Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are the indications for adjuvant radiotherapy for basal cell carcinoma of the skin of the head and neck?
I rarely give adjuvant radiotherapy for resected BCCs because there is little data demonstrating a benefit. For BCCs, with squamous features or nodal metastases, I generally manage as a cSCC. Some reasons to consider adjuvant RT to resected BCC primary tumor might be: -T3/T4 primary (by AJCC 7) -R2 ...
What is your treatment approach to prevent progression of phymatous rosacea?
Isotretinoin has definitely been the gold standard at our office to shrink/slow the growth of the sebaceous glands. However, Monopolar RF (i.e. Agnes RF) can also selectively target and ablate sebaceous glands while minimizing epidermal damage if the goal is sebaceous control rather than dermaplanin...
How do you screen alopecia patients to determine whether they are appropriate candidates for JAK inhibitors?
Factors that have to be taken into account when considering a JAK inhibitor include but are not limited to age, past medical history (particularly smoking, cardiac risk factors, cancer, thrombosis), and the emotional toll of the alopecia on the patient. I have an informational handout on the use of ...
What are the best biologics for a pediatric patient with extensive guttate psoriasis that is poorly controlled on topicals?
Fortunately, we have a number of options for treatment of pediatric psoriasis that work well. With a guttate presentation, I would always recommend sending a throat swab and checking perianal skin to rule out Group A Strep as clearing this is an important step in getting the psoriasis under control....
What concentration of TCA is typically used to treat porokeratosis on the arms and legs?
I learned this on RXderm and apparently, it is a miracle and I have no idea how it works and who figured it out: compound lovastatin and cholesterol cream. Available on Chemistry Rx and Skin Medicinals. When I did peels, I used 20%. Nothing I had ever tried topically worked well. Some have used ...
What is your standard diagnostic workup to confirm GVHD in a patient post-BMT with skin rash and jaundice?
I assume there is no diarrhea, so sigmoidoscopy would not be helpful. Gut and liver pathology are useful. Skin biopsy is less helpful. It can be fairly nonspecific, but we do it to rule out other diagnoses that have more definitive pathology. Ultimately, it is a clinical diagnosis. Liver biopsy woul...
What is your preferred regimen for remission induction and maintenance in EGPA with cardiac involvement?
Cardiac involvement in EGPA is associated with a poor prognosis and is an independent predictor of mortality. Therefore, it needs to be treated aggressively. Depending on the study, between 15-30% of EGPA patients present with or develop cardiac manifestations. The manifestations are highly variable...
How do you utilize anifrolumab for SLE in your practice?
The answer to this SLE question involves a complex decision-making process. It is such an important question! I apologize in advance for the long answer. I am in the camp of achieving remission in my SLE patients and getting them off prednisone in the safest ways possible (Fanouriakis et al., PMID 3...
How do you approach symptom control in a patient with diffuse cutaneous systemic sclerosis (dcSSc) and rapidly progressive skin disease?
This patient clearly seems to be on the uphill trajectory for skin involvement in RNA Pol III+ dcSSc which can progress quite rapidly over 6-12 months. Pain, burning, tightness and pruritus are quite intense during this period, and can be very difficult to treat. It does improve somewhat with time, ...
How would you approach treatment failures with squamous cell carcinoma-keratoacanthoma-type lesions that did not respond to a standard SRT regimen after many sessions?
Most keratoacanthoma-type cutaneous squamous cell carcinomas that I see are bulky, and superficial radiotherapy (SRT) would not provide an adequate depth of radiation penetration to eliminate the carcinoma cells. If radiotherapy is being used for a bulky tumor like this, a higher energy form of more...