Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatment modalities have you had success with for treating sebaceous hyperplasia?
I have used light electrodesication with a blunt tip needle with good effective results without visible scarring for the vast majority of patients. I find that it is efficient and less expensive than laser modalities. The procedure is uncomfortable for my patients and typically I need to use topical...
Is it safe to use one TNF inhibitor (e.g., infliximab) in a patient who has had a severe allergic reaction to a different TNF inhibitor (e.g., adalimumab)?
The short answer is yes - it is ok to proceed with a different TNFi. First, it is important to determine whether the reaction was truly allergic or a nonspecific infusion reaction instead. If possible, obtaining a serum tryptase level at the time of the reaction can help clarify. Realistically, this...
How do you counsel patients who express concern about potentially harmful ingredients in sunscreens?
First, I acknowledge that there can be confusing and sometimes alarming information in the media about sunscreens. I like to point out that unprotected sun exposure is the primary driver of skin carcinogenesis and that it is more harmful than any known risks of sunscreen to date. I discuss that ther...
In patients with livedoid vasculitis and chronic venous insufficiency on rivaroxaban, what therapeutic strategies—beyond compression and topical care—are safe and effective for controlling pain, ulceration, and edema?
My experience has been that aspirin 365 mg, plus persantine or trental daily, plus leg elevation for 45 min or so in mid-afternoon, will produce pain relief and onset of healing within about two weeks. Only infrequently have I had to resort to metformin as an added medication or use both trental and...
Do you avoid progestin only contraceptives and IUDs in patients with acne due to their androgenic properties?
I counsel similarly to Dr. @Dr. First Last above. I also reference the following article, which shows the following odds ratios for certain conditions with hormonal IUDs vs copper: Acne vulgaris: 2.514 Hirsutism: 0.446 Rosacea: 0.376 Androgenetic alopecia: 0.109 Basically, I say they're less likely ...
Is there a role for resection of the cutaneous primary in a patient on dual-agent immunotherapy for metastatic melanoma?
Yes. The location and size (width, length) should be noted. The patient should first be treated with dual ICI. If the patient with metastatic melanoma, who has the primary intact, undergoes successful dual ICI therapy and has a documented CR, near CR, or excellent PR, which is typically noted within...
What outcome do you value as the most important measure of success when treating CHE?
Sustained symptom control that restores hand function is the priority. Pain, fissuring, and itch are what drive disability and quality of life impact, so meaningful improvement in these symptoms and return to daily activities define true success. Patient-reported symptoms and quality of life inform...
Would you ever use dupilumab for atopic dermatitis in a patient who also has EGPA?
I would consider it if AD was moderate to severe and not improving with TCS, TCI, or Opzelura. I would make sure the skin was biopsied to rule out a vasculitic component to the rash, as EGPA skin manifestations are varied.
How do you explain the use of an AI scribe to patients the first time it is used in their care?
In residency, we had to get patient permission to videotape sessions and allow our supervisors to watch sessions from behind a one-way mirror. If I were to use a scribe, especially an AI scribe, or if I were audio or video taping the sessions, I would definitely want to get a patient’s approval. I d...
What role do you feel topical steroids play in the management of atopic dermatitis with the growing availability of non-steroid topicals?
Corticosteroids remain my first-line topical treatment for atopic dermatitis due to their availability, cost, and efficacy. Obviously, topical corticosteroids are not an ideal long-term treatment for continuous use due to their cumulative local toxicity. Calcineurin inhibitors are more sustainable i...