Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your diagnostic and treatment approach for patients hospitalized with erythroderma?
I would like to know details regarding the patient's medical and family history since underlying primary dermatologic disorders, onclogic disorders, genetic disorders, medications, and infections can trigger erythroderma with medical complications.
Do you change your approach to prednisone taper based on rituximab dosing regimen when treating patients with pemphigus?
My approach to prednisone course/tapering at treatment outset or subsequent rituximab is typically dictated by clinical parameters, specifically PDAI/severity and potential comorbidities, rather than rituximab dosing regimen. This paper supports the notion that similar cumulative steroid exposure an...
Are there patients with pemphigus whom you plan to give additional doses of rituximab even if they are in complete remission at six months from their initial dose?
It depends on what you consider "complete remission". Antibody levels and types, both before and after treatment, probably help predict relapse. Generally, we plan to give another rituximab dose at 6 months and reassess a few months ahead to see if any predictors of relapse are present, with a fairl...
What topicals have you had success with treating body acne?
Agree with Jim Leyden that systemic therapy, especially isotretinoin, is far superior to topical therapy in treating truncal acne. However, in patients who refuse systemics, some of the newer topicals may be helpful. The newer retinoid formulations, trifarotene cream and tazarotene lotion, both have...
What treatment modalities have you had success with for treating sebaceous hyperplasia?
I have used light electrodesication with a blunt tip needle with good effective results without visible scarring for the vast majority of patients. I find that it is efficient and less expensive than laser modalities. The procedure is uncomfortable for my patients and typically I need to use topical...
Is it safe to use one TNF inhibitor (e.g., infliximab) in a patient who has had a severe allergic reaction to a different TNF inhibitor (e.g., adalimumab)?
The short answer is yes - it is ok to proceed with a different TNFi. First, it is important to determine whether the reaction was truly allergic or a nonspecific infusion reaction instead. If possible, obtaining a serum tryptase level at the time of the reaction can help clarify. Realistically, this...
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...
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.