Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Would you switch azathioprine to a different immunosuppressant if a controlled patient with SLE develops melanoma and/or non-melanoma skin cancer?
This is a difficult question with no definitive research-proven answer. Clearly, most of our drugs do enhance the chance of melanoma and nonmelanoma skin cancer. If one does a literature search the only one of our drugs that has not been reported to increase the chance for relapse of melanoma is Tac...
How do you manage calcium and vitamin D supplementation in patients with sarcoidosis on chronic steroids?
This is a great question with very limited data to help answer it well. The first-line therapy for sarcoidosis is corticosteroids, and chronic use can lead to decreased bone mass. Of course, Vitamin D supplementation is a very important factor in rebuilding bone mass. In sarcoid patients, this issue...
What work up do you pursue for a thorough evaluation in patients that present with a potential diagnosis of dermatitis artefacta?
I have found dermatologic complaints some of the most challenging in my psychiatric practice. Dermatitis artefacta (DA) occurs when an individual produces self-inflicted skin lesions in order to assume the sick role, making it a type of factious disorder. When evaluating a patient with suspected DA,...
How do you approach the use of commercial testing such as AVISE CTD in clinical practice?
Short story to start off with: A little over 20 years ago, I was a young rheumatologist sitting in a meeting room full of more experienced rheumatologists from the Washington DC area. Some of them were very well known in the field. The person in charge asked, "anti-CCP antibodies are now available t...
How frequently do you recommend skin cancer screens in your patients with kidney transplants who are on immunosuppression?
For those with a history of skin cancers prior to transplant would recommend every 6 months. For those with no history of skin cancer I recommend skin checks every 6 months starting 1-2 years after transplant. Those at highest risk are the Latino and Caucasian propulations but even those in the less...
What treatment do you recommend for painful large plaques of leiomyomas on the back of a patient with HLRCC syndrome when lesions are too large for excision?
Depending on the extent of discomfort, surgery may be required for debilitating leiomyoma-associated pain. In some cases, a larger exophytic nodule(s) can be isolated as the lesion(s) that are most painful and selectively excised, but broad segmental involvement is common in HLRCC, particularly on t...
How do you approach a patient with scalp psoriasis who initially responds well to tildrakizumab but experiences a plateau in improvement or partial relapse after about 1 year?
I have found that 50% TCA applied monthly x 2-3 months often gives long-term remission without hair loss.Bubley et al., PMID 34646928
What treatment approach is best for management of neutrophilic dermatosis in a patient with acute myeloid leukemia? Any suggestions for long term management?
Sweets Syndrome is uncommon in AML although this is the most common hematologic malignancy that will have concomitant Sweets syndrome. The treatment is for managing the AML, of course. Glucocorticoids is the primary treatment-either systemic and or topically. Per uptodate, other options include daps...
How do you decide whether to locally excise vs deroof a persistent draining tunnel in a patient with otherwise medically optimized HS?
Great question. Both are great options. I usually try for a deroofing since it's a shorter healing time, but it doesn't always work out. If you can find an opening to the tunnel, that helps a lot. It gives you the opportunity to probe and a place to begin your incision. Both of those help you get in...
How would you manage BCC to the left cheek after only half of a radiation course was completed three months ago and non-operative management is preferred?
An assessment of three domains is going to help the patient and physicians in this case: Patient related factors: A medical emergency that lasts three months implies a lot-- so what is the performance status of the patient now and what is the prognosis; because an ECOG 3-4+ patient with new onset mu...