In this episode of Dermbusters, host Nicholas Brownstone, MD, sits down with Katherine Glaser, MD, a dermatologic surgeon specializing in Mohs surgery, about some common misperceptions heard from both colleagues and patients. 

Dr Glaser shares some insights on 2 frequently misunderstood topics: the use of lidocaine with epinephrine in the fingers and toes and the role of sunscreen in vitamin D absorption. 

Myth 1: Dermatologists should not use lidocaine with epinephrine in the fingers and toes. 

Contrary to a commonly held belief among dermatologists, Dr. Glaser emphasizes that there is robust data supporting the safe use of lidocaine with epinephrine in the fingers and toes. Despite concerns about vascular ischemia and resulting necrosis, studies from both dermatology and plastic surgery literature demonstrate the safety of lidocaine with epinephrine. 

Tips for advising colleagues: 

• Share the existing data and research findings that support the safe use of lidocaine with epinephrine in the fingers and toes 
• Highlight the lack of reported cases of ischemia with traditional lidocaine with epinephrine and contrast it with cases involving other substances, high concentrations of epinephrine, and improper tourniquet use 
• Emphasize the importance of adhering to safe injection practices, proper dosage, and avoiding direct arterial injection to mitigate any potential risks 

Myth 2: Sunscreen should not be used because it prevents absorption of vitamin D. 

Next, Dr Glaser addresses a common myth that dermatologists often hear from their patients: that they shouldn’t use sunscreen because it prevents them from absorbing an adequate amount of vitamin D. While sunscreen does block the UVB rays that aid in vitamin D synthesis, the AAD advises against UV exposure solely for the purpose of absorbing vitamin D. 

Tips for counseling your patients: 

• Explain that while sunscreen may affect vitamin D absorption, it's not a reason to skip it 
• Highlight alternative sources of vitamin D, such as diet and supplements 
• Encourage wearing sunscreen consistently and correctly 
• Stress the importance of protecting the skin from harmful UV rays to prevent skin damage and reduce the risk of skin cancer