Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are the main limitations or barriers to integrating gene expression profiling into routine melanoma management in your practice?
There have been about 250,000 tests done in the country. Around 40% of melanomas each year are tested, and somewhere around 10,000 to 11,000 doctors use it, so access has not been much of a barrier. As far as cost goes, everything has a cost, though patients do not pay for it. If the insurance compa...
What topical therapies and procedures do you recommend for improving facial pore size?
Ablative CO2 or Erb:YAG fractionated resurfacing laser would provide the best and most durable treatment for large pores. Topical neuromodulators don't have a particular role in reducing pore size. Topical exfoliants (AHA/BHA and retinoids) can be beneficial with chronic, consistent use by removing ...
How often do you draw screening ANAs for discoid lupus?
Because a positive ANA is associated with an increased risk of progression to SLE in patients with discoid lupus, I routinely check an ANA at the initial visit in virtually all patients. If negative, I repeat it only if new symptoms concerning systemic involvement arise (e.g., joint pain, cytopenias...
How would you approach management of a large, fungating squamous cell carcinoma of the auricle if surgical management is not desired by the patient?
For a tumor this size and with cartilage invasion, I would recommend starting with induction cemiplimab to best response (generally 4-6 cycles), followed by consolidative RT, generally electrons. Prior to starting the immunotherapy, I would stage the neck with a contrast CT scan, as tumors of this s...
What work up do you pursue for a thorough evaluation in patients that present with a potential diagnosis of dermatitis artefacta?
I have found dermatologic complaints some of the most challenging in my psychiatric practice. Dermatitis artefacta (DA) occurs when an individual produces self-inflicted skin lesions in order to assume the sick role, making it a type of factious disorder. When evaluating a patient with suspected DA,...
Do you recommend an additional procedure for melanomas if there is tumor within 1-2mm of the margin?
My understanding has been that a re-excision of melanoma is based on initial Breslow depth. As long as the margins are clear on that re-excision, regardless of being 1-2 mm away from any one edge, there is no indication for additional surgery.
How soon after excising a keloid do you inject kenalog?
I ran into this issue in clinic a few months ago when I started doing keloid excisions on patients' ears - there's some decent data in the following article for doing immediate kenalog injections without impairing wound healing.Burusapat et al., PMID 34367855
How has the AAD atopic dermatitis guideline changed your threshold to start systemic therapy rather than rotating topicals in a child with persistent atopic dermatitis despite good adherence?
For me, this has not changed my practice as I have always started systemic therapy early in patients with atopic dermatitis. I find these new updated guidelines reinforce what I believe to be the correct practice. Although we don't have a perfectly matched set of guidelines for AD as we do with psor...
What do you prioritize when a patient has discordant clinicopathologic features and genomic risk scores to estimate melanoma recurrence risk?
At this time, the test to assess genomic risk score (i.e., Castle DecisionDx) is based on retrospective analysis, and there are no prospective data yet. So it should not be used solely for decision-making, especially when it comes to whether to do adjuvant systemic therapy or not. The traditional Am...
What is your approach to young teenagers with acne who have extremely sensitive skin, cannot tolerate typical acne regimens, cannot tolerate oral antibiotics, and refuse Accutane?
The formulation of benzoyl peroxide encapsulated in silica shells is extremely well tolerated by sensitive-skinned individuals. I was involved in pre-approval studies and found it remarkably well tolerated in such patients.