Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What preoperative printed materials would you provide to a patient, if any, to prepare them to have Mohs surgery?
We provide patients with a written preoperative packet that explains what Mohs surgery is, what to expect on the day of surgery, and basic preoperative instructions such as taking their usual medications unless otherwise directed, wearing comfortable clothing, and eating breakfast. You can also incl...
What is your approach to counseling patients on the safety and side-effect profile of a biosimilar compared to its reference biologic?
Relevant question as insurance companies may require a biosimilar over the reference biologic. According to the FDA, the spin-off (my term) must be "highly similar" to the original in both efficacy and safety. Approval is based on review of clinical trial data. As for my approach: until proven other...
What do you include in differential diagnosis when evaluating a patient with calcinosis cutis?
When evaluating the patient with calcinosis cutis, I first make sure that the patient indeed has calcinosis cutis. In general, there are two types of ectopic calcifications in soft tissues: metastatic and ectopic. Metastatic calcifications occur in the setting of abnormal. serum calcium and/or phosp...
How would you approach management of a patient who develops squamous cell skin cancer while on abatacept?
I would discontinue abatacept. Several studies now have reported an increased risk of squamous cell cancer/non-melanoma skin cancers in patients on abatacept (Wadstrom et al., PMID 28975211, Simon et al., PMID 37932010) and in someone who actually develops this malignancy on the drug, I would hesita...
Which sclerotherapy agents do you prefer and why?
Hypertonic saline has no risk of allergic reaction/anaphylaxis, and if you dilute it a bit, it doesn't sting yet works well. We dilute a little for large vessels and cut the strength in half for small/tiny vessels. Key is to get into the vessels without extravasation and only inject enough to blanch...
When do you recommend HLA testing prior to prescribing lamotrigine, carbamazepine, or oxcarbazepine to patients of Asian descent?
I never use carbamazepine, given how it’s a pan-inducer and often lowers the level of other medications that may be in the regimen, such as quetiapine and haloperidol, since they are mainly metabolized by CYP3A4.Oxcarbazepine has a 50% reduction in the induction of carbamazepine, so I use that somet...
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.
How should the results of the ADVOCATE trial be applied in AAV patients who receive rituximab induction and maintenance therapy?
The following answer was jointly drafted by Dr. Peter Merkel and Dr. David Jayne:The data from ADVOCATE indicate that patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) treated with avacopan 30 mg twice daily and prednisone placebo were able to achieve remission w...
Are there particular subsets of AAV patients in which avacopan is more effective?
The following answer was jointly drafted by Dr. Peter Merkel and Dr. David Jayne:Patients in the ADVOCATE trial were stratified at entry according to time of diagnosis (new/relapsing), diagnosis (GPA/MPA), ANCA serotype (PR3/MPO), and background immunosuppressive (cyclophosphamide/rituximab) with re...
Does baseline facial dermatitis in a patient with AD cause hesitation when starting Dupixent due to conjunctivitis-related complications, especially when there are many available options?
Yes, I definitely do consider this. Not necessarily because of conjunctivitis but because I’ve seen a significant number of patients with “dupilumab facial redness or reaction” with out-of-proportion head/neck flaring in AD patients. In patients with significant facial involvement at baseline, I pre...