Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you adjust PSA for finasteride use when determining prostate cancer stage and risk category?
We generally use the rule of 50% (real PSA is twice the lab value when on Finasteride).
Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?
The short answer is yes, in that most lupus patients with cardiomyopathy do not have hydroxychloroquine drug induced cardiac injury. That is to say most of these patients either have ischemic cardiomyopathy or non-drug NICM. With that said, antimalarials can produce adverse effects both on the cardi...
What is your preferred setup/immobilization for patients with cutaneous malignancy of the toe involving the medial aspect of the digit?
I prefer surgery.
How would you approach a patient with metastatic Merkel cell carcinoma to the axillary/supraclavicular lymph nodes of unknown primary?
It's important to note that the first step is to thoroughly stage the patient - PET/CT (additional imaging as warranted) and a skin survey. For a patient with a nodal-only disease, I would approach this as a potentially curative case. While it's possible that the risk of distant metastatic disease i...
Do you use hydroxychloroquine for prevention of neonatal lupus in patients with a positive SSA who are planning on becoming pregnant?
There is some evidence that hydroxychloroquine can prevent CHB in patients at high risk (mothers who already had a fetus with CHB in a previous pregnancy (Izmirly et al., PMID 32674792). There is scant evidence about neonatal lupus and the use of HCQ to prevent it. HCQ is generally well-tolerated an...
Is there benefit in switching between sonedegib to vismodegib or vice versa for patients with unresectable basal cell carcinoma of the face that progresses on first line hedgehog inhibitor?
Immunotherapy has largely supplanted hedgehog inhibitors for most BCC patients given the toxicity of hedgehog inhibitors and the reliable recurrences seen after initial responses. If I want short term palliative care, I think hedgehog. If I want a real chance at a cure, I think immunotherapy.
Has anyone used radiation to treat a plantar wart not responding to other modalities?
Cutaneous warts are commonly treated with topical salicylic acid and cryotherapy as primary interventions, according to the British Association of Dermatologists' 2014 guidelines for managing cutaneous warts. Should these treatments prove insufficient, additional options include topical immunotherap...
Are there any clinical situations in which checking for anti-chromatin antibodies is helpful?
Chromatin is the native complex of histones and DNA found in the cell nucleus of eukaryotes. The prevalence of anti-chromatin (nucleosome) antibodies in systemic lupus erythematosus (SLE) varies from 50% to 90%, being similar to that of the historic LE cell.The question is whether this provides addi...
Would you avoid the use of a TNF inhibitors in patients with a remote history of melanoma, including those with ocular melanoma?
Clinical trials of TNF inhibitors have identified a small but increased risk of malignancy with the use of TNF inhibitors, and most, but not all, of the follow-up studies done with real-world registries have confirmed this. These registries are of course sometimes affected by the behavior of physici...
Do you recommend on-demand versus fixed-schedule dosing for rituximab maintenance in ANCA vasculitis?
This is a fairly hot question in the field, and one that reflects the success we have had with advancing therapy for ANCA-associated vasculitis; it’s nice to have choices! Although there are data for both approaches, there are more data (larger numbers, etc.), in my opinion, for fixed-dosing. The tr...