Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
In patients with Fitzpatrick skin types IV–VI presenting with extensive nasal sebaceous hyperplasia refractory to oral isotretinoin, what is your preferred procedural or targeted approach to achieve clearance while minimizing dyspigmentation?
The 1726 nm laser can target the sebum in sebaceous hyperplasia (SH) and is safe for darker skin types. Off-label, and the handpiece is large, but I have used it to shrink SH.
Would you consider neoadjuvant immunotherapy followed by radiation for a patient with locally advanced basal cell carcinoma?
This is a relatively data-free area, so there's no “right” answer.I think the first question to ask is whether this basal cell carcinoma (BCC) is amenable to curative intent radiotherapy (assuming surgery is not possible). If so, any adjunctive drug therapies are of secondary relevance.For locally a...
What treatment and management recommendations do you have for amphetamine-induced skin picking disorder without insight?
Assuming the stimulant is prescribed for ADHD, I recommend dose reduction or switching to a different medication, or, rarely, I recommend the patient consider a "stimulant holiday" for at least 1-2 months. I explain that most of my patients notice improvement with adjustments or breaks from their st...
What therapies do you recommend for preventing keloid recurrence after surgical resection?
For earlobe keloids specifically, we have had reasonable results with a mixture of 40mg/ml triamcinolone mixed with 50mg/ml 5FU in a 1:1 ratio. This is injected day of keloid removal, then every 4 weeks for at least the first 6 months. No more than 0.1-0.3 mL per session. The treatments can be space...
What's the best approach for severe calcinosis cutis in a patient with dermatomyositis who is unresponsive to diltiazem and colchicine?
Calcinosis cutis remains one of the most frustrating, typically recalcitrant manifestations of DM for both patients and physicians.Like Dr.@Dr. First Last, I also find that while there have been multiple case reports or small trials of various regimens published, the disappointing real-world variabi...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
I use an AI scribe in my outpatient clinic, and around 90–95% of my patients agree to it. I obtain consent at the start of each visit and make it clear that it's completely optional—that they can say no at the start or change their mind at any point in the visit, with no impact on their care. I also...
What first-line therapies do you recommend for patients with folliculotropic mycosis fungoides?
Agree with Dr. @Dr. First Last as above. For first-line topical therapies for patients with limited skin disease, you can consider topical steroids or topical nitrogen mustard, although these agents may not penetrate the skin to a sufficient depth to treat the disease at the hair follicle. Other opt...
What is your preferred radiotherapy regimen for palliative treatment of cutaneous T cell lymphoma?
Cutaneous T-cell lymphomas (CTCLs) comprise numerous distinct entities in the WHO classification of hematologic malignancies. The most common CTCL is mycosis fungoides (MF) followed by primary cutaneous anaplastic large cell lymphoma. As with most hematologic malignancies, both diseases are particul...
How do you approach a patient with stoma bag adhesive allergic contact dermatitis?
To keep the area dry, I have patients use Cavilon spray and Skins, an antimicrobial spray.
Is there a role for phenotyping patients with CSU outside of a research setting by ordering IgG-anti-TPO, IgG anti-FceRI, total IgE, total IgA, etc.?
I do think it can be helpful in patients who have difficult-to-control disease. Many of these (e.g. IgG-anti-TPO, total IgE, anti-thyroglobulin antibody) have been shown to help predict responsiveness to omalizumab treatment or have been associated with disease activity (Højgaard Pedersen et al., PM...