Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you offer prophylactic antibiotics or valacyclovir prior to ablative laser therapy?
All ablative resurfacing, especially perioral region, should be prescribed valacyclovir as outbreaks can be devastating, especially if it's their first one.
For microneedling to treat boxcar scars, how should the needle be oriented?
Boxcar facial scars are difficult to treat because the dermis is fibrous, the sides are fixed, and they can range in size from several millimeters. The purpose of microneedling is to improve the underlying dermis, so it would make the most sense to aim the needle directly under the deepest part of t...
Do you counsel isotretinoin patients to use supplements (fish oil, OTC antihistamines, or Omega 3s) to decrease purging and mucocutaneous dryness?
Agreed with the above on omega-3 fatty acids.I always recommend 2nd gen antihistamines as well (Pandey & Agrawal, PMID 31734672). Harmless addition that seems to not only help some of the symptoms associated with isotretinoin, but also seems to improve efficacy.Finally, if omega-3s don't help with j...
Do you typically excise cellular dermatofibromas?
I don't see a reason to remove them beyond cosmetic reasons or patient preference.
In a patient with high-risk cutaneous squamous cell carcinoma of the face with extracapsular extension after ipsilateral neck dissection and rapid contralateral cervical nodal recurrence, what is the optimal management?
In various published series, around half of patients fail to achieve a complete response to cemiplimab. From the clinical details, the current active area of disease appears to be the contralateral neck with no distant disease. Curative treatment is preferred. C-POST trial established surgery + adju...
Is anyone doing Nemluvio q3 weeks?
There is no contraindication to more frequent dosing than every 4 weeks, assuming you can get coverage. It's a tad easier for flex dosing using the PN indication and documenting weight >90 kg. In that case, the patient can get two 30 mg injections every 4 weeks, but what I've done for patients that ...
How often do you draw screening ANAs for discoid lupus?
Because a positive ANA is associated with an increased risk of progression to SLE in patients with discoid lupus, I routinely check an ANA at the initial visit in virtually all patients. If negative, I repeat it only if new symptoms concerning systemic involvement arise (e.g., joint pain, cytopenias...
Can any superficial chemical peels be safely used for patients with preadolescent comedonal acne which is not responding to typical topical therapies?
Yes, salicylic acid chemical peels can be used in this age group and are both safe & effective.
How do you choose between various JAK inhibitors in the management of alopecia areata?
Mostly, the first line is baricitinib as it has been approved the longest. However, if a patient has lipid abnormalities at baseline, you could consider ritlecitinib, which does not impact the lipid profile. At the same time, however, ritlecitinib interacts with statins and other CYP3A and 1A2 medic...
What factors do you weigh most heavily when deciding on the duration of treatment with dupilumab in a patient with atopic dermatitis who is responding well and tolerating therapy?
If the atopic dermatitis was severe and longstanding, I would continue dupilumab indefinitely. If the patient wanted to cut back, they could try gradually spreading out the doses until the disease recurred.