Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you prefer to repair skin cancer excisions done on lower extremities?
The approach to repairing on the lower legs after Mohs surgery often depends on the size and depth of the surgical defect, as well as patient-specific factors such as vascular status and mobility. I typically discuss the available options with the patient, outlining the pros and cons of each. On the...
Would you continue adjuvant nivolumab or pembrolizumab in a resected stage III melanoma patient that developed local-only recurrence at the site of previous surgery?
I am presuming that the patient is experiencing an in-transit recurrence while receiving anti-PD-1 monotherapy. Whilst, the intention for anti-PD1 monotherapy in the adjuvant setting is to prevent distant relapses, an in-transit recurrence is the most difficult to treat with systemic therapy. In our...
How do you manage injection site reactions in patients on subcutaneous biologics such as TNF inhibitors?
Injection site reactions are not infrequent, though the majority are self-limited and do not result in discontinuation of the drug. For those uncommon few individuals whose skin lesions are more prominent and symptoms (such as pain and itch) are aggravating, I first review that they are properly sel...
What topical therapies and procedures do you recommend for improving facial pore size?
Ablative CO2 or Erb:YAG fractionated resurfacing laser would provide the best and most durable treatment for large pores. Topical neuromodulators don't have a particular role in reducing pore size. Topical exfoliants (AHA/BHA and retinoids) can be beneficial with chronic, consistent use by removing ...
What treatments do you consider for cholinergic urticaria refractory to high dose H1 blockers and omalizumab?
Generally, my initial approach to cholinergic urticaria (CholU) is the same for chronic spontaneous urticaria and other forms of chronic inducible urticaria [1]. Most patients with antihistamine-refractory cholinergic urticaria (CholU) will respond to omalizumab 300 mg monthly. Those individuals wit...
Do you typically excise clear cell acanthomas?
Clear cell acanthomas are benign. Shave excision/shave removal, or electrofulguration and curettage are usually adequate treatment options.
What procedures do you recommend for patients interested in xanthelasma removal?
I have had success treating xanthelasma with both hyfrecation (particularly for very small lesions) and fully ablative laser (both CO2 and Erb-YAG).
What criteria do you prioritize when trying to select the most effective exosome products for your patients?
I do not use exosome products. The evidence doesn’t yet support the use and expense.
How do you approach sequentially tapering combination therapy (i.e., IVIG, mycophenolate, rituximab) for dermatomyositis that is in remission?
This process involves trial and error and requires collaboration between the physician and the patient to determine the most appropriate tapering strategy. My personal preference is to begin tapering medications with the highest risk of side effects. Among IVIG, mycophenolate, and rituximab, I would...
What treatment regimen would you recommend for a patient with biopsy-proven giant cell arteritis and diffuse cutaneous systemic sclerosis?
This is a challenging situation in which you must weigh the well-known high risk of irreversible blindness in untreated GCA with the known increased risk (but not necessarily 100% risk) of scleroderma renal crisis with steroid exposure >=15mg (Steen and Medsger, PMID 9751093). It is important to und...