Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you approach the treatment of bullous cutaneous lupus?
First, I ensure that the diagnosis is correct (referring to my favorite local medical dermatologist) and that it is not a non-lupus-related bullous disease. As most would do, I use hydroxychloroquine plus dapsone as my initial treatment of choice along with strict ultraviolet light protection measur...
What duration do you feel comfortable maintaining for the pediatric population on topical calcineurin inhibitors?
Topical calcineurin inhibitors are safe and effective for both the treatment and maintenance of atopic dermatitis in the pediatric population. The FDA approval age for topical tacrolimus is 2, however, many pediatric dermatologists and general dermatologists safely use these medications off-label in...
What biologic for psoriasis do you prescribe most often in patients with a history of malignancy?
I like an IL-17 inhibitor for psoriasis with a current or history of malignancy. IL-17 is involved with cancer neoangiogenesis, so blocking it may have an anti-tumor effect. This hasn’t been studied yet but it makes me feel better that the IL-17 class doesn’t have an increased risk of cancer and may...
What is your treatment algorithm for actinic cheilitis?
Great question. We prefer to use efudex for broad involvement or liquid nitrogen for more localized AK. Some people do use CO2 laser as another modality for treatment. You can also pre-prescribe valacyclovir to help prevent cold sore recurrence during treatment with laser.
How will you sequence therapies in dermatomyositis given the results of the ProDERM trial?
I will try oral immunosuppressants first, either methotrexate, azathioprine, or mycophenolate first; and then add IVIG if there is no response or even minimal response.
How do you manage docetaxel or other taxane-induced nail toxicity?
A variety of nail conditions have been reported with chemotherapy, particularly with docetaxel. There are no proven prevention strategies for taxane-induced nail toxicity. However, there are limited data that the cooling of extremities may help prevent nail complications (Scotte, F, Cancer 2008) but...
How do you approach patients with onychomycosis that does not respond to terbinafine and prolonged courses of fluconazole?
Terbinafine is usually effective in the treatment of the most common nail infections. Failure of treatment with terbinafine and fluconazole should make us consider bacterial co-infection or other non-dermatophyte organisms (i.e., aspergillus or non-C albicans). Fungal cultures are often falsely nega...
How do you monitor patients with cutaneous lupus for progression to SLE?
I think it is prudent to check patients with a new diagnosis of cutaneous lupus for any signs of SLE, typically with CBC, CMP, UA, complement levels, and ANA by IFA. If negative, I just screen with review of systems and check labs if something comes up.
What is your experience with iontophoresis for hyperhidrosis?
I always offer iontophoresis as a choice for my patients. One of the major roadblocks is affording the unit. In my experience, insurance does not uniformly cover the unit. Patients who have used it have had mixed success, mostly they report it was not effective in controlling their hyperhidrosis.
How do you approach treating younger patients with early female pattern hair loss?
I approach most younger patients similarly to older women with androgenetic alopecia. In younger patients, I try to do a more detailed history/exam to make sure they have no evidence of androgen excess, PCOS, and to identify if they have a strong family history of AGA. Spironolactone can be a good o...