Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What clinical scenarios warrant the use of a skin substitute?
Chronic wounds like diabetic and venous leg ulcers are the most common clinical indication, especially when healing fails to progress after standard wound care. Extensive full-thickness burns are also a primary indication, particularly when there is insufficient donor skin available for autografts o...
What psychiatric medications do you feel comfortable prescribing as a dermatologist?
How do you approach Pityriasis rubra pilaris that is retinoid resistant?
I find most PRPs to respond, at best, incompletely to retinoids - they are not my first line. Any TNF-alpha or IL-12/23 inhibitor is reasonable to try, and there are no head-to-head trials to my knowledge to endorse one other. Mtx may need to be added. IL-17s likely work too for some patients. Depen...
How do you bill cosmetic follow-up appointments?
Most of these are no-charge visits unless a new problem is presented.
What should be done for a patient with biopsy-proven seborrheic dermatitis on the scalp and central forehead (presenting as a large annular scaly thin plaque) who has failed treatment with fluconazole, antifungal creams, and Zoryve (which is too expensive)?
I don't think dupilumab is reasonable for seborrheic dermatitis. For seborrheic dermatitis, I'd typically prescribe a potent topical steroid in a vehicle the patient prefers and have them use it twice a day for just 3 days (along with ketoconazole or other medicated shampoo). Adherence to topical tr...
Are you managing chronic urticaria/angioedema any differently if the patient is only/predominantly presenting with urticaria or angioedema?
The mechanism is similar for urticaria and histamine-induced angioedema, so I would expect a similar response. The evidence to support the use of montelukast for U/A is slim, but there are some supporting data. Nonetheless, the newest WAO guideline does not suggest an addition to the therapeutic pyr...
When do you order genetic studies such as comparative genomic hybridization for melanocytic lesions?
In my practice, I confine copy number alteration studies (SNP array testing) for cases where the biological potential of a melanocytic proliferation is in question. I do not perform the testing if the case is diagnostic histopathologically and/or immunohistochemically of a nevus or melanoma.The seco...
How do you manage patients with erosive pustular dermatosis?
First of all, it is very important not to miss underlying squamous cell carcinoma in cases labeled with erosive pustular dermatosis. I diagnosed moderately to poorly differentiated squamous cell carcinoma underneath the crusts in a couple of patients with known erosive pustular dermatosis of the sca...
How do you manage cannabinoids (ex: medicinal, recreational) in dermatology?
I use dronabinol 2.5-10 mg qd-tid for recalcitrant pruritus (typically neuropathic or CPUO as an adjunct treatment). Very cheap using GoodRx if not covered by insurance. It’s a scheduled drug, so it requires DEA, but you don’t need a “medical marijuana license,” and it’s very well tolerated outside ...
Is there a role for adjuvant RT in a pleomorphic dermal sarcoma after WLE?
Adjuvant radiotherapy (RT) should be considered for pleomorphic dermal sarcoma on a case-by-case basis. There is no clear data to support the use or omission of radiotherapy in this disease, but we base our clinical decision-making on three factors: Estimated local recurrence risk Morbidity of treat...