Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you avoid epilation in patients hoping to preserve their facial hair during radiotherapy?
Interesting question. I have not created an avoidance. It’s my experience that doses of about 50 Gy+ commonly cause permanent hair loss. It’s hard to avoid hair loss in areas where elective nodal or mucosal/skin coverage is needed. It’s certainly disappointing for some patients. In many scenarios of...
Do you utilize AIT for atopic dermatitis if there is no AR present?
Allergen Immunotherapy (AIT) was included as an adjunctive treatment option for patients with moderate to severe atopic dermatitis (AD) in the updated 2023 Guidelines for Atopic Dermatitis. The recommendation was made based on results from a systematic review and meta-analysis of 23 randomized contr...
How do you approach the timing of skin tightening interventions in patients who experience significant weight loss to optimize both intermediate and long-term aesthetic outcomes?
I like PLLA to add natural-looking volume and use HA fillers for areas not suitable for PLLA.
How have you used GLP1s in dermatology?
No, not yet.
Should ertapenem use in refractory HS be managed by ID, and how many times would you consider using it in a patient?
I wish that infectious disease would manage severe hidradenitis suppurativa with IV ertapenem. In my experience, ID is typically reluctant to use ertapenem. I can understand that they are thinking about antibiotic stewardship and maintaining the utility of this broad-spectrum antibiotic. When I have...
At what age are you comfortable to start prescribing spironolactone for acne in adolescent females?
When I first reported the utility of spironolactone in women, I was concerned about possible development issues,in young women particularly muscle development which is influenced by androgens. After consulting with pediatric endocrinologist colleagues at Children's Hospital Philadelphia who saw no c...
How do you use transexamic acid (TXA) during dermatologic procedures?
I personally use it topically, but others have used subcutaneous injections. When used topically, it has been easiest to soak a gauze/pad in the TXA and place it directly on the defect, as described in the reference below. Otherwise, it can be injected directly (subcutaneously) into the wound, inclu...
In older male patients with a history of underlying autoimmune disease, what clinical manifestations would prompt you to evaluate for VEXAS Syndrome?
Hello!!!Skin lesions, elevated MCV, elevated inflammatory markers.
Have you had success in treating extensive lichen nitidus with a systemic therapy?
I have never attempted to treat lichen nitidus with systemic therapy, as most patients are largely asymptomatic, and we know it is typically a self-limited condition.
What is your approach to patients with SLE who develop a rash after hydroxychloroquine initiation?
First, I diagnose the type of rash. If it is a severe cutaneous reaction, e.g., Stevens-Johnson syndrome, toxic epidermal necrolysis (SJS/TEN), drug reaction with eosinophilia and systemic symptoms (DRESS), or if it is a more persistent type of reaction like a lichenoid reaction, I stop hydroxychlor...