Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your approach to patients with SLE who develop a rash after hydroxychloroquine initiation?
First, I diagnose the type of rash. If it is a severe cutaneous reaction, e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), or if it is a more persistent type of reaction like a lichenoid reaction, I stop hydroxychlor...
How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?
Chronic urticaria (6 weeks or longer) is often a self-limited disorder seemingly idiopathic in etiology. There are certain autoimmune disease more prevalent in patients with chronic urticaria including systemic lupus erythematosus, Sjogren's syndrome, autoimmune thyroid disease, celiac sprue, and rh...
Would oral roflumilast be a reasonable and tolerable option for severe psoriasis in an elderly patient with a history of pulmonary aspergillosis who has failed other systemic therapies?
It couldn't be a better option. Shouldn't exacerbate the aspergillosis at all, might help with the COPD, and is substantially more effective than apremilast (at least that's my take based on the data - no head-to-head data). I'd estimate that 30% of elderly patients can't tolerate it, but the other ...
What are the best treatment options for adults with widespread Molluscum and on immunosuppressive medication?
Treatment of these lesions are not always necessary, they can sometimes resolve spontaneously. The approach also can depend on location, number of lesions, and the patient's tolerance for pain and preferred procedure. I have found: topical tretinoin cream or gel hs as tolerated topical imiquimod 5%...
How do you approach workup and management of hyperhidrosis?
Oral anticholinergics
What is the longest interval that you have been able to stretch a biologic before losing efficacy?
Some biologics have the potential to provide benefit 4-6 months after the last dose. In psoriasis, certainly that probability is highest with the Il-23's than IL-17s and the TNFi's. In AD, IL4/13 inhibitors average 3-4 months though the newest IL-13i has benefit lasting 38 weeks in their withdrawal ...
What is your approach when a female patient does not want a male MA/scribe present in the exam room but other staff are unavailable?
I think we need to respect a patient’s request for same sex providers. Some patients are shy. For some, it is religion-based. I would ask the scribe to stand behind the curtain while I am seeing the patient. Regarding the MA, I would ask the MA to leave the room during my full-body skin exam. If I n...
How do you approach extensive recurrent genital warts that have failed liquid nitrogen, imiquimod, 5 fluorouracil and electrodessication?
I have used 0.2 ml of Candida IL with success for recalcitrant scrotal warts (injected in 2-3 lesions). I used this study below as a reference. My patient cleared in 3 sessions (4-6 weeks apart), the study below states max 5 sessions.Nofal et al., PMID 31923442
How does nemolizumab fit into your current treatment approach to prurigo nodularis relative to other biologics?
It is my first-line recommendation.
How would you approach management of a patient who develops squamous cell skin cancer while on abatacept?
I would discontinue abatacept. Several studies now have reported an increased risk of squamous cell cancer/non-melanoma skin cancers in patients on abatacept (Wadstrom et al., PMID 28975211, Simon et al., PMID 37932010) and in someone who actually develops this malignancy on the drug, I would hesita...