Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Does your institution have formal policies or work flows to reduce unnecessary IGRAs ordered for patients on biologics?
We have developed a multi-specialty working group to implement this as a lot of unnecessary testing is getting done. This will include having a 2-3 question screening pre start of biologics, and then annually to asses risk, that we hope will be incorporated into the visit or an order set.
What protocol do you follow when performing staged excision with paraffin sections for the treatment of cutaneous melanoma?
Our surgical protocol is as follows: Place marking sutures at 12 and 6-o'clock on debulk, margins, and patient (more marking sutures if a big tumor). Take a central debulk with 1-3mm margins around visible tumor (+/- Woods lamp) for breadloaf sections. Depth of excision is down to superficial fat. ...
How effective is the use of genomic testing methods, such as tape strip tests, for assessing suspicious pigmented lesions in clinical practice?
A biopsy often gives a more definitive response. Thanks.
Is the phase 2 data regarding neoadjuvant cemiplimab in cutaneous squamous cell carcinoma sufficient to adopt for all patients or will you await phase 3 data?
The current data are quite compelling, but not sufficient to adopt for all patients. We need to see the long-term recurrence and survival rates from the phase II study and also perform a confirmatory phase III trial with a survival endpoint. Unless this treatment approach results in equivalent to im...
What's the best approach for severe calcinosis cutis in a patient with dermatomyositis who is unresponsive to diltiazem and colchicine?
Calcinosis cutis remains one of the most frustrating, typically recalcitrant manifestations of DM for both patients and physicians.Like Dr.@Dr. First Last, I also find that while there have been multiple case reports or small trials of various regimens published, the disappointing real-world variabi...
How do you treat a young patient with desmoplastic trichoepitheliomas?
I would biopsy to confirm the diagnosis, and then involve a Mohs surgeon.
What laboratory workup do you perform in patients with symptoms consistent with erythromelalgia?
The usual CBC with differential, as well as CRP, ANA, ESR, and Rheumatoid Factor.
How would you manage a scalp squamous cell carcinoma s/p Mohs with high risk features who underwent placental grafting to expedite the healing process?
When the plastic surgeon says it is safe to deliver radiotherapy, proceed.Clearly, the primary method used here in this case was surgery, so those physicians carry the water. What should be avoided is the situation where the skull becomes exposed, so the graft's health is important. Various systemic...
How do you approach management of patients with psoriatic arthritis who have significant improvement in skin disease, but ongoing inflammatory arthritis despite multiple DMARDs and/or biologics?
Psoriatic arthritis is a heterogeneous disease and often the severity of MSK involvement and psoriasis are not well correlated. This is also true regarding treatment response. The approach to management in these cases depends on several factors:Psoriasis type and severity: If the patient has mild ps...
How would you counsel a patient with systemic sclerosis who wants to consider microneedling on the face or other skin which is not clearly involved with scleroderma?
Microneedling is a cosmetic procedure that utilizes multiple small needles to create tiny holes in the skin that stimulate the skin’s own "healing process", which, entails the production of collagen and elastin. While regardless of the specific device used, it is considered a relatively safe procedu...