Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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...
What are your preferred treatment options for patients with chronic non-healing leg ulcers?
In addition to all the typical things (decreasing edema with meds, compression, etc + treating superinfection, critical colonization, or debriding eschars), there is some evidence for pentoxifylline 400 mg TID or 800 BID in ulcerations of any etiology. There is also newer evidence for using topical ...
How would you approach diagnosis of a patient with recurrent episodes of abdominal pain, severe myalgias, low grade fevers and urticaria?
Without the mEFV variant, from a rheumatologist viewpoint, the differential includes IBD, a periodic fever syndrome such as FMF or FCAS, and MCAS. Therefore, I would consider that workup with genetic testing (anyone can send!), fecal calprotectin, and MCAS eval with A/I. I don't think of urticarial ...
What clinical scenarios warrant the use of a skin substitute?
Chronic wounds like diabetic and venous leg ulcers are the most common clinical indication, especially when healing fails to progress after standard wound care. Extensive full-thickness burns are also a primary indication, particularly when there is insufficient donor skin available for autografts o...
What psychiatric medications do you feel comfortable prescribing as a dermatologist?
How do you approach Pityriasis rubra pilaris that is retinoid resistant?
I find most PRPs to respond, at best, incompletely to retinoids - they are not my first line. Any TNF-alpha or IL-12/23 inhibitor is reasonable to try, and there are no head-to-head trials to my knowledge to endorse one other. Mtx may need to be added. IL-17s likely work too for some patients. Depen...
How do you bill cosmetic follow-up appointments?
Most of these are no-charge visits unless a new problem is presented.
What should be done for a patient with biopsy-proven seborrheic dermatitis on the scalp and central forehead (presenting as a large annular scaly thin plaque) who has failed treatment with fluconazole, antifungal creams, and Zoryve (which is too expensive)?
I don't think dupilumab is reasonable for seborrheic dermatitis. For seborrheic dermatitis, I'd typically prescribe a potent topical steroid in a vehicle the patient prefers and have them use it twice a day for just 3 days (along with ketoconazole or other medicated shampoo). Adherence to topical tr...
Are you managing chronic urticaria/angioedema any differently if the patient is only/predominantly presenting with urticaria or angioedema?
The mechanism is similar for urticaria and histamine-induced angioedema, so I would expect a similar response. The evidence to support the use of montelukast for U/A is slim, but there are some supporting data. Nonetheless, the newest WAO guideline does not suggest an addition to the therapeutic pyr...
What resources do you provide patients with alopecia areata?
For any patient with alopecia areata, I recommend the National Alopecia Areata Foundation for them and their family. NAAF provides lots of resources and have a yearly patient meeting that is always a hit for patients and their families. In addition, we discuss all appropriate treatment options for t...