Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you counsel patients with chronic urticaria on the role of stress management strategies in their treatment plan?
There are certain situations or times of the year when increased aeroallergen exposure is expected. It follows that increased vigilance is a management technique for those who suffer with sensitivity to these aeroallergen-induced symptoms in the areas of environmental control, pharmacotherapy, and, ...
Is there an age cut off below you would not treat a keloid with radiation post surgical excision?
While radiotherapy is considered an extremely useful modality in the treatment of recurrent keloids in the adult population, most would contend that the risks do not justify the application of adjuvant radiotherapy in the pediatric population (PMID: 10703484) for a benign condition when other modali...
How is your approach to a patient referred for radiotherapy for keloids with a history of Beals syndrome?
Although of theoretical concern, I am not aware of any contraindication to RT (treatment philosophy similar to Ehlers-Danlos syndrome).
What topical therapies have you found most effective for managing scarring alopecias?
I use a lot of clobetasol shampoo 1-2 times weekly, which is easier and tends to cause less atrophy. Overall, any of the steroid-sparing agents can be helpful: tacrolimus ointment (or compounded as a solution), roflumilast foam, or topical JAK inhibitors. For maintenance.
What is your approach to a patient with undetectable MMR titers checked prior to or during immunosuppression and a history of MMR vaccination in childhood?
MMR titers are good correlates of protection. If any titer is undetectable it could be one of these situations: Primary failure. The components of the MMR have different efficacy. Two doses of appropriately given MMR will have 96+% against measles, but only 88% for mumps. Thus 1 in 10 appropriately...
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.
What is the appropriate pediatric dose of litfulo for a preadolescent with refractory alopecia areata?
Given that Litfulo is not yet approved for preadolescents and data from clinical trials in this age group are not yet available, it's hard to know the optimal dosing. With that said, typically I would treat a preadolescent with refractory alopecia areata off-label with Litfulo 50 mg (i.e., the same ...
What chemoprophylaxis, if any, would you consider in a transplant patient with numerous KC/NMSCs?
Besides treating actinic keratoses with all methods available to try to prevent their progression, acitretin is #1 in my book for these patients. It’s best to get them on it before they reach the point of developing big, bad SCCs. Dosing is based on patient size and tolerance. Start with 10 mg per d...
What is the role of hair transplantation for scarring alopecias like lichen planopilaris?
The primary disorder needs to be under control before considering hair transplantation. I would suggest waiting at least a year after the disorder is under control and many suggest 2-5 years of stability before considering transplantation. Hopefully, in some areas, the scarring will be mild to moder...
What are your favorite sutures to use in dermatologic surgery?
The type of suture I prefer can vary based on location, tension, and skin quality. For the majority of cases on the face, I prefer 4-0 monocryl for deep sutures and 6-0 nylon or 5-0 Prolene for top sutures. I use Vicryl for deep-tacking sutures. I occasionally use 4-0 PDS on nasal flaps. For grafts,...