Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What laser and topical therapies have you found to be most effective for post-inflammatory hyperpigmentation from acne?
While the most important issue is to mitigate and reduce the active acne, but once that has been performed, 1 can use a combination hydroquinone, retinoid cream, tend to avoid steroids with the acne. Also very gentle fractional 1927 nm lasers can be used as well as laser toning with a pico second or...
Are there situations in which you treat calcinosis cutis that is not symptomatic for the patient?
There is NO treatment for either the prevention of calcinosis or the dissolution of calcinosis. Every 5-10 years over the past 40 years there have been potential treatments but none have been confirmed. I do not use anything specific for the asymptomatic patient. I do rarely recommend surgery by an ...
How would you approach management of a patient with rapidly progressive systemic sclerosis with worsening skin disease, myositis, arthritis, dysphagia and failure to thrive developing within 6 months?
This is a unique subset of patients with very aggressive disease and high risk for poor outcomes with myopathy, poor GI dysmotility, at risk for early PH. We tend to treat them aggressively. I would consider rapid escalation of immunosuppression such as MMF and consider IVIG up front as well, especi...
How do you manage patients with bullous pemphigoid who have IgE autoantibodies to BP180?
40% of patients with BP can have IgE class autoantibodies directed against BP. Treatment does not have to differ from patients without IgE class autoantibodies: for mild or localized disease or in patients who cannot tolerate immunosuppression, doxycycline and high potency topical steroids can be us...
Any concern for lupus flare in patients undergoing laser hair removal?
Great question - no there is little concern for this because LHR wavelengths are not in the ultraviolet spectrum which is known to spark SLE flares. Even narrow-band UVB (phototherapy) has been used in SLE patients without much issue, however, this is controversial and some feel that depending on th...
What recommendations do you provide to patients with sensitive skin that can not tolerate retinoids more than a few times per week?
Our studies showed sensitive skin is mostly the result of a compromised stratum corneum. Microfissures provide channels allowing access to the underlying vulnerable epidermal epithelium. In the past, these patients were very difficult. Low doses of tretinoin partially encapsulated in microsponges we...
What treatments do you recommend and how do you counsel patients with postpartum hair loss?
I start with reassuring that it's fairly common to experience excessive hair shedding after pregnancy, about 3-6 months postpartum and usually peaking at about 4 months after giving birth. I counsel that many patients regain their normal hair growth over time, without any treatment. However, if they...
Do you typically categorize keratoacanthomas as a distinct entity from squamous cell carcinomas, and do you favor medical treatment vs surgery?
I consider keratoacanthoma (KA) to be a well-differentiated, low-risk subtype of squamous cell carcinoma (SCC). I will counsel patients on the risks and benefits of medical treatment and surgical treatment. There are several factors to consider such as patient age, location and size of the lesion, a...
What recommendations do you provide to isotretinoin patients about delaying cosmetic procedures (lasers, fillers, botox) once they have reached their goal dose?
We basically perform any and laser procedures, even when patients are on isotretinoin if it is appropriate as far as the indication. We do tend to wait for 3 to 4 months for ablative fractional treatments, but all other treatments, such as hair removal, pigment removal, and vascular laser removal, a...
How do you differentiate atopic dermatitis from mycosis fungoides histologically?
Differentiating mycosis fungoides from any spongiotic process (atopic dermatitis, allergic contact dermatitis, etc.) is extremely difficult and typically requires correlation with clinical features and sometimes molecular findings. Some features that favor mycosis fungoides are: Lymphocytic exocyto...