Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you transition to a topical retinoid after a patient completes a course of isotretinoin?
Yes. I give them the RX and tell them to start 4-6 weeks after completing the isotret course. Most of my acne patients are adult females (my niche), so using the retinoid is integral for anti-aging. I also find it helpful with any leftover scarring or pigmentation. Choice of retinoids depends on ski...
How would you approach management of a patient with longstanding history of SLE, but having active psoriasis?
In addition to above, I would consider deucravicitinib. It has PASI75 scores that are in the 60s, and is in trials for SLE. Its phase 2 trials seemed promising. Other PO JAK inhibitors should be efficacious but may carry worse side effect profile. I have also employed PDE4 inhibitors such as po apre...
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...