Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you approach ongoing screening for TB in patients with a history of treated latent TB, but who have ongoing use of DMARDs and/or biologics given Quantiferon testing and PPD can remain positive?
Interferon-release assays (such as Quantiferon) and PPD testing do not discriminate between infection, reinfection, and prior infection with TB. However, in most developed countries, the likelihood that a patient who has once been treated for LTBI becomes reinfected and develops LTBI again is low, i...
What is your approach to managing pyoderma gangrenosum recalcitrant to oral steroids?
Pyoderma gangrenosum is notoriously difficult to treat. The first thing I'd recommend in a case refractory to steroids is to reconsider the diagnosis. Notably, a high percentage of PG is misdiagnosed, so lack of response may indicate that you are dealing with a mimicker (e.g., infection, neoplasm, v...
How have you incorporated LED light therapies in your practice?
High quality evidence is nearly nonexistent, thus I have not incorporated this into my practice.
What is your approach to treating patients with chronically brittle nails?
Brittle nails is a relatively common condition, but pathophysiology of this nail condition is poorly understood. Thus, there is limited clinical trial data of treatments. Inflammatory, infectious, and systemic and traumatic conditions should be ruled in/out before starting treatment. For all patient...
How would you manage a large area of multiple, recurrent cutaneous squamous cell carcinomas of the scalp with ulcerations and non-healing areas despite cryotherapy, multiple Mohs procedures, and 5-FU?
Consider sending the patient to medical oncology for evaluation for cemiplimab. Large areas of the scalp can also be treated by making a 1 cm "cap" of bolus and utilizing VMAT to cover scalp soft tissues, with elective coverage of nodes and perineural pathways if indicated.
Would you switch to a TNFi if a patient developed squamous cell skin cancer on abatacept after failure of methotrexate for seropositive RA?
All biologics or immunosuppressants have been associated with various rates of skin cancers. The decision to change or continue biologics should be based on disease activity through shared decision-making with the patient. The need for frequent skin examinations and treatment through their dermatolo...
What is your approach to a patient with generalized morphea, no systemic involvement but a positive RNA Polymerase III?
I would perform age-appropriate cancer screening given the link between RNA pol III and cancer. Otherwise, I would simply monitor for onset of systemic sclerosis or other autoimmune disease symptoms.
What alternative medications other than dapsone would you consider for dermatitis herpetiformis in a sulfa-allergic patient?
Dapsone is a sulfone and in my experience, does not usually cross-react with sulfonamide-allergic patients (e.g., bactrim allergies).
What is your approach to a patient with undetectable MMR titers checked prior to or during immunosuppression and a history of MMR vaccination in childhood?
MMR titers are good correlates of protection. If any titer is undetectable it could be one of these situations: Primary failure. The components of the MMR have different efficacy. Two doses of appropriately given MMR will have 96+% against measles, but only 88% for mumps. Thus 1 in 10 appropriately...
Would you consider prophylactic metformin as an anti-aging treatment?
Yes, but wouldn't prescribe.