Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you counsel patients who inquire about microplastics in their cosmetics or physician-dispensed products given emerging associations with conditions such as psoriasis, eczema, lupus, and hormonal disruption?
That’s a really good question. It is absolutely true that patients are increasingly aware of environmental exposures, and microplastics in personal care products. When I address it with my patients, I tell them that there is ongoing research on microplastics in cosmetics and personal care products. ...
When would you pursue genetic testing for severe recalcitrant atopic dermatitis?
Not an easy question to answer, but severe and treatment-refractory AD, especially if early onset, is concerning for immune dysregulation and should warrant immune evaluation early. By treatment-refractory, I do not just mean topical therapies, but attempts to control the Th2 pathway that fail repea...
If you’re transitioning laterally between biologic classes due to adverse effects, do you repeat the loading dose?
I do usually repeat the loading dose when starting a new biologic, even if in the same class. If there is data on whether or not you should do this, I am not aware of it.
How do you approach the workup and initial treatment of systemic AL amyloidosis?
1: Ensure that this is light chain. Mass spectroscopy of the tissue to identify/confirm is very important. Even if a patient has positive serum monoclonal protein or light chain, it does not indicate that this is light chain amyloidosis. I have had patients with MGUS and smoldering myeloma with ATTR...
Do you recommend work up for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
How extensive of a workup do you do for systemic AL amyloidosis for a patient with a resected amyloidoma, localized AL amyloid deposition in their airway or lungs, who has no other symptoms?
It's common to over-test in these patients. We in hematology/oncology, often order bone marrow biopsies, PET/CTs, and cardiac MRIs without realizing that each test costs around $10,000 and can potentially harm the patient.Here are two points to assist with the work-up for these patients: Understand...
What additional workup do you pursue in a patient in whom you suspect Yellow Nail Syndrome?
Mandatory pulmonology (and/or ENT for sinusitis) for comorbit workup or monitoring. Detailed ROS for eval of any underlying disease and workup as indicated. Age-appropriate cancer screenings.
Do you obtain MRI for cutaneous SCC with microscopic PNI to assess for gross perineural tumor spread?
I would recommend both an MRI as well as consulting the pathologist regarding the exact nature of the PNI. We had an experience with more than 100 patients (Sapir et al., PMID 27475277). Those with gross PNI (evidenced by MRI, with or without cranial nerve deficit) and microscopic extensive PNI (>2 ...
How do you approach melanoma patients with a positive sentinel node with extra-nodal extension for definitive surgical management?
This is a multidisciplinary question so I reached out to our surgical oncologist (Dr. @Dr. First Last) at the Ohio State University Comprehensive Cancer Center for his thoughts as well. This is a grey area as the patients with extra-nodal extension (ENE) were not specifically studied in the landmark...
How should one manage a non-healing wound with tunneling at the site of a cyst excision on the back, now two months postoperatively, with negative wound cultures and in the context of a self-pay patient?
"Non-healing wound" suggests persistent granulation tissue or similar exam findings, which in the context of tunnel formation at the site of follicular cyst raises my concern for hidradenitis suppurativa (if only a diathesis toward follicular occlusion in a patient without a history of HS). If there...