Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you counsel parents of children with atopic dermatitis about preventing recurrent Staph infections?
For recurrent Staph infections, I recommend bathing daily, as well as giving a bleach bath 2-3 nights per week. If they are struggling with multiple or recurrent abscesses, and/or other family members are also having recurrent Staph infections, that is when I recommend intranasal mupirocin. I typica...
How long are you comfortable with keeping pediatric patients on oral antibiotics for acne?
I start all acne patients on a topical retinoid and if they need an oral antibiotic, I will prescribe that with a follow-up at 3 months. It takes about that long for a topical retinoid to kick in. If they need a couple of months longer, that's okay, but I might add topical or oral spironolactone to ...
What oral treatment options would you offer a patient with severe onychomycosis who is also on methotrexate for another condition?
I prefer pulsed terbinafine at 250 mg daily x1 week every other month. Dr. Zaias showed in a comparative study that pulsed terbinafine works as well as giving it daily for 3 months, and since the patient is only taking this for 1 week every other month, risks for hepatotoxicity are minimal.
How have you used Hedgehog pathway inhibitors as neoadjuvant/adjuvant therapies?
I am presuming that the question is directed towards Basal cell cancer. We don't use Hedgehog pathway inhibitors (HHIs) in an adjuvant setting, but sometimes in the neoadjuvant setting, when the risk of getting a positive margin is high. I prefer alternate-day dosing of vismodegib (less muscle cramp...
Do you prescribe fluocinolone in peanut oil in patients with peanut allergies?
Yes. Paller et al., PMID 12664021
How do you manage new-onset vitiligo in a patient on immune checkpoint inhibitors?
Vitiligo is quite often (not always) associated with good long-term clinical outcomes for melanoma patients treated with immune checkpoint therapy. It is an indication of the activity of the drug, as it is due to unleashing of the T-cells’ attack on the bystander melanocytes in addition to melanoma ...
What are your preferred alternative biologic agents for Blau Syndrome when anti-TNFα therapies are contraindicated?
As is true for most of us, I have limited direct clinical experience treating patients with Blau Syndrome. I have treated members of several families and am convinced that corticosteroids are effective and fraught with long-term toxicity. As the question implies, a TNF inhibitor (specifically a mono...
Can Dupixent (dupliumab) be safely used in patients who are taking other biologics for rheumatic disease?
This is a really broad question given how many biologics exist now, but the answer is likely yes, given its outstanding safety profile. I have used it concurrently with other biologics on many occasions without any issues so far. As concurrent use increases, we may find out more if there are any "tw...
What topical therapies have you found most effective for managing scalp psoriasis?
For tough scalp psoriasis, I use an old regimen. 10% LCD 2% Sal acid in olive oil applied tiw x 1 hour under a shower cap. This is then washed out with a zinc-based shampoo followed by the application of a potent topical steroid. This is labor intensive but can be incredibly effective and sometimes ...
How do you counsel patients with dermatomyositis on sun protection?
We make sure patients know that sun exposure can trigger flares, so we strongly recommend staying out of direct sunlight between 10 AM and 4 PM, using broad spectrum, SPF30+ sunscreen daily even when indoors (as UVA can penetrate through windows), and wearing sun protective clothing (ideally UPF-rat...