Steven Chen, MD MPH MS-HPEd
@drsteventchen.bsky.social
Dermatologist/internist @ MGH- Love complex/onco-dermatology & MedEd | Vice Chair of Education | Harvard Derm APD | Dad | Husband | Recovering a cappella nerd. Posts are mine & ≠ advice
Speaking now with our wonderful panel of speakers at #aadinnovation2025!
Come join us for “what’s new in complex dermatology!”
Come join us for “what’s new in complex dermatology!”
July 11, 2025 at 3:43 PM
Speaking now with our wonderful panel of speakers at #aadinnovation2025!
Come join us for “what’s new in complex dermatology!”
Come join us for “what’s new in complex dermatology!”
March 26, 2025 at 10:35 PM
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
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
March 10, 2025 at 8:15 PM
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
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
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
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
March 6, 2025 at 9:52 AM
In patients with darker skin, the redness is less obvious, and just looks like skin colored or darker bumps.
cdc.gov/measles/sign...
7/
cdc.gov/measles/sign...
7/
March 2, 2025 at 1:13 PM
In patients with darker skin, the redness is less obvious, and just looks like skin colored or darker bumps.
cdc.gov/measles/sign...
7/
cdc.gov/measles/sign...
7/
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/
This also means measles affects the face often, whereas drug rashes can often spare the face.
cdc.gov/measles/sign...
6/
March 2, 2025 at 1:13 PM
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/
This also means measles affects the face often, whereas drug rashes can often spare the face.
cdc.gov/measles/sign...
6/
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/
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/
March 2, 2025 at 1:13 PM
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/
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/
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/
These are thought to be pathognomonic for measles!
PC: onlinelibrary.wiley.com/doi/10.1111/...
4/
March 2, 2025 at 1:13 PM
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/
These are thought to be pathognomonic for measles!
PC: onlinelibrary.wiley.com/doi/10.1111/...
4/
An earthquake?! In New England?!
::Sees that it's 3.8 on the Richter scale::
"Oh, that's cute" ~the Californian in me
::Sees that it's 3.8 on the Richter scale::
"Oh, that's cute" ~the Californian in me
January 28, 2025 at 2:06 AM
An earthquake?! In New England?!
::Sees that it's 3.8 on the Richter scale::
"Oh, that's cute" ~the Californian in me
::Sees that it's 3.8 on the Richter scale::
"Oh, that's cute" ~the Californian in me
January 26, 2025 at 12:11 PM
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/
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/
January 15, 2025 at 3:36 PM
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/
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/
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/
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/
January 15, 2025 at 3:36 PM
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/
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/
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/
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/
January 15, 2025 at 3:36 PM
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/
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/
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/
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/
January 15, 2025 at 3:36 PM
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/
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/
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/
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/
January 15, 2025 at 3:36 PM
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/
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/
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/
So "plaque" is the primary lesion, and "atrophic/depressed" is the secondary change used to further describe.
(Dx here is linear morphea).
5/
January 15, 2025 at 3:36 PM
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/
So "plaque" is the primary lesion, and "atrophic/depressed" is the secondary change used to further describe.
(Dx here is linear morphea).
5/
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/
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/
January 15, 2025 at 3:36 PM
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/
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/
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/
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/
January 15, 2025 at 3:36 PM
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/
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/
And now we wait for midnight…
(and for a 2 or 5 😬)
(and for a 2 or 5 😬)
January 1, 2025 at 12:30 AM
And now we wait for midnight…
(and for a 2 or 5 😬)
(and for a 2 or 5 😬)
Ringing in the new year the best way I know!
December 31, 2024 at 10:46 PM
Ringing in the new year the best way I know!
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
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
December 25, 2024 at 3:54 PM
December 13, 2024 at 9:03 PM
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…
This store didn’t accept cash, so naturally…
December 12, 2024 at 1:05 AM
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…
This store didn’t accept cash, so naturally…