Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are your preferred IHC stain(s) for desmoplastic melanoma?
Desmoplastic melanoma (DM) often comprises variably atypical spindle cells in the dermis within a collagenous stroma and surrounding solar elastosis. By histology, DM can mimic benign processes such as scar or neurofibroma, in addition to other malignancies such as sarcomatoid carcinoma, atypical fi...
How do you manage axillary hyperhidrosis that is refractory to oral glycopyrrolate and aluminum-based antiperspirants in patients with neuromuscular disorders?
An excellent option for a patient in this clinical scenario is the miradry procedure. Miradry is a machine that utilizes microwave-like technology to preferentially and permanently destroy sweat glands in the axillae. While not typically covered by insurance, its effects are very long-lasting and th...
What therapies have you had success with in treating CARP when they have failed minocycline?
Treating with oral ketoconazole or fluconazole in two separate doses a week apart can be helpful in treating concurrent tinea versicolor that may be present along with CARP.
How do you approach the treatment of bullous cutaneous lupus?
First, I ensure that the diagnosis is correct (referring to my favorite local medical dermatologist) and that it is not a non-lupus-related bullous disease. As most would do, I use hydroxychloroquine plus dapsone as my initial treatment of choice along with strict ultraviolet light protection measur...
What duration do you feel comfortable maintaining for the pediatric population on topical calcineurin inhibitors?
Topical calcineurin inhibitors are safe and effective for both the treatment and maintenance of atopic dermatitis in the pediatric population. The FDA approval age for topical tacrolimus is 2, however, many pediatric dermatologists and general dermatologists safely use these medications off-label in...
What biologic for psoriasis do you prescribe most often in patients with a history of malignancy?
I like an IL-17 inhibitor for psoriasis with a current or history of malignancy. IL-17 is involved with cancer neoangiogenesis, so blocking it may have an anti-tumor effect. This hasn’t been studied yet but it makes me feel better that the IL-17 class doesn’t have an increased risk of cancer and may...
What is your treatment algorithm for actinic cheilitis?
Great question. We prefer to use efudex for broad involvement or liquid nitrogen for more localized AK. Some people do use CO2 laser as another modality for treatment. You can also pre-prescribe valacyclovir to help prevent cold sore recurrence during treatment with laser.
How will you sequence therapies in dermatomyositis given the results of the ProDERM trial?
I will try oral immunosuppressants first, either methotrexate, azathioprine, or mycophenolate first; and then add IVIG if there is no response or even minimal response.
How do you manage docetaxel or other taxane-induced nail toxicity?
A variety of nail conditions have been reported with chemotherapy, particularly with docetaxel. There are no proven prevention strategies for taxane-induced nail toxicity. However, there are limited data that the cooling of extremities may help prevent nail complications (Scotte, F, Cancer 2008) but...
How do you approach patients with onychomycosis that does not respond to terbinafine and prolonged courses of fluconazole?
Terbinafine is usually effective in the treatment of the most common nail infections. Failure of treatment with terbinafine and fluconazole should make us consider bacterial co-infection or other non-dermatophyte organisms (i.e., aspergillus or non-C albicans). Fungal cultures are often falsely nega...