Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatments do you recommend and how do you counsel patients with postpartum hair loss?
I start with reassuring that it's fairly common to experience excessive hair shedding after pregnancy, about 3-6 months postpartum and usually peaking at about 4 months after giving birth. I counsel that many patients regain their normal hair growth over time, without any treatment. However, if they...
Do you typically categorize keratoacanthomas as a distinct entity from squamous cell carcinomas, and do you favor medical treatment vs surgery?
I consider keratoacanthoma (KA) to be a well-differentiated, low-risk subtype of squamous cell carcinoma (SCC). I will counsel patients on the risks and benefits of medical treatment and surgical treatment. There are several factors to consider such as patient age, location and size of the lesion, a...
What recommendations do you provide to isotretinoin patients about delaying cosmetic procedures (lasers, fillers, botox) once they have reached their goal dose?
We basically perform any and laser procedures, even when patients are on isotretinoin if it is appropriate as far as the indication. We do tend to wait for 3 to 4 months for ablative fractional treatments, but all other treatments, such as hair removal, pigment removal, and vascular laser removal, a...
How do you differentiate atopic dermatitis from mycosis fungoides histologically?
Differentiating mycosis fungoides from any spongiotic process (atopic dermatitis, allergic contact dermatitis, etc.) is extremely difficult and typically requires correlation with clinical features and sometimes molecular findings. Some features that favor mycosis fungoides are: Lymphocytic exocyto...
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...