Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you counsel patients with pemhigus on the main safety benefits of a low or ultra low dose rituximab regimen?
Although I read this article with interest and an open mind, I have not adopted ultra-low dose rituximab into my clinical practice of treating pemphigus patients for several reasons. The author's conclusions may very well end up being correct over time, but there are too many concerns with the study...
Would you continue cemiplimab adjuvantly, following resection of initially unresectable cutaneous squamous cell carcinoma treated with downstaging immunotherapy?
This is a challenging question because, as you know, we have no randomized data to address it. I generally do not continue immune checkpoint therapy after resection of SCC skin. However, given the adjuvant data in melanoma and the high efficacy of anti-PD1 in skin SCC, I do think it is reasonable to...
How do you treat gram-negative folliculitis in a transplant patient on sirolimus who cannot use isotretinoin due to drug interactions?
The most critical issue with these infections in the immunocompromised host is the correct identification of the organism and its sensitivities to allow appropriate selection and course of antibiotics. Because the infection is deep in the hair follicle and the patient will shave the area, there is a...
Is keratosis follicularis (Darier disease) a contraindication to the receipt of PMRT?
Thanks for this interesting question. It prompted me to do a bit of literature search and think about how I'd approach this case.For a postmenopausal patient with ER-negative, PR-negative, HER2-negative (triple-negative) pT2N0(sn) breast cancer and unresectable positive surgical margins after mastec...
How have you applied the findings of this trial to your current approach to prescribing rituximab for pemphigus patients?
For the MMF vs MMF + Rituximab trial, the patients received two courses of Rituximab six months apart. The B cells don’t start to recover until about six months after the infusions. The data shows more patients in the rituximab group achieved sustained CRoff pred for 15 weeks or more relative to MMF...
Would you stop bimekizumab in a patient who has severe psoriasis and has responded well to this therapy but is found to have newly diagnosed cirrhosis?
I'd want to know if there was some other cause for the cirrhosis. If there were, I would not stop the bimekizumab. If there was not a clear, obvious cause, I'd want the patient evaluated by a hepatologist. If the hepatologist could find some other reason for the cirrhosis, it might not be necessary ...
How do you manage recurrent scabies in both a patient and their partner when standard therapy fails?
I would recommend 2 weekly treatments with oral ivermectin and topical permethrin. It is also very important to discuss control of fomite exposure as well as possible occult sources e.g., relatives and close friends.
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
How would you manage active severe psoriasis in a patient planning pregnancy, who also has psoriatic arthritis with well-controlled joint symptoms on certolizumab pegol (anti-TNF therapy)?
If the psoriasis was sufficiently limited in area that topicals were a practical solution, I'd first try to assure that the prescribed topical steroids were being used well. Poor adherence is a common issue with topical treatment. Phototherapy might be my next choice. I feel comfortable prescribing ...
Do you check IgA levels before starting IVIG for other autoimmune conditions?
Whereas it is not mandatory to check IgA levels before starting IVIG, it is prudent to do so in non-urgent situations since the patients with IgA deficiency, especially those who have developed anti-IgA antibodies, are at an increased risk of severe hypersensitivity or anaphylactic reactions from IV...