Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your treatment algorithm for dissecting cellulitis of scalp?
I view dissecting cellulitis as a variant of HS (and we know it's a component of the follicular tetrad along with acne conglobata and pilonidal cysts). Anti-TNFa inhibitors and isotretinoin are preferred therapies for this condition with a high level of efficacy.
What treatments have you found most effective in removing syringomas?
Most often the syringomas I have treated have been multiple small lesions around the eyes. Because it is readily available, safe, of minimal cost, and easy, I like to use pinpoint electrodesiccation. I use a Hyfrecator 2000 electrosurgical unit on the low setting with 2-3 watts. Because electrodesic...
What is your preferred method of wound closure after wide excision for hidradenitis suppurativa?
My favorite is always secondary intention healing. It has the best outcomes and the least risk of recurrence, plus it's the easiest since you don't have to do anything. It is important to counsel patients ahead of time, and I find it helpful to show them some photos. When they see the open wound, it...
How would you palliate a large, symptomatic vaginal melanoma recurrence with limited small pelvic lymph node metastases?
Palliation. Treat problems that are symptomatic. No expensive systemic work up. Pall RT to the pelvis if it’s symptomatic. 30 Gy/10 fractions, 25 Gy/5 fractions, or 20 Gy/2 fractions with a 1 week inter-fraction interval. Apologize for the lengthy response.
When do you consider adding steroids alongside intravenous antibiotics for patients with orbital cellulitis?
If the orbital cellulitis is infectious, I never add steroids. There is no literature or proof that they do anything, and decreasing immunity, in my opinion, is simply a bad idea. If it is inflammatory, then absolutely. Most infectious orbital cellulitis is from the sinuses and is more common in chi...
Do you attempt to taper or discontinue a JAK inhibitor in a patient with severe alopecia areata who has maintained complete scalp hair regrowth for at least one year?
I do not routinely attempt to discontinue a JAK inhibitor in a patient with severe alopecia areata (AA) who has achieved complete regrowth. There has to be a compelling reason for me to stop the medicine, such as cost, pregnancy, or adverse events. Since severe AA behaves more like a chronic immune-...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
Where in the current treatment algorithm for CHE do you feel delgocitinib best fits?
Given the cost of delgocitinib, I have difficulty justifying it unless there has been an inadequate response to high-potency topical steroids and calcineurin inhibitors. I expect there to be significant improvement with these, and consider an inadequate response to be the inability to decrease to a ...
How would you treat pattern hair loss in a woman on aromatase inhibitors for breast cancer?
I treat with topical or oral minoxidil. Spironolactone is considered safe. I avoid 5alpha reductase inhibitors, both topical and oral, in patients with a history of estrogen receptor-positive breast cancer. Topical 5α reductase inhibitors must be absorbed systemically for any benefit. Other tools fo...
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...