Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your approach for severe SCLE in patients unable to tolerate HCQ?
30% of subacute cutaneous lupus erythematosus (SCLE) is worsened by or caused by drugs, especially PPIs, calcium channel blockers (CCBs), thiazides, minocycline, and anti-fungal meds. Very different from other drug-induced disorders, the culprit drug could have been started months to years (as long...
How do you approach a patient with stoma bag adhesive allergic contact dermatitis?
To keep the area dry, I have patients use Cavilon spray and Skins, an antimicrobial spray.
What dosing range of spironolactone do you prescribe for hormonal acne?
I most commonly prescribe 50-100mg daily, but I may titrate up to 150mg occasionally as needed. I prefer QAM dosing to minimize diuresis in the evening. I find that starting at 25mg and up-titrating by 25mg weekly leads to better tolerability, especially when it comes to orthostasis and dizziness.
How do you manage perineural inflammation when encountered on Mohs?
Chronic inflammatory cell (lymphocytes, histiocytes) perineural inflammation is a sign of potential perineural invasion nearby. If there is perineural invasion elsewhere on Mohs sections, one should be particularly wary of chronic perineural inflammation and consequently carefully examine multiple s...
How often do you pursue malignant transformation screening In patients with lymphomatoid papulosis or pityriasis lichenoides?
In the case of patients with lymphomatoid papulosis (LyP) or pityriasis lichenoides, regular follow-up and monitoring for signs of malignant transformation is important, given the potential (though generally low) risk of progression to lymphoma, especially cutaneous T-cell lymphoma. For LyP, follow-...
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...