Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is the incidence of melanoma arising from vitiliginous patches, and do they develop from different mechanisms than melanomas arising from normal skin?
The exact incidence of melanoma arising within established vitiligo lesions has not been well defined. Generally, patients with vitiligo develop melanoma (as well as non-melanoma skin cancers) in the areas of their normal skin compared to their de-pigmented lesions [1, 11].That being said, there are...
When do you prescribe clascoterone cream for your acne patients?
Clascoterone cream can be beneficial in anyone who has acne. I do believe it should be used BID and I generally couple it with a topical retinoid. Remember that we are always trying to hit all four of the pathogenic targets in acne. Those targets are follicular hyperkeratinization, inflammation, C a...
Do you routinely check G6PD level prior to initiation of hydroxychloroquine?
No, we do not routinely check G6PD levels prior to initiation of hydroxychloroquine (HCQ). The American College of Rheumatology does not recommend routine testing for G6PD prior to initiation of hydroxychloroquine (HCQ), but interestingly, package inserts often recommend caution in these patients. O...
Do you routinely collect debulking specimens for paraffin-embedded or frozen section staining prior to taking a Mohs layer for all skin cancers?
The majority of the time, there is no need to send a Mohs debulk for permanent sections. Sending a debulk for permanent section pathology is helpful in rare cases. If I am concerned about sampling error for a high-risk SCC, I very rarely will send a debulk to examine the tumor for PNI/LVI, depth of ...
How would you treat pemphigus foliaceous in an elderly patient intolerant to oral steroids?
It depends on the extent of the disease and the severity of symptoms. Home wet wraps, when they can be done, can be essentially as effective as oral steroids in many situations, but can be time intensive. I provide the patient with instructions and a pound jar of triamcinolone ointment. Be careful s...
What maintenance therapies do you most commonly recommend for patients with improving genital lichen sclerosis?
Betamethasone dipropionate with clotrimazole cream is my treatment of choice to provide a sufficiently potent corticosteroid while mitigating the risk of secondary Candida infections. Adjust the frequency of application from daily to once weekly to every other week for severe symptoms vs maintenance...
What treatments have you found to be most effective for granulomatous rosacea?
Isotretinoin 20mg/day
How do you approach balancing the potential risk of worsening actinic damage and maintaining CTCL clearance in patients treated with nb-UVB?
NB-UVB continues to be the most effective skin directed therapy for patch MF. I try to use it as much as possible as monotherapy, or commonly in combination with retinoids for treatment and maintenance of early-stage disease. In patients with severe solar damage, I may continue phototherapy adding l...
What biologics have you found to be most effective in treating hidradenitis suppurativa?
I'll answer the easy part of the question first. For insurance coverage, the HS Foundation website has wonderful prior auth letter templates for biologics, laser therapy, and other treatments. I have had a lot of successes in getting off-label biologics covered with them. It doesn't always work, but...
Are there certain subsets of ANCA vasculitis patients for whom you would consider life long maintenance therapy?
Overall the field is moving towards longer, and sometimes indefinite maintenance therapy. This is because multiple studies have demonstrated that relapse risk increases when maintenance therapy is stopped. I consider indefinite maintenance therapy for the following patients: 1. Frequent relapsers - ...