Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your experience with using dupilumab for alopecia areata?
Why would you use an unproven, off-label drug when there are proven and effective on-label drugs?
What would be your next step in management of a dermatomyositis patient on hydroxychloroquine and methotrexate whose skin is still active?
There are many different options for this kind of scenario. Depending on the physician's preference, patient's lifestyle, and insurance coverage, one could switch to mycophenolate, which seems to be more effective for skin manifestations, or azathioprine. If the patient did have a partial response t...
How do you decide between IL-4/IL-13 blockade (dupixent) versus IL-13 blockade only (Adbry) as treatments for Atopic Dermatitis?
First, disclosure that I work closely with all companies in the systemic atopic dermatitis space. The best data we have says that dupilumab is more effective at 16 weeks but that the drugs are equally effective at 32 weeks. The caveat is that there are no head-to-head trials, this is based on review...
What is your recommended dosing regimen for propranolol in treating an infantile hemangioma after the proliferative phase?
Generally, in most infants/toddlers that have infantile hemangiomas that are already in the involution phase, I do not start propranolol, but rather wait until the end of the involution phase and then consider PDL or surgery if needed, based on the location/size/appearance of the residual lesion. Pr...
When performing a closure with deeps then applying dermabond or glue, do you bill for a simple or intermediate closure?
Intermediate.
Can patients receive adjuvant radiation therapy after keloid excision without primary closure, or would radiation impede healing by secondary intention?
I have personally treated several patients where primary closure was not obtained due to the large size of the keloid (back and anterior mid-chest). Due to the limitation of raising a large flap around these regions to close the wound primarily and poor take rates of a skin flap, these resections we...
In a pregnant patient with scarring alopecia (LPP or CCCA), what treatment options are available?
For LPP, LLLT is a good option in pregnancy, also topical and intralesional steroids can be used. For a very severe case, I would discuss Plaquenil with her OGB. For CCCA, topical and intralesional steroids.
When do you refer pediatric patients with eczema to an allergist?
I refer concerns about immediate-type hypersensitivity symptoms (e.g. anaphylaxis, rhinitis, or asthma) to an allergist. Eczema is delayed-type hypersensitivity from contact with an inorganic or a protein allergen. Many dermatologists and allergists perform extended patch testing for these contribut...
How do you determine if a pyoderma gangrenosum lesion is “burned out"?
The first sign is it becomes much less exudative.
How do you approach cosmetic removals of labial melanocytic macules?
Patients respond incredibly well to Q-switched laser either 532 or 755. The picosecond laser is working equally well with these wavelengths. The lowest energy to cause some mild whitening is the endpoint. You can use long-pulse technologies as well, but my favorite is the short-pulsed technologies.