Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How would you manage a patient with severe Hurley Stage 3 active, draining, HS who is also currently requiring Rituxan for management of vasculitis?
This case might be best discussed through oral conversation rather than this format, but here it goes.I try hard NOT to combine a TNFi with Rituxan. The additive immunosuppression will significantly increase the risk of severe infection to a level that is uncomfortable for me. I have done similar co...
Do you wait on initiating biologic therapy for guttate psoriasis?
First, and foremost, it is important to identify the trigger for guttate psoriasis, which is often caused by step (which requires antibiotics). For most patients, a guttate flare will resolve on its own. When using biologics, we can help clear guttate psoriasis (note, this is largely based on anecd...
What is your approach in counseling a patient with delusions of parasitosis?
Delusions of parasitosis (DOP) or delusions of infestation (DOI) are among the most challenging conditions we treat as dermatologists. I am not sure there is one approach to treating these patients and it can often feel very frustrating and unsatisfying. Nonetheless, we all will encounter these pati...
Can Xolair (omalizumab) be safely used in combination with biologics for patients with rheumatic disease?
Ghazanfar & Thomsen, PMID 30132352 The above article addresses combined Xolair and Enbrel. Keep in mind, if RA flares or worsens after starting Xolair, it could be SE as it is well known to have a polyarticular small joint pattern similar to RA. So, the timing of Xolair initiation to RA loss of cont...
Have you considered intralesional cempilumab for locally advanced NMSC/KCs prior to surgery?
Similar to IL MTX or 5-FU, cempilumab would be a great tool in the arsenal to use as an alternative treatment for patients with skin cancers who are not surgical candidates or who would benefit from neoadjuvant treatment prior to surgery to decrease morbidity. We currently use systemic cempilumab an...
What is your preferred protocol for squaric acid (SADBE) treatments for alopecia areata/totalis?
Based on a few series published showing that sensitization is not necessary for contact immunotherapy, I tend to do one of two things: Start patients at squaric acid 0.001% solution every other day at home and increase the concentration by 10 (0.01%, then 0.1%, then 0.5%) monthly if not reacting. ...
What is your treatment algorithm for managing scalp vitiligo?
It is reasonable, safe, and effective to start with topical steroids and topical calcineurin inhibitors.
How would you manage a patient with progressive/refractory molluscum contagiosum who is well controlled on methotrexate for seropositive rheumatoid arthritis?
Molluscum can be more challenging to treat when a pt is taking any immunosuppressive. In treating that patient, I would attempt to use cimetidine 400 mg TID along with a topical retinoid such as Retin A 0.1% bid to each individual molluscum. If there are only a few remaining, recalcitrant lesions, I...
What is your approach to evaluation and management of a patient with Blau Syndrome and GI manifestations?
Blau syndrome is certainly an unusual diagnosis, as noted by @Dr. First Last. I've also only cared for one patient with this. However, it's important to first confirm the diagnosis of Blau. Did the patient have arthritis, dermatitis, and uveitis? Did you get a biopsy that revealed noncaseating granu...
How do you counsel and manage joint pain after isotretinoin treatment?
Firstly, if one starts with 0.5mg/kg joint symptoms rarely happen. My approach is to temporarily stop isotretinoin until symptoms pass and then start at half the previous dose and treat until clear. The ineffective dose was never found. We know now the critical factor in relapse is age-no matter wha...