Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What scented alternatives do you recommend patients with fragrance allergies try to replace perfumes/colognes?
My approach is to initially advise for the first 3 months a strict personal care “product elimination diet” free of fragrances, botanicals, and essential oils for patients who test positive to fragrance-related allergens. “Product elimination diet” is a term coined by expert Canadian dermatologist S...
Is narrow-band ultraviolet B (nbUVB) phototherapy contraindicated or recommended with caution in patients with a personal history of melanoma?
Although it is challenging to be definitive, our current literature suggests that nbUVB does not increase the risk of melanoma or nonmelanoma skin cancer.Previous studies suggesting a possible increased risk with nbUVB included patients with a history of PUVA, which has been shown to increase risk. ...
Do you discontinue IL-17A, IL-17A/F, or IL-23 blockade in pregnant patients with psoriasis?
I always give my patients the option of discontinuing but put it in perspective. For the most part, my patients do end up stopping, with the plan to restart after delivery. We discuss a few topics: Pregnancy doesn't tend to worsen psoriasis in general, in fact in many patients, it gets better. It i...
Do you feel PRP is effective in treating androgenetic alopecia?
PRP is an excellent adjunct to medical care. The best response happens in younger patients who have had alopecia for a shorter time interval. I use it most often in androgenetic alopecia although some use it in cases of scarring alopecia. I typically do one session every month for 3 months, then mai...
For how long would you treat Klebsiella aerogenes folliculitis of the face manifesting as a cystic lesion?
My recommendation would be to treat for 7-10 days. It is more typical to see gram-positive organisms causing facial folliculitis so I would choose an antimicrobial that has gram-positive coverage as well if possible, based on sensitivity. Additionally, I would ask the patient (if male, to change to ...
How do you weigh the risks of intraocular eye shields when performing CO2 laser to the eyelids and periocular area?
Eye shields should always be used in such situations.
What treatment regime would you recommend for localized hyperhidrosis affecting the scalp that has failed topical aluminum chloride and oral glycopyrrolate?
I have personally found that oxybutinin is more effective than glycopyrrolate with fewer anticholinergic side effects.
Do you pursue a cardiac evaluation in all patients with an excised cutaneous myxoma?
I'm a dermatopathologist, not a clinician, but would note the following data points: Many things are called myxomas. Those associated with Carney complex, in which atrial myxomas also occur, are a specific variant, superficial angiomyxomas. They usually have inactivation of protein kinase regulator...
What is your experience with using oral deucravacitinib off label for conditions such as recalcitrant facial discoid lupus or recalcitrant lichen planus?
This is an excellent question and importantly highlights the potential for newer therapies to help treat challenging diseases with few if any FDA approved options. In the case of DLE, I have found deucravacitinib to be a good option, sometimes as monotherapy or perhaps in conjunction with other topi...
Do you transition to a topical retinoid after a patient completes a course of isotretinoin?
Yes. I give them the RX and tell them to start 4-6 weeks after completing the isotret course. Most of my acne patients are adult females (my niche), so using the retinoid is integral for anti-aging. I also find it helpful with any leftover scarring or pigmentation. Choice of retinoids depends on ski...