Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What recommendations do you provide to patients on isotretinoin about timing of tattoos?
No specific recommendations due to the absence of robust data
What questions are important to ask before performing PDL laser?
Before performing PDL treatment, the patient should be asked if they‘ve had previous laser treatment and if they have had any adverse effects. They should be asked if they are on retinoids, topical acne preparations, or any skin irritants, as these should be discontinued for a couple of weeks post-t...
What’s your favorite topical OTC moisturizer that you recommend, and why?
There is no easy answer to this question as recommendations for moisturizers are quite patient and location specific and depend on degrees of dryness. The best moisturizer is one that feels good to the individual patient and is one that he/she will then use. For example, someone with mild facial dry...
Would you give adjuvant radiation after complete resection of a small primary cutaneous follicular lymphoma of the scalp?
Not a lot of data, but here goes. First, one has to go back decades in the literature to find series of patients with lymphoma rx'd with surgical resection alone. In general addition of RT improved outcome even when ostensibly resected with neg margins. With today's technology risk of additional RT ...
In an infant whose mother resumes TNF inhibitor therapy (e.g., adalimumab, infliximab, certolizumab) after delivery and is breastfeeding, do you recommend delaying live vaccinations?
IgG-based biologic therapies - including TNF inhibitors - are all considered compatible with breastfeeding, since IgG passes only minimally into breast milk. Given these agents are proteins, the minimal drug that is transferred is unlikely to remain intact (or active) with passage through the infant...
How should the results of the ADVOCATE trial be applied in AAV patients who receive rituximab induction and maintenance therapy?
The following answer was jointly drafted by Dr. Peter Merkel and Dr. David Jayne:The data from ADVOCATE indicate that patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) treated with avacopan 30 mg twice daily and prednisone placebo were able to achieve remission w...
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...
What clinical criteria do you use to decide when to start oral nicotinamide for chemoprevention?
Consider oral nicotinamide (500 mg bid) for chemoprevention in patients with several non-melanoma skin cancers in the past 5 years or those with high-risk features such as extensive actinic damage or field cancerization. Studies show the strongest evidence for its use in immunocompetent patients wit...
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
I find the biggest gains come from having clear and consistent communication around patient identification and treatment planning. Aligning on what constitutes “high risk” — both for local recurrence and metastasis — and which patients truly fall into the very-high-risk category is essential. It’s c...
In elderly patients with advanced melanoma and idiopathic pulmonary fibrosis receiving active antifibrotic therapy, would neoadjuvant or adjuvant immune checkpoint inhibition be preferred?
Given this scenario, it is most important to have a goal-of-care discussion. That would help sort out the optimal treatment for such patients. Always treat to relieve pain as needed.