Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What therapies have you found most effective for JAK-induced/associated acne (JAKcne)?
Doxy will work quickly and is pretty safe. If all goes well, you can taper the dose of the oral antibiotic and use topical agents.
Why/How do patients report seeing flashes of light when receiving Pulsed Dye Light (PDL) treatments on the face?
Patients commonly report seeing flashes of light during pulsed dye laser treatments, especially on the face, although it happens even with proper eye protection. I typically will place an eye pad under the laser goggles for those patients more sensitive to the flashes. We understand the mechanism of...
What is your approach to managing moderate to severe atopic dermatitis in pregnancy?
Gentle skin care practices, dilute bleach baths, diligent use of topical steroids, and phototherapy will cover most moderate to severe cases. If patients have any persistent lichenified areas, intralesional steroids can help temporize until after delivery/lactation. If a biologic is needed, work wit...
What are your preferred treatment options for recalcitrant pemphigus vulgaris?
Rituximab, typically combined with short-term corticosteroids, is the preferred treatment for recalcitrant pemphigus vulgaris, demonstrating superior efficacy compared to conventional immunosuppressants. In patients with moderate-to-severe disease, rituximab achieved sustained complete remission in ...
How long do you apply patch testing before interpreting the results?
In most instances, patches are removed after 48 hours (2 days). This timeframe is specifically chosen to allow sufficient time for the allergen to penetrate the stratum corneum and trigger a T-cell-mediated response, while simultaneously reducing the potential for significant skin irritation that ca...
What data exist regarding treatment for facial erythema from dupilumab in children <5 years of age?
In AD patients >6 years, the incidence of facial erythema for dupilumab was 1% vs placebo 0.7% (Paller et al., PMID 41163262). The placebo-controlled LIBERTY AD PRESCHOOL trial (Paller et al., PMID 36116481) and the subsequent open-label trial up to 2 years (Paller et al., PMID 41926052) for 6-month...
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 approach selection of systemic treatment in a patient with atopic dermatitis with severe itch?
The good news is we have 6 approved options here, 4 biologics and 2 small molecules, and all of these therapies have excellent itch data. Selecting a systemic therapy needs to take other comorbid conditions, medications, delivery preference (pill or injection), lifestyle, and other patient attribute...
For a positive anti-TPO and normal TSH in the workup of CSU, are you referring to endocrinology?
I typically do not refer these patients to endocrinology. I do provide the patient with these results and have them communicate this with their PCP and/or communicate with the PCP myself so they can monitor for any symptoms associated with thyroid dysfunction.
What clinical criteria do you use to decide when to start oral nicotinamide for chemoprevention?
Consider oral nicotinamide (500 mg bid) for chemoprevention in patients with several non-melanoma skin cancers in the past 5 years or those with high-risk features such as extensive actinic damage or field cancerization. Studies show the strongest evidence for its use in immunocompetent patients wit...