Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What chemoprophylaxis, if any, would you consider in a transplant patient with numerous KC/NMSCs?
Besides treating actinic keratoses with all methods available to try to prevent their progression, acitretin is #1 in my book for these patients. It’s best to get them on it before they reach the point of developing big, bad SCCs. Dosing is based on patient size and tolerance. Start with 10 mg per d...
What is the role of hair transplantation for scarring alopecias like lichen planopilaris?
The primary disorder needs to be under control before considering hair transplantation. I would suggest waiting at least a year after the disorder is under control and many suggest 2-5 years of stability before considering transplantation. Hopefully, in some areas, the scarring will be mild to moder...
What are your favorite sutures to use in dermatologic surgery?
The type of suture I prefer can vary based on location, tension, and skin quality. For the majority of cases on the face, I prefer 4-0 monocryl for deep sutures and 6-0 nylon or 5-0 Prolene for top sutures. I use Vicryl for deep-tacking sutures. I occasionally use 4-0 PDS on nasal flaps. For grafts,...
How would you manage BCC to the left cheek after only half of a radiation course was completed three months ago and non-operative management is preferred?
An assessment of three domains is going to help the patient and physicians in this case: Patient related factors: A medical emergency that lasts three months implies a lot-- so what is the performance status of the patient now and what is the prognosis; because an ECOG 3-4+ patient with new onset mu...
What are your recommendations in managing pudendal neuralgia/red scrotum syndrome?
Red scrotum syndrome is very challenging to treat. The list of reported treatments is long, but I have not found one to be consistently effective. Treatment selection depends significantly on patient characteristics and preferences. In my opinion, every patient with red scrotum syndrome should under...
How do you approach management of a patient with coexisting psoriasis and systemic sclerosis, particularly when both active psoriasis and skin tightening are present?
It depends if both diseases are considered significant and active. If so, a JAK-inhibitor would kill two birds with one stone. JAK's are already approved for psoriatic arthritis, and there is decent data for skin psoriasis as well, on par with some of our currently FDA-approved therapies. There is s...
Would you utilize rituximab or dupilumab for treatment resistant bullous pemphigoid?
Dupilumab is a phenomenal drug for BP in most patients and is inarguably safer. Updated to add that coverage is much easier with the new FDA approval! As an aside, tralokinumab has a better patient assistance program than dupilumab, and so far has worked just as well in my clinic as dupilumab. If a ...
Are there subgroups of patients with pemphigus in whom you prioritize lower-dose rituximab regimens?
Lower doses don’t work as well, with less depletion and earlier relapses.
How do you screen for colon cancer in patients with Behcet syndrome with colonic involvement?
Behcet syndrome, unlike some other rheumatologic conditions, for the most part, has not been shown to increase risk of malignancies in patients. This may in part be due to the fact that the disease tends to get milder/less severe with time and treatment. As such, colon cancer screening should follow...
For a contact allergy, do you need to test for the metals individually or does it suffice to just test with a piece of metal from the device?
I asked Dr. Brandon Adler about this question and he said:Testing with metal discs or samples from a manufacturer is not recommended because irritant reactions, false negatives, and false positives are known to occur. Even if there were to be a true positive reaction, there would be no way to know w...