Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Are there subgroups of patients with pemphigus in whom you prioritize lower-dose rituximab regimens?
No, I do not recommend ultra-low-dose rituximab for my patients. In general, even for patients with comorbidities, the overall complication rate with rituximab infusions is low, with infusion reaction being the most common, and this rarely has any long-term consequences for the patient. In Dr. Werth...
How do you counsel patients who ask if there are any dietary modifications they can make to help control their autoimmune disease?
I send patients to a website called nutritionfacts.org. This is a non-profit website that reviews medical literature related to nutrition and diseases. It was founded by Dr. Greger and he is not trying to sell anything which I appreciate. He has bite-sized videos on anything you can think about rela...
Do you scale up 2nd generation anti-histamines to 4x daily in acute urticaria in the pediatric population as you do in adults?
Severe urticaria is certainly a therapeutic challenge. Updosing 2nd generation antihistamines in children has been studied, more trials need to be done. For refractory urticaria in children, I will often recommend 2X the recommended dose of a 2nd generation antihistamine in the morning and maximize ...
What therapies have you most effective in managing the pruritus associated with lichen amyloid?
Lichen amyloidosis itch would respond extremely well to Nemolizumab. See the report by Talias group. Makes sense as we found that IL31R and OSM are key factors in pathogenesis.Gabriela Soto-Canetti et al., JAAD Case Reports 2025If Nemo is not available, MTX works.Methotrexate for the Treatment of Re...
How would you approach management of a large, fungating squamous cell carcinoma of the auricle if surgical management is not desired by the patient?
For a tumor this size and with cartilage invasion, I would recommend starting with induction cemiplimab to best response (generally 4-6 cycles), followed by consolidative RT, generally electrons. Prior to starting the immunotherapy, I would stage the neck with a contrast CT scan, as tumors of this s...
How do you approach patients who continue to experience pruritus and ongoing concern for persistent scabies despite having completed appropriate treatment?
Pruritus can not uncommonly continue in patients for 6 weeks or more after infestation is managed. High-dose antihistamines may be of some benefit. Consider if there is an ongoing untreated exposure that the patient has not thought of or cannot/will not share with you. Not all people infested with s...
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...
What is your approach to tapering off rituximab in a patient with pemphigus who seems to be remission?
When a patient has achieved clinical remission and also has low-titer antibodies to desmoglein 1 and 3 (with the exception of patients who may have non-pathogenic antibodies, which can be trended over time), we discuss tapering rituximab. There are, of course, pemphigus patients, especially those wi...
How do you counsel patients with pemhigus on the main safety benefits of a low or ultra low dose rituximab regimen?
Although I read this article with interest and an open mind, I have not adopted ultra-low dose rituximab into my clinical practice of treating pemphigus patients for several reasons. The author's conclusions may very well end up being correct over time, but there are too many concerns with the study...
What do you view as the optimal use and timing of cemiplimab in high risk CSCC?
Increasingly, neoadjuvant cemiplimab has become our preferred approach for many patients with resectable high-risk CSCC, and this is consistent with what several high-volume centers are now doing. The high pathologic response rates, durable recurrence-free survival in responders, and meaningful surg...