Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Have you seen CD30+ lymphoproliferative skin lesions with Upadacitinib treatment of atopic dermatitis?
I have seen this occur in the setting of atopic dermatitis in one instance with a patient on dupilumab who developed head and neck CD30+ disease. It is certainly possible with upadacitinib but I think most if not all cases of CTCL in the setting of AD were always CTCL from the beginning and just mis...
In what clinical scenarios do you consider pre- or post-treatment with Imiquimod for cutaneous melanoma?
In short, never. I can think of hypothetical situations but in reality I've never done it. I do Mohs for melanoma on the head and neck so no need for adjuvant imiquimod ("out is out"). For melanomas of trunk or extremities, I use WLE. In the rare case of positive margins after excision, I would then...
Will you offer patients urea-based creams or topical diclofenac for hand-foot prophylaxis with capecitabine after the D-TORCH trial results?
This study was presented at ASCO, Abstract 12005. Patients with breast or GI cancers treated with single agent capecitabine (1,000 mg/m2 bid) were randomized to treatment with prophylactic diclofenac cream bid x 12 weeks vs placebo. Primary endpoint was incidence of grade 2 or greater HFS. HR for th...
What clinical outcomes or measures of success do you prioritize in your patients with ichthyosis?
Control of ichthyosis is important to ensure quality of life issues associated with comfort, scale, insensible water loss, and clinical appearance. Control of dryness, pruritus, and pain is important to allow for quality of life issues, too. This requires important collaboration with family and the ...
What is your preferred radiotherapy regimen for palliative treatment of cutaneous T cell lymphoma?
Cutaneous T-cell lymphomas (CTCLs) comprise numerous distinct entities in the WHO classification of hematologic malignancies. The most common CTCL is mycosis fungoides (MF) followed by primary cutaneous anaplastic large cell lymphoma. As with most hematologic malignancies, both diseases are particul...
What is your treatment approach to non-uremic calciphylaxis?
Assess renal function since renal failure can be associated with elevated calcium that can trigger calciphylaxis. Assessment of parathyroid hormone and vitamin D can also be associated with similar findings.
What are some practical tips for caring for resource-limited patients with severe, Hurley Stage III hidradenitis suppurativa?
HS can be a really expensive disease, so this is a great topic. For wound care, ordering gauze and supplies through Amazon can be a big savings. Hidrawear, clothing made to hold bandages for HS, can also be covered by insurance. If you need order forms, you can reach out to the company www.hidrawear...
When do you recommend SRT, if ever, for small SCCs and BCCs?
SRT is a highly effective treatment for superficial radiation therapy. What is alarming is the use of daily US guidance for something we can visualize with our eyes. With electrons, I’ve never heard of anyone using image guidance. With SRT, the request for daily image guidance is routinely requested...
What is the maximum dose or treatment course of topical steroids that you generally recommend to avoid causing systemic adverse effects?
Topical steroids cause essentially no systemic AEs. Dosing is limited by local AEs.
Do you increase the frequency of hemodialysis for patients with calciphylaxis?
Optimally I would: Stop or change warfarin Stop any Vit D or analogs Dialyze on lower Ca Bath (dialysate) Stop CA-based PO4 binders Give Vit K Increase the frequency of HD Give sodium thiosulfate as tolerated by patient's [HCO3] but I would prefer to increase HD than cut the dose