Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your preferred treatment algorithm for a patient with alopecia universalis who has failed oral and intralesional steroids?
My treatment ladder for severe AA is: Potent topical steroid under occlusion Contact sensitization therapy Oral Jak inhibitor Addition of low-dose oral minoxidil after 3 months if no response I sometimes use oral steroids for acute progressive disease. I do not think ILK is practical for severe d...
Do you offer radiation in the setting of a resected desmoplastic melanoma with negative margins given that several retrospective studies show a local control benefit?
Desmoplastic melanoma represents a minority of cutaneous melanoma lesions and typically occurs in the head and neck region, more commonly in elderly men, and typically diagnosed with an advanced Breslow depth. Historically, the outcomes associated with desmoplastic melanoma following resection were ...
How do you manage patients on biologics peri-operatively?
There was an article in the NEJM Journal Watch in regards to stopping biologics (DMARDs and TNFs) for rheum disease before surgery, and there was no statistically significant benefit in regards to surgical recovery but, as expected, flares of the Rheum disease. In regards to the newer targeted injec...
Do you recommend the HPV vaccine for patients with recalcitrant verruca vulgaris?
Yes, I recommend the HPV vaccine for children and adolescents of eligible age. I have seen warts resolve after vaccine administration. There are reports of dramatic resolution after vaccination. A cross-protective mechanism of action is suggested. Literature suggests there may be an age-dependent re...
Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?
Circling back to this now that we have more data. I agree with Dr. @Dr. First Last's main conclusion that GN or the presence of concomitant anti-GBM antibodies are the primary scenarios in which there may be a role for plasma exchange patients with ANCA-associated vasculitis.Following the PEXIVAS tr...
What is your approach to ongoing assessment and medication tapering in well controlled discoid lupus without systemic features?
As with many systemic lupus (SLE) complications, the patient with discoid lupus (DLE) is often best managed by a rheumatologist in tandem with a specialist of that complication, in this case, a good medical dermatologist experienced with cutaneous lupus. Although I think I am good at telling most ac...
What chemical peels or alternative treatment modalities have you found most effective for hyperpigmentation?
For me, it depends on the type of hyperpigmentation. If it's related to sun damage or old acne marks on the face, a series of vitalize or rejuvenize peels (with concentrated retinol placed at the end) can be helpful. I also recommend supplementing office procedures with at-home products that contain...
What are your preferred IHC stain(s) for desmoplastic melanoma?
Desmoplastic melanoma (DM) often comprises variably atypical spindle cells in the dermis within a collagenous stroma and surrounding solar elastosis. By histology, DM can mimic benign processes such as scar or neurofibroma, in addition to other malignancies such as sarcomatoid carcinoma, atypical fi...
How do you manage axillary hyperhidrosis that is refractory to oral glycopyrrolate and aluminum-based antiperspirants in patients with neuromuscular disorders?
An excellent option for a patient in this clinical scenario is the miradry procedure. Miradry is a machine that utilizes microwave-like technology to preferentially and permanently destroy sweat glands in the axillae. While not typically covered by insurance, its effects are very long-lasting and th...
What therapies have you had success with in treating CARP when they have failed minocycline?
Treating with oral ketoconazole or fluconazole in two separate doses a week apart can be helpful in treating concurrent tinea versicolor that may be present along with CARP.