Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you approach treating necrobiosis lipoidica, especially cases that have ulcerated?
ILK for early lesions, Pentoxyphylline helps with pain, optimize glycemic control, doxycycline, unna boot/wound care.
What is the negative predictive value of a negative extended myositis panel in dermatomyositis patients?
The short answer is "not great, but it depends" since the more nuanced answer is contingent on: the constellation of myositis-specific antibodies (MSA) included on the panel, the nitty-gritty of how the commercial lab is checking the MSA included (this detail can change between vendors, or even ...
Is there a role for cyclophosphamide in refractory digital ischemia in patients with scleroderma?
Great question! The vascular disease in Scleroderma (Systemic sclerosis/SSc) is characterized by vasospasm, a proliferative vasculopathy with intimal hyperplasia, thrombosis and/or occlusive (fibro-obliterative) arterial disease with near blockage of the vascular lumen in many cases and impaired ang...
Do you routinely provide GI protection in the form of a PPI or histamine blocker for patients with immunobullous disease initiated on high doses of oral corticosteroids?
I honestly don’t unless a patient brings up GI symptoms during the visit. However, the literature does have clear recommendations. A recent JAAD CME stated that on any dose of prednisone for 3 months or greater, GI prophylaxis is needed for those who must be on a concomitant NSAID. It also recommend...
What is your approach to diagnosing and managing suspected dental amalgam-triggered lichen planus?
Suspected dental amalgam-triggered oral lichen planus occurs when oral lichenoid lesions are topographically in close proximity to the dental amalgam. Patch testing can support this diagnosis. Common metals to test include palladium, gold, mercury, tin, copper, nickel, and amalgam powder. A recent a...
What is your work-up for acquired keratoderma?
The differential diagnosis for acquired keratoderma is broad and includes categories such as inflammatory skin disorders (such as pityriasis rubra pilaris, cutaneous T cell lymphoma, etc), infections (syphilis, crusted scabies, HIV, etc), medications (tyrosine kinase inhibitors, etc), nutritional de...
Are smooth muscle hamartomas associated with hypoplasia of underlying structures?
Not that I am aware of.
Do you utilize surgical and medical treatments when treating patients with erythroplasia of queyrat, bowenoid papulosis or giant condyloma acuminatum?
Bowenoid papulosis can remit spontaneously (especially in those who are <35 and immunocompetent) so initial management is typically conservative with locally destructive methods. I prefer treatment with cryotherapy and/or topical treatment with Aldara or Efudex 5% cream. Other options include electr...
What is your preferred OCP protocol when the aim is reduction of sebum production in teenage female acne?
I tend to choose Ortho-Cyclen (Sprintec) or Yaz or newer OCP slynd which is dros only. I have had excellent results as monotherapy (plus a topical retinoid) or in combo with oral Aldactone. OCP with WINLEVI for those who do not want Aldactone has also been successful for me.
Can you continue checkpoint inhibitor therapy in the setting of severe cutaneous irAE while concurrently treating the cutaneous reaction?
Cutaneous reactions from immune checkpoint inhibitors (ICPi) generally fit into 3 categories: rash/inflammatory dermatitis, bullous dermatoses, and severe cutaneous adverse reaction (SCAR). For grade 1-2 rash/inflammatory dermatitis, if symptoms can be managed with topical therapy or non-steroidal o...