Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What recommendations do you provide patients regarding immunization or boosters prior to initiating rituximab?
To my knowledge, there is no unified recommendation, although the majority of us recommend all age-appropriate immunizations plus strong consideration of younger-than-standard-age immunization for diseases such as pneumococcus and VZV prior to initiation of rituximab when medically feasible. Timing ...
What is your approach to counseling patients on the safety and side-effect profile of a biosimilar compared to its reference biologic?
Relevant question as insurance companies may require a biosimilar over the reference biologic. According to the FDA the spin-off (my term) must be "highly similar" to the original in both efficacy and safety. Approval is based on review of clinical trial data.As for my approach: until proven otherwi...
How has the AAD atopic dermatitis guideline changed your threshold to start systemic therapy rather than rotating topicals in a child with persistent atopic dermatitis despite good adherence?
For me, this has not changed my practice as I have always started systemic therapy early in patients with atopic dermatitis. I find these new updated guidelines reinforce what I believe to be the correct practice. Although we don't have a perfectly matched set of guidelines for AD as we do with psor...
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.
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...
How should the use of the DecisionDx-Melanoma test be integrated into clinical practice to potentially avoid sentinel lymph node biopsy?
At this time, DecisionDx should be used as an extra piece of molecular information, not for clinical decision-making. The study done on DecisionDx was mainly retrospective, not prospective, so it has limited value in guiding patient care at this time. I would base your decision on SLBx on the curren...
How do gene expression profiling results influence your recommendations for surveillance intensity in patients with early-stage melanoma?
Currently, next-generation sequencing (NGS) is not used to determine surveillance intensity. The only molecular test that may have some impact on surveillance intensity is circulating tumor DNA (ctDNA), such as Signatera from Natera. Signatera is more established in solid tumor types that are known ...
What do you prioritize when a patient has discordant clinicopathologic features and genomic risk scores to estimate melanoma recurrence risk?
At this time, the test to assess genomic risk score (i.e., Castle DecisionDx) is based on retrospective analysis, and there are no prospective data yet. So it should not be used solely for decision-making, especially when it comes to whether to do adjuvant systemic therapy or not. The traditional Am...
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 ...
What is your approach to young teenagers with acne who have extremely sensitive skin, cannot tolerate typical acne regimens, cannot tolerate oral antibiotics, and refuse Accutane?
The formulation of benzoyl peroxide encapsulated in silica shells is extremely well tolerated by sensitive-skinned individuals. I was involved in pre-approval studies and found it remarkably well tolerated in such patients.