Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What’s your approach to treating multiple facial BCCs in gorlin syndrome?
Patients get surgically exhausted, and often fearful of radiation or is not acceptable, I use twice weekly erivedge even with multiple comorbidities not only suppresses but often complete resolution of lesions. Intermittent dosing has a 12 day half-life and I take advantage of that.
How do you determine the need to biopsy subcutaneous nodules in infants to rule out Infantile myofibromatosis?
For most subcutaneous nodules in infants of unknown etiology, I would check an ultrasound with doppler first as deep infantile hemangioma and other vascular lesions may be on your differential. If it is not vascular, and small and stable in size, it may be OK to clinically monitor. One may also cons...
Do you incorporate laser hair removal into your treatment plan for patients with HS?
I utilize laser hair removal quite a bit for HS. I find it particularly helpful in early-ish disease. Once there is a lot of scarring and tunnels, it may not work as well, but you could still give it a try. For earlier diseases, it's a great way to stop the disease process. It seems to work really w...
What treatment regimen do you start for patients who present with mucous membrane pemphigoid?
The treatment plan for mucous membrane pemphigoid (MMP) is individualized based on the disease severity, medical comorbidities, patient preferences, and medication availability/cost. For severe MMP, yes, I commonly use the combination of Rituxan, IVIG along with high dose systemic corticosteroids (...
What therapies have you found most effective in providing rapid improvement in patients with erythrodermic atopic dermatitis?
For me, the most critical part of treating erythrodermic atopic dermatitis is making sure you have the correct diagnosis. While biopsies can be helpful, my pathology colleagues have told me it can be difficult to determine the diagnosis in the biopsy of an erythrodermic patient. Likewise, labs or hi...
What is your preferred topical retinoid for acne?
I generally start with tretinoin 0.025% cream as the first-line for acne. If the patient has a history of eczema or sensitive skin, then I would start with adapalene 0.1% gel/cream and then ramp up from there if they tolerate it for a few months without side effects.
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.