Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you reassure families that no allergy testing is needed for urticaria?
I explain to them that it is an immunologic phenomenon (inside job) and not allergic (outside job).
Do you always pursue biopsy confirmation before diagnosing IgA vasculitis?
Technically, yes (by definition), but practically, not necessarily: Biopsy for direct immunofluorescence (DIF) testing would be required to confirm the status of IgA in cutaneous vasculitis. However, the presence of lesional IgA correlates positively with the clinical presentation (e.g., Henoch Schö...
When a pathology report shows SCC not connected to the epidermis, how often is this truly metastatic versus a sampling artifact, and do you routinely pursue full metastatic workup or referral in these cases?
Clinical correlation is always required, but, overall in my experience, partial samplings of SCC not connected to background epithelium in the tissue sections are more likely undermining extension of a primary tumor than metastasis, and the submitted clinical impression correlates with this. Perineu...
With emerging therapies, what is your general treatment ladder for chronic spontaneous urticaria (CSU)?
Antihistamines remain the first-line therapy for chronic spontaneous urticaria (CSU), and doses should be optimized before turning to other therapies. If patients fail a trial of adequately dosed first- and second-generation antihistamines, montelukast is a reasonable adjunct. For patients with high...
In a patient with high-risk cutaneous squamous cell carcinoma of the face with extracapsular extension after ipsilateral neck dissection and rapid contralateral cervical nodal recurrence, what is the optimal management?
In various published series, around half of patients fail to achieve a complete response to cemiplimab. From the clinical details, the current active area of disease appears to be the contralateral neck with no distant disease. Curative treatment is preferred. C-POST trial established surgery + adju...
In an elderly patient with limited transportation issues, is there a hypofractionated regimen you have found acceptable for a localized squamous cell carcinomas of the eyelid?
Assuming curative intent, treatment 55 Gy in 20 fx should do the job.
What therapies have you found most effective for JAK-induced/associated acne (JAKcne)?
Doxy will work quickly and is pretty safe. If all goes well, you can taper the dose of the oral antibiotic and use topical agents.
Why/How do patients report seeing flashes of light when receiving Pulsed Dye Light (PDL) treatments on the face?
Patients commonly report seeing flashes of light during pulsed dye laser treatments, especially on the face, although it happens even with proper eye protection. I typically will place an eye pad under the laser goggles for those patients more sensitive to the flashes. We understand the mechanism of...
What is your approach to managing moderate to severe atopic dermatitis in pregnancy?
Gentle skin care practices, dilute bleach baths, diligent use of topical steroids, and phototherapy will cover most moderate to severe cases. If patients have any persistent lichenified areas, intralesional steroids can help temporize until after delivery/lactation. If a biologic is needed, work wit...
What are your preferred treatment options for recalcitrant pemphigus vulgaris?
Rituximab, typically combined with short-term corticosteroids, is the preferred treatment for recalcitrant pemphigus vulgaris, demonstrating superior efficacy compared to conventional immunosuppressants. In patients with moderate-to-severe disease, rituximab achieved sustained complete remission in ...