Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your approach for disease activity monitoring in patients with sarcoidosis?
Disease activity monitoring is useful in managing therapy and prognostication in sarcoidosis. Since the disease activity can vary across different organ systems, it can be a challenge. Broadly, good bio-markers of overall disease activity are lacking in this disease.ACE level lacks the sensitivity b...
What have you found to be effective for keratosis pilaris?
The best treatment for KP is time. With age KP improves on the face, forearms and legs during and after puberty. Natural oil production on the face is likely the reason for improvement in this area. Natural terminal hair growth on the legs/forearms likely improves KP in these areas. Posterior upper ...
What combinational therapies do you recommend for skin tightening that can be completed on the same day?
I often do a tightening procedure that has no downtime combined with a fractional resurfacing procedure that can improve the skin color, quality, and texture, and will often add in an IPL or Q-Switched alexandrite and pulsed dye/KTP laser for lentigines, to target vessels before the fractional laser...
How do you manage psoriasis in pregnant patients?
This really depends on the severity of the disease and the treatment resources available. I always would consider the use of topical corticosteroids if possible, of course. If this is not appropriate, a reasonable next choice would likely be UVB (broadband or narrowband) therapy, if that is accessib...
How do you counsel male patients with Androgenetic Alopecia who are trying to conceive about using oral or topical minoxidil?
No specific counseling. There is little evidence that it affects fertility.
Are there any contraindications to starting a patient on Dupixent for prurigo nodularis if the patient is already on Xolair for asthma?
No, and in fact, I have this combination in several patients.
What therapies have you found most helpful for recalcitrant non-infectious cases of folliculitis?
In my experience, noninfectious folliculitis can be complicated by superficial infections with skin organisms, herpes, or fungi so treatment will include a topical anti-microbial. The folliculitis can be triggered by fragrances in laundry products, irritation by coarse fabrics or occlusion. The prim...
What initial workup do you perform when there is a concern for porphyria?
This is a terrific question. But a broad question. Porphyria refers to a defect in heme biosynthesis leading to the accumulation of porphyrins and porphyrin precursors. We should remember that there are three general categories of porphyria based on clinical manifestations: acute hepatic porphyria (...
What treatments have you found most effective for cholestatic pruritus?
My experience is mainly in Sjogren's or Sjogren's with PBC, ursodiol has been effective. Occasionally, I have used hydroxyzine or H1+H2 blockers. In Sjogren's where the skin biopsy has shown significant lymphocytic infiltration, mycophenolate or a calcineurin inhibitor trial has lead to the resoluti...
What recommendations do you have for treatment-resistant Darier's Disease?
Low dose naltrexone, start in 1 mg and slowly increase to 5 mg pod.