Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you counsel patients who express concern about potentially harmful ingredients in sunscreens?
First, I acknowledge that there can be confusing and sometimes alarming information in the media about sunscreens. I like to point out that unprotected sun exposure is the primary driver of skin carcinogenesis and that it is more harmful than any known risks of sunscreen to date. I discuss that ther...
In patients with livedoid vasculitis and chronic venous insufficiency on rivaroxaban, what therapeutic strategies—beyond compression and topical care—are safe and effective for controlling pain, ulceration, and edema?
My experience has been that aspirin 365 mg, plus persantine or trental daily, plus leg elevation for 45 min or so in mid-afternoon, will produce pain relief and onset of healing within about two weeks. Only infrequently have I had to resort to metformin as an added medication or use both trental and...
Do you avoid progestin only contraceptives and IUDs in patients with acne due to their androgenic properties?
I counsel similarly to Dr. @Dr. First Last above. I also reference the following article, which shows the following odds ratios for certain conditions with hormonal IUDs vs copper: Acne vulgaris: 2.514 Hirsutism: 0.446 Rosacea: 0.376 Androgenetic alopecia: 0.109 Basically, I say they're less likely ...
What outcome do you value as the most important measure of success when treating CHE?
Sustained symptom control that restores hand function is the priority. Pain, fissuring, and itch are what drive disability and quality of life impact, so meaningful improvement in these symptoms and return to daily activities define true success. Patient-reported symptoms and quality of life inform...
Would you ever use dupilumab for atopic dermatitis in a patient who also has EGPA?
I would consider it if AD was moderate to severe and not improving with TCS, TCI, or Opzelura. I would make sure the skin was biopsied to rule out a vasculitic component to the rash, as EGPA skin manifestations are varied.
Does Dupixent interfere with patch testing?
Dupilumab suppresses Th2 skewed responses such as those associated with systemic contact dermatitis (e.g. propylene glycol, compositae mix, carmine, etc.) so testing while on dupilumab results in incomplete results. Responses to Th1 skewed allergens (e.g. epoxy or methylchloroisothiazolinone) may be...
What is your preferred workup for a patient who has a biopsy consistent with “dermal hypersensitivity reaction”?
When encountering a patient with a biopsy consistent with "dermal hypersensitivity reaction," it's crucial to acknowledge the inherent non-specificity of such a diagnosis. In my role as the Director of the Contact Dermatitis Clinic at Penn, I've found that clinical pathologic correlation becomes inv...
Is whole body phototherapy for skin disorders a contraindication to chest wall or breast radiation?
I would not consider prior phototherapy a contraindication. I regularly treat patients with cutaneous lymphomas and occasionally, refractory dermatitis after phototherapy, mostly narrow band UVB. Some of them have received maintenance phototherapy for 1-2 years before treatment with significant skin...
What factors influence your decision to recommend surgical versus non-surgical options for patients with severe skin laxity post-weight loss?
I think it’s important to explore all options—both surgical and non-surgical. You need to assess the degree of laxity the patient is experiencing and understand what their end goal is. Honesty is key, and the only way to achieve that is by having a real discussion about the options you can provide a...
What criteria do you utilize in deciding between different jak inhibitors for atopic dermatitis?
There are no evidence-based reasons to pick abrocitinib or upadacitinib in the vast majority of patients. Differences between the two drugs are 1) abrocitinib is highly JAK1 selective while upadacitinib inhibits both JAK1 and JAK2 and 2) upadacitinib has more safety data - the only worrisome adverse...