Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What psychiatric medications do you feel comfortable prescribing as a dermatologist?
How do you approach Pityriasis rubra pilaris that is retinoid resistant?
I find most PRPs to respond, at best, incompletely to retinoids - they are not my first line. Any TNF-alpha or IL-12/23 inhibitor is reasonable to try, and there are no head-to-head trials to my knowledge to endorse one other. Mtx may need to be added. IL-17s likely work too for some patients. Depen...
What cosmetic options can you provide to patients with facial discoid lupus that seems stable?
Procedures such as botulinum toxin A, fillers, and autologous fat grafting can be considered in patients with discoid lupus if the disease has been clinically stable, typically meaning no new lesions or active inflammation for about a year. Light-based vascular treatments such as pulsed dye laser ca...
What recommendations do you provide to patients on isotretinoin about timing of tattoos?
No specific recommendations due to the absence of robust data
How do you bill cosmetic follow-up appointments?
Most of these are no-charge visits unless a new problem is presented.
What should be done for a patient with biopsy-proven seborrheic dermatitis on the scalp and central forehead (presenting as a large annular scaly thin plaque) who has failed treatment with fluconazole, antifungal creams, and Zoryve (which is too expensive)?
I don't think dupilumab is reasonable for seborrheic dermatitis. For seborrheic dermatitis, I'd typically prescribe a potent topical steroid in a vehicle the patient prefers and have them use it twice a day for just 3 days (along with ketoconazole or other medicated shampoo). Adherence to topical tr...
How reliable are the expiration dates of patch test allergens?
An AI search of this question revealed the following: "Expiration dates for patch test allergens are generally considered reliable and should be strictly honored to ensure diagnostic accuracy. While some allergens remain stable for years, others degrade rapidly, and using expired materials significa...
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...
Which patient factors drive you to pursue patch testing in the workup of chronic hand eczema?
Seasonal hand eczema occurring only during the cold season is usually irritant and best addressed by minimizing hand washing and using cotton under occlusive gloves with frequents changes for wet work. Careful examination for signs of psoriasis and anti-synthetase syndrome is important. Next step is...
Are you managing chronic urticaria/angioedema any differently if the patient is only/predominantly presenting with urticaria or angioedema?
The mechanism is similar for urticaria and histamine-induced angioedema, so I would expect a similar response. The evidence to support the use of montelukast for U/A is slim, but there are some supporting data. Nonetheless, the newest WAO guideline does not suggest an addition to the therapeutic pyr...