Rethinking the Toolbox
In this episode of SkinSync, PA Buchi Neita sits down with Keri Holyoak, PA-C, a dermatology PA who has practiced for all 21 years of her career in Salt Lake City, Utah, seeing both medical and surgical patients. Rather than a metal box of hammers and drills, Holyoak frames the dermatology toolbox as a treasure chest — a combination of knowledge and resources, procedural skills, and a professional network that clinicians rely on to diagnose and treat patients.
Both hosts stress that this toolbox isn’t static; it evolves as clinicians add new tools, retire old ones, and personalize what they reach for. Holyoak notes that early in training her toolbox was very resource-heavy — she remembers carrying stacks of books through clinic to double-check diagnoses. As experience builds, she says, clinical judgment sharpens, and the toolbox becomes more intuitive and faster to reach for. For PAs and NPs who typically don't complete a residency, both agree that intentionally building this toolbox from scratch is part of the job.
Reference Tools: From Textbooks to Apps
Holyoak still keeps a collection of classic texts — Andrews' Diseases of the Skin, Wolverton's comprehensive dermatologic drug therapy, and a Lange pocket guide for ordering tests — though she admits she rarely pulls them out anymore except for drug reactions. When she does reach for a book, it's usually for the photos. She singles out Dr. Susan Taylor's dermatology for skin of color text and newer color atlas (co-authored with Dr. Nada Elbuluk from USC), plus the Fitzpatrick color atlas, all of which she values for their photo-heavy approach to varied presentations.
Most of the reference work has moved online. Neita and Holyoak both praise VisualDx for building differentials by inputting symptoms and morphology, and for its intentional inclusion of skin of color photos and morphology discussions — Neita says she has made accurate diagnoses off its differential lists. They also lean on Open Evidence for the latest clinical data with citations, prior authorization and appeal letters, and patient education. Neita notes she uses ChatGPT casually but turns to Open Evidence when she needs to be medically accurate.
Other named favorites include Epocrates for medication dosing, interactions, and side effects (Holyoak jokes it rescues her from 'mom brain' moments like forgetting a biologic loading dose); DermNet for high-quality teaching images; UpToDate for summaries beyond dermatology; and the Journal of Drugs and Dermatology (JDD), which offers an inclusive Derm Atlas of conditions across skin tones. Holyoak flags a practical tip for CME dollars: VisualDx runs a Black Friday sale.
Journals, Podcasts, and Patient-Facing Resources
For staying current, Neita favors free journals with email highlight lists she can click through, calling out the JDNPPA, the JDPA (through the SDPA), JAAD with its PA/NP perspectives, Dermatology Times, and Practical Dermatology. On the podcast front, Holyoak says she consumes most of her derm education in audio form now, naming Dr. Lisa Swanson's podcast, DermaSpheres with Dr. Michelle Tarbox, and Derms on Drugs with Dr. Matt Zirwas.
Both hosts also emphasize controlling what patients read. Because in-room time is limited, Holyoak refers patients to trusted organization websites — the National Psoriasis Foundation, National Eczema Association, HS Foundation, and the International Hyperhidrosis Society — where patients can also connect with support communities. Two lesser-known tools she highlights: Doximity for secure audio and video calls so a personal number stays hidden, and MotherToBaby, a free, tax-funded pregnancy risk line staffed by geneticists, nurses, and physicians that clinicians and patients can call directly with questions about medications in pregnancy or breastfeeding.
The Human Toolbox
One of Holyoak's most emphasized tools is what she calls the 'human toolbox' — the professional network. She describes knowing who is good at what: a colleague strong in complex medical dermatology, one in dermatopathology, or one who always knows the latest in psoriasis and atopic derm. She shares a recent case in which she diagnosed a patient with PAD and used her oncology network to connect them quickly with a breast specialist rather than waiting for a standard referral.
With specialist access getting harder, both hosts encourage building relationships across rheumatology, GI, psychiatry, oncology, and OB/GYN, and connecting with industry contacts like MSLs at conferences. Holyoak recommends in-person meetings — including her local weekly grand rounds at the university, which offers a Zoom login for those who can't attend in person — as accessible ways to grow that network.
Core Procedural Skills
On procedures, Holyoak favors a KOH prep enhanced with chlorazol black stain to better visualize fungal elements, and she uses the same stain for scabies and Demodex. Neita champions intralesional triamcinolone as underutilized, listing acne cysts and nodules, acne keloidalis, keloids, lichen simplex chronicus, psoriasis, and alopecia areata as targets. Both stress mastering the tool — Neita mentions going up to 40 mg/mL for a keloid but dropping to around 2.5 mg/mL for an acne cyst, warning that improper depth can harm the skin.
Dermoscopy is a staple both call essential, with a nod to trichoscopy for hair loss on full-body exams. Neita uses the Wood's lamp routinely — for erythrasma's coral-red fluorescence, vitiligo, and picking up subtle facial lesions in a dark room. For hidradenitis suppurativa, Neita recommends mini-deroofing (a 'punch deroofing') over incision and drainage given high recurrence rates, often combined with intralesional Kenalog, and points listeners to Dr. Jocelyn Kirby's online video for technique.