Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What role, if any, do biomarkers play in selecting appropriate patients for neoadjuvant cemiplimab in cutaneous squamous cell carcinoma?
Cutaneous squamous cell carcinoma (CSCC) is primarily a UV radiation driven malignancy and harbors many mutations. These cancers generally respond very favorably to PD-1 pathway inhibition, and thus biomarkers do not currently play a role in patient selection for neoadjuvant cemiplimab in CSCC. In t...
What topical therapies do you most commonly prescribe for rashes near the eyes?
This is a difficult question because the term "rashes" is extremely broad! I think that as in most of medicine, moving through the appropriate steps is critical. There can be a rush to move towards treatment, but remember, there is an order to medicine: History -> Physical -> Diagnosis -> Treatment ...
How do you approach patients with advanced resectable basal cell carcinoma for possible use of hedgehog inhibitors?
Hello, @Dr. First Last! If surgically resectable, then surgery. If a response to hedgehog inhibitors will reduce the morbidity of the surgery, then I would give one as tolerated (good responses seen within 3 months). Fosko et al., PMID 31836564Kahana et al., PMID 33988881
How do you counsel patients on preventing and treating "maskne"?
Prevention: Cleanse and moisturize the face daily using products that are appropriate for your skin type. If using a cloth mask, make sure it is washed regularly. Take off the mask when safe and appropriate. Skip makeup when wearing a mask. If makeup cannot be avoided, make sure it is labeled "non...
Do you use apremilast in combination with biologic DMARDs for psoriatic arthritis and/or psoriasis?
I have used apremilast in combination with a biologic in my practice. Monotherapy with biologics is not always effective in relevant treatment domains in patients with psoriasis and psoriatic arthritis. Then the choices are to switch to a different biologic agent, add a traditional DMARD or consider...
What topical therapies do you find are most effective for treating inverse psoriasis in areas of the body with thinner skin?
I have had excellent results from 1% LCD in 2.5% hydrocortisone cream or 1% LCD in 0.1% TAC. Irwin Braverman
How do you approach longitudinal melanonychia of one fingernail in a pediatric patient?
Unless the history and/or appearance are terribly concerning, I will generally measure, photograph, and follow up in 3 months for a re-check. Unless it has grown or changed dramatically during that time frame, I will usually just monitor clinically until it is stable.
What alternative antibiotics or other therapies do you recommend for patients with papulopustular rosacea and a tetracycline allergy?
PO Ivermectin and PO Niacinamide can be helpful. However, for antibiotics, anything works/is anti-inflammatory, but usually, I’ll do azithromycin.
How do you approach the diagnosis of erythronychia?
Erythronychia has a broad differential including inflammatory diseases (lichen planus), infectious diseases (verruca), and benign (onychopapilloma, glomus tumor), and malignant tumors (SCC, amelanotic melanoma). I approach erythronychia with history and physical examination including measuring width...
What is your treatment approach to persistent chillblains lesions in the absence of systemic lupus?
In idiopathic chillblains/perniosis, I think treatment centered on lifestyle modifications is key. As this is a cold-associated dermatosis, counseling patients to wear warm gloves or socks and avoiding cold exposure is important. Beyond lifestyle modifications, I typically start with a high-potency ...