Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are the best treatment options for adults with widespread Molluscum and on immunosuppressive medication?
Treatment of these lesions are not always necessary, they can sometimes resolve spontaneously. The approach also can depend on location, number of lesions, and the patient's tolerance for pain and preferred procedure. I have found: topical tretinoin cream or gel hs as tolerated topical imiquimod 5%...
How do you approach workup and management of hyperhidrosis?
Oral anticholinergics
What is the longest interval that you have been able to stretch a biologic before losing efficacy?
Some biologics have the potential to provide benefit 4-6 months after the last dose. In psoriasis, certainly that probability is highest with the Il-23's than IL-17s and the TNFi's. In AD, IL4/13 inhibitors average 3-4 months though the newest IL-13i has benefit lasting 38 weeks in their withdrawal ...
What is your approach when a female patient does not want a male MA/scribe present in the exam room but other staff are unavailable?
I think we need to respect a patient’s request for same sex providers. Some patients are shy. For some, it is religion-based. I would ask the scribe to stand behind the curtain while I am seeing the patient. Regarding the MA, I would ask the MA to leave the room during my full-body skin exam. If I n...
How do you approach extensive recurrent genital warts that have failed liquid nitrogen, imiquimod, 5 fluorouracil and electrodessication?
I have used 0.2 ml of Candida IL with success for recalcitrant scrotal warts (injected in 2-3 lesions). I used this study below as a reference. My patient cleared in 3 sessions (4-6 weeks apart), the study below states max 5 sessions.Nofal et al., PMID 31923442
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...
How does nemolizumab fit into your current treatment approach to prurigo nodularis relative to other biologics?
It is my first-line recommendation.
How would you approach management of a patient who develops squamous cell skin cancer while on abatacept?
I would discontinue abatacept. Several studies now have reported an increased risk of squamous cell cancer/non-melanoma skin cancers in patients on abatacept (Wadstrom et al., PMID 28975211, Simon et al., PMID 37932010) and in someone who actually develops this malignancy on the drug, I would hesita...
How would you work up a patient with cutaneous mastocytosis?
In adults, consider mastocytosis as being systemic until you prove it is not. A single normal or low-elevated tryptase does not eliminate the possibility of systemic mastocytosis. All patients should go to Heme/Onc for consideration of bone marrow biopsy and ideally high-sensitivity PCR to look for ...
How does the location or type of psoriasis affect your initial biologic choice?
Scalp and palmoplantar psoriasis are always tough. Inverse and nail psoriasis as well, but I don't find as much of a disconnect with inverse psoriasis (nb: it tends to be one of the "easier" to treat areas of psoriasis once you've made the diagnosis, evidenced by the rather stronger efficacy results...