Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your approach to severe discoid lupus refractory to conventional topical and systemic therapies?
Agree with Dr. @Dr. First Last's comprehensive answer regarding the treatment of refractory DLE. However, would add two biological options, Belilumab and anifrolumab. In fact, just now evaluated with a fellow a patient in Lupus clinic with refractory DLE to intralesional steroids, Chloroquine after ...
Do you recommend an additional procedure for melanomas if there is tumor within 1-2mm of the margin?
Yes, for most invasive melanomas. For melanoma in situ, I often measure the distance between the tumor and the margin and add that information to the dermatopathology report. In certain anatomical locations (near eye, nose, ears, digits, genitals) or certain clinical situations, 2mm of clear margin ...
What recommendations do you offer for patients who have nail longitudinal ridging?
Nail longitudinal ridging is also called onychorrhexis. Onychorrhexis may become more prominent with age and is a diagnostic feature of brittle nail syndrome, along with onychoschizia, or nail peeling. For onychorrhexis, I recommend moisturizers around the nailfolds, clear nail protectants to the na...
What biologic (e.g. porcine xenografts) or alternative dressings have you found helpful for second-intention wound healing?
Over the last 6 years, I have utilized a number of allograft/xenograft options for select wounds where linear/flap closure is not ideal and an FTSG/STSG/Burow's Graft is not preferred. They range from Animal derived Collagens, Placental, and Amniotic products, and Cadaver skin grafts (i.e. Theraskin...
Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?
TSpot testing has better performance than Quantiferon Gold in patients with low lymphocyte levels, and/or on glucocorticoids (especially moderate to high doses). This is partially related to the way the essay is performed, and as such the Tspot is much less likely to result in an indeterminate or fa...
What are some techniques you’ve used in the past to manage medial canthal webbing after surgery?
Z-plasty
What is your experience with ritlecitinib and how does it compare to baricitinib for alopecia areata?
I agree with Dr. @Dr. First Last that it’s more similar to 4 mg of bari and I like that makes it simple with one dose only. Their 52-week and beyond data also looks superior to bari but it’s hard to compare across trials I truly think of them as on par. Ultimately though, I have had failure of one r...
Which myositis patients are good candidates for IVIG?
Good candidates for IVIG in myositis include any patient with refractory dermatomyositis, refractory necrotizing myopathy, anti-HMGCR antibody-positive patients, as well as patients with dysphagia, pregnancy, infection or malignancy. In general, it can be added to 1st-, 2nd- or 3rd-line treatment in...
How do your adjuvant treatment recommendations change, if at all, for clinically node positive Stage III desmoplastic melanoma?
We will assume that the diagnosis has been confirmed by an expert pathologist and that surgically adequate local excision and lymphadenectomy have been performed.One area in which adjuvant therapy of desmoplastic melanomas may differ is radiation of the primary. Local recurrence rates are considered...
How do you counsel patients who report a history of a lidocaine allergy?
Actual lidocaine allergy is vanishingly rare. I usually ask if this report is based on an episode at the dentist, which it very frequently is, and then I follow by asking if their "allergy" consisted of rapid heart rate, chest tightness, and an oftentimes intense feeling of anxiety. This report is l...