Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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.
How do you manage cannabinoids (ex: medicinal, recreational) in dermatology?
I use dronabinol 2.5-10 mg qd-tid for recalcitrant pruritus (typically neuropathic or CPUO as an adjunct treatment). Very cheap using GoodRx if not covered by insurance. It’s a scheduled drug, so it requires DEA, but you don’t need a “medical marijuana license,” and it’s very well tolerated outside ...
What therapies have you found most effective for managing patients with Darier disease?
Because of the amazing bench-to-bedside paper below, my most severe Darier's patient started on an IL17 inhibitor, and it is the closest thing I've seen to a miracle in ages. She was refractory to everything we tried, and is now 80+% clear. What a joy to see science change people's lives!Ettinger et...
What has been your experience using gene expression profiles (GEPs) to predict treatment response in atopic dermatitis?
Thanks for your request. I don't use GEPs to predict treatment response in AD. I advise against using similar tests in general, as they tend to add cost without improving treatment outcomes.
Is there a role for adjuvant RT in a pleomorphic dermal sarcoma after WLE?
Adjuvant radiotherapy (RT) should be considered for pleomorphic dermal sarcoma on a case-by-case basis. There is no clear data to support the use or omission of radiotherapy in this disease, but we base our clinical decision-making on three factors: Estimated local recurrence risk Morbidity of treat...
What threshold do you use to escalate to a multidisciplinary child sexual abuse evaluation when a child with newly diagnosed lichen sclerosus also has persistent/recurrent vulvovaginal symptoms despite appropriate lichen sclerosus therapy?
Several variables need to be explored. What "appropriate" LS therapy has been utilized and, equally important, over what duration of time for this "newly diagnosed" case? Clobetasol ointment is to date the most effective treatment, but often requires months of continuous use; prescribing physicians ...
Would you recommend adjuvant radiation for an atypical fibroxanthoma of the scalp that is completed resected with +PNI and +LVI?
Atypical fibroxanthoma (AFX) is a rare cutaneous neoplasm. Diagnosis is often difficult, and may require the input of an expert soft tissue or dermatologic pathologist. I have seen many of these cases diagnosed elsewhere as AFX, and upon re-review, the diagnosis is changed to cutaneous squamous cell...
What has been your experience with tecovirimat for monkeypox?
I thought it worked well in 2 patients of mine with rectal Mpox. However, the clinical trial did not confirm this, and it was a lot of trouble to get TPOXX going with consent, investigational drug, etc so we have abandoned use here.
When do you recommend HLA testing prior to prescribing lamotrigine, carbamazepine, or oxcarbazepine to patients of Asian descent?
I never use carbamazepine, given how it’s a pan-inducer and often lowers the level of other medications that may be in the regimen, such as quetiapine and haloperidol, since they are mainly metabolized by CYP3A4.Oxcarbazepine has a 50% reduction in the induction of carbamazepine, so I use that somet...
Is there a preferred JAK inhibitor for the treatment of alopecia associated with childhood-onset systemic lupus erythematosus?
Unfortunately, this question likely comes down to FDA and insurance approval and not scientific evidence. Since only one JAKi is approved for alopecia right now and and 2 for poly JIA and none for SLE currently in any age, it will come down to which diagnosis you are going to use to get coverage.