Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Which myositis patients are good candidates for IVIG?
Good candidates for IVIG in myositis include any patient with refractory dermatomyositis, refractory necrotizing myopathy, anti-HMGCR antibody-positive patients, as well as patients with dysphagia, pregnancy, infection or malignancy. In general, it can be added to 1st-, 2nd- or 3rd-line treatment in...
How do your adjuvant treatment recommendations change, if at all, for clinically node positive Stage III desmoplastic melanoma?
We will assume that the diagnosis has been confirmed by an expert pathologist and that surgically adequate local excision and lymphadenectomy have been performed.One area in which adjuvant therapy of desmoplastic melanomas may differ is radiation of the primary. Local recurrence rates are considered...
How do you counsel patients who report a history of a lidocaine allergy?
Actual lidocaine allergy is vanishingly rare. I usually ask if this report is based on an episode at the dentist, which it very frequently is, and then I follow by asking if their "allergy" consisted of rapid heart rate, chest tightness, and an oftentimes intense feeling of anxiety. This report is l...
What is your preferred treatment algorithm for a patient with alopecia universalis who has failed oral and intralesional steroids?
My treatment ladder for severe AA is: Potent topical steroid under occlusion Contact sensitization therapy Oral Jak inhibitor Addition of low-dose oral minoxidil after 3 months if no response I sometimes use oral steroids for acute progressive disease. I do not think ILK is practical for severe d...
Do you offer radiation in the setting of a resected desmoplastic melanoma with negative margins given that several retrospective studies show a local control benefit?
Desmoplastic melanoma represents a minority of cutaneous melanoma lesions and typically occurs in the head and neck region, more commonly in elderly men, and typically diagnosed with an advanced Breslow depth. Historically, the outcomes associated with desmoplastic melanoma following resection were ...
How do you manage patients on biologics peri-operatively?
There was an article in the NEJM Journal Watch in regards to stopping biologics (DMARDs and TNFs) for rheum disease before surgery, and there was no statistically significant benefit in regards to surgical recovery but, as expected, flares of the Rheum disease. In regards to the newer targeted injec...
Do you recommend the HPV vaccine for patients with recalcitrant verruca vulgaris?
Yes, I recommend the HPV vaccine for children and adolescents of eligible age. I have seen warts resolve after vaccine administration. There are reports of dramatic resolution after vaccination. A cross-protective mechanism of action is suggested. Literature suggests there may be an age-dependent re...
Is there a subset of ANCA vasculitis patients for which you would try plasma exchange?
Circling back to this now that we have more data. I agree with Dr. @Dr. First Last's main conclusion that GN or the presence of concomitant anti-GBM antibodies are the primary scenarios in which there may be a role for plasma exchange patients with ANCA-associated vasculitis.Following the PEXIVAS tr...
What is your approach to ongoing assessment and medication tapering in well controlled discoid lupus without systemic features?
As with many systemic lupus (SLE) complications, the patient with discoid lupus (DLE) is often best managed by a rheumatologist in tandem with a specialist of that complication, in this case, a good medical dermatologist experienced with cutaneous lupus. Although I think I am good at telling most ac...
What chemical peels or alternative treatment modalities have you found most effective for hyperpigmentation?
For me, it depends on the type of hyperpigmentation. If it's related to sun damage or old acne marks on the face, a series of vitalize or rejuvenize peels (with concentrated retinol placed at the end) can be helpful. I also recommend supplementing office procedures with at-home products that contain...