Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your approach to managing moderate to severe atopic dermatitis in pregnancy?
Gentle skin care practices, dilute bleach baths, diligent use of topical steroids, and phototherapy will cover most moderate to severe cases. If patients have any persistent lichenified areas, intralesional steroids can help temporize until after delivery/lactation. If a biologic is needed, work wit...
What are your vaccine recommendations while patients are on biologics?
Live vaccines are best completed at least a month before initiation of biologics when these are appropriate (e.g., MMR, chickenpox, yellow fever). The data on non-live vaccines is limited. I personally think that some degree of protection is better than none. I will not interrupt biological therapy ...
If a BRAF-mutated melanoma patient developed metastatic disease progression on adjuvant anti-PD-1 monotherapy, do you recommend switching to BRAF/MEK targeted therapy or combination immunotherapy?
The developing pre-clinical and clinical data is clear on this and I believe it becomes even more clear with time. While the DREAMseq study did not enroll patients following adjuvant therapy as the patient in the case, the overall evidence clearly shows that BRAF/MEK inhibitor resistant melanomas ar...
Does baseline facial dermatitis in a patient with AD cause hesitation when starting Dupixent due to conjunctivitis-related complications, especially when there are many available options?
Yes, I definitely do consider this. Not necessarily because of conjunctivitis but because I’ve seen a significant number of patients with “dupilumab facial redness or reaction” with out-of-proportion head/neck flaring in AD patients. In patients with significant facial involvement at baseline, I pre...
What topical therapies have you found most effective for managing scarring alopecias?
I use a lot of clobetasol shampoo 1-2 times weekly, which is easier and tends to cause less atrophy. Overall, any of the steroid-sparing agents can be helpful: tacrolimus ointment (or compounded as a solution), roflumilast foam, or topical JAK inhibitors. For maintenance.
What is your approach to management of patients with recurrent orolabial herpes?
Recurrent orolabial herpes is fundamentally a disease of viral latency with episodic reactivation, so my approach focuses less on “treating infection” and more on reducing recurrence burden, shortening symptom duration, and improving quality of life. First, I make sure we are actually dealing with H...
Should the use of avacopan be limited to those patients at increased risk of steroid toxicity given the anticipated high cost of this medication?
Once Avacopan is available for clinical use in the treatment of patients with AAV, providers will need to carefully weigh risks and benefits of the medication while considering other factors including cost.The ADVOCATE trial used a novel glucocorticoid toxicity index that captures common GC-related ...
Among the metastatic/unresectable melanoma patients you would historically treat with anti-PD-1 monotherapy, are you now recommending nivolumab/relatlimab instead?
Based on the published RELATIVITY-047 study, the nivo/rela combination leads to a superior median PFS of 10.2 mo (vs 4.6 mo for nivo alone) - both updated at ASCO 2022. At the most recent update at the ASCO 2022, the median survival has not been reached yet for the patients treated with nivo/rela (v...
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
How do you feel the oral IL-23 (Icotyde) will shape psoriasis management?
I think this new med will be the leading first-line systemic medication for psoriasis patients who have been inadequately controlled by topicals but are hesitant to go straight to a biologic. Systemic treatment-naive psoriasis patients will likely represent the largest population of new oral IL-23 s...