Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are the benefits and potential risks of using bisphosphonates for pseudoxanthoma elasticum?
There are not a lot of data regarding the use of bisphosphonates in pseudoxanthoma elasticum (PXE). The major pathogenic event in PXE is ectopic mineralization of elastic tissue in middle-size arteries, Bruch’s membrane of the choroid (predisposing to choroidal neovascularization and retinal bleeds ...
How would you approach management of a young male patient with discoid lupus who has had minimal response to hydroxychloroquine (and subtherapeutic whole blood levels) who continues to use tobacco products?
First, is he taking his HCQ (55% chance he is not)? Check a trough whole blood HCQ drug level and you want it to be 1000 - 1200 ng/mL (that is my goal in uncontrolled lupus; 750 - 1200 is fine in lupus under remission per Garg et al., PMID 37667434). Thanks, @Dr. First Last for reminding me. :-) Wh...
How long can you continue chronic low dose isotretinoin for refractory acne or other conditions?
I agree that there is not a time limit for the use of low-dose, long-term isotretinoin for the treatment of refractory acne or other conditions, but monitoring issues need to be considered. If dosing is intermittent, then minimal monitoring is required (an annual check of standard labs is probably f...
How do you manage inflammatory post filler nodules?
My approach to inflammatory nodules from HA filler will depend on several factors. Assuming these are delayed nodules (developed one to three months after HA placement), I’ll question the patient on a few issues. First, has this ever happened before? Often a patient will give a history of having sma...
How do you approach preventing and treating bruising after filler injections?
Prevention is to discontinue anything that thins blood prior (e.g., turmeric, garlic, alcohol, etc. that is reasonable). However, do not discontinue meds for medical reasons such as anticoagulants for Afib, etc. Bruising can be variable, sometimes none, other times severe, just based on the patient...
What goes into your decision making when deciding between superficial radiation and Mohs surgery for cutaneous squamous cell carcinoma of the head and neck?
When it comes down to deciding between surgical resection and definitive radiotherapy for well-differentiated, non-melanomatous skin malignancies, my simple rule of thumb is: While surgery may be the gold standard, whenever the post-operative cosmetic or functional sequelae are perceived to be poten...
What is your approach to treating patients with melasma that does not respond to hydroquinone-based topical therapies?
This is my Melasma algorithm: Hydroquinone triple cream qhs x 6 months + azelaic acid in the AM + tinted sunscreen Consider PO TXA (half of 650 mg tab bid), polypodium leucotomos bid (heliocare) Maintenance: stop hydroquinone and switch to compounded TXA/kojic/tretinoin combo cream qhs + vitamin C/...
What topical and oral therapies do you prescribe for patients with recalcitrant melasma?
This is my Melasma algorithm: Hydroquinone triple cream qhs x 6 months + azelaic acid in the AM + tinted sunscreen Consider PO TXA (half of 650 mg tab bid), polypodium leucotomos bid (heliocare) Maintenance: stop hydroquinone and switch to compounded TXA/kojic/tretinoin combo cream qhs + vitamin C/...
How are you utilizing vibratory devices for reducing pain associated with injection or procedures?
Specifically for intra-articular/bursal/tenosynovial/carpal tunnel injections: Our office purchased the vibration distraction devices over a decade ago based upon the promising use from the pediatric literature. Our providers were underwhelmed with their use in our adult patients and we all stopped ...
What alternative therapies do you recommend for botox non-responders?
For non-responders, I recommend waiting longer between injection sessions, trying different brands especially those with less protein associated with them such as Xeomin which has the least amount of protein, and therefore, less likely to trigger the development of neutralizing antibodies. In some c...