Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you evaluate livedo reticularis (not livideo racemosa)?
Livedo reticularis appears as an interrupted vascular network on the lower limbs. One does not need to warm up the affected area in order to make this diagnosis. The response to heat usually occurs in cutis marmorata that is found in children. Livedo reticularis when it is acquired in teenage and la...
Any role for adjuvant systemic therapy for resected sebaceous skin carcinoma?
There is no data about this situation.I would probably treat adjuvantly if margins are positive or if there are localized metastatic lesions that were resected with the primary surgery. I strongly recommend genomic studies to look at mismatch repair, as 25 to 30% of cases could have a deficiency and...
How do you treat patients with Linear IgA that are deficient in G6PD?
Quite a unique clinical situation! One in which the diagnosis is rather rare, but with an added wrinkle where the most classic textbook therapy, dapsone, cannot be used.A few case reports have shown that omalizumab and dupilumab have been reported to effectively treat LABD: Almuhanna et al., PMID 37...
What is your approach to treating patients with dupilumab induced facial redness?
Literature is quite clear that the majority of these patients have Malassezia hypersensitivity as the etiology and the pathophysiology is essentially the same as seborrheic dermatitis. The IL-4 blockade allows upregulation of Th17 activity, which is the inflammatory pathway for seborrheic dermatitis...
How would you manage eccrine porocarcinoma of the great toe with positive superficial groin and pelvic lymph nodes s/p toe amputation and pelvic lymph node dissection?
Eccrine porocarcinoma (EPC) is an aggressive but rare skin malignancy, let alone one occurring at the great toe! A meta-analysis (Salih et al., PMID 28721214) of worldwide reports on EPC prior to 2016 offered a good overview of the disease’s natural history. It was noted that 31% had metastasis upon...
After diagnosing genital warts (condyloma accuminatum), do you order an STI panel?
Only sometimes. Not sure why I don't more often.
Are there certain disease domains in a patient with psoriatic arthritis that will make bimekizumab a particularly good option?
Bimekizumab has shown comparable efficacy in PsA patients who are TNFi naive and TNFi inadequate responders. Therefore, I would choose bimekizumab in bDMARD-IR patients. My second answer might surprise you - I would choose bimekizumab in a PsA patient with recurrent uveitis.
Should TNF inhibitors be held in patients undergoing radiation therapy?
We do not hold TNF inhibitors when needed for patients undergoing radiation therapy.
What is the role of radiotherapy in cutaneous pseudolymphoma?
I generally like the term "Cutaneous B-cell lymphoid hyperplasia" to describe this entity which is characterized by a reactive B-cell proliferation within the dermis developing in response to an adverse stimulus (medication, insect bite, etc.). Sometimes the antigenic stimulus can't be identified. ...
How would you manage a patient who developed stage III melanoma while receiving cemiplimab (cycle 10) for locally advanced cutaneous squamous cell carcinoma?
That depends on whether you want to manage the stage III melanoma in the adjuvant vs neoadjuvant setting. If adjuvant, can likely continue cemiplimab (off-label for melanoma) as it has the same MoA as other anti-PD-1 ICI. If intending to manage stage III melanoma in neoadjuvant setting, consider swi...