Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Can Dupixent (dupliumab) be safely used in patients who are taking other biologics for rheumatic disease?
This is a really broad question given how many biologics exist now, but the answer is likely yes, given its outstanding safety profile. I have used it concurrently with other biologics on many occasions without any issues so far. As concurrent use increases, we may find out more if there are any "tw...
What topical therapies have you found most effective for managing scalp psoriasis?
For tough scalp psoriasis, I use an old regimen. 10% LCD 2% Sal acid in olive oil applied tiw x 1 hour under a shower cap. This is then washed out with a zinc-based shampoo followed by the application of a potent topical steroid. This is labor intensive but can be incredibly effective and sometimes ...
How do you counsel patients with dermatomyositis on sun protection?
We make sure patients know that sun exposure can trigger flares, so we strongly recommend staying out of direct sunlight between 10 AM and 4 PM, using broad spectrum, SPF30+ sunscreen daily even when indoors (as UVA can penetrate through windows), and wearing sun protective clothing (ideally UPF-rat...
How would you approach adjuvant RT for porocarcinoma of the face?
The reported outcomes after surgery in the published literature are all over the place. With some saying surgery alone is adequate and others reporting that these have a high incidence of local, in-transit, and regional recurrence. I tend to treat these with Merkel cell carcinoma volumes.
What is your approach to managing Grover's Disease (Transient Acantholytic Dermatosis) that has failed topical steroids?
I'm a big fan of low-dose naltrexone for Grover's Disease (and Hailey-Hailey and Darier's Disease). It's a safe and effective treatment that I've seen work very well. The dose ranges between 1-5mg daily. It seems like 3mg is often the sweet spot. Patients sometimes report more trouble sleeping and/o...
What are the most effective treatments for flat warts on the face?
Facial flat warts are notoriously difficult to treat. I’ve had success using Tretinoin 0.025-0.05% cr HS MWF HS and iniquimod 5% cr sparingly on the lesions only HS T and Th. It is often slow but steady progress without scarring as long as the patient does not have significant actinic damage.
How do you determine if a positive thimerosal patch test isn't a false positive?
Thimerosal is commonly positive on patch testing and frequently not relevant. In fact, it was voted (non) Allergen of the Year by the American Contact Dermatitis Society. While small amounts are used in some influenzae vaccines, there is not much else that contains this. At one time, it was a preser...
What is your workup for patients presenting with hypopigmented macules?
None
How would you manage a patient with nonspecific clinical symptoms and pathology consistent with spongiotic and psoriasiform dermatitis other than oral JAK inhibitors?
Vast majority of these patients will not have any diagnosable underlying cause (like 99% in a non-academic setting) and the longer and more you look before you treat, the longer and worse they suffer. Take your best guess if more psoriasiform or more eczematous. If guess psoriasiform give them sampl...
In what situations would you treat elective regional lymph nodes for a squamous cell carcinoma of the skin on the extremity/trunk that was clinically node negative?
Nodal metastasis from small, to medium size [up to 3 cm in diameter] squamous cell carcinoma on the extremity is not that common. Considering the morbidity of nodal treatment in a patient with clear margins of resection I would not prophylactically treat the nodes. If the tumor shows perineural or l...