Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your treatment algorithm for treating patients with lichen planopilaris?
LPP can be localized and smoldering or widespread like a wildfire. All patients are treated with a potent topical steroid solution. For some that is all that is required. For those with severe or active disease I will start an oral agent such as doxycycline or hydroxychloroquine and consider intrale...
How do you approach nail surgery to diagnose NUBs (neoplasms of uncertain behavior)?
I tend to opt for punch biopsy to diagnose nail tumors. A larger punch (i.e. 4-6mm) can be used to remove the nail plate. Then, a slightly smaller punch (i.e. 3-5mm) can be used to biopsy the tumor. If there is no concern for involvement or relevant pathology of the nail plate, it can be secured bac...
What’s your approach to treating multiple facial BCCs in gorlin syndrome?
Patients get surgically exhausted, and often fearful of radiation or is not acceptable, I use twice weekly erivedge even with multiple comorbidities not only suppresses but often complete resolution of lesions. Intermittent dosing has a 12 day half-life and I take advantage of that.
How do you determine the need to biopsy subcutaneous nodules in infants to rule out Infantile myofibromatosis?
For most subcutaneous nodules in infants of unknown etiology, I would check an ultrasound with doppler first as deep infantile hemangioma and other vascular lesions may be on your differential. If it is not vascular, and small and stable in size, it may be OK to clinically monitor. One may also cons...
Do you incorporate laser hair removal into your treatment plan for patients with HS?
I utilize laser hair removal quite a bit for HS. I find it particularly helpful in early-ish disease. Once there is a lot of scarring and tunnels, it may not work as well, but you could still give it a try. For earlier diseases, it's a great way to stop the disease process. It seems to work really w...
How do you approach managing nausea and GI side effects when initiating methotrexate?
There are several strategies to minimize nausea and gastrointestinal symptoms with the use of methotrexate. The medication can be taken with food, just not with caffeine. The dose can be split throughout the day it is taken such as half the dose in the morning and the other half in the evening. The ...
Do you generally utilize calcium channel blockers on an as needed basis for patients with Raynaud's phenomenon?
Can certainly help when patients have conditions that trigger Raynaud's. If otherwise healthy, I discuss keeping the extremities protected from excessive cooling.
What treatment regimen do you start for patients who present with mucous membrane pemphigoid?
The treatment plan for mucous membrane pemphigoid (MMP) is individualized based on the disease severity, medical comorbidities, patient preferences, and medication availability/cost. For severe MMP, yes, I commonly use the combination of Rituxan, IVIG along with high dose systemic corticosteroids (...
What therapies have you found most effective in providing rapid improvement in patients with erythrodermic atopic dermatitis?
For me, the most critical part of treating erythrodermic atopic dermatitis is making sure you have the correct diagnosis. While biopsies can be helpful, my pathology colleagues have told me it can be difficult to determine the diagnosis in the biopsy of an erythrodermic patient. Likewise, labs or hi...
What is your preferred topical retinoid for acne?
I generally start with tretinoin 0.025% cream as the first-line for acne. If the patient has a history of eczema or sensitive skin, then I would start with adapalene 0.1% gel/cream and then ramp up from there if they tolerate it for a few months without side effects.