Summary Background First‐generation antihistamines (FGAs) are classified as ‘potentially inappropriate’ for use in older patients (patients aged ≥ 65 years). However, the prevalence of and factors associated with FGA prescription have not been studied. Objectives To examine FGA prescription rates for older patients who visited dermatology offices, and compare them to those for younger patients (patients aged 18–65 years) who visited dermatology offices and those for older patients who visited primary‐care physicians (PCPs). Methods This was a multiyear cross‐sectional observational study using data from the U.S. National Ambulatory Medical Care Survey (2006–2015). Visits by patients aged 18 years or older were included in the study; the data comprised 15 243 dermatology office visits and 66 036 PCP office visits. The main outcome was FGA prescription. Other variables included physician specialty (dermatologist or PCP), patient's age, diagnosis of dermatological conditions and reason for visit. Results For dermatology visits, the overall FGA prescription rate for older patients was similar to that for younger patients (1·5% vs. 1·2%; P = 0·19), even when the diagnosis was dermatitis or pruritus (3·7% vs. 4·8%; P = 0·21) or when itch was a complaint (7·6% vs. 6·7%; P = 0·64). However, the rate of FGA prescription for dermatology visits was lower than that for PCP visits, in analyses matched for patient and visit characteristics (3·9% vs. 7·4%; P = 0·02). Conclusions Our findings suggest that FGAs are overprescribed to older patients but that dermatologists are less likely to prescribe FGAs than PCPs. What's already known about this topic? First‐generation antihistamines (FGAs) have been shown to pose substantial risks to older adults, including cognitive impairment, falls, confusion, dry mouth and constipation. Therefore, FGAs have been classified as ‘potentially inappropriate’ for use in older patients by the American Geriatrics Society. It has also been shown that dermatologists do not always take patient characteristics (e.g. age or life expectancy) into account when deciding on a treatment, instead following a ‘one‐size‐fits‐all’ approach. What does this study add? FGAs are often prescribed during dermatology visits, and prescription rates do not differ between older and younger patients. There were no significant differences in prescription rates when comparing younger and older adults with the same diagnosis or symptom (e.g. dermatitis, pruritus or itch). FGAs are prescribed at higher rates in primary‐care offices than in dermatology offices.

Most conclusions on LM have been drawn from research on invasive or lentigo maligna melanoma (LMM), with the inference that LM acts similarly to LMM. This study evaluates the epidemiologic characteristics of LM and the histopathologic characteristics of LM compared to LMM. A retrospective chart review of all cases of LM and LMM diagnosed at Rhode Island Hospital from 1980-2017 was evaluated. Rhode Island Hospital serves as a tertiary referral center for the entire state and serves a catchment area of 2 million people across 3 states. Demographic data was extracted, as well as histopathologic characteristics. Only cases of LM and LMM with histopathologic confirmation read by a pathologist or dermatopathologist were included for review. A total of 706 cases of LM and 43 cases LMM were evaluated. Compared to LMM patients, LM patients were more likely male (p¼.04), with tumors on the left side of the face (p¼.03). Compared to females with LM, males with LM were more likely to present with tumors on the scalp (p<.01), nose (p<.01), and ear (p<.01). Females with LM were more likely to present with tumors on the lower extremity when compared to males (p<.01). On histopathologic review, LM was less likely to show a lymphocytic response (p<.01) and have a concurrent lesion preset on the same slide (p<.01). For LMMs with concurrent lesions present on the same slide, the most common diagnoses were dysplastic nevi (5%) and keratinocyte carcinoma (26%). Several clinical differences exist between men and women with LM, and several histologic differences exist between LM and LMM.