Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is the current role for genetic profile testing (e.g. DecisionDx-SCC) in the treatment paradigm for cutaneous malignancies?
This is a very cool test that has a lot of potential to help us make decisions in practice (full disclosure, I advise Castle and get research support from them, but am not directly compensated by them). The data published thus far shows that it is prognostic to predict nodal or distant mets. However...
How do you manage severe chronic scalp pruritus in older women when biopsies and exams show no primary skin disease and standard therapies fail?
I use gabaergic drugs like Pregabalin and Gabapentin in high doses up to 300 mg and 3600 mg, slowly tapering up as many of these cases are neuropathic. I use compounded topical KAL cream 10% ketamine, lidocaine 5, and amitriptyline 5, or foam formulation or pramoxine lotion bid or topical compounded...
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...
Do you read contact patch tests on removal at 48 hours, and do those results matter if negative at 72 or 96 hours?
Great question, and one that comes up frequently in clinical practice. I remove patches at 48 hours, and at that point I do perform a quick read or, at a minimum, have the tested areas thoroughly photographed. While it is difficult to draw firm conclusions from a 48-hour read alone, it is genuinely ...
How soon after stopping oral steroids can patch testing be performed?
Dose strength and duration of oral steroid therapy should factor into the equation. I would say at least 2 weeks to be on the less cautious side and up to 1 month if there is no urgency to patch test.
Would you consider topical estrogen for facial anti-aging?
Before I put anything on my skin, I want to know what it does, whether it is safe, and whether there are clinical trials on humans that show it works. Topical estrogen, like estriol, may be an option for postmenopausal skin, as it has the potential to increase collagen, hydration, and elasticity. Ho...
What has been your experience in using topical hydroquinone prior to a chemical peel for melasma to reduce post-inflammatory hyperpigmentation?
Topical hydroquinone, in patients not sensitive to it, as well as sunscreen, are routinely used in this situation.
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...
What recommendations or protocol do you have in reducing pain when using levulan with blue light for field therapy to treat AKs?
Applying the blue light directly after the application of Levulan without an incubation period practically eliminates all of the discomfort associated with this type of field therapy for actinic keratoses. You may choose to double the usual exposure time to 34 minutes, but this is not necessary.
What have you found more effective, blue-light or red-light photodynamic therapy (PDT) in treating AKs or NMSCs?
Need to say what you are treating.