free health care screening events,” she told Block. “And I initially helped with the CISC Free Clinic as a volunteer when I was in PA school, and that kind of boosted me up to do more for the community.”

“My journey with the free clinic actually started because I wanted to give back to the community, and that's how I got involved. And from there I stepped into SDPA as a PA student, and I started my journey with the CME committee, their fellowship committee,” Raza explained. “This organization has fostered me to be where I am today. I'm truly humbled and you know, kind of like proud and humble at the same time.”

Block asked Raza about her work in aesthetics. “My passion started with architecture; I did my degree in architecture engineering. I love designing. I love sculpting. I love forming things, and that's how I got involved into dermatology aesthetics field,” Raza said. “I feel like what I love most about this profession is to make my patients look beautiful. Make them confident in their own skin, so that they can carry themselves and be happy about how they are. So I think enhancing their natural beauty is what I strive for.”

Are you attending the 2024 SDPA Annual Summer Dermatology Conference? Share your thoughts and insights via 

social media or email us at DTEditor@mmhgroup.com.

The Dermatology Physician Assistant Foundation (DPAF), established in 2015, supports dermatology PAs' leadership and contributions. Incoming chair Faseeha Raza aims to increase brand awareness, promote programs like Medical Mission Academy, and secure grants for initiatives such as SCAN. Raza's community involvement includes volunteering at the Cleveland Ibn Sina Free Clinic, which inspired her journey in dermatology. Her passion for aesthetics stems from her background in architecture, focusing on enhancing patients' natural beauty. The DPAF encourages PAs to give back and engage in professional development.

Renata Block, MMS, PA-C, and Faseeha Raza, PA-C, discuss the DPAF, philanthropy, leadership, and the importance of patient care. 

Savanna Vidal

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