For the past year, Duke rheumatologists and dermatologists have been collaborating to treat patients with presentations that share immunological and dermatological disease characteristics. One of the first of its kind in North Carolina, the shared patient approach has matured into a multidisciplinary initiative described by leaders as an “immunodermatology clinic.”

With plans to launch clinical trials involving other specialties, the dermatologists and rheumatologist host virtual case reviews—"a sort of hybrid ‘rheum-derm’ grand rounds,” says Matilda W. Nicholas, MD, PhD, a Duke dermatologist who helped create the multidisciplinary care model.

The approach offers appointments scheduled for patient convenience and gives referring physicians the option to direct patients with complex skin or inflammatory conditions to more specialized care. Presentations seen by the team include:

• Discoid or systemic lupus
• Dermatomyositis
• Scleroderma, morphea, and related disorders
• Vasculitis
• Blistering disorders (pemphigus and pemphigoid)
• Cutaneous disease
• Other autoimmune and inflammatory disorders

Nicholas says the collaboration allows physicians from both specialties to access share administrative support and prescribe off-label medications when needed. “We have realized that we work well together, and we complement each other in terms of strengths and expertise,” she adds. “It often requires quite a bit of work to take care of the patients with complex presentations, so the shared model helps everyone.”

Duke rheumatologist Jayanth R. Doss, MD, MPH, says the shared initiative has helped providers from both specialties. “We have many rheumatology patients who present with significant dermatologic manifestations of disease,” says Doss. “There are situations in which our treatments for rheumatologic disease are not adequate for dermatologic presentations.”

Every rheumatological-dermatological presentation is distinctive and challenging, Doss says. “These conditions require collective, collaborative experience to treat successfully. Often, there is no specific textbook solution for each problem.”

Nicholas says the partnership serves the dermatological community across North Carolina. “We have really fantastic dermatological care in this state. When patients are referred to us, we have to work a little harder because the referring professionals have tried many therapies before us,” Nicholas says. Adding the perspective of a related specialty from an academic medical center that often helps identify the problem, she adds.