Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you choose between various JAK inhibitors in the management of alopecia areata?
Mostly, the first line is baricitinib as it has been approved the longest. However, if a patient has lipid abnormalities at baseline, you could consider ritlecitinib, which does not impact the lipid profile. At the same time, however, ritlecitinib interacts with statins and other CYP3A and 1A2 medic...
Does Dupixent interfere with patch testing?
Dupilumab suppresses Th2 skewed responses such as those associated with systemic contact dermatitis (e.g. propylene glycol, compositae mix, carmine, etc.) so testing while on dupilumab results in incomplete results. Responses to Th1 skewed allergens (e.g. epoxy or methylchloroisothiazolinone) may be...
How would you manage a patient with FFA that is refractory to intralesional steroids, dutasteride, hydroxychloroquine, systemic retinoids and methotrexate?
Oral minoxidil (≤5 mg daily) serves as a reasonable adjunctive therapy for refractory FFA, primarily targeting hair regrowth in non-scarred areas rather than reversing follicular destruction, though evidence remains limited to case series and retrospective studies. Low-dose oral minoxidil has demons...
What is your preferred workup for a patient who has a biopsy consistent with “dermal hypersensitivity reaction”?
When encountering a patient with a biopsy consistent with "dermal hypersensitivity reaction," it's crucial to acknowledge the inherent non-specificity of such a diagnosis. In my role as the Director of the Contact Dermatitis Clinic at Penn, I've found that clinical pathologic correlation becomes inv...
Is whole body phototherapy for skin disorders a contraindication to chest wall or breast radiation?
I would not consider prior phototherapy a contraindication. I regularly treat patients with cutaneous lymphomas and occasionally, refractory dermatitis after phototherapy, mostly narrow band UVB. Some of them have received maintenance phototherapy for 1-2 years before treatment with significant skin...
What factors influence your decision to recommend surgical versus non-surgical options for patients with severe skin laxity post-weight loss?
I think it’s important to explore all options—both surgical and non-surgical. You need to assess the degree of laxity the patient is experiencing and understand what their end goal is. Honesty is key, and the only way to achieve that is by having a real discussion about the options you can provide a...
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 criteria do you utilize in deciding between different jak inhibitors for atopic dermatitis?
There are no evidence-based reasons to pick abrocitinib or upadacitinib in the vast majority of patients. Differences between the two drugs are 1) abrocitinib is highly JAK1 selective while upadacitinib inhibits both JAK1 and JAK2 and 2) upadacitinib has more safety data - the only worrisome adverse...
How do you manage atopic dermatitis in patients who have failed dupilumab?
The therapeutic landscape for atopic dermatitis is being updated every year, meaning that this question will have different answers in the next few years. In fact, new guidelines are being updated more frequently to capture new drug approvals. As always, medication selection should weigh risks and b...
Would you start glycopyrrolate in elderly population and how do you counsel the patient?
The short answer is no, I would not start systemic glycopyrrolate in the elderly population. Of course, more information is needed to thoroughly answer this question. For simplicity, I will assume glycopyrrolate is being considered for excessive sweating. A complete history and physical exam are nec...