Mid-level caregivers are taking on an ever-larger role in dermatologic care. According to professional organizations, about 11,500 board-certified dermatologists practice in the United States. In addition, there are about 3,000 dermatology physician assistants and 1,650 nurse practitioners working in dermatology offices — or the equivalent of about one mid-level dermatologic caregiver for every 2.5 dermatologists.

Big on promises and a little short on delivery. That's the way Marta Rendon, M.D., would describe most of the skin-lightening therapies proffered as alternatives to hydroquinone. She says it's not that the herbal compounds currently being touted as safer alternatives to hydroquinone don't work at all, but, she says, they don't work nearly as well.

Exercise, sun, a nice meal and a little wine sounds like the perfect prescription for a good and healthy life, and it might be — unless this is a patient who suffers from rosacea. But how should a physician approach the treatment of a condition when contributing factors consist of daily living?

Recognizable, but not always easily diagnosed, is lichen sclerosus et atrophicus. Occurring more often in prepubescent girls and postmenopausal women, and believed to be an autoimmune disorder, LS presents as white, shiny, atrophic patches and plaques with an erythematous halo.

Sixty thousand new cases of invasive melanoma are diagnosed each year, and depending on the severity, many patients stand a chance of those malignancies recurring in the following five or 10 years or beyond. On Call asked dermatologists around the country about their approach to follow-up care for their melanoma patients.

Approved by the Food and Drug Administration, a number of fillers containing lidocaine hit the market this spring and are quickly coming into fairly widespread use. Arielle Kauvar, M.D., director of the New York Laser & Skin Care Center, says she started using them in March, and unless a patient is allergic to lidocaine, she sees no reason now to use fillers without the anesthetic already included.

As surely as summer follows spring, every year, questions about the effectiveness of sunscreens flourish. This year, the Environmental Working Group, a public health watchdog organization in Washington, has raised the issue not only of sunscreens not doing the job they're supposed to, but of these products contributing to the spread and seriousness of skin cancers.

Where do dermatologists find themselves falling in their assessment of the healthcare reform legislation in the U.S.? On Call found dermatologists who place themselves in each of the camps, as well as a group that wishes someone could explain what the legislation actually does.

Could e-prescribing be a boon to the operation of your practice? Or is it one more layer of bureauracy the federal government is trying to lay on physicians? On Call wondered whether dermatologists are using e-prescriptions, and if so, whether they actually like them.