Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How would you manage subclinical ILD associated with MDA-5 Dermatomyositis?
Subclinical ILD in anti-MDA5 is like a time bomb waiting to explode. Would do aggressive monitoring for ILD symptoms/tests and give at least 1st line immunosuppression with CellCept or tacrolimus.
How do you approach patients that develop atopic dermatitis while on biologics for psoriasis?
We have a few patients on dual-biologic therapy who have features of both psoriasis and atopic dermatitis, where each is severe enough to merit systemic therapy on their own. Probably a little less now with more JAK inhibitors available, but we still have some patients maintaining on these regimens....
What is your first treatment of choice in patients with dermatomyositis sine myositis?
Great question! For better or worse, there isn't a great one-size-fits-all answer since choosing the "best" agent means assessing the severity of the disease, assessing if there are extracutaneous manifestations that also need to be addressed (e.g., interstitial lung disease? inflammatory arthritis?...
What dosing range of oral minoxidil do you prescribe for patients with hair loss?
I have really enjoyed adding this to our AGA treatment algorithm. I like to start at half of the 2.5 mg tab for women daily and the full tab for men. I then increase at each follow-up based on the patient's tolerance for AEs (increased hair elsewhere, BP, edema, lightheadedness). I max out at 5 in w...
What’s your approach to recurrent “idiopathic” Erythema Nodosum that failed NSAIDs?
Next step in treatment would be SSKI with gradual dose titration upward to improve tolerance. For recurrent cases of EN, perform pharyngeal culture to look for strep.
Is biopsy of the nail matrix necessary to rule out atypia associated with longitudinal melanonychia?
Since longitudinal melanonychia arises in the nail matrix, the nail matrix must be biopsied to rule out a melanoma. While a punch biopsy can be performed, a tangential shave of the matrix gives a more complete sample to the pathologist and causes less dystrophy. In both cases, the proximal nail fold...
What nutritional supplements do you recommend for patients with hair loss?
Protein 30-40 grams a day. These skinny dieters who only eat fish aren't getting enough. I do check iron and ferritin and get ferritin to at least 50, even 60-70 for shedding hair. I really like untangled by foundation skincare.
How would you approach a 2 cm malignant primary cutaneous adnexal adenocarcinoma of the axilla s/p resection with positive margin who is unable to undergo additional surgery?
I would consider imaging of the regional node basin (axilla) first. If there was evidence of regional lymph node metastasis, I would image the body to evaluate for distant metastases. If there was distant metastasis, I would probably refer for systemic therapy. If there was no distant metastasis, ...
Which ANCA vasculitis patients are better candidates for cyclophosphamide rather than rituximab?
Both can be used for induction in GPA/MPA vasculitis. I would use rituximab (RTX) if the patient has previously been treated with cyclophosphamide (CYC) and developed a relapse/flare and in patients who are young and with fertility concerns. In GPA/MPA, I tend to use RTX most of the time for inducti...
What approach, or dosing interval, do you find is most effective reducing side effects of Hedgehog Inhibitors (i.e., vismodegib) for patients with numerous BCC?
I have scarcely used hedgehog inhibitors as a preferred treatment in BCC. I rely more on Immunotherapy or clinical trials or even prefer local RT for a non-IO responsive BCC. Having said that, I usually begin at full dose and go down to alternate day dosing if patients have terrible side effects. I ...