Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you find that hydroxyzine worsens cognitive symptoms in patients who are already susceptible to cognitive impairment?
Hydroxyzine should not have a direct negative effect on cognition. For decades after its inception, it was lopped in with Benadryl in terms of its receptor binding affinity profile and is listed in several anticholinergic burden scales as being anticholinergic. Similar to the child’s game ‘telephone...
In older male patients with a history of underlying autoimmune disease, what clinical manifestations would prompt you to evaluate for VEXAS Syndrome?
Hello!!!Skin lesions, elevated MCV, elevated inflammatory markers.
Have you had success in treating extensive lichen nitidus with a systemic therapy?
I have never attempted to treat lichen nitidus with systemic therapy, as most patients are largely asymptomatic, and we know it is typically a self-limited condition.
What's your therapeutic approach for patients with severe cystic acne who have a history of inflammatory bowel diseases?
Persons with IBD and severe cystic acne warrant therapy with Accutane. I have successfully treated several cases with no exacerbation of IBD, publishing a case report in 1985: Oral isotretinoin and inflammatory bowel disease.A more recent study reached a similar conclusion: Does taking isotretinoin ...
What is your approach to patients with SLE who develop a rash after hydroxychloroquine initiation?
First, I diagnose the type of rash. If it is a severe cutaneous reaction, e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), or if it is a more persistent type of reaction like a lichenoid reaction, I stop hydroxychlor...
How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?
Chronic urticaria (6 weeks or longer) is often a self-limited disorder seemingly idiopathic in etiology. There are certain autoimmune disease more prevalent in patients with chronic urticaria including systemic lupus erythematosus, Sjogren's syndrome, autoimmune thyroid disease, celiac sprue, and rh...
Would oral roflumilast be a reasonable and tolerable option for severe psoriasis in an elderly patient with a history of pulmonary aspergillosis who has failed other systemic therapies?
It couldn't be a better option. Shouldn't exacerbate the aspergillosis at all, might help with the COPD, and is substantially more effective than apremilast (at least that's my take based on the data - no head-to-head data). I'd estimate that 30% of elderly patients can't tolerate it, but the other ...
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 ...