Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Does Dupixent interfere with patch testing?
Dupilumab suppresses Th2 skewed responses such as those associated with systemic contact dermatitis (e.g. propylene glycol, compositae mix, carmine, etc.) so testing while on dupilumab results in incomplete results. Responses to Th1 skewed allergens (e.g. epoxy or methylchloroisothiazolinone) may be...
What is your preferred workup for a patient who has a biopsy consistent with “dermal hypersensitivity reaction”?
When encountering a patient with a biopsy consistent with "dermal hypersensitivity reaction," it's crucial to acknowledge the inherent non-specificity of such a diagnosis. In my role as the Director of the Contact Dermatitis Clinic at Penn, I've found that clinical pathologic correlation becomes inv...
Is whole body phototherapy for skin disorders a contraindication to chest wall or breast radiation?
I would not consider prior phototherapy a contraindication. I regularly treat patients with cutaneous lymphomas and occasionally, refractory dermatitis after phototherapy, mostly narrow band UVB. Some of them have received maintenance phototherapy for 1-2 years before treatment with significant skin...
What factors influence your decision to recommend surgical versus non-surgical options for patients with severe skin laxity post-weight loss?
I think it’s important to explore all options—both surgical and non-surgical. You need to assess the degree of laxity the patient is experiencing and understand what their end goal is. Honesty is key, and the only way to achieve that is by having a real discussion about the options you can provide a...
What criteria do you utilize in deciding between different jak inhibitors for atopic dermatitis?
There are no evidence-based reasons to pick abrocitinib or upadacitinib in the vast majority of patients. Differences between the two drugs are 1) abrocitinib is highly JAK1 selective while upadacitinib inhibits both JAK1 and JAK2 and 2) upadacitinib has more safety data - the only worrisome adverse...
How do you manage atopic dermatitis in patients who have failed dupilumab?
The therapeutic landscape for atopic dermatitis is being updated every year, meaning that this question will have different answers in the next few years. In fact, new guidelines are being updated more frequently to capture new drug approvals. As always, medication selection should weigh risks and b...
Would you start glycopyrrolate in elderly population and how do you counsel the patient?
The short answer is no, I would not start systemic glycopyrrolate in the elderly population. Of course, more information is needed to thoroughly answer this question. For simplicity, I will assume glycopyrrolate is being considered for excessive sweating. A complete history and physical exam are nec...
How do you counsel patients on safety and toxicity of delgocitinib?
I request all eligible patients to complete the vaccines for herpes zoster prior to starting. Delgocitinib has been reported to cause neutropenia, suggesting there is systemic absorption, so I do not recommend it for patients with a history of VTE. I rarely see highly immunosuppressed patients with ...
Does the presence of psoriatic arthritis affect your decision to use an anti-IL-17 or IL-23 drug in your psoriasis patients?
I tend to prefer IL-17s in patients with PsA as an indirect assessment of clinical trials suggests they are more effective than IL-23s (which fits my clinical experience) for PsA. IL-17s are also more effective for axial disease (IL-23s are not very effective in axial disease). If there is a history...
Where in the current treatment algorithm for CHE do you feel delgocitinib best fits?
I see delgocitinib fitting in early in the algorithm after emollients, barrier repair, and avoidance strategies; particularly for patients who either fail a brief potent steroid course or who are not good candidates for ongoing steroid use, whether it be preference or previous experience. It can als...