Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...
What are your favorite modalities for preventing hypergranulation tissue?
Although exuberant granulation tissue is not totally preventable nor predictable, persistent inflammatory impetus, such as from hairs embedded in a surgical closure, or spitting suture reactions, can stimulate excess granulation tissue. Careful avoidance of trapped hairs as well as burying absorbabl...
How do you treat gram-negative folliculitis in a transplant patient on sirolimus who cannot use isotretinoin due to drug interactions?
The most critical issue with these infections in the immunocompromised host is the correct identification of the organism and its sensitivities to allow appropriate selection and course of antibiotics. Because the infection is deep in the hair follicle and the patient will shave the area, there is a...
Is keratosis follicularis (Darier disease) a contraindication to the receipt of PMRT?
Thanks for this interesting question. It prompted me to do a bit of literature search and think about how I'd approach this case.For a postmenopausal patient with ER-negative, PR-negative, HER2-negative (triple-negative) pT2N0(sn) breast cancer and unresectable positive surgical margins after mastec...
How have you applied the findings of this trial to your current approach to prescribing rituximab for pemphigus patients?
For the MMF vs MMF + Rituximab trial, the patients received two courses of Rituximab six months apart. The B cells don’t start to recover until about six months after the infusions. The data shows more patients in the rituximab group achieved sustained CRoff pred for 15 weeks or more relative to MMF...
How do you manage lamotrigine or lithium-induced acne?
For Lithium, I have referred patients to dermatology but it seems the interventions suggested such as Doxycycline, Spironolactone, or Bactrim do not fully help. I try to reduce the dose if possible or switch to another mood stabilizer if the acne is severe and bothersome that it is making the patien...
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 ...
Would you give adjuvant radiation after complete resection of a small primary cutaneous follicular lymphoma of the scalp?
Not a lot of data, but here goes. First, one has to go back decades in the literature to find series of patients with lymphoma rx'd with surgical resection alone. In general addition of RT improved outcome even when ostensibly resected with neg margins. With today's technology risk of additional RT ...
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
Agree that recurrence is common, but there are no data that a high cholesterol or increased serum lipid is associated with them.
What treatment options are there for uremic pruritus in an elderly patient with risk of sundowning?
Uremic pruritus is increasingly recognized as a multifactorial condition involving peripheral neuropathy and immune dysregulation, particularly upregulation of type 2 cytokine pathways. Dysregulated opioid signaling further contributes to itch amplification. Accordingly, κ-opioid receptor agonists, ...