Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
In patients with livedoid vasculitis and chronic venous insufficiency on rivaroxaban, what therapeutic strategies—beyond compression and topical care—are safe and effective for controlling pain, ulceration, and edema?
My experience has been that aspirin 365 mg, plus persantine or trental daily, plus leg elevation for 45 min or so in mid-afternoon, will produce pain relief and onset of healing within about two weeks. Only infrequently have I had to resort to metformin as an added medication or use both trental and...
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...
Are there any situations in which you would treat a cutaneous in-situ squamous cell carcinoma of the head and neck with radiation?
Primary radiotherapy (RT) is generally not indicated for carcinoma in-situ (CIS) or pre-invasive malignancies for which surgical resection aimed at achieving negative margin is the mainstay approach. Even if the patient were inoperable or the tumor was unresectable (two distinct scenarios), active s...
Do you routinely recommend transition to dual PO antibiotic coverage for strep species and MRSA, for patients with purulent cellulitis and in the absence of culture data?
I use mostly Linezolid because: It’s now much cheaper. Even if on serotonin drugs, I can half the serotonin dose while they are on it. Covers pretty much all Strep and Staph, including MRSA. Protein synthesis inhibition may reduce toxins (like clinda in Strep fasciitis). There is no renal dose adju...
What resources do you provide patients with alopecia areata?
For any patient with alopecia areata, I recommend the National Alopecia Areata Foundation for them and their family. NAAF provides lots of resources and have a yearly patient meeting that is always a hit for patients and their families. In addition, we discuss all appropriate treatment options for t...
How frequently do you recommend skin exams in patients with multiple AKs?
I generally do complete skin exams on patients with multiple AKs annually, however, areas of involvement are checked more frequently. If there is marked involvement, we recommend field therapy generally with PDT or topical preparations such as 5-fluorouracil with calcipotriene. If there is a history...
How do you decide when to recommend non-surgical management of Bowen's disease in light of long-term data showing very low risk of invasive cSCC after treatment with 5-FU as compared to surgical excision?
Generally, this is a low-risk lesion that can be treated effectively by a variety of modalities or, in some cases, not treated. However, one should always bear in mind that a biopsy may not truly represent the full extent of the lesion. One of the worst invasive SCCs I’ve observed was initially read...
How would you work up a patient with cutaneous mastocytosis?
In adults, consider mastocytosis as being systemic until you prove it is not. A single normal or low-elevated tryptase does not eliminate the possibility of systemic mastocytosis. All patients should go to Heme/Onc for consideration of bone marrow biopsy and ideally high-sensitivity PCR to look for ...
How would you manage a patient who developed stage III melanoma while receiving cemiplimab (cycle 10) for locally advanced cutaneous squamous cell carcinoma?
That depends on whether you want to manage the stage III melanoma in the adjuvant vs neoadjuvant setting. If adjuvant, can likely continue cemiplimab (off-label for melanoma) as it has the same MoA as other anti-PD-1 ICI. If intending to manage stage III melanoma in neoadjuvant setting, consider swi...
How do you optimize retinopathy screening schedules for patients on hydroxychloroquine while also prioritizing cost-effectiveness?
I'll approach this from the cost-effectiveness standpoint as I agree with Drs. @Dr. First Last and @Dr. First Last on their excellent points.Patients with SLE have remarkably high costs when you add up copays, medications, imaging studies, travel, missing work, etc. Anything we can do to help reduce...