Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?
The evidence for this is not very clear and limited. I think a honest discussion about the risk of JAKs and IVIG with the patient will be the most important; but as long as there is no clotting history or high risk of DVTs/PEs, and this is documented, and if a patient needs both medications to attai...
Do you always pursue testing for NOD2 mutations when you are suspecting a diagnosis of Blau syndrome?
Blau Syndrome is a rare, autosomal dominant disease caused by mutations in the NOD2 gene, which codes for an intracellular sensor for muramyl dipeptide which is present in bacterial cell walls. The classic triad is arthritis, uveitis, dermatitis, but other organs can be affected. I do think that any...
Do you always biopsy patients who present with classic skin findings of dermatomyositis?
I actually very rarely perform a skin biopsy to confirm dermatomyositis, much like I rarely biopsy classic psoriasis or classic eczema. Because I see dermatomyositis frequently enough in my practice, most times, I can confidently diagnose it by physical examination alone. I reserve performing skin b...
What cosmetic treatments have you had success with in treating dermatofibromas?
Excellent question. For patients who want cosmetic removal, we usually offer excision, shave removal, or punch excision. This is most definitive. We also counsel patients that there may be a scar. CO2 laser therapy and cryotherapy can also be used alternatively.
How have you incorporated new psoriasis therapies such as deucravacitinib and bimekizumab into your hierarchy of psoriasis treatments?
I have had good success with both deucravacitinib and bimekizumab and these agents are two welcome additions to our psoriasis treatment arsenal. For deucravacitinib, ever since I included it in my list of options in treating psoriasis - as an aside, I used to skip over orals due to lack of efficacy ...
How do you counsel patients on the risks and benefits of an IL-23 agent versus an IL-17A or IL-17A/F agent?
Both IL-17 and IL-23 agents have demonstrated excellent efficacy for psoriasis. Choosing between them often comes down to access and insurance coverage.With that being said, considerations include: Side effect profile: The side effect profile for both IL-23 and IL-17 agents is similar, with the exc...
How soon after excising a keloid do you inject kenalog?
I ran into this issue in clinic a few months ago when I started doing keloid excisions on patients' ears - there's some decent data in the following article for doing immediate kenalog injections without impairing wound healing.Burusapat et al., PMID 34367855
What orals or biologics do you reach for in a child with recalcitrant inverse psoriasis in the groin who has tried and failed topical including steroids, pimecrolimus, zoryve, ketoconazole, and tacrolimus?
I would first ensure that we couldn't get it under control with even higher potency topical corticosteroids for a short period of time and then maintenance with lower potency topical corticosteroids and steroid-sparing agents or sometimes along with the higher potency topical corticosteroids twice p...
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...