Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you manage anti-Mi-2 positive dermatomyositis with predominantly cutaneous manifestations?
Anti-Mi-2 usually has a good prognosis. So, if patients only have skin manifestations with anti-Mi-2, I would give methotrexate either without steroids (if symptoms are currently tolerable and the patient can wait for a few months) or with steroids (if intolerable symptoms). If this fails, I would g...
How do you manage patients with recurrent periorificial dermatitis?
I typically use oral doxycycline, whenever possible, and often the low subantimicrobial doses work as well as higher doses and are much more tolerable for patients. If they can't take antibiotics or prefer to avoid oral ones, I will use some combination of topical metronidazole, clindamycin, and top...
How do you manage patients with Dercum's disease?
Fortunately, I haven't had too many patients with Dercum's Disease (Adiposis Dolorosa). I had a patient with a few tumors that were particularly painful. We excised those tumors, which helped her. I've never tried an intralesional steroid injection, but I know it's been reported. In terms of systemi...
How do you approach treating patients with trigeminal trophic syndrome?
Very difficult to treat but I have found some success with compounded topical gabapentin (I use gabapentin, amitriptyline, lidocaine from skinmedicinals) +/- PO neuromodulator drugs (gabapentin, TCA) followed by reconstructive surgery with a flap of innervated skin as a last-line. For an itching ...
What IHC stains do you routinely use for identifying invasive squamous cell carcinomas?
In the skin, special stains are generally not needed for the vast majority of SCC. In poorly differentiated tumors or spindle cell tumors, cytokeratin stains or p63 are beneficial (and other stains to exclude other diagnoses). Also, for some SCC, S100-keratin double stain may be helpful in identifyi...
Do you feel comfortable using azathioprine for dermatomyositis in patients with cirrhosis?
Azathioprine can cause liver damage, albeit this is a rare complication and usually asymptomatic. Therefore, I would probably avoid it in cases of liver cirrhosis and try other medications, like mycophenolate, IVIG, tofactinib. In either case, I would consult at the same time with the patient's hepa...
How do you differentiate erythrodermic mycosis fungoides and Sezary syndrome - is it primarily based on the burden of blood involvement of malignant cells?
You are correct: Sezary and erythrodermic MF are not the same things, and Sezary is erythroderma (defined as 80% BSA or more) right from the start. But our current definition of Sezary also requires Stage B2 blood involvement, and specifically that the sum of CD4+ CD7- and CD4+CD26 - cells is > 1000...
With the approval of oral JAK inhibitors such as Upadacitinib for atopic dermatitis, how are you considering its safety profile in comparison to traditional immunosuppressants such as prednisone, methotrexate, azathioprine, and mycophenolate?
In every treatment situation, we need to help the patient understand the potential benefits and potential risks of a medication. In my opinion, Upadacitinib is in a completely different category than traditional immunosuppressants such as prednisone, methotrexate, azathioprine, and mycophenolate, si...
With the increasing reports of correlation of frontal fibrosing alopecia and titanium dioxide sunscreens, do you advise patients against the use of micronized sunscreens on the face?
Yes, I believe titanium nanoparticles can be a trigger, and I advise avoiding this ingredient in sunscreens and foundations.
Is there a role for IVIG in the treatment of active morphea refractory to immunosuppressive agents?
While the exact mechanism of action remains unclear, IVIg therapy has demonstrated good efficacy in several rheumatic conditions including Inflammatory myositis, refractory cutaneous lupus, and also in sclerotic conditions like Systemic sclerosis where it is believed to work by increasing regulatory...