Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you tailor rituximab dosing for mucosal-predominant vs mucocutaneous pemphigus?
No, I do not dose cutaneous vs mucocutaneous patients with pemphigus differently with rituximab. I am more likely to recommend rituximab as first-line therapy if a patient has severe oral or genital disease, as this can be very quality-of-life limiting. Furthermore, relapse assessment can be challen...
Among the metastatic/unresectable melanoma patients you would historically treat with anti-PD-1 monotherapy, are you now recommending nivolumab/relatlimab instead?
Based on the published RELATIVITY-047 study, the nivo/rela combination leads to a superior median PFS of 10.2 mo (vs 4.6 mo for nivo alone) - both updated at ASCO 2022. At the most recent update at the ASCO 2022, the median survival has not been reached yet for the patients treated with nivo/rela (v...
How soon after stopping oral steroids can patch testing be performed?
Dose strength and duration of oral steroid therapy should factor into the equation. I would say at least 2 weeks to be on the less cautious side and up to 1 month if there is no urgency to patch test.
If a BRAF-mutated melanoma patient developed metastatic disease progression on adjuvant anti-PD-1 monotherapy, do you recommend switching to BRAF/MEK targeted therapy or combination immunotherapy?
The developing pre-clinical and clinical data is clear on this and I believe it becomes even more clear with time. While the DREAMseq study did not enroll patients following adjuvant therapy as the patient in the case, the overall evidence clearly shows that BRAF/MEK inhibitor resistant melanomas ar...
Are there any special considerations for treatment of metastatic acral melanoma?
In general, acral melanoma is a higher-risk disease. There are higher rates of acquired and primary resistance. Given this, I favor ipi-nivo since the overall risk is higher and response rates to single-agent PD-1 or nivo-rela tend to be lower. Emerging data suggest TIL therapy can work reasonably w...
How do you feel the oral IL-23 (Icotyde) will shape psoriasis management?
As a first oral option with a specific targeted pathway differing from apremilast, minimal to no blood lab needs, no needle involvement, and once daily dosing, this medication is a dramatic shift for patients. Personally, I am hopeful for lower-age pediatric dosing. Looking forward to how this medic...
What are your top takeaways from AAD 2026?
Cutaneous lupus erythematosus - the pipeline is very exciting and many mentions of the FDA breakthrough status of litifilimab. Also, talks on potentially using anifrolumab sooner in the treatment ladder to prevent scarring, which is approved for SLE and currently in trials for CLE. The clinical tri...
How would you manage treatment of keloid that is so large it requests a graft?
16 Gy/4 fractions
Would you consider adding dupilumab to adalimumab (or other monoclonal antibodies) in a patient who has RA and refractory atopic dermatitis and already is on MTX 25 mg weekly?
No. Unless the problem has been chronic since childhood, I would first run through the diagnostic checklist for adult-onset generalized dermatitis to be sure this is not a mimic of AD. If no other diagnosis is established after a thorough investigation, I would stop adalimumab and change to upadacit...
How do you educate patients about the risks of actinic keratosis progressing to skin cancer?
I use verbiage from Dr. Kirby’s excellent study to describe risk appropriate to the patient’s history. Except in immunocompromised or patients with a history of SCC, I avoid characterizing AKs as “pre-cancer” so that they can make a value-informed choice regarding observation vs treatment.Berry et a...