Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is considered an adequate treatment period to assess response of AAV induction therapy with rituximab or cyclophosphamide?
This is an issue of considerable interest both clinically and for research studies, and the approach to both settings is currently similar: are there any signs or symptoms of ongoing active disease? The key words being “ongoing” and “active”. The expectation once glucocorticoids are started and then...
Are there AAV patients for whom you would consider combination therapy with cyclophosphamide and rituximab?
The combination of RTX and CYC does not have a significant evidence base. The rationale for this regimen comes from the hypothesis that CYC acts quicker than RTX and can serve to quiet down the disease early and potentially spare steroids. However, there is no empirical support for this concept so f...
How would you approach an early inguinal recurrence after surgical resection of Merkel Cell carcinoma in the popliteal region?
I would make sure there is no distant metastases with a PET-CT. Would try to enroll this patient in a trial. Current approach if localized in surgery followed by radiation, but with availability of immunotherapy, I would recommend at least an adjuvant immunotherapy after surgery. No one knows if rad...
What treatment options are available for patients with spondyloarthritis who develop biologic-induced psoriasis?
Management of patients in these situations is quite challenging and the approach should be individualized. Biologic induced psoriasis is most commonly seen with TNF-α inhibitors as a paradoxical response. However, this has also been rarely described with other biologic agents: Interleukin-6 blockers...
Is it okay to use medications associated with drug-induced lupus in patients with SLE?
In the current era, I find it useful to divide drug-induced lupus into two classes. First, the traditional medications such as procainamide and hydralazine that are associated with ANA by IFA, anti-histone antibodies, and a type of drug induced lupus not characterized by certain clinical features su...
How do you clinically distinguish between cutaneous lupus with photosensitivity and polymorphic light eruption-like reactions?
Polymorphous light eruption (PMLE) typically occurs at the onset of Spring or Summer when patients have been exposed to light for the first time that season. Because patients' faces are usually not covered up, even in the winter (in non-COVID times), they usually continue to get sun on their faces. ...
Is there a role for adjuvant systemic therapy (in addition to adjuvant radiation) in an early-stage, resected cutaneous angiosarcoma of the head/neck?
Angiosarcomas have a high rate of local (or distant) recurrence, but with all tumor resected and if there were wide surgical margins then radiation may be sufficient for a small superficial tumor, followed by close surveillance. If there is a recurrence, then our practice is to give neoadjuvant chem...
How would you approach treatment of a patient with asymptomatic, oligometastatic basal cell carcinoma?
This is an unusual situation. I would want to clarify whether this is regional versus distant metastasis, and what is meant by "oligometastatic". I would also want the diagnosis of metastatic basal cell carcinoma confirmed histopathologically (and possibly even molecularly) for both a putative prima...
How would you treat a patient with an keratoacanthoma of the right nasal ala?
In my experience, these patients are treated surgically and radiation does not play a role.
How would you approach refractory gangrenous Raynaud's secondary to type one cryoglobulins?
Type I cryoglobulins are monoclonal immunoglobulins, and typically occur in the context of a hematologic disorder such as MGUS, multiple myeloma, Waldenstrom macroglobulinemia, or lymphoma. Vascular occlusions due to the cryoglobulins may occur and lead to digital ischemia.The patient should be eval...