Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How have you used GLP1s in dermatology?
No, not yet.
Should ertapenem use in refractory HS be managed by ID, and how many times would you consider using it in a patient?
I wish that infectious disease would manage severe hidradenitis suppurativa with IV ertapenem. In my experience, ID is typically reluctant to use ertapenem. I can understand that they are thinking about antibiotic stewardship and maintaining the utility of this broad-spectrum antibiotic. When I have...
What is your approach to young teenagers with acne who have extremely sensitive skin, cannot tolerate typical acne regimens, cannot tolerate oral antibiotics, and refuse Accutane?
The formulation of benzoyl peroxide encapsulated in silica shells is extremely well tolerated by sensitive-skinned individuals. I was involved in pre-approval studies and found it remarkably well tolerated in such patients.
What is your preferred treatment for actinic cheilitis?
PDT is effective as well as an ablative laser for long-term control. Efudex or imiquimod for multiple weeks is good for localized or milder disease. Consider getting a biopsy if you’re concerned for invasive SCC. Encourage them to use sunscreen too.
At what age are you comfortable to start prescribing spironolactone for acne in adolescent females?
When I first reported the utility of spironolactone in women, I was concerned about possible development issues,in young women particularly muscle development which is influenced by androgens. After consulting with pediatric endocrinologist colleagues at Children's Hospital Philadelphia who saw no c...
What therapies do you recommend for preventing keloid recurrence after surgical resection?
For earlobe keloids specifically, we have had reasonable results with a mixture of 40mg/ml triamcinolone mixed with 50mg/ml 5FU in a 1:1 ratio. This is injected day of keloid removal, then every 4 weeks for at least the first 6 months. No more than 0.1-0.3 mL per session. The treatments can be space...
How do you educate patients about the risks of actinic keratosis progressing to skin cancer?
I use verbiage from Dr. Kirby’s excellent study to describe risk appropriate to the patient’s history. Except in immunocompromised or patients with a history of SCC, I avoid characterizing AKs as “pre-cancer” so that they can make a value-informed choice regarding observation vs treatment.Berry et a...
What treatment and management recommendations do you have for amphetamine-induced skin picking disorder without insight?
Assuming the stimulant is prescribed for ADHD, I recommend dose reduction or switching to a different medication, or, rarely, I recommend the patient consider a "stimulant holiday" for at least 1-2 months. I explain that most of my patients notice improvement with adjustments or breaks from their st...
How do you use transexamic acid (TXA) during dermatologic procedures?
I personally use it topically, but others have used subcutaneous injections. When used topically, it has been easiest to soak a gauze/pad in the TXA and place it directly on the defect, as described in the reference below. Otherwise, it can be injected directly (subcutaneously) into the wound, inclu...
What is your approach to managing moderate to severe atopic dermatitis in pregnancy?
Gentle skin care practices, dilute bleach baths, diligent use of topical steroids, and phototherapy will cover most moderate to severe cases. If patients have any persistent lichenified areas, intralesional steroids can help temporize until after delivery/lactation. If a biologic is needed, work wit...