Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Are there certain patient characteristics that drive you to recommend intralesional 5-FU or MTX for a large SCC on the back?
Intralesional 5-FU or MTX can be an option for a large SCC on the back if the patient is not a good surgical candidate due to advanced elderly age, significant co-morbidities, or for those who decline surgery. These treatments can also be used neoadjuvantly to shrink large tumors and potentially red...
What recommendations do you provide to patients on isotretinoin about timing of tattoos?
No specific recommendations due to the absence of robust data
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...
Would you give adjuvant radiation after complete resection of a small primary cutaneous follicular lymphoma of the scalp?
Not a lot of data, but here goes. First, one has to go back decades in the literature to find series of patients with lymphoma rx'd with surgical resection alone. In general addition of RT improved outcome even when ostensibly resected with neg margins. With today's technology risk of additional RT ...
Do you counsel isotretinoin patients to use supplements (fish oil, OTC antihistamines, or Omega 3s) to decrease purging and mucocutaneous dryness?
Agreed with the above on omega-3 fatty acids.I always recommend 2nd gen antihistamines as well (Pandey & Agrawal, PMID 31734672). Harmless addition that seems to not only help some of the symptoms associated with isotretinoin, but also seems to improve efficacy.Finally, if omega-3s don't help with j...
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 factors do you weigh most heavily when deciding on the duration of treatment with dupilumab in a patient with atopic dermatitis who is responding well and tolerating therapy?
If the atopic dermatitis was severe and longstanding, I would continue dupilumab indefinitely. If the patient wanted to cut back, they could try gradually spreading out the doses until the disease recurred.
Do you prefer switching to a biologic with a different mechanism of action such as an IL-17 inhibitor over cycling to another TNF inhibitor in a patient with moderate-to-severe HS who has experienced secondary failure to adalimumab after an initial good response?
I agree with @Dr. First Last's excellent suggestions. One other idea is adding methotrexate 10 mg weekly to adalimumab to see if neutralizing antibodies are the problem. I tend to do this if a patient has a good response but loses it down the road. I don't do this as much as I used to, now that we h...
Do certain subtypes of BCC respond better to hedgehog pathway inhibitors?
I have found that the larger the BCC, the more dramatic the response (unfortunately, not all tumors respond). These are invariably of the nodular/infiltrative subtypes for which hedgehog inhibitors are indicated.
What is your strategy for managing radiation dermatitis in breast cancer in the prophylactic, erythema/dry desquamation, and moist desquamation stages?
Good question. Everyone seems to have a favorite home remedy with very little good supporting data. I am unaware of any good prophylaxis rx. The best thing is good treatment planning to minimize inhomogeneity. There are phase III data demonstrating the efficacy of soap and water cleansing for rx of ...