Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you manage patients with erosive pustular dermatosis?
First of all, it is very important not to miss underlying squamous cell carcinoma in cases labeled with erosive pustular dermatosis. I diagnosed moderately to poorly differentiated squamous cell carcinoma underneath the crusts in a couple of patients with known erosive pustular dermatosis of the sca...
What have you found more effective, blue-light or red-light photodynamic therapy (PDT) in treating AKs or NMSCs?
Need to say what you are treating.
How do you approach managing perioperative anxiety in Mohs patients?
Great question. Music, stress balls, having your team engage in conversations with the patient, and other distraction techniques are helpful. Some patients may need medications such as Halcion to help with anxiety but this should be given after the patient signs consent and has a verified driver aft...
Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?
This is a very good question with direct clinical practice implications. I do not check or follow anti-drug antibodies when using TNF inhibitors for the treatment of rheumatoid arthritis or psoriatic arthritis. There are reports that suggest, on a group level, that these antibodies, if present, impa...
What therapies have you found most effective for managing patients with Darier disease?
Because of the amazing bench-to-bedside paper below, my most severe Darier's patient started on an IL17 inhibitor, and it is the closest thing I've seen to a miracle in ages. She was refractory to everything we tried, and is now 80+% clear. What a joy to see science change people's lives!Ettinger et...
How do you manage cannabinoids (ex: medicinal, recreational) in dermatology?
I use dronabinol 2.5-10 mg qd-tid for recalcitrant pruritus (typically neuropathic or CPUO as an adjunct treatment). Very cheap using GoodRx if not covered by insurance. It’s a scheduled drug, so it requires DEA, but you don’t need a “medical marijuana license,” and it’s very well tolerated outside ...
How should the use of the DecisionDx-Melanoma test be integrated into clinical practice to potentially avoid sentinel lymph node biopsy?
At this time, DecisionDx should be used as an extra piece of molecular information, not for clinical decision-making. The study done on DecisionDx was mainly retrospective, not prospective, so it has limited value in guiding patient care at this time. I would base your decision on SLBx on the curren...
Do you typically excise Spitz nevus/nevi?
I excise Spitz nevi in patients 12 years of age or older.
What has been your experience using gene expression profiles (GEPs) to predict treatment response in atopic dermatitis?
Thanks for your request. I don't use GEPs to predict treatment response in AD. I advise against using similar tests in general, as they tend to add cost without improving treatment outcomes.
Is there a role for adjuvant RT in a pleomorphic dermal sarcoma after WLE?
Adjuvant radiotherapy (RT) should be considered for pleomorphic dermal sarcoma on a case-by-case basis. There is no clear data to support the use or omission of radiotherapy in this disease, but we base our clinical decision-making on three factors: Estimated local recurrence risk Morbidity of treat...