Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Is there a role for empiric scabies treatment in itchy patients without clear clinical signs of scabies?
I have seen many astute clinicians miss scabies or consider it after months of treating for AD with biologics and other systemics (including myself). Though this is very rare my personal rule of thumb is to treat with oral ivermectin if at any point patient is not responding the way I expect to trea...
What questions are important to ask before performing PDL laser?
Before performing PDL treatment, the patient should be asked if they‘ve had previous laser treatment and if they have had any adverse effects. They should be asked if they are on retinoids, topical acne preparations, or any skin irritants, as these should be discontinued for a couple of weeks post-t...
When would you offer post-op radiation for the treatment of sebaceous carcinoma of the eyelid?
I think of them as poorly differentiated and it’s a location where margins are likely close so always.
How does trimethoprim-sulfamethoxazole's efficacy against S. pyogenes influence your empirical treatment of skin infections in regions with high resistance rates?
Recommendations against using trimethoprim-sulfamethoxazole (TMP/SMX) for group A strep (GAS) skin and soft tissue infections (SSTIs) likely stemmed from a misconception that GAS is inherently resistant to the drug. Older studies reporting resistance used media containing a high thymidine concentrat...
Have you used JAK inhibitors with TNF blockade at the same time?
Generally, no. For three reasons: I find the addition of a JAK inhibitor to a TNF inhibitor to be too immunosuppressive with a high risk of infection and/or malignancy. If I am choosing a JAK inhibitor, it would serve to "replace" the TNF inhibitor usually, so I don't see a strong indication to sta...
How do you approach patients with metastatic uveal melanoma not a candidate for tebentafusp-tebn?
I perform genomics and try to find a clinical trial that fits the patient. Including local liver therapies, such as the Delcath catheter treatment if available. Isolated liver lesion could also be resectable, so I request a surgical opinion. If nothing is available, then I offer ipilimumab/nivolumab...
Are there any situations in which you would treat a cutaneous in-situ squamous cell carcinoma of the head and neck with radiation?
Primary radiotherapy (RT) is generally not indicated for carcinoma in-situ (CIS) or pre-invasive malignancies for which surgical resection aimed at achieving negative margin is the mainstay approach. Even if the patient were inoperable or the tumor was unresectable (two distinct scenarios), active s...
What circumstances would drive you to consider using an oral IL-23 inhibitor over parenteral options for the management of psoriasis and/or psoriatic arthritis?
Psoriatic arthritis is a heterogeneous disease and the choice of therapy is driven by many factors.The most important factors in the decision tree are whether the patient has 1) axial disease and/or 2) severe psoriasis.Additional Considerations include: prior therapies, extramusculoskeletal manifest...
How do you approach postoperative radiation therapy in a patient with head and neck cancer who has high risk of recurrence in the setting of active epidermolysis bullosa?
Epidermolysis bullosa is a rare genetic entity characterized by collagen mutations affecting the attachment of epithelial cells to the basement membrane of the skin and mucosa, manifesting in blistering and non-healing skin wounds and mucosal strictures in the GI tract. There is a risk of non-healin...
In what situations would you recommend adjuvant radiation therapy for patients with locally advanced and/or recurrent basal cell carcinoma that receive vismodegib followed by surgery?
Adjuvant radiation therapy should be considered for locally advanced basal cell carcinomas when surgical margins are positive, or when there is perineural invasion, particularly in high-risk anatomical locations such as the face. This recommendation is endorsed by both the NCCN and the American Acad...