Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you recommend testing for HPV in patients with oral lichen planus?
I do not routinely use anti-viral medications for HSV when treating oral lichen planus. I begin treatment with topical steroids. I would only consider testing or treating for HSV in cases of long-term recurrent and or recalcitrant disease.
Would you recommend SLNBx in a patient with moderately differentiated SCC on the scalp?
Role of SLNBX in SCC is up in the air. We will present these high-risk patients at tumor board, but our recommendation for SLNBX is not consistent and rare. Just for "mod diff SCC on scalp" we would not. If it were 5 cm, down to bone with perineural, maybe...
How do you approach the management of patients on lamotrigine who develop a minor rash?
Lamictal rash can be dangerous but if we stop or switch lamictal for any rash during treatment we can run out of options soon. Get a good history and pictures, if possible. How long have they been on lamictal and was there a recent dose change or did the pharmacy change their generic brand? Have an...
Do you have concerns with the use of oral contraceptives in patients on JAK inhibitors given the black box warning for thromboembolic events?
I would be concerned with the use of estrogen-containing OC especially in patients who are smokers, obese, and/or with a strong family history of CV disease. However, I know many rheumatologists who would still cautiously prescribe JAK inhibitors to these patients, particularly in the absence of add...
What are the benefits and potential risks of using bisphosphonates for pseudoxanthoma elasticum?
There are not a lot of data regarding the use of bisphosphonates in pseudoxanthoma elasticum (PXE). The major pathogenic event in PXE is ectopic mineralization of elastic tissue in middle-size arteries, Bruch’s membrane of the choroid (predisposing to choroidal neovascularization and retinal bleeds ...
How would you approach management of a young male patient with discoid lupus who has had minimal response to hydroxychloroquine (and subtherapeutic whole blood levels) who continues to use tobacco products?
First, is he taking his HCQ (55% chance he is not)? Check a trough whole blood HCQ drug level and you want it to be 1000 - 1200 ng/mL (that is my goal in uncontrolled lupus; 750 - 1200 is fine in lupus under remission per Garg et al., PMID 37667434). Thanks, @Dr. First Last for reminding me. :-) Wh...
How long can you continue chronic low dose isotretinoin for refractory acne or other conditions?
No limit.
How do you manage inflammatory post filler nodules?
My approach to inflammatory nodules from HA filler will depend on several factors. Assuming these are delayed nodules (developed one to three months after HA placement), I’ll question the patient on a few issues. First, has this ever happened before? Often a patient will give a history of having sma...
How do you approach preventing and treating bruising after filler injections?
Prevention is to discontinue anything that thins blood prior (e.g., turmeric, garlic, alcohol, etc. that is reasonable). However, do not discontinue meds for medical reasons such as anticoagulants for Afib, etc. Bruising can be variable, sometimes none, other times severe, just based on the patient...
What goes into your decision making when deciding between superficial radiation and Mohs surgery for cutaneous squamous cell carcinoma of the head and neck?
When it comes down to deciding between surgical resection and definitive radiotherapy for well-differentiated, non-melanomatous skin malignancies, my simple rule of thumb is: While surgery may be the gold standard, whenever the post-operative cosmetic or functional sequelae are perceived to be poten...