Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...
How do you manage dyshidrotic eczema in children during the winter months?
I typically use class 3 topical steroids, i.e., mometasone 0.1% ointment for flares and then tacrolimus ointment for maintenance if needed. Occasionally, higher potency topical steroids are needed for flares. I encourage frequent emollients, at least 3 times per day (before school, when home from sc...
Does the presence of paraneoplastic pemphigus influence your treatment options in CLL?
Paraneoplastic pemphigus is often difficult to treat, and if traditional measures do not control it, I often will use continuous therapy for CLL to both eliminate the disease and continue suppressing the autoimmune source of this paraneoplastic complication.
How would you treat a late local recurrence of extramammary Paget's disease of the vulva, not amenable to resection?
If the patient does not have any invasive disease, or underlying malignancy or nodes, then I would consider treating this with radiation, specifically superficial brachytherapy. At our institution, we routinely treat similar patients with large perineal, inguinal EMPD patients with 3D custom printed...
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
A network of specialists familiar with cSCC is necessary to optimize care that is tailored and appropriate for each unique case. Avoiding under-treatment and over-treatment is important, but also challenging, given the high volume of cSCC tumors with variable patterns of presentation and numerous cr...
What is your approach to using intraperitoneal sodium thiosulfate for a patient with ESKD on peritoneal dialysis who develops calciphylaxis?
I believe if the patient has calciphylaxis, PD should not be continued, and more efficient IHD or HHD with the addition of sodium thiosulfate is better.
What treatments have you found to be most effective in treating oral lichen planus?
Agree, have had good response with oral tacrolimus solution. Patients can work in nystatin mouthwash or clotrimazole troches +/- chlorhexidine gluconate oral rinse 0.12%. Dexamethasone solution may be rotated with the tacrolimus if desired (I've just used the lower strength 0.5mg/5mL, dose: 10cc, sw...
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.
Should JAK inhibitors be avoided in patients with a recent history of melanoma?
Given the FDA-boxed warning about risk of malignancy, JAK inhibitors should be used with extreme caution in patients with a recent history of malignancy, including melanoma. It would be important to have an extensive conversation with the patient to ensure understanding of the potential risks, with ...
How do you approach treating patients who develop psoriasis while on Dupixent?
Stop the Dupixent. These patients likely had a non-Th2 driven type of dermatitis e.g. Malassezia yeast hypersensitivity, which is Th17 driven, or stasis dermatitis with autoeczematization, or eczematous drug reaction. Revisit the Diagnostic Checklist for Generalized Dermatitis.