Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Does IVIG or subcutaneous Ig interfere with monoclonal antibody therapy (i.e. dupilumab, infliximab, rituximab, etc)?
I definitely agree with Dr. @Dr. First Last concerns. For what it’s worth, I use a lot of IVIG in combination with monoclonal medications in my myositis clinic, and have anecdotally noted multiple instances in which I feel that the efficacy of one of those monoclonals seems to have been worse when t...
How would you manage a patient with Takayasu arteritis controlled on TNFi who develops erythema nodosum that is only partially responsive to NSAIDs?
Erythema nodosum and pyoderma gangrenosum (as well as erythema induratum) are well recognized as cutaneous manifestations of TAK. Unfortunately, we do not know how often cutaneous and the vascular disease are decoupled from each other due to a lack of available data. Most case series document associ...
How do you dose oral tranexamic acid for melasma?
I typically do 325 mg BID (1/2 tab of 650mg) during May-Sept then off in the winter. Double layer of sunscreen: chemical then mineral over it. Two favorites are La Roche Posay Cooling Water Lotion SPF60 then Eucerin Sensitive Mineral Agave SPF35 over that every morning regardless of the days activit...
What treatment method do you prefer for the cosmetic removal of benign pigmented moles?
We usually do shave removal, excision or punch excision and send for pathology.
What scented alternatives do you recommend patients with fragrance allergies try to replace perfumes/colognes?
My approach is to initially advise for the first 3 months a strict personal care “product elimination diet” free of fragrances, botanicals, and essential oils for patients who test positive to fragrance-related allergens. “Product elimination diet” is a term coined by expert Canadian dermatologist S...
Is narrow-band ultraviolet B (nbUVB) phototherapy contraindicated or recommended with caution in patients with a personal history of melanoma?
Although it is challenging to be definitive, our current literature suggests that nbUVB does not increase the risk of melanoma or nonmelanoma skin cancer.Previous studies suggesting a possible increased risk with nbUVB included patients with a history of PUVA, which has been shown to increase risk. ...
Do you discontinue IL-17A, IL-17A/F, or IL-23 blockade in pregnant patients with psoriasis?
I always give my patients the option of discontinuing but put it in perspective. For the most part, my patients do end up stopping, with the plan to restart after delivery. We discuss a few topics: Pregnancy doesn't tend to worsen psoriasis in general, in fact in many patients, it gets better. It i...
Do you feel PRP is effective in treating androgenetic alopecia?
PRP is an excellent adjunct to medical care. The best response happens in younger patients who have had alopecia for a shorter time interval. I use it most often in androgenetic alopecia although some use it in cases of scarring alopecia. I typically do one session every month for 3 months, then mai...
For how long would you treat Klebsiella aerogenes folliculitis of the face manifesting as a cystic lesion?
My recommendation would be to treat for 7-10 days. It is more typical to see gram-positive organisms causing facial folliculitis so I would choose an antimicrobial that has gram-positive coverage as well if possible, based on sensitivity. Additionally, I would ask the patient (if male, to change to ...
How do you weigh the risks of intraocular eye shields when performing CO2 laser to the eyelids and periocular area?
Eye shields should always be used in such situations.