Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What threshold do you use to escalate to a multidisciplinary child sexual abuse evaluation when a child with newly diagnosed lichen sclerosus also has persistent/recurrent vulvovaginal symptoms despite appropriate lichen sclerosus therapy?
Several variables need to be explored. What "appropriate" LS therapy has been utilized and, equally important, over what duration of time for this "newly diagnosed" case? Clobetasol ointment is to date the most effective treatment, but often requires months of continuous use; prescribing physicians ...
Would you recommend adjuvant radiation for an atypical fibroxanthoma of the scalp that is completed resected with +PNI and +LVI?
Atypical fibroxanthoma (AFX) is a rare cutaneous neoplasm. Diagnosis is often difficult, and may require the input of an expert soft tissue or dermatologic pathologist. I have seen many of these cases diagnosed elsewhere as AFX, and upon re-review, the diagnosis is changed to cutaneous squamous cell...
How do you clinically and diagnostically distinguish stiff skin syndrome from scleroderma?
They are distinct conditions, with scleroderma primarily manifesting as skin thickness, fibrosis, and Raynaud's, while stiff person syndrome is a neurological condition manifesting as rigidity and with muscle spasms. The latter serologically has anti-GAD antibodies, compared to scleroderma, which ha...
What has been your experience with tecovirimat for monkeypox?
I thought it worked well in 2 patients of mine with rectal Mpox. However, the clinical trial did not confirm this, and it was a lot of trouble to get TPOXX going with consent, investigational drug, etc so we have abandoned use here.
If methotrexate is contraindicated or not tolerated, what systemic treatments do you use for generalized morphea?
I assume they failed hydroxychloroquine.
What laboratory studies do you routinely order when evaluating a patient with interface dermatitis on biopsy?
Rule out lupus.
Do you reduce the dose of hydroxychloroquine in patients with skin graying if they are not particularly bothered by this side effect?
I wouldn't if they're not bothered, but I would think to look into their HCQ blood levels... we know that certain doses of HCQ are more effective in controlling disease activity than others, and that of course, higher levels may be associated with adverse effects, not just in the skin.
When do you recommend HLA testing prior to prescribing lamotrigine, carbamazepine, or oxcarbazepine to patients of Asian descent?
I never use carbamazepine, given how it’s a pan-inducer and often lowers the level of other medications that may be in the regimen, such as quetiapine and haloperidol, since they are mainly metabolized by CYP3A4.Oxcarbazepine has a 50% reduction in the induction of carbamazepine, so I use that somet...
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...
Is there a preferred JAK inhibitor for the treatment of alopecia associated with childhood-onset systemic lupus erythematosus?
Unfortunately, this question likely comes down to FDA and insurance approval and not scientific evidence. Since only one JAKi is approved for alopecia right now and and 2 for poly JIA and none for SLE currently in any age, it will come down to which diagnosis you are going to use to get coverage.