Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What therapies do you most commonly utilize for patients with SCC in situ on the head and neck?
SCCis of the face scalp head and neck almost always involves diffuse field disease. One of the first articles I give my new MOHS fellows is one by @Dr. First Last that deals with diffuse epidermal and periadnexal actinic keratosis and SCCis or what we call DEPS. I point out to them that virtually ev...
What skin care regimen do you prefer during radiation for patients with inflammatory breast cancer?
The treatment of acute skin reactions is historically a morass, with most centers and physicians (including ourselves) doing different things based on limited evidence and lots of hoary mythology. The myth that most bothers me is patients being told not to use moisturizers before treatment. A phanto...
What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?
There are likely two different questions here: 1) For patients who have responded to steroids, but are unable to taper off (or to a minimally acceptable chronic dose), I have favored mycophenolate as a steroid sparing agent. 2) For patients with severe pneumonitis that is refractory to steroid ther...
What topical therapies and procedures do you recommend for patients with atrophic acne scarring?
If the patient has hyperpigmentation, then some sort of topical lightening approach (i.e., tretinoin/kojic acid/niacinamide/Vit C/tranexamic acid, etc) or chemical peels. For the actual scarring, assuming that the acne process has burned out, the most ideal procedure depends on the particular type o...
What topical and oral therapies do you prescribe for patients with papulopustular rosacea?
Over the years, metronidazole cream/gel monotherapy has been less effective in the patients we see. Skin Medicinals has a triple rosacea cream with ivermectin/itraconazole/azeleic acid and has been quite effective as well as cheaper than getting all 3 separately. Doxycycline at doses between 40mg - ...
What is your treatment algorithm for patients with lichen planus?
There are many potential approaches depending on the severity, subtype, comorbidities, and impact on QOL. For "classic" LP (no symptomatic or significant oral involvement)" Typically itch is the primary complaint although the appearance can be understandably upsetting to some patients. Depending on ...
What is your treatment approach to patients with confluent actinic keratoses on lower extremities?
I find these patients can be very challenging to treat. It is difficult to completely clear the AKs and even if there is success initially, these patients will often develop new adjacent lesions or recurrent lesions within a short time. Nonetheless, we have used various approaches to treating these ...
Would you offer upfront radiation for a large painful keloid of the chest that has arisen from an irritated pyoderma gangrenosum lesion?
Radiation therapy is actually used (rarely) for pyoderma gangrenosum that has been unresponsive to medical management via immunosuppression [1]. Single fraction doses of 400 to 800 cGy have been used with slow regression of the lesions. In the case report cited, the lesion started fading after 3 mon...
Do you ever offer scalp cooling therapy to metastatic breast cancer patients wishing to avoid alopecia?
I routinely offer scalp cooling to such patients. I do acknowledge to patients that we do not have evidence to support scalp cooling in the metastatic setting, that the best evidence to support its efficacy is with taxane-based regimens, and that we really cannot be sure how or if scalp cooling will...
At what age do you recommend annual skin exams in a patient without a personal or family history of skin cancer?
I don't have a specific age but rather it depends on the risk factors: Male, fair skin, and older age are risk factors, certain occupations Evidence of actinic damage Immunosuppression, especially organ transplants Multiple nevi > 50 History of dysplastic nevi Childhood radiation exposure Chronic l...