Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What lifestyle modifications do you recommend for patients with hidradenitis suppurativa?
It's important to approach this carefully since many patients have been told many myths that cause shame and stigma. I usually don't bring up smoking cessation or weight loss during the first visit. It's better to build a good relationship and trust, then address those. I always recommend patients g...
What is your treatment algorithm for managing porokeratosis?
Porokeratoses do not necessarily require treatment unless desired by the patient for symptomatic or cosmetic reasons. At minimum, I counsel on the increased risk of squamous cell carcinoma within the lesion and recommend sun protection. If treatment is desired, cryotherapy, topical retinoids, imiqui...
Is morphea, cutaneous scleroderma, with no organ involvement a contraindication for radiation in early stage breast cancer as part of breast conservation therapy?
I am not sure anyone can answer this question with a solid yes or no answer. The information we have about limited scleroderma and radiotherapy is for, lack of a better term, limited. We can draw from some experiences to guide the thought process. In one large series of patients from two scleroderm...
What is the recommended approach for systemic therapy in a patient with metastatic cutaneous squamous cell carcinoma with active autoimmune disease (dermatomyositis)?
Dermatomyositis can occur with myositis/myasthenia gravis (overlap syndrome). At the Ohio State University Comprehensive Cancer Center, we have established an Immunotoxicity Clinic headed by a rheumatologist, Dr. @Dr. First Last. I would recommend engaging with a rheumatologist who is familiar with ...
How do you utilize methotrexate and/or hydroxychloroquine in the setting of limited scleroderma/CREST?
Thank you for this great question!The use of immune-suppression in systemic sclerosis is generally reserved for progressing skin sclerosis, progressive ILD, inflammatory arthritis, inflammatory myositis, and myocarditis. These manifestations have a significantly higher prevalence in diffuse cutaneou...
How do you determine which patients you prescribe 5-fluorouracil vs 5-fluorouracil with calcipotriene for actinic field disease?
We tend to prescribe almost exclusively 5FU + calcipotriene as a compounded agent, the cost is reasonable usually around $50 for 30gms. Standard treatment is BID x 4 days, but many times use up to 7 days, and the response increases through 14 days with what patients experience. Patient adherence is...
How do you perform patch testing in patients who are allergic to adhesives?
True allergy to the Scanpor tape most often used in patch testing is rare, even in patients allergic to colophony, p-tert-butyl phenol formaldehyde resin, rubber, or acrylate-based adhesives. What is more common, especially in atopic patients with microbial dysbiosis driving their dermatitis, is fla...
How do you approach treating neuropathic itch?
Localized Neuropathic Pruritus: Life-changing OTC topical called Dermeleve. Key ingredient is strontium, which interferes with the calcium-dependent receptors and calcium channels that are necessary for itch signaling. Works in about 5 minutes, lasts for about 5 hours. STUNNING EFFICACY. It burns li...
What is your stepwise approach to a patient with erosive gingivitis?
The most important test here is DIF. You can be >1cm away from lesional mucosa in the mouth to obtain an accurate diagnosis, so any dermatologist can do this; best spot is usually the labial sulcus or the lower mucosal lip.While awaiting this result, topical treatments can often be surprisingly help...
In difficult cases, what is your approach to find a causative agent of fixed drug or fixed food eruption?
I don't think there is any answer other than advising the patient of the natural course/behavior of the eruption and having them keep a strict journal of all intake until the culprit is determined. Data on testing has been mixed at best (Jayasundera & Watts, PMID 38336399) -- though there may be a r...