Kirk Gautier, PA-C discusses Practical Tips and Pearls and his experience as a new attendee at the 2021 Elevate-Derm Conference.
In this video
Sitting down with Carrie in his home state of Texas, Kirk Gautier walks through his approach to nail biopsies — procedures he says "can be really scary" and even make some people gag, but that fit within a normal office appointment. His trick: hold an ice cube on the finger for a minute or two, then inject 2–3 cc of lidocaine with epi on the volar aspect right in the center rather than the lateral aspects, avoiding the digital artery and nerve while numbing both sides with fewer pokes. The ice cube, he notes, makes even the 30-gauge needle insertion nearly painless.
He also tackles disseminated superficial actinic porokeratosis, admitting he's tried cryo, 5-FU, Aldara, and light C&D with limited results. A colleague's suggestion — a compounded cholesterol cream with 2% lovastatin, applied twice daily — has given him good success, flattening the lesions and softening that "Great Wall of China" raised edge so patients feel and notice them less. He reminds clinicians to counsel on photosensitivity and sun protection and to monitor these patients for malignancy.
- For nail biopsies, numb with an ice cube for 1–2 minutes, then inject 2–3 cc lidocaine with epi on the volar aspect in the center to numb both digital nerve branches while avoiding the digital artery and nerve.
- The ice cube also makes the 30-gauge needle insertion essentially painless and reduces the number of pokes.
- For disseminated superficial actinic porokeratosis, a compounded cholesterol cream with 2% lovastatin twice daily can flatten lesions and reduce the raised edge when other treatments fall short.
- Reinforce sun protection and photosensitivity counseling so you aren't creating more porokeratosis lesions, and monitor these patients for malignancy given their slightly increased risk.
