Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are your vaccine recommendations while patients are on biologics?
Live vaccines are best completed at least a month before initiation of biologics when these are appropriate (e.g., MMR, chickenpox, yellow fever). The data on non-live vaccines is limited. I personally think that some degree of protection is better than none. I will not interrupt biological therapy ...
How do you manage restarting isotretinoin for patients who have to abruptly stop treatment for a few months due to side effects (e.g., cheilitis, xerosis)?
I would probably start over with 20 mg and see how it was tolerated and continue to go for the same total dose. I use 150 mg per kg, but some go for much higher. I would recommend an omega-3 supplement and Xyzal. Sadly, there is no test of cure telling us when we can stop. I want to see 2 months of ...
Do you use topical corticosteroids to manage severe inflammatory reactions after 5-FU treatment, or do you allow the reaction to run its course?
Once I've achieved adequate inflammation for an adequate length of time, I think cool compresses followed by triamcinolone ointment several times a day help the patient feel more comfortable.
How do you manage lamotrigine or lithium-induced acne?
For Lithium, I have referred patients to dermatology but it seems the interventions suggested such as Doxycycline, Spironolactone, or Bactrim do not fully help. I try to reduce the dose if possible or switch to another mood stabilizer if the acne is severe and bothersome that it is making the patien...
Do you screen for interstitial lung disease in patients with newly diagnosed polymyositis or dermatomyositis in the absence of respiratory symptoms?
I do screen all newly diagnosed IIM patients with PFTs and chest CT. This has a double purpose: establishing a baseline of lung function and, screening for lung cancer. While the patient might not have lung symptoms on presentation, respiratory involvement can manifest later on the course of the d...
What treatment options are there for uremic pruritus in an elderly patient with risk of sundowning?
Uremic pruritus is increasingly recognized as a multifactorial condition involving peripheral neuropathy and immune dysregulation, particularly upregulation of type 2 cytokine pathways. Dysregulated opioid signaling further contributes to itch amplification. Accordingly, κ-opioid receptor agonists, ...
What therapies do you recommend for patients with recalcitrant seborrheic dermatitis?
Topical roflumilast is easily the most effective thing I've ever seen. Prior to that being available, here were the go-to drugs for difficult seb derm: Itraconazole 200 mg qd until better, then 200 mg qd on weekends long term Fluconazole, exact same regimen if itraconazole not accessible Oral Roflu...
In patients with moderate to severe psoriasis who also have obesity or type 2 diabetes, what is your approach to counseling them on the potential role of adjunctive GLP-1 receptor agonists in reducing overall psoriasis disease burden?
I am a firm believer that these medications are key to maximizing therapeutic response in diseases like psoriasis and even more so in HS. They have been shown to reduce the production of inflammatory markers in both diseases. The Together PsO and PsA trials showed better PASI responses (including PA...
What treatment modalities have you had success with for treating recalcitrant warts?
More than digital warts, I find plantar warts challenging to treat. This is my usual approach: Paring down warts on feet. Multiple rounds of cryotherapy every 4-6 weeks. Between cryotherapy sessions- use of topical 5-FU with 40-70% salicylic acid After 3 rounds of cryo- if still persistent- IL Cand...
What specific comorbidities do you routinely screen for, beyond food allergy, in a child with moderate-to-severe atopic dermatitis?
I routinely screen for psychosocial dysfunction in all my patients, which is especially important for those with significant symptoms like pruritus or pain impacting quality of life, as in children with moderate-to-severe atopic dermatitis. This screening specifically includes quality of sleep (whic...