Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your approach to managing Grover's Disease (Transient Acantholytic Dermatosis) that has failed topical steroids?
I'm a big fan of low-dose naltrexone for Grover's Disease (and Hailey-Hailey and Darier's Disease). It's a safe and effective treatment that I've seen work very well. The dose ranges between 1-5mg daily. It seems like 3mg is often the sweet spot. Patients sometimes report more trouble sleeping and/o...
What are the most effective treatments for flat warts on the face?
Facial flat warts are notoriously difficult to treat. I’ve had success using Tretinoin 0.025-0.05% cr HS MWF HS and iniquimod 5% cr sparingly on the lesions only HS T and Th. It is often slow but steady progress without scarring as long as the patient does not have significant actinic damage.
What is your preferred method of wound closure after wide excision for hidradenitis suppurativa?
My favorite is always secondary intention healing. It has the best outcomes and the least risk of recurrence, plus it's the easiest since you don't have to do anything. It is important to counsel patients ahead of time, and I find it helpful to show them some photos. When they see the open wound, it...
How do you determine if a positive thimerosal patch test isn't a false positive?
Thimerosal is commonly positive on patch testing and frequently not relevant. In fact, it was voted (non) Allergen of the Year by the American Contact Dermatitis Society. While small amounts are used in some influenzae vaccines, there is not much else that contains this. At one time, it was a preser...
What is your workup for patients presenting with hypopigmented macules?
None
How would you manage a patient with nonspecific clinical symptoms and pathology consistent with spongiotic and psoriasiform dermatitis other than oral JAK inhibitors?
Vast majority of these patients will not have any diagnosable underlying cause (like 99% in a non-academic setting) and the longer and more you look before you treat, the longer and worse they suffer. Take your best guess if more psoriasiform or more eczematous. If guess psoriasiform give them sampl...
In what situations would you treat elective regional lymph nodes for a squamous cell carcinoma of the skin on the extremity/trunk that was clinically node negative?
Nodal metastasis from small, to medium size [up to 3 cm in diameter] squamous cell carcinoma on the extremity is not that common. Considering the morbidity of nodal treatment in a patient with clear margins of resection I would not prophylactically treat the nodes. If the tumor shows perineural or l...
How often do you recommend ophthalmologic screening exams for patients with sarcoidosis?
The American Academy of Ophthalmology has guidelines for routine eye exams for an asymptomatic, healthy individual (not someone with sarcoidosis). These guidelines include a complete, dilated eye exam at age 40, interim exams at the discretion of the patient and one's ophthalmologist, and an exam ev...
What treatments would you recommend for patients with chronic urticaria who have minimal improvement with anithistamines and Xolair?
Cyclosporine, no question about it. I start at about 3 mg/kg/d of modified cyclosporine if omalizumab been failed, then try to taper once it is well controlled. I also want to give glucosamine at about 25 mg/kg/d - which has been shown in a randomized double-blind placebo-controlled clinical trial t...
How do you evaluate livedo reticularis (not livideo racemosa)?
Livedo reticularis appears as an interrupted vascular network on the lower limbs. One does not need to warm up the affected area in order to make this diagnosis. The response to heat usually occurs in cutis marmorata that is found in children. Livedo reticularis when it is acquired in teenage and la...