Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?
I think the dermatomyositis could be more paraneoplastic that would actually benefit from controlling the cancer with ICI. I would give the treatment but I would carefully follow-up the patient for any irAEs. I will also document the rheumatological assessment, CPK, and myositis panel before startin...
What is your approach to a young adult patient with significant nail psoriasis and not much cutaneous disease?
This is a great question and honestly it depends on how aggressive the patient wants to be. An algorithm could look like this but ultimately you’d discuss it with the patient and see where they stand: Tazarotene +/- Calcipotriene during the week and clobetasol on weekends vs. taclonex or wynzora ev...
When should you discontinue narrow band UVB when a patient is in clinical remission from patch stage mycosis fungoides?
It depends on the patient, and whether they have a history of flaring after stopping phototherapy. In that setting, maintenance phototherapy (once weekly or sometimes every other week) may be helpful.
What treatment options do you recommend to patients with microstomia secondary to scleroderma?
Perioral and masseter botox 8U upper lip and 4U lower lip. 16U per masseter.
What dressings do you recommend for patients with hidradenitis suppurativa to help prevent friction and collect drainage from open areas?
My favorite is a dressing/garment called Hidrawear. It’s clothing made specifically for HS with pockets to hold bandages for drainage. Patients can pay out of pocket, but it is also covered by some insurances. Order forms are available through the website: https://hidrawear.com/ Otherwise, the pati...
What diet modifications do you recommend for patients with acne to help prevent breakouts?
For those motivated to make dietary changes, I recommend avoiding high-glycemic index food, dairy (especially skim milk), and red meat. I do recommend a Mediterranean diet enriched in vegetables, legumes, fish, as well as vitamin D and zinc.References: Meixiong et al., PMID 35373155 Hasamoh et al.,...
What is your treatment approach for steroid-refractory necrobiosis lipoidica?
I have never had success treating NLD. I have seen rare spontaneous improvement over the course of several years however.
Do you hold histone deacetylase (HDAC) inhibitors for patients receiving palliative radiation therapy for cutaneous lymphomas?
Histone deacetylase (HDAC) inhibitors are often used in the management of mycosis fungoides, the most common cutaneous lymphoma. NCCN guidelines include two HDAC inhibitors in their list of recommended systemic therapies- romidepsin and vorinostat. Romidepsin was FDA approved for CTCL in 2009 and vo...
How do you treat non-melanomatous skin cancers in poorly vascularized tissue?
BCC/SCC? An unusual differential. Was it biopsied? If it meets anatomic, size, and depth criteria, radiation oncology options would include electronic brachytherapy. Would likely offer 40 Gy in 10 fractions, twice weekly. Of course, would need to travel to an appropriate facility.
Do you offer finasteride to teenagers with androgenetic alopecia?
Finasteride can prevent the development of the beard, so I never offer it if the beard is not completely grown.