Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What’s your immediate post-procedure protocol for fractionated laser resurfacing (i.e., Sciton Pro-fractional Laser)?
My immediate post procedure protocol for fractionated laser resurfacing is to decrease stinging with the Zimmer chiller (approximately 10-30 minutes followed by the application of Vaseline. I have not seen significant pinpoint bleeding while treating acne scarring (Lumenis Encore laser) but have see...
What clinical criteria do you use to decide when to start oral nicotinamide for chemoprevention?
Consider oral nicotinamide (500 mg bid) for chemoprevention in patients with several non-melanoma skin cancers in the past 5 years or those with high-risk features such as extensive actinic damage or field cancerization. Studies show the strongest evidence for its use in immunocompetent patients wit...
In what situation would you recommend ipilimumab + nivolumab over relatlimab + nivolumab in the treatment of metastatic melanoma?
There is no clinical trial to provide a direct comparison between the two regimens, hence the answer to this question is usually driven by personal interpretation of the data and patient preference. The data for both regimens show a statistically significant PFS benefit and a superior response rate ...
How do you counsel patients regarding the improvement they can expect when starting nemolizumab?
I tell patients that this medicine is a relatively newly approved medication in dermatology, although we have had significant experience with it in veterinary medicine for years. I state that the benefits of this drug go beyond just improving itch and skin clearance, but also have a role in impactin...
In what circumstances would you recommend adjuvant radiation for a keratocanthoma with SCC after resection?
KA by itself (in the absence of SCC) is at the interface of benign and malignant. In a pure KA, if margins are negative, no further RT is needed. If there is SCC mixed, as can happen even with BCCs, the adjuvant RT indication rules pertaining to SCC prevail.
How should the results of the ADVOCATE trial be applied in AAV patients who receive rituximab induction and maintenance therapy?
The following answer was jointly drafted by Dr. Peter Merkel and Dr. David Jayne:The data from ADVOCATE indicate that patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) treated with avacopan 30 mg twice daily and prednisone placebo were able to achieve remission w...
What is your approach to prescribing JAK inhibitors in patients with alopecia areata who have a prior history of cutaneous malignancy, such as DFSP?
For something like DFSP, it would depend on how long it has been since their diagnosis, and a shared decision-making process with the patient. Close monitoring with skin checks would be recommended.
What’s your favorite topical OTC moisturizer that you recommend, and why?
There is no easy answer to this question as recommendations for moisturizers are quite patient and location specific and depend on degrees of dryness. The best moisturizer is one that feels good to the individual patient and is one that he/she will then use. For example, someone with mild facial dry...
What is your approach to management of patients with recurrent orolabial herpes?
Recurrent orolabial herpes is fundamentally a disease of viral latency with episodic reactivation, so my approach focuses less on “treating infection” and more on reducing recurrence burden, shortening symptom duration, and improving quality of life. First, I make sure we are actually dealing with H...
In patients treated with infliximab, do rates of immunogenicity vary based on underlying disease (RA, IBD, sarcoidosis, etc) and/or baseline disease activity?
Yes, rates of infliximab immunogenicity appear to vary based on underlying disease, with evidence showing higher rates for RA than IBD and spondyloarthritis, and tend to increase with higher baseline disease activity. Most patients tend to develop anti-drug antibodies within the first year, but this...