Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatment combination approach would you recommend for mucous membrane pemphigoid?
First, it is important to know the extent and severity of the disease (oral, ocular, esophageal); the type of inflammatory infiltrate on histopathology (neutrophils, eosinophils, or cell-poor); and the results of salt split skin and antibody titers on monkey esophagus and/or target antigens (collage...
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 ...
How do you treat molluscum on the eyelid in a child or an adult?
Usually, I don't treat molluscum in this area due to sensitivity, especially in kids. It's been decades since I encountered MC on the eyelid of an adult, but if bothersome, and the patient is cooperative, I would numb the sites and remove larger lesions with an iris scissors. Last week, Zelsuvmi top...
What therapies have you found most effective in treating teenagers with recurrent CARP?
I have found CARP to be uniformly responsive to minocycline. In my experience, the incidence of recurrence is low and normally responds to minocycline.
What patient factors do you feel are most important when considering reduced dosing regimens of IL17a inhibitors such as secukinumab and ixekizumab for psoriasis?
If the psoriasis is completely clear, the patient may wonder if they need to continue treatment. If they want to spread out the doses to see how little they need, I usually have no objection.
How do you counsel patients with AKs such that they are motivated to improve or optimize sun protection behaviors?
Some thoughts and approaches that may help: It is very challenging (possibly close to impossible!) to induce behavior change in anyone, much less someone not motivated to change, so recognize your role as being a teacher/provider of information and do not assume a sense of personal responsibility f...
How do you avoid epilation in patients hoping to preserve their facial hair during radiotherapy?
Interesting question. I have not created an avoidance. It’s my experience that doses of about 50 Gy+ commonly cause permanent hair loss. It’s hard to avoid hair loss in areas where elective nodal or mucosal/skin coverage is needed. It’s certainly disappointing for some patients. In many scenarios of...
Do you utilize AIT for atopic dermatitis if there is no AR present?
Allergen Immunotherapy (AIT) was included as an adjunctive treatment option for patients with moderate to severe atopic dermatitis (AD) in the updated 2023 Guidelines for Atopic Dermatitis. The recommendation was made based on results from a systematic review and meta-analysis of 23 randomized contr...
How do you approach the timing of skin tightening interventions in patients who experience significant weight loss to optimize both intermediate and long-term aesthetic outcomes?
I like PLLA to add natural-looking volume and use HA fillers for areas not suitable for PLLA.
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...