Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
In an infant whose mother resumes TNF inhibitor therapy (e.g., adalimumab, infliximab, certolizumab) after delivery and is breastfeeding, do you recommend delaying live vaccinations?
IgG-based biologic therapies - including TNF inhibitors - are all considered compatible with breastfeeding, since IgG passes only minimally into breast milk. Given these agents are proteins, the minimal drug that is transferred is unlikely to remain intact (or active) with passage through the infant...
How do you counsel patients who inquire about microplastics in their cosmetics or physician-dispensed products given emerging associations with conditions such as psoriasis, eczema, lupus, and hormonal disruption?
That’s a really good question. It is absolutely true that patients are increasingly aware of environmental exposures, and microplastics in personal care products. When I address it with my patients, I tell them that there is ongoing research on microplastics in cosmetics and personal care products. ...
What is your late or no-show policy for patients?
I'm really interested in reading answers by those of you who have punitive policies for these patients. I wrestle with these problems several times per week, as I have Mohs surgery patients either no-show or cancel/reschedule with less than 24 hours' notice. On the one hand, I find that most patient...
Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (e.g., cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (e.g., neuropathy, palpable purpura, or glomerulonephritis)?
Yes, I would consider early starting biologics for infiltrative EGPA.
How do you decide when to biopsy a patient with overlapping signs of female-pattern hair loss and possible early central centrifugal cicatricial alopecia?
Biopsy is indicated when the diagnosis is uncertain, particularly when distinguishing between female-pattern hair loss (FPHL) and central centrifugal cicatricial alopecia (CCCA), as these conditions can have overlapping clinical presentations. Our T-shirt should also represent fibrosing alopecia and...
Do you routinely screen for cardiovascular risk factors in a patient with moderate-to-severe psoriasis?
Review of systems. Depending on age, consider lipids and HbA1c if no data for the past year.
What therapies do you most commonly recommend for prevention of NMSC in organ transplant patients?
First and foremost, we assess transplant patients and circle, number, and label all their skin cancers so we can catalogue them. We then prioritize their skin cancers in order to remove them in order of "worst first". We immediately start field therapy with calcipitrione and 5-FU twice a day for a w...
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 procedures do you recommend for patients interested in xanthelasma removal?
I have had success treating xanthelasma with both hyfrecation (particularly for very small lesions) and fully ablative laser (both CO2 and Erb-YAG).
What topical regimens do you recommend for redness related to rosacea in patients who defer laser treatments?
Naturally, laser is the most ideal and best solution. Green-tinted makeup is also a great adjunct. Aside from the usual routine counseling (avoidance of sun, food triggers, etc.), one product that I have found remarkable results with is the compounded SkinMedicinals ET-Rosacea Cream, which contains ...