iiinova — where your digital self keeps evolving

Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 11/07/2025

Speaking now with our wonderful panel of speakers at #aadinnovation2025! Come join us for “what’s new in complex dermatology!”

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 01/04/2025

My last day on the medicine service (for now) means an end to our running “Rash of the Day!” Until next time! #dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 26/03/2025

You know this #medderm is on the medicine service when this board appears… #dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 10/03/2025

Thanks to this MGH dream team for joining for today’s session on advanced therapeutics for complex dermatologic disease! Didn’t get him in the group pic, but thanks also to @misharosenbach.bsky.social who had to run! Thanks to UPenn for loaning him to us for the afternoon ;) #dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 06/03/2025

I’ll be speaking at #aad2025. Come join me! Friday: C002 - conquer the boards, core C006 - conquer the boards, applied Monday: S053 - consultative dermatology for the hospitalized patient S066 - advanced therapeutics for complex disease F099 - skin and systemic malignancy #dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 02/03/2025

In patients with darker skin, the redness is less obvious, and just looks like skin colored or darker bumps. cdc.gov/measles/sign... 7/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 02/03/2025

Unlike a drug rash, measles often starts up top and moves down (cephalocaudal), whereas drug rashes start on the chest & move out often. This also means measles affects the face often, whereas drug rashes can often spare the face. cdc.gov/measles/sign... 6/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 02/03/2025

Then ~4 days after symptoms started, the rash pops up. The term we use to describe a classic "measles-like" rash is "morbilliform." This means 3-4 mm pink papules that coalesce into plaques. That probably sounds familiar because that's how we describe regular ol' drug rashes! 5/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 02/03/2025

Koplik spots are whitish/reddish papules that are commonly in the buccal mucosa, but can also be on the palate itself. These are thought to be pathognomonic for measles! PC: onlinelibrary.wiley.com/doi/10.1111/... 4/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 28/01/2025

An earthquake?! In New England?! ::Sees that it's 3.8 on the Richter scale:: "Oh, that's cute" ~the Californian in me

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 26/01/2025

Sigh… Tis the season Be safe out there, and #maskup if you’re feeling sick to protect others!

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 15/01/2025

One last note. I tried to include side by side examples of lighter and darker skin, but to be explicit, notice that the exam can be quite different. Color will change quite a bit based on skin tone, and what is "pink/red" in lighter skin will look purple or hyperpigmented in darker skin. 10/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 15/01/2025

Finally, ULCERS and EROSIONS. ULCERS extend into dermis, and EROSIONS into epidermis. L is an ulcer of pyoderma grangrenosum, and R is an erosion in staph scalded skin. Some consider these secondary change instead of primary lesion (so an ulcerated or eroded plaque instead). 9/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 15/01/2025

What if it's filled with pus? Then it's a PUSTULE! We don't have a size cut off here, so anything filled with pus is a pustule (a really big spot is a "lake of pus"). NB: any vesicle or bullae that is left alone for 2-3 days turns into a pustule, so make sure you look at a new spot! Miliaria👇 8/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 15/01/2025

OK, now we're getting to VESICLES and BULLAE! These are fluid filled. Vesicles are <1cm in diameter, and bullae are >1 cm. We're looking at some VZV in the first 2 photos, and bullous pemphigoid in the 3rd! 7/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 15/01/2025

Next up: NODULES & TUMORS! These are deeper lesions, and there's some debate about definitions. I think it's easiest to remember that nodules feel like they are at least 1 cm deep, and tumors are at least 2 cm deep and in diameter. (You need 2cm 2B a 2mor - if that helps 😬) 1. sweets 2. CTCL 6/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 15/01/2025

Here's the nuance. This is a depressed or atrophic plaque. Notice how we're using depressed and atrophic as ways to describe the primary lesion. So "plaque" is the primary lesion, and "atrophic/depressed" is the secondary change used to further describe. (Dx here is linear morphea). 5/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 15/01/2025

Next up are PAPULES AND PLAQUES. These are raised OR depressed! While we often learn it's just raised spots, it's really any change in elevation of the skin. So that means with closed eyes, you should be able to tell where it starts and stops! PAPULES are <1 cm & PLAQUES are >1 cm. Psoriasis👇 4/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 15/01/2025

So let's start with MACULES & PATCHES! These are flat. If you closed your eyes and ran your finger over them, you wouldn't be able to tell where they started or stopped. MACULES are <1cm in diameter, and PATCHES are >1 cm in diameter. Here we see vitiligo (1), & cafe-au-lait macules (2)! 3/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 01/01/2025

And now we wait for midnight… (and for a 2 or 5 😬)

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 31/12/2024

Ringing in the new year the best way I know!

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 25/12/2024

Merry Christmas! I celebrated by giving a talk on cutaneous lymphomas at National Taiwan University Hospital in the dermatology department… can I count this as overtime??🫣 Seriously though, great to see old friends and discuss future research collaboration opportunities! #dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 17/12/2024

An honor to give a talk at Changgung Memorial Hospital （長庚醫院）this morning! I spoke about Biologic Medications beyond atopic dermatitis and psoriasis. What a great honor to join my colleagues across the ocean focused on severe cutaneous adverse reactions! #dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 12/12/2024

Remember when cash only stores would have atms in case you didn’t have cash? Well… apparently now we’ve pulled a 180😂 This store didn’t accept cash, so naturally…

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 26/11/2024

This feels like the start to some bizarro nursery rhyme…

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 25/11/2024

Can I get added to this starter pack?! If I may humbly submit some random pics of my baking :)

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 13/11/2024

Just watched the first episode of St Denis Medical and I know their medical consultants must’ve insisted on this scene for accuracy’s sake 😬😂 Now she just needs to get out of that leg’s way… #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 11/11/2024

Attending #aamc24 has been wonderful for all the talks and sessions on #meded and academic medicine. But getting to hang out with my research fellow, Natalie Baker, who is doing amazing work in climate change, was an awesome bonus!

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