Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatment strategies are effective for senile gluteal dermatosis when patients do not improve with standard lifestyle modifications and emollients?
Senile gluteal dermatosis is very difficult to treat, as you know. What I have tried to do is methodically go through each lifestyle modification, such as sitting position and having the patient move frequently - be as sure as you can - that they are able to achieve these modifications to some degre...
How have you incorporated gene expression profiling tests for melanoma or SCC into your practice and has it changed your approach to treatment and/or monitoring?
This is a controversial topic for sure, but most emerging technologies in medicine are. I do use gene-expression profiling in the treatment of cutaneous SCC and invasive melanoma. My theoretical framework for using GEP testing is that it is a forward looking test, while clinical staging is backward...
How do you counsel patients who ask if there are any dietary modifications they can make to help control their autoimmune disease?
I send patients to a website called nutritionfacts.org. This is a non-profit website that reviews medical literature related to nutrition and diseases. It was founded by Dr. Greger and he is not trying to sell anything which I appreciate. He has bite-sized videos on anything you can think about rela...
Do you scale up 2nd generation anti-histamines to 4x daily in acute urticaria in the pediatric population as you do in adults?
Severe urticaria is certainly a therapeutic challenge. Updosing 2nd generation antihistamines in children has been studied, more trials need to be done. For refractory urticaria in children, I will often recommend 2X the recommended dose of a 2nd generation antihistamine in the morning and maximize ...
What therapies have you most effective in managing the pruritus associated with lichen amyloid?
Lichen amyloidosis itch would respond extremely well to Nemolizumab. See the report by Talias group. Makes sense as we found that IL31R and OSM are key factors in pathogenesis.Gabriela Soto-Canetti et al., JAAD Case Reports 2025If Nemo is not available, MTX works.Methotrexate for the Treatment of Re...
How would you approach management of a large, fungating squamous cell carcinoma of the auricle if surgical management is not desired by the patient?
For a tumor this size and with cartilage invasion, I would recommend starting with induction cemiplimab to best response (generally 4-6 cycles), followed by consolidative RT, generally electrons. Prior to starting the immunotherapy, I would stage the neck with a contrast CT scan, as tumors of this s...
How do you approach patients who continue to experience pruritus and ongoing concern for persistent scabies despite having completed appropriate treatment?
Pruritus can not uncommonly continue in patients for 6 weeks or more after infestation is managed. High-dose antihistamines may be of some benefit. Consider if there is an ongoing untreated exposure that the patient has not thought of or cannot/will not share with you. Not all people infested with s...
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...
What is your approach to tapering off rituximab in a patient with pemphigus who seems to be remission?
When a patient has achieved clinical remission and also has low-titer antibodies to desmoglein 1 and 3 (with the exception of patients who may have non-pathogenic antibodies, which can be trended over time), we discuss tapering rituximab. There are, of course, pemphigus patients, especially those wi...
How do you counsel patients with pemhigus on the main safety benefits of a low or ultra low dose rituximab regimen?
Although I read this article with interest and an open mind, I have not adopted ultra-low dose rituximab into my clinical practice of treating pemphigus patients for several reasons. The author's conclusions may very well end up being correct over time, but there are too many concerns with the study...