Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What procedures do you recommend for patients interested in xanthelasma removal?
I have had success treating xanthelasma with both hyfrecation (particularly for very small lesions) and fully ablative laser (both CO2 and Erb-YAG).
What criteria do you prioritize when trying to select the most effective exosome products for your patients?
I do not use exosome products. The evidence doesn’t yet support the use and expense.
How do you approach sequentially tapering combination therapy (i.e., IVIG, mycophenolate, rituximab) for dermatomyositis that is in remission?
This process involves trial and error and requires collaboration between the physician and the patient to determine the most appropriate tapering strategy. My personal preference is to begin tapering medications with the highest risk of side effects. Among IVIG, mycophenolate, and rituximab, I would...
What treatment regimen would you recommend for a patient with biopsy-proven giant cell arteritis and diffuse cutaneous systemic sclerosis?
This is a challenging situation in which you must weigh the well-known high risk of irreversible blindness in untreated GCA with the known increased risk (but not necessarily 100% risk) of scleroderma renal crisis with steroid exposure >=15mg (Steen and Medsger, PMID 9751093). It is important to und...
Why is it recommended that patients not apply moisturizer in the radiation field immediately prior to daily treatment?
The received wisdom of Radiation Oncology that patients should not apply topical agents before radiation treatment was promulgated out of concern that said topical agents would act as "bolus" of sorts, and increase the radiation dose to the skin in a way that would enhance radiation dermatitis. For ...
How do you reassure families that no allergy testing is needed for urticaria?
I explain to them that it is an immunologic phenomenon (inside job) and not allergic (outside job).
Do you routinely perform de-fatting for full thickness skin grafts?
I de-fat full thickness skin graft skin simply because I am concerned about optimal graft take. I do realize, however, that leaving some fat behind may in some circumstances not interfere with graft take. Some feel that leaving fat behind, such on scalp grafts, may promote better contour fill of the...
What is your approach to diagnosis and treatment to intermittent cheilitis that does not respond to anti fungal therapy?
Clinical features matter. The differential is broad: granulomatous cheilitis, contact dermatitis, irritant dermatitis, lichen planus, and I have even seen SCLE present with cheilitis. Biopsy during a flare can be helpful even if only to rule out some possibilities, and a 3mm punch typically heals qu...
How would you treat disseminated flat warts in an immunosuppressed patient with skin of color?
Hard to imagine Imiquimod working in a dry wart. Thinking back to the genital studies... only the occluded (moist) warts responded. I generally try to curette them over several visits. Compounded cidofovir (off-label, etc.) might be the best bet.
Where do oral and topical JAK inhibitors fit into your treatment algorithm and approach to atopic dermatitis?
When considering systemic treatment for dermatitis, I perform extended patch testing based upon patient's history of cutaneous contactants. This identifies patients with dermatitis that can often be cured by avoiding cutaneous and systemic (i.e. ingestion) exposure to identified allergens. Patients ...