Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Can Xolair (omalizumab) be safely used in combination with biologics for patients with rheumatic disease?
Ghazanfar & Thomsen, PMID 30132352 The above article addresses combined Xolair and Enbrel. Keep in mind, if RA flares or worsens after starting Xolair, it could be SE as it is well known to have a polyarticular small joint pattern similar to RA. So, the timing of Xolair initiation to RA loss of cont...
Have you considered intralesional cempilumab for locally advanced NMSC/KCs prior to surgery?
Similar to IL MTX or 5-FU, cempilumab would be a great tool in the arsenal to use as an alternative treatment for patients with skin cancers who are not surgical candidates or who would benefit from neoadjuvant treatment prior to surgery to decrease morbidity. We currently use systemic cempilumab an...
What is your preferred protocol for squaric acid (SADBE) treatments for alopecia areata/totalis?
Based on a few series published showing that sensitization is not necessary for contact immunotherapy, I tend to do one of two things: Start patients at squaric acid 0.001% solution every other day at home and increase the concentration by 10 (0.01%, then 0.1%, then 0.5%) monthly if not reacting. ...
What is your treatment algorithm for managing scalp vitiligo?
It is reasonable, safe, and effective to start with topical steroids and topical calcineurin inhibitors.
How would you manage a patient with progressive/refractory molluscum contagiosum who is well controlled on methotrexate for seropositive rheumatoid arthritis?
Molluscum can be more challenging to treat when a pt is taking any immunosuppressive. In treating that patient, I would attempt to use cimetidine 400 mg TID along with a topical retinoid such as Retin A 0.1% bid to each individual molluscum. If there are only a few remaining, recalcitrant lesions, I...
What is your approach to evaluation and management of a patient with Blau Syndrome and GI manifestations?
Blau syndrome is certainly an unusual diagnosis, as noted by @Dr. First Last. I've also only cared for one patient with this. However, it's important to first confirm the diagnosis of Blau. Did the patient have arthritis, dermatitis, and uveitis? Did you get a biopsy that revealed noncaseating granu...
How do you counsel and manage joint pain after isotretinoin treatment?
Firstly, if one starts with 0.5mg/kg joint symptoms rarely happen. My approach is to temporarily stop isotretinoin until symptoms pass and then start at half the previous dose and treat until clear. The ineffective dose was never found. We know now the critical factor in relapse is age-no matter wha...
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,...