Internal Medicine

Dermatology   

Questions discussed in this category


The patient was diagnosed on the basis of ANA 1:1,280, strongly positive Smith, Sm-RNP, dsDNA, pericarditis, inflammatory arthritis, and discoid lupus...

Are you less likely to prescribe it for patients with dyslipidemia or autoimmune disease?

How do you balance concern for causing skin hypopigmentation with many of the traditional treatment modalities we have?

Given that Accutane can affect calcium homeostasis, would you recommend continuing Accutane or are additional steps or workups warranted?

Do you reserve biologics for more systemic involvement? When do you initiate biologics such as secukinumab? 

What changes do you make to your treatment approach to adapt to this altered disease state?

Are you aware of any data regarding relative risk of molluscum contagiosum infection in reference to DMARDs/biologics?

SLE manifestations include arthralgias and cytopenias which are stable. Previously did well on methotrexate, but developed GI side effects. HCQ is on ...

Would you view this as a sign that disease is not adequately controlled despite labs and imaging suggesting no active vasculitis? 

What specific settings and devices do you prefer to use? 

Do you have a preference for biologics or phosphodiesterase inhibitors? 

The patient has ongoing inflammatory arthritis despite methotrexate, apremilast, and jak inhibitor trials.

What treatment regimen have you found most effective? Do you recommend any lifestyle changes or prescribe oral azoles? Any experience with topical r...

Do you start/trial them on another biologic or just rely on topical therapies?

Female in her early 40s with chronic spontaneous urticaria occurring consistently only at night for the past 4 years. Lesions develop only at night wh...

 What treatment do you initiate before you have a clear diagnosis?

Drug elimination is often helpful, but some triggers are not easy to identify because they are found in food items.

When do you switch to steroid-sparing medications? What steroid-sparing therapies do you prefer?

Do you empirically treat itchy patients -with a non specific rash- for scabies without obvious clinical findings for scabies? 

Do you use combination therapies such as betamethasone and calcipotriene foam?

Given the side effect profile and risk of relapse off oral TXA therapy, do you prefer pulse dosing (i.e. 3 months on, 3 months off) or continuous ther...

Do you first try adding topicals or UV? At what point do you decide to switch biologics and at that point do you try to class switch to a different MO...

In which situations or patient populations do you find this useful? How is it sterilized?

What side effects do you highlight in conversation with them? How do you approach toxicity monitoring?

Mother's insurance plan has a high deductible and phototherapy is inconvenient (family lives 50 minutes away). 

For instance - any tips regarding coordination of care/transportation, associated lymphedema management, wound care, and pain control would be welcome...

I have an elderly patient with a history of biopsy-proven psoriasis on IL-17 biologic therapy. She has developed an intense itch without a primary ras...

Do you order blood work to evaluate for underlying dyslipidemia or other metabolic diseases?

Have you had success with deroofing or surgical excision? Is ILK the best option?

Is a BM biopsy a must when there is skin involvement? If tryptase level is mildly elevated but less than 20 would you recommend a BM biopsy?

Have you recommended supplementing less common supplements such as zinc or selenium?

Do your recommendations differ depending on the fragrance category (i.e fragrance mix I, II or balsam of Peru)?

This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).

(Refractory to mycophenolate, azathioprine, and methotrexate. UpToDate suggests thalidomide or IVIG with mixed efficacy, while there are some case rep...

https://www.jaad.org/action/showPdf?pii=S0190-9622%2824%2903329-2

And if so, what is your approach to the diagnosis?

Do you recommend any dietary changes or supplements? Do you modify your recommendations if the patient is breast feeding?

Do you typically order a systemic workup? And, after topical corticosteroids, what other treatment options do you prefer?

Do you do blood work? Or do you rely on review of systems?

Are dilute bleach baths enough? Should they use any topical therapies? Is there a need for Staph decolonization with something like mupirocin?

Do you typically start the patient on hydroxychloroquine?  What work-up do you perform?

Are there ways to overcome barriers in insurance coverage of this combination of treatments?

Several speakers at ACR 2021 commented on the important role of drug levels in the management of these patients and cautioned against adding medicatio...

What labs do you order? How often do you order labs?  Have you ever needed to discontinue isotretinoin due to lab abnormalities?

Are there cases where food or environmental allergies significantly worsen eczema in children?

Does your treatment management differs for oral erosive lichen planus? How would you approach patients with active malignancy on chemo and radiation?

If so, where can patients find it? And besides topical clindamycin, what other topicals do you find helpful for individual lesions?

The symptoms can be really miserable.I try to control it with antihistamines (don't find these helpful in most cases) and topical steroids, but that d...

Do you refer them to Ophthalmology? Have you had to switch patients off of Dupixent due to their ocular side effects?

Should one restart lamotrigine or look for an alternative? If no other alternative available, is slow titration vs regular titration preferred?

Are there any medications that surgeons like discontinued before their procedure?

Do you recommend any changes to their personal hygiene practices? or changes to their environment?

What recommendations do you provide if there is concern that the patient is beginning to flare? Have you prescribed any of the new JAK inhibitors?

Does your evaluation hinge on nonresolution with warming? How extensive is your workup?

In your experience, do specific patient features predict a better response?

Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease? 

Would you switch to itraconazole or perform fungal cultures? When would you consider repeating the course of treatment? 

Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?

In other words, do we think of TNFi induced lupus and TNFi induced psoriasis as a drug effect or a class effect? 

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?

If so, are there specific patient populations for which you would use this metric?

This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet


Papers discussed in this category


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Journal of the American Academy of Dermatology, 2020 Apr 28

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