Difficult Cases and Red Flags in Dermatology, With Kassandra Holzem, MD

Kassandra Holzem, MD, assistant professor of Dermatology at the Medical College of Wisconsin, sat down in an interview with the HCPLive team during the 2025 Society of Dermatology Physician Associates (SDPA) Fall Conference in San Antonio, Texas.

In her on-camera discussion, Holzem was asked about some of the most notable elements highlighted in her session presented at SDPA, titled ‘Difficult Cases & Red Flags in Dermatology: When to Admit From the Clinic.’ Holzem was asked about her talk and why she chose to pursue the topic as a presentation for attendees of the conference.

“I do the bulk of our inpatient consults at Medical College of Wisconsin, so I'm seeing a lot of the patients that do get admitted for cutaneous concerns or develop cutaneous concerns during their hospitalization,” Holzem explained. “I think it's important to note that a lot of those will actually present in the clinic first, before they become severe enough to maybe warrant a hospital admission. Or sometimes it's something that's like brewing in the outpatient setting for several weeks…and the only option then is to be admitted to the hospital.”

Holzdem stressed the importance of clinicians, including PAs, to recognize cutaneous signs of such diseases to potentially prevent the need for admission to a hospital emergency room. She was asked about some of the key signs to look out for.

“I think the big things are just like your spidey sense for how well or not well the patient is,” Holzem said. “Really, [look out for] if they're not well, if they're febrile, they're fatigued, they're losing weight, and if they don't look well, they're not eating well, if they have such severe inflammation in their mouth that they're not able to keep water down, things like that where you know that this patient really is not like thriving in the outpatient setting.”

Later in her interview, Holzem was asked about additional takeaways from the session on red flags in dermatology practices.

“Drug reactions are probably the biggest thing that we will treat in the inpatient setting, for sure, but actually, it's a big part of my outpatient practice as well,” Holzem said. “They're a wide variety of severity, and it’s a big spectrum there. We might see a kind of mild rash that's there, it's bothersome, but really, at most, it's just a nuisance…Actually, [sometimes] the rash is just the sign that there's kind of deeper, more systemic, more dangerous inflammation going on underneath the surface. I think no matter what, it's gauging if you see a rash that you think might be drug-related. It's gauging, ‘How sick is this patient? Is this someone that, at minimum, maybe I need to check some blood work on to see if they're systemically inflamed?’

For any additional information on cutaneous symptoms potentially leading to hospitalization, view Holzem’s full interview segment posted above. To find out more from SDPA, view the latest conference coverage.

The quotes used in Holzem’s interview summary were edited for the purposes of clarity.

Holzem had no relevant financial disclosures of note.

References

1. Holzem K. Difficult Cases & Red Flags in Dermatology: When to Admit From the Clinic. Presented at the Society of Dermatology Physician Associates (SDPA) Fall Conference, November 5-9, San Antonio, TX.