Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are your favorite topicals when treating scarring alopecia?
Fortunately, topicals can often be effective for scarring alopecia. In general, I tend to use high-potency topical steroids in combination with non-steroidal topicals, including topical JAK inhibitors (e.g., ruxolitinib, delgocintib, or compounded tofacitinib). Because the inflammatory process is re...
How do you manage pemphigus patients who have persistent disease and circulating autoantibodies despite two full courses of rituximab?
I currently manage two recalcitrant pemphigus patients, both of whom have undergone various courses of typical systemic immunosuppression (e.g., CellCept, MTX, steroids) but continued to flare. Combinations of these traditional therapies, along with topicals, were not particularly helpful. While dis...
Do you prescribe silvadene cream for patients with a sulfa allergy?
No. I will consider hydrogel wound dressings in those situations
What is your approach to deciding when to stop therapy for cutaneous Mycobacterium chelonae infections?
I have an ongoing case of M abscessus cutaneous infection, possibly acquired from a pedicure. This is a similar bug to M chelonea, but even harder to treat. Our approach was to gather the opinion of several experts through email communication. The conclusion was to treat for 6-12 months, and follow ...
Is there a role for empiric scabies treatment in itchy patients without clear clinical signs of scabies?
I have seen many astute clinicians miss scabies or consider it after months of treating for AD with biologics and other systemics (including myself). Though this is very rare my personal rule of thumb is to treat with oral ivermectin if at any point patient is not responding the way I expect to trea...
What questions are important to ask before performing PDL laser?
Before performing PDL treatment, the patient should be asked if they‘ve had previous laser treatment and if they have had any adverse effects. They should be asked if they are on retinoids, topical acne preparations, or any skin irritants, as these should be discontinued for a couple of weeks post-t...
When would you offer post-op radiation for the treatment of sebaceous carcinoma of the eyelid?
I think of them as poorly differentiated and it’s a location where margins are likely close so always.
How does trimethoprim-sulfamethoxazole's efficacy against S. pyogenes influence your empirical treatment of skin infections in regions with high resistance rates?
I am a little confused by the question. Why would you use TMP/SMX monotherapy for SSTI? During the emergence of CA-MRSA, cephalexin with or without TMP/SMX had the same efficacy rates (Pallin). I agree with Dr. @Dr. First Last; linezolid is a great choice if MRSA is a concern. Cephalexin or cefadrox...
Have you used JAK inhibitors with TNF blockade at the same time?
Generally, no. For three reasons: I find the addition of a JAK inhibitor to a TNF inhibitor to be too immunosuppressive with a high risk of infection and/or malignancy. If I am choosing a JAK inhibitor, it would serve to "replace" the TNF inhibitor usually, so I don't see a strong indication to sta...
How do you approach patients with metastatic uveal melanoma not a candidate for tebentafusp-tebn?
I perform genomics and try to find a clinical trial that fits the patient. Including local liver therapies, such as the Delcath catheter treatment if available. Isolated liver lesion could also be resectable, so I request a surgical opinion. If nothing is available, then I offer ipilimumab/nivolumab...