Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you prefer switching to a biologic with a different mechanism of action such as an IL-17 inhibitor over cycling to another TNF inhibitor in a patient with moderate-to-severe HS who has experienced secondary failure to adalimumab after an initial good response?
I agree with @Dr. First Last's excellent suggestions. One other idea is adding methotrexate 10 mg weekly to adalimumab to see if neutralizing antibodies are the problem. I tend to do this if a patient has a good response but loses it down the road. I don't do this as much as I used to, now that we h...
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...
Do certain subtypes of BCC respond better to hedgehog pathway inhibitors?
I have found that the larger the BCC, the more dramatic the response (unfortunately, not all tumors respond). These are invariably of the nodular/infiltrative subtypes for which hedgehog inhibitors are indicated.
What is your strategy for managing radiation dermatitis in breast cancer in the prophylactic, erythema/dry desquamation, and moist desquamation stages?
Good question. Everyone seems to have a favorite home remedy with very little good supporting data. I am unaware of any good prophylaxis rx. The best thing is good treatment planning to minimize inhomogeneity. There are phase III data demonstrating the efficacy of soap and water cleansing for rx of ...
How do you approach managing perioperative anxiety in Mohs patients?
Great question. Music, stress balls, having your team engage in conversations with the patient, and other distraction techniques are helpful. Some patients may need medications such as Halcion to help with anxiety but this should be given after the patient signs consent and has a verified driver aft...
Do you generally utilize calcium channel blockers on an as needed basis for patients with Raynaud's phenomenon?
Can certainly help when patients have conditions that trigger Raynaud's. If otherwise healthy, I discuss keeping the extremities protected from excessive cooling.
What laboratory studies do you routinely order when evaluating a patient with interface dermatitis on biopsy?
Rule out lupus.
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.
Do you offer prophylactic antibiotics or valacyclovir prior to ablative laser therapy?
All ablative resurfacing, especially perioral region, should be prescribed valacyclovir as outbreaks can be devastating, especially if it's their first one.
For microneedling to treat boxcar scars, how should the needle be oriented?
Boxcar facial scars are difficult to treat because the dermis is fibrous, the sides are fixed, and they can range in size from several millimeters. The purpose of microneedling is to improve the underlying dermis, so it would make the most sense to aim the needle directly under the deepest part of t...