Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What’s your immediate post-procedure protocol for fractionated laser resurfacing (i.e., Sciton Pro-fractional Laser)?
My immediate post procedure protocol for fractionated laser resurfacing is to decrease stinging with the Zimmer chiller (approximately 10-30 minutes followed by the application of Vaseline. I have not seen significant pinpoint bleeding while treating acne scarring (Lumenis Encore laser) but have see...
In what situation would you recommend ipilimumab + nivolumab over relatlimab + nivolumab in the treatment of metastatic melanoma?
There is no clinical trial to provide a direct comparison between the two regimens, hence the answer to this question is usually driven by personal interpretation of the data and patient preference. The data for both regimens show a statistically significant PFS benefit and a superior response rate ...
In what circumstances would you recommend adjuvant radiation for a keratocanthoma with SCC after resection?
KA by itself (in the absence of SCC) is at the interface of benign and malignant. In a pure KA, if margins are negative, no further RT is needed. If there is SCC mixed, as can happen even with BCCs, the adjuvant RT indication rules pertaining to SCC prevail.
What is your approach to prescribing JAK inhibitors in patients with alopecia areata who have a prior history of cutaneous malignancy, such as DFSP?
For something like DFSP, it would depend on how long it has been since their diagnosis, and a shared decision-making process with the patient. Close monitoring with skin checks would be recommended.
How do you approach managing nausea and GI side effects when initiating methotrexate?
There are several strategies to minimize nausea and gastrointestinal symptoms with the use of methotrexate. The medication can be taken with food, just not with caffeine. The dose can be split throughout the day it is taken such as half the dose in the morning and the other half in the evening. The ...
What topical therapies and procedures do you recommend for patients with atrophic acne scarring?
If the patient has hyperpigmentation, then some sort of topical lightening approach (i.e., tretinoin/kojic acid/niacinamide/Vit C/tranexamic acid, etc) or chemical peels. For the actual scarring, assuming that the acne process has burned out, the most ideal procedure depends on the particular type o...
Which serologic tests are most helpful when evaluating for suspected drug-induced lupus?
If I suspect drug-induced lupus, I typically order the following laboratory testing: ANA/IFA Anti-histone antibody, usually positive in drug-induced lupus Anti-Ro antibody, usually positive in drug-induced subacute cutaneous lupus Anti-dsDNA, usually negative in drug-induced lupus vs positive in id...
Would you offer upfront radiation for a large painful keloid of the chest that has arisen from an irritated pyoderma gangrenosum lesion?
Radiation therapy is actually used (rarely) for pyoderma gangrenosum that has been unresponsive to medical management via immunosuppression [1]. Single fraction doses of 400 to 800 cGy have been used with slow regression of the lesions. In the case report cited, the lesion started fading after 3 mon...
Does baseline facial dermatitis in a patient with AD cause hesitation when starting Dupixent due to conjunctivitis-related complications, especially when there are many available options?
Yes, I definitely do consider this. Not necessarily because of conjunctivitis but because I’ve seen a significant number of patients with “dupilumab facial redness or reaction” with out-of-proportion head/neck flaring in AD patients. In patients with significant facial involvement at baseline, I pre...
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...