Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatments have you found most effective in removing syringomas?
Most often the syringomas I have treated have been multiple small lesions around the eyes. Because it is readily available, safe, of minimal cost, and easy, I like to use pinpoint electrodesiccation. I use a Hyfrecator 2000 electrosurgical unit on the low setting with 2-3 watts. Because electrodesic...
What is your approach for female patients with severe atopic dermatitis well controlled on Dupixent planning to conceive or already pregnant?
Based on published data, I have a few concerns. However, the clinical trials of Dupixent failed to study effects on learning and memory.IL-4 and IL-13 are known to be important for learning and memory in mice. IL-4-producing T cells accumulate in the meningeal spaces, and acute depletion of these ce...
Do you find that hydroxyzine worsens cognitive symptoms in patients who are already susceptible to cognitive impairment?
Hydroxyzine should not have a direct negative effect on cognition. For decades after its inception, it was lopped in with Benadryl in terms of its receptor binding affinity profile and is listed in several anticholinergic burden scales as being anticholinergic. Similar to the child’s game ‘telephone...
In older male patients with a history of underlying autoimmune disease, what clinical manifestations would prompt you to evaluate for VEXAS Syndrome?
Hello!!!Skin lesions, elevated MCV, elevated inflammatory markers.
Have you had success in treating extensive lichen nitidus with a systemic therapy?
I have never attempted to treat lichen nitidus with systemic therapy, as most patients are largely asymptomatic, and we know it is typically a self-limited condition.
What's your therapeutic approach for patients with severe cystic acne who have a history of inflammatory bowel diseases?
Persons with IBD and severe cystic acne warrant therapy with Accutane. I have successfully treated several cases with no exacerbation of IBD, publishing a case report in 1985: Oral isotretinoin and inflammatory bowel disease.A more recent study reached a similar conclusion: Does taking isotretinoin ...
What is your approach to patients with SLE who develop a rash after hydroxychloroquine initiation?
First, I diagnose the type of rash. If it is a severe cutaneous reaction, e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), or if it is a more persistent type of reaction like a lichenoid reaction, I stop hydroxychlor...
How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?
Chronic urticaria (6 weeks or longer) is often a self-limited disorder seemingly idiopathic in etiology. There are certain autoimmune disease more prevalent in patients with chronic urticaria including systemic lupus erythematosus, Sjogren's syndrome, autoimmune thyroid disease, celiac sprue, and rh...
What is your strategy for managing radiation dermatitis in breast cancer in the prophylactic, erythema/dry desquamation, and moist desquamation stages?
Good question. Everyone seems to have a favorite home remedy with very little good supporting data. I am unaware of any good prophylaxis rx. The best thing is good treatment planning to minimize inhomogeneity. There are phase III data demonstrating the efficacy of soap and water cleansing for rx of ...
Would oral roflumilast be a reasonable and tolerable option for severe psoriasis in an elderly patient with a history of pulmonary aspergillosis who has failed other systemic therapies?
It couldn't be a better option. Shouldn't exacerbate the aspergillosis at all, might help with the COPD, and is substantially more effective than apremilast (at least that's my take based on the data - no head-to-head data). I'd estimate that 30% of elderly patients can't tolerate it, but the other ...