Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What workup do you recommend for pediatric patients with telogen effluvium?
If the onset was relatively recent, and there is a history of a known trigger, such as a significant illness (e.g., high fever, surgery, other physical trauma) or other stressful life events, I don't usually do any workup right away. I recommend giving it at least 2-3 months to see if it starts to s...
Do you get routine MRI brain for surveillance on patients with history of stage III melanoma?
Unfortunately, this is an area that doesn't have a lot of data to support recommendations. It is rare to develop CNS/brain metastasis as the only site of metastatic disease (~5% of metastatic patients). Therefore, I try to get an annual MRI brain for stage IIIB-IIID (resected) patients, especially i...
How do you manage long-term xerosis and xerophthalmia in patients who have completed a course of isotretinoin?
Xeropthalmia can be a real problem. In a study in rabbits, we showed that isotretinoin in doses up to 1mg/kg has effects on meibobian glands similar to those on that occur in sebaceous glands. Meibum is responsible for preventing the tear film from evaporating. The third patient I ever treated devel...
How do you manage nausea in the setting of hydroxychloroquine use?
My method for approaching hydroxychloroquine (HCQ)-induced nausea: Stop HCQ When nausea is gone, restart with just 1/2 tablet every night after food or milk(I recall a study suggesting that nocturnal use caused less side effects, but I cannot find it. If anyone has the source, please chime in). A we...
How do you approach treating patients with lupus profundus?
For lupus profundus/lupus panniculitis, I would first confirm the diagnosis with a deep punch biopsy or incisional biopsy. The differential for lupus profundus includes factitial panniculitis, traumatic panniculitis, morphea profundus, and subcutaneous panniculitis-like T-cell lymphoma.Once the diag...
How long can you treat dermatomyositis with IVIG?
Typically, in best-case scenarios, you can treat dermatomyositis with IVIG for 1 year, but some patients require it for 18-24 months, and the minority of patients continue to require it over several years. Some patients may only need it until you achieve improvement, especially in some countries whe...
What is your preferred management for eruptive vellus hair cysts?
I have not found any topical medication that helps to clear these and often end up doing quick electrodessication one by one for these small cysts.
How do you approach treating acute and chronic Demodex folliculitis?
Demodex folliculitis is often a diagnosis of exclusion and is considered when treating refractory rosacea, bacterial or fungal folliculitis. The organism can be found on normal skin and is seen on KOH prep of a skin scraping. Combination treatments with oral and topical medications have been found t...
How do you manage patients with rapidly progressing vitiligo?
I treat rapidly progressing vitiligo very similarly to rapidly progressing alopecia areata. Sort of like a medical emergency. Literature review suggests one should suspect rapid progression when the patient is developing new spots every month. This is especially distressing in patients of ethnic b...
How would you approach the post-operative radiation treatment volumes for a Merkel cell carcinoma of the hand?
Get a PET-CT. Treat the primary site, axillary, and probably epitrochlear nodes electively.