Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you counsel patients who inquire about microplastics in their cosmetics or physician-dispensed products given emerging associations with conditions such as psoriasis, eczema, lupus, and hormonal disruption?
That’s a really good question. It is absolutely true that patients are increasingly aware of environmental exposures, and microplastics in personal care products. When I address it with my patients, I tell them that there is ongoing research on microplastics in cosmetics and personal care products. ...
What is your late or no-show policy for patients?
I'm really interested in reading answers by those of you who have punitive policies for these patients. I wrestle with these problems several times per week, as I have Mohs surgery patients either no-show or cancel/reschedule with less than 24 hours' notice. On the one hand, I find that most patient...
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
Would you consider anti-IL-5 therapy (mepolizumab or benralizumab) to either prevent or treat the more severe manifestations of eosinophilic granulomatosis with polyangiitis, such as "infiltrative" (e.g., cardiomyopathy, pulmonary infiltrates, or gastroenteritis) or "vasculitic" (e.g., neuropathy, palpable purpura, or glomerulonephritis)?
Yes, I would consider early starting biologics for infiltrative EGPA.
How do you decide when to biopsy a patient with overlapping signs of female-pattern hair loss and possible early central centrifugal cicatricial alopecia?
Biopsy is indicated when the diagnosis is uncertain, particularly when distinguishing between female-pattern hair loss (FPHL) and central centrifugal cicatricial alopecia (CCCA), as these conditions can have overlapping clinical presentations. Our T-shirt should also represent fibrosing alopecia and...
Do you routinely screen for cardiovascular risk factors in a patient with moderate-to-severe psoriasis?
Review of systems. Depending on age, consider lipids and HbA1c if no data for the past year.
Under what circumstances would brachytherapy be preferred over electron therapy for treating skin cancers?
For small (<2 cm) nonmelanoma skin cancers, I would say that brachytherapy is preferred for these reasons: Better cosmesis - 90-95% report excellent, which is better than electron series, particularly at the edge. Better for curved surfaces like the nose b/c applicator is flush on the skin with no ...
What therapies do you most commonly recommend for prevention of NMSC in organ transplant patients?
First and foremost, we assess transplant patients and circle, number, and label all their skin cancers so we can catalogue them. We then prioritize their skin cancers in order to remove them in order of "worst first". We immediately start field therapy with calcipitrione and 5-FU twice a day for a w...
How do you manage worsening cutaneous dermatomyositis when muscle disease appears controlled?
The fact that the patient still has an active pruritic rash while tapering steroids suggests that the current regimen isn't fully controlling the disease, and it can affect quality of life. I would consider adjusting immunosuppression, either adding another agent or switching therapies. The specific...
What cosmetic options can you provide to patients with facial discoid lupus that seems stable?
Procedures such as botulinum toxin A, fillers, and autologous fat grafting can be considered in patients with discoid lupus if the disease has been clinically stable, typically meaning no new lesions or active inflammation for about a year. Light-based vascular treatments such as pulsed dye laser ca...