Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Would you stop bimekizumab in a patient who has severe psoriasis and has responded well to this therapy but is found to have newly diagnosed cirrhosis?
I'd want to know if there was some other cause for the cirrhosis. If there were, I would not stop the bimekizumab. If there was not a clear, obvious cause, I'd want the patient evaluated by a hepatologist. If the hepatologist could find some other reason for the cirrhosis, it might not be necessary ...
How do you manage recurrent scabies in both a patient and their partner when standard therapy fails?
I would recommend 2 weekly treatments with oral ivermectin and topical permethrin. It is also very important to discuss control of fomite exposure as well as possible occult sources e.g., relatives and close friends.
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
How would you manage active severe psoriasis in a patient planning pregnancy, who also has psoriatic arthritis with well-controlled joint symptoms on certolizumab pegol (anti-TNF therapy)?
If the psoriasis was sufficiently limited in area that topicals were a practical solution, I'd first try to assure that the prescribed topical steroids were being used well. Poor adherence is a common issue with topical treatment. Phototherapy might be my next choice. I feel comfortable prescribing ...
Do you check IgA levels before starting IVIG for other autoimmune conditions?
Whereas it is not mandatory to check IgA levels before starting IVIG, it is prudent to do so in non-urgent situations since the patients with IgA deficiency, especially those who have developed anti-IgA antibodies, are at an increased risk of severe hypersensitivity or anaphylactic reactions from IV...
Do all patients initiating omalizumab need to have it administered in a healthcare setting?
In the trials, all cases of anaphylaxis were on first administration--suggesting it is not intrinsic to drug and is more likely because you are giving it to a group of people who may be more susceptible to anaphylaxis in general. FDA has cleared at home use, so my general approach in a patient witho...
How do you tailor rituximab dosing for mucosal-predominant vs mucocutaneous pemphigus?
No, I do not dose cutaneous vs mucocutaneous patients with pemphigus differently with rituximab. I am more likely to recommend rituximab as first-line therapy if a patient has severe oral or genital disease, as this can be very quality-of-life limiting. Furthermore, relapse assessment can be challen...
What is your advice to patients with IBD who are on biologic therapies and planning for pregnancy?
Biologics are effective therapies for many autoimmune conditions, including IBD. The best outcome of a pregnancy is if a patient is in remission at the time of conception, which means she does not stop her therapy to get pregnant. Indeed, there are studies on women with nonspecific infertility who w...
Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (e.g., cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (e.g., neuropathy, palpable purpura, or glomerulonephritis)?
Yes, I would consider early starting biologics for infiltrative EGPA.
What treatment modalities have you had success with for treating extensive molluscum in the pediatric population?
I've had very good success with the use of oral cimetidine, 400 mg PO tid in children. Usually, they remain on this tx for 4-6 weeks with sig clearing beginning by the 1st 2-3 weeks. I also use tretinoin gel 0.1% qd-bid to the more stubborn lesions if necessary.