Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
When do you recommend SRT, if ever, for small SCCs and BCCs?
SRT is a highly effective treatment for superficial radiation therapy. What is alarming is the use of daily US guidance for something we can visualize with our eyes. With electrons, I’ve never heard of anyone using image guidance. With SRT, the request for daily image guidance is routinely requested...
What is the maximum dose or treatment course of topical steroids that you generally recommend to avoid causing systemic adverse effects?
Topical steroids cause essentially no systemic AEs. Dosing is limited by local AEs.
Do you increase the frequency of hemodialysis for patients with calciphylaxis?
Optimally I would: Stop or change warfarin Stop any Vit D or analogs Dialyze on lower Ca Bath (dialysate) Stop CA-based PO4 binders Give Vit K Increase the frequency of HD Give sodium thiosulfate as tolerated by patient's [HCO3] but I would prefer to increase HD than cut the dose
How do you counsel patients who inquire about benzene exposure and carcinogenic risk from BPO containing acne and rosacea products?
This question is easier to answer after this recent report from the FDA: Limited number of voluntary recalls initiated after FDA testing of acne products for benzene; findings show a small number of products with elevated levels of benzene contamination It supports the overall safety of BP. More t...
How long can a patient with newly diagnosed merkel cell carcinoma wait for wide local excision with sentinel node biopsy?
A recent study I read on this same question regarding sentinel node biopsy (SNB) performed after melanoma wide excision found that the sentinel node could still be found just fine. And I have found that in practice a number of times when I wide-excised obvious melanomas at first presentation visit. ...
How would you approach the treatment of an SLE patient with refractory mucocutaneous ulcerations and lichenoid skin eruption despite treatment with MMF, Aza, Benlysta, Saphnelo, Rituximab, and JAK inhibitors?
This is an interesting case and the co-occurrence of SLE and Crohn's disease is rare but not unprecedented. The first issue is if the mucocutaneous lesions are related to SLE or the IBD and oral lesions are well described in Crohn's disease. Second, although cutaneous manifestations of Crohn's disea...
What biologics would you use in a patient with rheumatoid arthritis who developed multiple basal cell carcinomas requiring Mohs surgery while on a TNF-inhibitor and did not respond to rituximab?
It would be a discussion with the patient about risks and benefits if the RA is well controlled on a TNF-inhibitor. If the patient wanted to switch, I'd consider switching to an IL-6R inhibitor like tocilizumab or sarilumab.
What considerations do you take when using prednisone in patients with systemic sclerosis?
We tend to have a very high threshold for using systemic steroids in patients with systemic sclerosis and when we do, we try to limit it to less than 15 mg/day of prednisone. There is no clear evidence that it improves or slows down disease activity/progression even in the very early inflammatory ("...
How do you counsel patients with alopecia on the timing of response and what sort of outcomes they should expect with JAK inhibitors?
Hair growth can begin within three months but sometimes is delayed and some patients do not respond. Regrowth is often patchy at first. Good responders can expect full regrowth, but there are also partial responders and non-responders.
How do you utilize JAK inhibitors for alopecia in the pediatric population?
There is little difference about counseling between adolescents (lowest age group approved) and adults, but the greater concern is really understanding the risks, especially given that the lifetime duration on the medication is likely going to be longer in an adolescent vs an adult -- and we know th...