Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you anticipate trying nemolizumab in patients with other difficult to treat pruritic conditions?
I have already used this drug in a multitude of off-label indications, including but not limited to lichen simplex chronicus, acne keloidalis nuchae, keloids secondary to acne fulminans, delusions of parasitosis, itch of unknown origin, nostalgia parasitic, scrotal pruritus, and occipital neuralgia.
What therapies have you found most effective for managing patients with Darier disease?
Because of the amazing bench-to-bedside paper below, my most severe Darier's patient started on an IL17 inhibitor, and it is the closest thing I've seen to a miracle in ages. She was refractory to everything we tried, and is now 80+% clear. What a joy to see science change people's lives!Ettinger et...
What incubation times do you use for PDT?
We have had good success with the zero incubation time + 2 back-to-back illumination cycles method described by Gandy et al. This method involves no pain and an overall shorter visit time compared to standard incubation protocols.Briefly, this method includes the following steps: Prep treatment area...
What is your approach to a patient with generalized morphea, no systemic involvement but a positive RNA Polymerase III?
I would perform age-appropriate cancer screening given the link between RNA pol III and cancer. Otherwise, I would simply monitor for onset of systemic sclerosis or other autoimmune disease symptoms.
Among the metastatic/unresectable melanoma patients you would historically treat with anti-PD-1 monotherapy, are you now recommending nivolumab/relatlimab instead?
Based on the published RELATIVITY-047 study, the nivo/rela combination leads to a superior median PFS of 10.2 mo (vs 4.6 mo for nivo alone) - both updated at ASCO 2022. At the most recent update at the ASCO 2022, the median survival has not been reached yet for the patients treated with nivo/rela (v...
Do you obtain MRI for cutaneous SCC with microscopic PNI to assess for gross perineural tumor spread?
I would recommend both an MRI as well as consulting the pathologist regarding the exact nature of the PNI. We had an experience with more than 100 patients (Sapir et al., PMID 27475277). Those with gross PNI (evidenced by MRI, with or without cranial nerve deficit) and microscopic extensive PNI (>2 ...
What is your approach to tapering off rituximab in a patient with pemphigus who seems to be remission?
When evaluating a patient in clinical remission, I think the decision to taper should be weighed in light of multiple variables, including the patient’s duration and severity of disease prior to remission, extent of previously failed therapies, tolerability of rituximab, and anti-desmoglein antibody...
What therapies do you recommend for preventing keloid recurrence after surgical resection?
For earlobe keloids specifically, we have had reasonable results with a mixture of 40mg/ml triamcinolone mixed with 50mg/ml 5FU in a 1:1 ratio. This is injected day of keloid removal, then every 4 weeks for at least the first 6 months. No more than 0.1-0.3 mL per session. The treatments can be space...
What do you view as the optimal use and timing of cemiplimab in high risk CSCC?
Increasingly, neoadjuvant cemiplimab has become our preferred approach for many patients with resectable high-risk CSCC, and this is consistent with what several high-volume centers are now doing. The high pathologic response rates, durable recurrence-free survival in responders, and meaningful surg...
What is your approach for female patients with severe atopic dermatitis well controlled on Dupixent planning to conceive or already pregnant?
Based on published data, I have a few concerns. However, the clinical trials of Dupixent failed to study effects on learning and memory.IL-4 and IL-13 are known to be important for learning and memory in mice. IL-4-producing T cells accumulate in the meningeal spaces, and acute depletion of these ce...