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 · 07/04/2025

::Listening to music in the car:: 7: this is catchy! Me: oh yeah? 7: yeah! My feet won’t stop wiggling!

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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 · 29/03/2025

Haha, usually I'd just take care of it with my medicine team to spare the derm team the consult. I actually think it's also a nice learning experience for the IM team (but I'm probably the only one that thinks that)...

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 28/03/2025

Getting my dermato-stethoscope ready for this weekend of joint internal medicine and dermatology inpatient calls! Going to try real hard to avoid consulting myself... #dermsky #medsky

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 27/03/2025

Yes! I’m starting to use it and hoping it’s a game changer

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

Quibble away! What say you about DRESS treatment! I want to learn!

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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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Reposted by Steven Chen, MD MPH MS-HPEd

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

For better or for worse (worse), MEASLES are back, so here's a #skytorial on recognizing this once thought eradicated disease. MEASLES: a tutorial! #dermsky #medsky #MedEd 1/

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

Based on what I see, patients would be contagious around when fever and other symptoms start, so I think theoretically you could have viral shedding leading to contagiousness prior to those symptoms but it should be around the same time. If others know please chime in!

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Reposted by Steven Chen, MD MPH MS-HPEd

Misha Rosenbach, MD @misharosenbach.bsky.social · 02/03/2025

Sadly very important tweetorial from @drsteventchen.bsky.social re: measles #IDsky #DermSky #MedSky 👇🏼

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

So to recap: ✅Measles is super contagious ✅rash occurs 4 days after symptom onset, 2 weeks after exposure ✅rash is morbiiliform and spread top down ✅also can see Koplik spots, cough, coryza, conjunctivitis, fever ✅vaccines save lives Thanks for joining! 12/12

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

Finally, measles is more common with more serious complications in younger kids (<5), especially the unvaccinated. Patients go on to have otitis media, encephalitis, and can even die from this disease. 11/

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

And as someone who sees a LOT of morbilliform eruptions, my personal plan is to remember to look in the mouths of my patients, ask about how the rash spread (top to bottom), and paying particular attention to other symptoms like cough, coryza, and conjunctivitis! 10/

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

So what can we do? Well, vaccination has always been the best way to prevent measles. BUT, your immunity can wane after immunization, so that means even in a fully vaccinated individual, we shouldn't forget about measles on the ddx if you see this constellation of symptoms! 9/

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

Patients are thought to be contagious from symptom onset to 4 days after the rash (so basically a little over a week surrounding the rash). The virus is transmitted through respiratory droplets that can linger in the air for hours! 8/

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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 · 02/03/2025

After exposure, measles usually has an ~ 10 day incubation period, and then symptoms start with a fever, and the 3 C's: Cough, Coryza (runny nose), and Conjunctivitis. 2-3 days after symptoms starts, you can also see Koplik spots in the mouth. This is all BEFORE the rash! 3/

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

Measles is caused by a ssRNA virus in the Paramyxoviridae family. It's HIGHLY contagious. It has a higher primary and secondary attack rate than Covid (meaning getting measles after an exposure is easier than Covid). Then transmitting it to close contacts later is ALSO easier! 2/

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

For better or for worse (worse), MEASLES are back, so here's a #skytorial on recognizing this once thought eradicated disease. MEASLES: a tutorial! #dermsky #medsky #MedEd 1/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 25/02/2025

My student on #derm consults is going into internal medicine. So...we talked about pressor choice and the difference in alpha and beta activity between pressors. And what the addition of vasopressin tells you. As I was midway thru teaching, I looked over at my derm residents and👇 #dermsky #medsky

media.tenor.com

a woman says i did n't sign up for this in a netflix ad

ALT: a woman says i did n't sign up for this in a netflix ad

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 25/02/2025

With the AAD (annual #derm meeting) coming up next week, it feels like my full time job is making powerpoint slide decks. Send help... and infographics...

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 30/01/2025

Happy lunar new year!! Hope everyone had their fill of auspicious foods! - Fish (b/c in chinese it sounds like “surplus”) - Dumplings (b/c they look like ingots) - noodles (for a long life) - apples (sounds like “peace” in Chinese) - oranges (kiiind of sounds like “good luck”) - etc etc! 🧧 🦁 🕺 🧧

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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

Thanks for joining for my first ever #skytorial! Let me know what you want to see next! I'm also experimenting with YouTube, so stay tuned for some videos I'll share here too. Thanks to DermnetNZ for all the photos. Until next time! 12/12

media.tenor.com

a little girl is sitting on an orange slide with the words ok bye written above her

ALT: a little girl is sitting on an orange slide with the words ok bye written above her

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

SUMMARY: ✅MACULES are flat & <1 cm ✅PATCHES are flat & >1 cm ✅PAPULES are raised/depressed & <1 cm ✅PLAQUES are raised/depressed & >1 cm ✅VESICLES are fluid filled & <1 cm ✅BULLAE are fluid filled & >1 cm ✅PUSTULE is anything filled with pus ✅ULCERS go into dermis ✅EROSIONS stay in epidermis 11/

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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 · 15/01/2025

First off, why do we as dermatologists obsess of morphology so much?! It's because we base much of our clinical care on the morphology of the lesion! As opposed to other specialties where history is key, in derm, we like to start with the exam and use the history to further whittle down our DDx. 2/

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

Hi #dermsky, #medsky! It's been a minute, but there's never a better time to do a little teaching about #dermatology! Since it's my first attempt at a #skytorial (sp?) here, let's start with the basics and talk #DERM #MORPHOLOGY! The 10 basic types of primary lesions! 1/

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Steven Chen, MD MPH MS-HPEd @drsteventchen.bsky.social · 05/01/2025

Friend: we’ve got our kid listening to classic music from our childhood. Like Bon Jovi, Rolling Stones, Pink Floyd, etc. My wife and I: that’s awesome! We should try the same with our kids… -a few months later- Our 7 yo: 🎶🎶I… want… it… that… uhh-way….TELL ME WHYYY🎶🎶 #parenting

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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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Reposted by Steven Chen, MD MPH MS-HPEd

Misha Rosenbach, MD @misharosenbach.bsky.social · 17/12/2024

Congratulations @drsteventchen.bsky.social! For those not aware, Steven is a brilliant medical dermatologist and one of the best educators of this generation. Steven when are you going to bring some #dermtwitter tweetorials here to #DermSky!

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

I will! I promise! Thanks for the kind words!

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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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