Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What work up do you pursue for splinter hemorrhages in an otherwise healthy patient?
I would take a good history, ask for a thorough review of systems, review their medications, etc., and do a physical exam to rule out signs of a systemic illness. The workup (for endocarditis, etc.) can be directed by those findings, if present. Otherwise, the most common cause of splinter hemorrhag...
How do you manage polymorphic light eruption (PMLE)?
It depends on the severity and frequency of the case but typically: strict photoprotection with sunscreen, UPF clothing, etc., topical steroids bid starting the day before planned sun exposure and continuing for a week or two, intermittent prednisone course (best for my patients who flare the same ...
What exfoliative regimen do you recommend for patients with recurrent plantar keratoderma?
Keratolytics are my go-to for keratodermas, particularly urea 40% or ammonium lactate. You can also have salicyclic acid compounded with propylene glycol, although I have rarely had to do this. For certain patients, it is helpful to soak the feet for 10-15 minutes, file down areas with a pumice ston...
What treatment modalities have you had success with for treating recalcitrant warts?
More than digital warts, I find plantar warts challenging to treat. This is my usual approach: Paring down warts on feet. Multiple rounds of cryotherapy every 4-6 weeks. Between cryotherapy sessions- use of topical 5-FU with 40-70% salicylic acid After 3 rounds of cryo- if still persistent- IL Cand...
What are your favorite billing tips for EM and CPT codes that you wish you knew earlier in your career?
I learned that dermatologists report E/M codes along with a procedure code more frequently than any other specialty. We need to appropriately justify the E/M billing in the patient record. It is imperative to know what is included in every procedure code, as each procedure contains some inherent E/M...
What is your approach for disease activity monitoring in patients with sarcoidosis?
Disease activity monitoring is useful in managing therapy and prognostication in sarcoidosis. Since the disease activity can vary across different organ systems, it can be a challenge. Broadly, good bio-markers of overall disease activity are lacking in this disease.ACE level lacks the sensitivity b...
What have you found to be effective for keratosis pilaris?
The best treatment for KP is time. With age KP improves on the face, forearms and legs during and after puberty. Natural oil production on the face is likely the reason for improvement in this area. Natural terminal hair growth on the legs/forearms likely improves KP in these areas. Posterior upper ...
What combinational therapies do you recommend for skin tightening that can be completed on the same day?
I often do a tightening procedure that has no downtime combined with a fractional resurfacing procedure that can improve the skin color, quality, and texture, and will often add in an IPL or Q-Switched alexandrite and pulsed dye/KTP laser for lentigines, to target vessels before the fractional laser...
How do you manage psoriasis in pregnant patients?
This really depends on the severity of the disease and the treatment resources available. I always would consider the use of topical corticosteroids if possible, of course. If this is not appropriate, a reasonable next choice would likely be UVB (broadband or narrowband) therapy, if that is accessib...
How do you counsel male patients with Androgenetic Alopecia who are trying to conceive about using oral or topical minoxidil?
No specific counseling. There is little evidence that it affects fertility.