Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you find that hydroxyzine worsens cognitive symptoms in patients who are already susceptible to cognitive impairment?
Hydroxyzine should not have a direct negative effect on cognition. For decades after its inception, it was lopped in with Benadryl in terms of its receptor binding affinity profile and is listed in several anticholinergic burden scales as being anticholinergic. Similar to the child’s game ‘telephone...
With the increasing availability of biosimilars and their adoption onto payer formularies, how do you approach selection among available biosimilars in clinical practice?
Insurance payers consider FDA‑approved biosimilars to be clinically equivalent. In my experience, selection is ultimately driven by the insurance payer formulary - what you can get for the patient on the time. This can be fleeting and quickly changing at times. Cases can be made for patient experien...
What type of surveillance would you recommend following resection of primary mucinous carcinoma of the skin?
A full skin examination every 6 to 12 months. Reminding the patient to call the clinic immediately for any symptoms that are unusual, or for a new skin lesion and perform a symptoms directed work-up.
If a patient has chronic spontaneous urticaria refractory to Xolair and is already on plaquenil, do you stop plaquenil and then initiate cyclosporine, or do you co-administer and then gradually stop plaquenil over time?
I would first increase the dose of Xolair, actually, up to 600 mg every 2 weeks.
When selecting between topical roflumilast and topical corticosteroids for seborrheic dermatitis in an area with a high actinic keratosis burden, could choosing a PDE4 inhibitor like roflumilast theoretically deliver a beneficial anti-neoplastic field effect while simultaneously clearing the patient's seborrheic dermatitis?
To my knowledge, there's no published trial data showing topical roflumilast reduces AK counts, reduces SCC incidence, or produces a measurable field effect. I love coming up with hypotheses, but remember, based on current clinical evidence, this hypothesis may be a side benefit story rather than a ...
If methotrexate is contraindicated or not tolerated, what systemic treatments do you use for generalized morphea?
I typically reach for mycophenolate as a second-line agent if methotrexate failed or is contraindicated. If the generalized morphea is actively progressing, I will add a steroid taper as a bridge until the DMARD has time to take effect. Whole body UVA1 is also a helpful adjunctive treatment to a DMA...
How do you manage worsening cutaneous dermatomyositis when muscle disease appears controlled?
The fact that the patient still has an active pruritic rash while tapering steroids suggests that the current regimen isn't fully controlling the disease, and it can affect quality of life. I would consider adjusting immunosuppression, either adding another agent or switching therapies. The specific...
What is your approach to counseling patients on the safety and side-effect profile of a biosimilar compared to its reference biologic?
Relevant question as insurance companies may require a biosimilar over the reference biologic. According to the FDA, the spin-off (my term) must be "highly similar" to the original in both efficacy and safety. Approval is based on review of clinical trial data. As for my approach: until proven other...
In an elderly patient with limited transportation issues, is there a hypofractionated regimen you have found acceptable for a localized squamous cell carcinomas of the eyelid?
I am fortunate to work with a “XRT for skin cancer” guru, Dr. W.H. Morrison, and sought his counsel to answer this question, as largely with the conversion of skin cancers from a radiation-treatable disease to a surgical disease with the advances in Mohs surgery and oculoplastics, at MDA we rarely s...
Which serologic tests are most helpful when evaluating for suspected drug-induced lupus?
If I suspect drug-induced lupus, I typically order the following laboratory testing: ANA/IFA Anti-histone antibody, usually positive in drug-induced lupus Anti-Ro antibody, usually positive in drug-induced subacute cutaneous lupus Anti-dsDNA, usually negative in drug-induced lupus vs positive in id...