Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you counsel patients who inquire about benzene exposure and carcinogenic risk from BPO containing acne and rosacea products?
This question is easier to answer after this recent report from the FDA: Limited number of voluntary recalls initiated after FDA testing of acne products for benzene; findings show a small number of products with elevated levels of benzene contamination It supports the overall safety of BP. More t...
How long can a patient with newly diagnosed merkel cell carcinoma wait for wide local excision with sentinel node biopsy?
A recent study I read on this same question regarding sentinel node biopsy (SNB) performed after melanoma wide excision found that the sentinel node could still be found just fine. And I have found that in practice a number of times when I wide-excised obvious melanomas at first presentation visit. ...
How would you approach the treatment of an SLE patient with refractory mucocutaneous ulcerations and lichenoid skin eruption despite treatment with MMF, Aza, Benlysta, Saphnelo, Rituximab, and JAK inhibitors?
This is an interesting case and the co-occurrence of SLE and Crohn's disease is rare but not unprecedented. The first issue is if the mucocutaneous lesions are related to SLE or the IBD and oral lesions are well described in Crohn's disease. Second, although cutaneous manifestations of Crohn's disea...
What biologics would you use in a patient with rheumatoid arthritis who developed multiple basal cell carcinomas requiring Mohs surgery while on a TNF-inhibitor and did not respond to rituximab?
It would be a discussion with the patient about risks and benefits if the RA is well controlled on a TNF-inhibitor. If the patient wanted to switch, I'd consider switching to an IL-6R inhibitor like tocilizumab or sarilumab.
What considerations do you take when using prednisone in patients with systemic sclerosis?
We tend to have a very high threshold for using systemic steroids in patients with systemic sclerosis and when we do, we try to limit it to less than 15 mg/day of prednisone. There is no clear evidence that it improves or slows down disease activity/progression even in the very early inflammatory ("...
How do you counsel patients with alopecia on the timing of response and what sort of outcomes they should expect with JAK inhibitors?
Hair growth can begin within three months but sometimes is delayed and some patients do not respond. Regrowth is often patchy at first. Good responders can expect full regrowth, but there are also partial responders and non-responders.
How do you utilize JAK inhibitors for alopecia in the pediatric population?
There is little difference about counseling between adolescents (lowest age group approved) and adults, but the greater concern is really understanding the risks, especially given that the lifetime duration on the medication is likely going to be longer in an adolescent vs an adult -- and we know th...
What are the indications for adjuvant radiotherapy for basal cell carcinoma of the skin of the head and neck?
I rarely give adjuvant radiotherapy for resected BCCs because there is little data demonstrating a benefit. For BCCs, with squamous features or nodal metastases, I generally manage as a cSCC. Some reasons to consider adjuvant RT to resected BCC primary tumor might be: -T3/T4 primary (by AJCC 7) -R2 ...
What is your treatment approach to prevent progression of phymatous rosacea?
Isotretinoin has definitely been the gold standard at our office to shrink/slow the growth of the sebaceous glands. However, Monopolar RF (i.e. Agnes RF) can also selectively target and ablate sebaceous glands while minimizing epidermal damage if the goal is sebaceous control rather than dermaplanin...
How do you screen alopecia patients to determine whether they are appropriate candidates for JAK inhibitors?
Factors that have to be taken into account when considering a JAK inhibitor include but are not limited to age, past medical history (particularly smoking, cardiac risk factors, cancer, thrombosis), and the emotional toll of the alopecia on the patient. I have an informational handout on the use of ...