Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatment options would you recommend for a patient with severe generalized pustular psoriasis who has a history of colon cancer (s/p chemotherapy) and well-controlled HIV?
I'd feel comfortable doing an IL17 or IL23. Bimekizumab would be my first choice with it's higher efficacy with almost all types of psoriasis. There's also a small dataset showing it worked quite well for GPP in a subset of japanese patients. IL36 is my favorite drug for GPP but I'm not aware of an...
How would you manage active psoriasis and psoriatic arthritis in patient on Rituximab and prednisone for MPO positive vasculitis?
The answer is it depends on several factors, the most important being how severe the psoriasis is and if the patient has axial involvement. Since the patient has failed or not responded to methotrexate or apremilast, adding these would not be an option here.While we do not have much data on combinat...
What is your treatment approach for hidradenitis suppurativa?
In HS, we talk about a "window of opportunity." It's the idea that since HS causes tissue damage, scarring, and tunneling, treatment becomes more difficult as the disease progresses. A delay of 10 years between symptom onset and starting adalimumab was associated with a 1.92x higher odds that the pa...
What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?
My approach has been: Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they re...
When is mechlorethamine better than more common treatments like light therapy and topical steroids for mycosis fungoides?
Topical mechlorethamine and light therapy are both treatment options for mycosis fungoides, but they have different advantages and disadvantages depending on the patient's individual history and circumstances. Topical steroids are rarely used alone as their long-term use results in skin damage (skin...
How has the recently FDA-approved topical cantharidin altered your molluscum treatment algorithm?
I recommend the use of topical cantharidin on a limited number of lesions, since the blistering can be painful especially in young children. Moreover, by treating a few lesions you may trigger an immunologic reaction that results in spontaneous resolution of untreated lesions as well. Moreover, we p...
How would you sequence lifileucel (TIL therapy) in a patient with metastatic melanoma who is BRAF wild-type (BRAF WT) and progressed on adjuvant Nivolumab?
The FDA-approved label for Amtagvi is for BRAF wild-type metastatic melanoma patients who progressed following anti-PD-1 containing immune checkpoint therapy. Thus, progression following ipi/nivo would certainly meet the indication for TIL therapy. What you will have to assess though is whether the ...
What systemic therapy would you offer a patient with metastatic melanoma who is BRAF WT and developed metastases while on adjuvant nivolumab?
Adding an anti-CTLA4 agent after progression on anti-PD1 (even in the adjuvant setting) should be a reasonable choice for patients who are ineligible for clinical trials. In our practice, we recommend using the CheckMate 067 dose (Ipi 3 and Nivo 1) when faced with such a situation. Zimmer et al., PM...
What treatment would you offer a patient with extensive lymphangioma circumscriptum intermittently covering the entire abdomen?
I would consider sirolimus (rapamycin) to shrink the lesion to a size that could be surgically excised.
Have you come across JAK treatment failure in severe alopecia areata?
I’ve considered Dupilumab, but first try to switch the JAK inhibitor, add minoxidil if not already on it, and add some type of steroid, less often systemic.