Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you manage alopecia areata in children with >50% of hair loss that is unresponsive to intralesional or topical steroids?
Treatment typically varies depending on the age of the child and the impact on the child's quality of life. Some options include adding topical minoxidil or compounded topical JAK inhibitors such as topical tofacitinib. In more severe cases, I offer oral minoxidil, monthly pulse prednisone, systemic...
How do you counsel male patients with Androgenetic Alopecia who are trying to conceive about using dutasteride or finasteride?
I advise against dutasteride for those trying to conceive or who might have unprotected intercourse with pregnant women since dutasteride is in the semen. For 5 alpha-reductase inhibitors in general, the effects on sperm count and sperm motility are very well characterized. There is a reduction in s...
Is there a role for patients who have a strong familial history of HS to receive a genetics evaluation or referral to clinical trials?
Unfortunately, there isn't yet a genetic test to determine the risk of HS. There are multiple centers working on genome-wide association studies looking for genetic markers. You can refer any HS patient to participate in those trials. Here are links to some of those studies: Chicago: NCT05710393 Sa...
How would you approach treating patients with biopsy-proven Hailey-Hailey disease refractory to multiple oral therapies (i.e. tetracyclines, naltrexone, apremilast, glycopyrrolate, Cellcept), and requiring monthly steroid tapers for disease flares?
I find Hailey-Hailey so challenging and so I often do throw the kitchen sink. Additional options behind what you mentioned include low-dose superficial XRT (recently reviewed in JAMA Dermatology), botulinum toxin, dupilumab, and oral jak inhibitors. My personal approach to those who respond to predn...
What role does oral roflumilast play in dermatology?
Cheap alternative to otezla for when insurance won't pay. Only about $20 with goodrx. Similar side effect profile.
How have you incorporated biologics targeting the IL-36 pathway (e.g. Spevigo) into your treatment algorithm for psoriasis?
I would use Spevigo for generalized pustular psoriasis. For more common forms of psoriasis, I prescribe biologics approved for plaque-type psoriasis.
How do you approach ongoing screening for TB in patients with a history of treated latent TB, but who have ongoing use of DMARDs and/or biologics given Quantiferon testing and PPD can remain positive?
Interferon-release assays (such as Quantiferon) and PPD testing do not discriminate between infection, reinfection, and prior infection with TB. However, in most developed countries, the likelihood that a patient who has once been treated for LTBI becomes reinfected and develops LTBI again is low, i...
What is your approach to managing pyoderma gangrenosum recalcitrant to oral steroids?
Pyoderma gangrenosum is notoriously difficult to treat. The first thing I'd recommend in a case refractory to steroids is to reconsider the diagnosis. Notably, a high percentage of PG is misdiagnosed, so lack of response may indicate that you are dealing with a mimicker (e.g., infection, neoplasm, v...
How have you incorporated LED light therapies in your practice?
High quality evidence is nearly nonexistent, thus I have not incorporated this into my practice.
What is your approach to treating patients with chronically brittle nails?
Brittle nails is a relatively common condition, but pathophysiology of this nail condition is poorly understood. Thus, there is limited clinical trial data of treatments. Inflammatory, infectious, and systemic and traumatic conditions should be ruled in/out before starting treatment. For all patient...