BACKGROUND Antibiotic prophylaxis is frequently used for the prevention of infection at a distant site such as the heart valve or prosthetic joint. However, there are no published data describing how dermatologists manage patients "at risk". OBJECTIVE The purpose of this study is to document prophylactic antibiotic use by dermatologists. METHODS A total of 211 randomly selected community dermatologists and 69 academic dermatologic surgeons were surveyed by questionnaire to determine whether they would provide antibiotic prophylaxis in 20 different clinical situations. RESULTS This survey showed that under certain circumstances, almost all dermatologists provide antibiotic prophylaxis to prevent infection at a distant site. However, many dermatologists use antibiotics in settings with relatively little or no indication and confuse a prophylactic regimen with treatment of a superficial infection. CONCLUSIONS This survey underscores the need for education and research into the prophylactic management of patients "at risk" who undergo dermatologic surgical procedures.