Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you treat a young patient with desmoplastic trichoepitheliomas?
I would biopsy to confirm the diagnosis, and then involve a Mohs surgeon.
What laboratory workup do you perform in patients with symptoms consistent with erythromelalgia?
The usual CBC with differential, as well as CRP, ANA, ESR, and Rheumatoid Factor.
How would you manage a scalp squamous cell carcinoma s/p Mohs with high risk features who underwent placental grafting to expedite the healing process?
When the plastic surgeon says it is safe to deliver radiotherapy, proceed.Clearly, the primary method used here in this case was surgery, so those physicians carry the water. What should be avoided is the situation where the skull becomes exposed, so the graft's health is important. Various systemic...
How do you approach management of patients with psoriatic arthritis who have significant improvement in skin disease, but ongoing inflammatory arthritis despite multiple DMARDs and/or biologics?
Psoriatic arthritis is a heterogeneous disease and often the severity of MSK involvement and psoriasis are not well correlated. This is also true regarding treatment response. The approach to management in these cases depends on several factors:Psoriasis type and severity: If the patient has mild ps...
How would you counsel a patient with systemic sclerosis who wants to consider microneedling on the face or other skin which is not clearly involved with scleroderma?
Microneedling is a cosmetic procedure that utilizes multiple small needles to create tiny holes in the skin that stimulate the skin’s own "healing process", which, entails the production of collagen and elastin. While regardless of the specific device used, it is considered a relatively safe procedu...
How would you treat a basal cell carcinoma on the temporal skin and zygomatic area s/p excision with PNI and significant flaps for closure?
This case is a challenge as it is not clear what the indication for PORT is. Margin status is important, so discuss with the surgeon, and if positive, can a repeat resection occur, likely not given the presence of the flaps, however. The guidelines from 2019 are a neat and logical review that establ...
What treatment options would you recommend for a patient with severe generalized pustular psoriasis who has a history of colon cancer (s/p chemotherapy) and well-controlled HIV?
I'd feel comfortable doing an IL17 or IL23. Bimekizumab would be my first choice with it's higher efficacy with almost all types of psoriasis. There's also a small dataset showing it worked quite well for GPP in a subset of japanese patients. IL36 is my favorite drug for GPP but I'm not aware of an...
How would you manage active psoriasis and psoriatic arthritis in patient on Rituximab and prednisone for MPO positive vasculitis?
The answer is it depends on several factors, the most important being how severe the psoriasis is and if the patient has axial involvement. Since the patient has failed or not responded to methotrexate or apremilast, adding these would not be an option here.While we do not have much data on combinat...
What is your treatment approach for hidradenitis suppurativa?
In HS, we talk about a "window of opportunity." It's the idea that since HS causes tissue damage, scarring, and tunneling, treatment becomes more difficult as the disease progresses. A delay of 10 years between symptom onset and starting adalimumab was associated with a 1.92x higher odds that the pa...
What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?
My approach has been: Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they re...