Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How would you manage a patient who developed stage III melanoma while receiving cemiplimab (cycle 10) for locally advanced cutaneous squamous cell carcinoma?
That depends on whether you want to manage the stage III melanoma in the adjuvant vs neoadjuvant setting. If adjuvant, can likely continue cemiplimab (off-label for melanoma) as it has the same MoA as other anti-PD-1 ICI. If intending to manage stage III melanoma in neoadjuvant setting, consider swi...
How do you prefer to repair skin cancer excisions done on lower extremities?
The approach to repairing on the lower legs after Mohs surgery often depends on the size and depth of the surgical defect, as well as patient-specific factors such as vascular status and mobility. I typically discuss the available options with the patient, outlining the pros and cons of each. On the...
Does baseline facial dermatitis in a patient with AD cause hesitation when starting Dupixent due to conjunctivitis-related complications, especially when there are many available options?
Yes, I definitely do consider this. Not necessarily because of conjunctivitis but because I’ve seen a significant number of patients with “dupilumab facial redness or reaction” with out-of-proportion head/neck flaring in AD patients. In patients with significant facial involvement at baseline, I pre...
Would you continue adjuvant nivolumab or pembrolizumab in a resected stage III melanoma patient that developed local-only recurrence at the site of previous surgery?
I am presuming that the patient is experiencing an in-transit recurrence while receiving anti-PD-1 monotherapy. Whilst, the intention for anti-PD1 monotherapy in the adjuvant setting is to prevent distant relapses, an in-transit recurrence is the most difficult to treat with systemic therapy. In our...
How do you manage injection site reactions in patients on subcutaneous biologics such as TNF inhibitors?
Injection site reactions are not infrequent, though the majority are self-limited and do not result in discontinuation of the drug. For those uncommon few individuals whose skin lesions are more prominent and symptoms (such as pain and itch) are aggravating, I first review that they are properly sel...
What topical therapies and procedures do you recommend for improving facial pore size?
Ablative CO2 or Erb:YAG fractionated resurfacing laser would provide the best and most durable treatment for large pores. Topical neuromodulators don't have a particular role in reducing pore size. Topical exfoliants (AHA/BHA and retinoids) can be beneficial with chronic, consistent use by removing ...
What treatments do you consider for cholinergic urticaria refractory to high dose H1 blockers and omalizumab?
Generally, my initial approach to cholinergic urticaria (CholU) is the same for chronic spontaneous urticaria and other forms of chronic inducible urticaria [1]. Most patients with antihistamine-refractory cholinergic urticaria (CholU) will respond to omalizumab 300 mg monthly. Those individuals wit...
Do you typically excise clear cell acanthomas?
Clear cell acanthomas are benign. Shave excision/shave removal, or electrofulguration and curettage are usually adequate treatment options.
What topical regimens do you recommend for redness related to rosacea in patients who defer laser treatments?
Naturally, laser is the most ideal and best solution. Green-tinted makeup is also a great adjunct. Aside from the usual routine counseling (avoidance of sun, food triggers, etc.), one product that I have found remarkable results with is the compounded SkinMedicinals ET-Rosacea Cream, which contains ...
What is your preferred oral regime with duration for treatment of onychomycosis?
Back in the old days of the "toenail wars" between terbinafine and itraconazole, I was a speaker for both and learned that the pharmacodynamics of the two drugs favored pulsing for the latter but NOT for the former. Terbinafine does NOT leave the blood for weeks, unlike itraconazole (days), so if th...