Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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 treatment for actinic cheilitis?
PDT is effective as well as an ablative laser for long-term control. Efudex or imiquimod for multiple weeks is good for localized or milder disease. Consider getting a biopsy if you’re concerned for invasive SCC. Encourage them to use sunscreen too.
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.
What is the appropriate pediatric dose of litfulo for a preadolescent with refractory alopecia areata?
Given that Litfulo is not yet approved for preadolescents and data from clinical trials in this age group are not yet available, it's hard to know the optimal dosing. With that said, typically I would treat a preadolescent with refractory alopecia areata off-label with Litfulo 50 mg (i.e., the same ...
What chemoprophylaxis, if any, would you consider in a transplant patient with numerous KC/NMSCs?
Besides treating actinic keratoses with all methods available to try to prevent their progression, acitretin is #1 in my book for these patients. It’s best to get them on it before they reach the point of developing big, bad SCCs. Dosing is based on patient size and tolerance. Start with 10 mg per d...
What is the role of hair transplantation for scarring alopecias like lichen planopilaris?
The primary disorder needs to be under control before considering hair transplantation. I would suggest waiting at least a year after the disorder is under control and many suggest 2-5 years of stability before considering transplantation. Hopefully, in some areas, the scarring will be mild to moder...
What are your favorite sutures to use in dermatologic surgery?
The type of suture I prefer can vary based on location, tension, and skin quality. For the majority of cases on the face, I prefer 4-0 monocryl for deep sutures and 6-0 nylon or 5-0 Prolene for top sutures. I use Vicryl for deep-tacking sutures. I occasionally use 4-0 PDS on nasal flaps. For grafts,...
How would you manage BCC to the left cheek after only half of a radiation course was completed three months ago and non-operative management is preferred?
An assessment of three domains is going to help the patient and physicians in this case: Patient related factors: A medical emergency that lasts three months implies a lot-- so what is the performance status of the patient now and what is the prognosis; because an ECOG 3-4+ patient with new onset mu...
What are your recommendations in managing pudendal neuralgia/red scrotum syndrome?
Red scrotum syndrome is very challenging to treat. The list of reported treatments is long, but I have not found one to be consistently effective. Treatment selection depends significantly on patient characteristics and preferences. In my opinion, every patient with red scrotum syndrome should under...
How do you approach management of a patient with coexisting psoriasis and systemic sclerosis, particularly when both active psoriasis and skin tightening are present?
It depends if both diseases are considered significant and active. If so, a JAK-inhibitor would kill two birds with one stone. JAK's are already approved for psoriatic arthritis, and there is decent data for skin psoriasis as well, on par with some of our currently FDA-approved therapies. There is s...