Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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.
How would you approach an ulcerative non-melanomatous skin cancer of the lower extremity s/p Mohs surgery with gross disease left behind?
If there is gross disease, then the wound is less likely to heal. Need to explore surgery with flap or RT as definitive management.
Do you commonly recommend oral minoxidil, dutasteride, or a combination of both for patients with androgenic alopecia?
Neither of these medications are approved for AGA, and treatment considerations are different in men vs. women. Oral minoxidil at low doses is very safe and generally well tolerated, and a great option for patients with irritation from topical use. It avoids potential side effects of finasteride, wh...
How would you evaluate and treat an older teenage patient with severe perioral dermatitis with histology demonstrating a granulomatous dermatitis and all stains have come back negative?
Minocycline (rarely use but for this, I would) with weekly ivermectin and Elidel. I have done a prednisone taper as well to calm it down. Isotretinoin or dapsone...
Do you recheck screening labs (ESR, BUN/Cr, urinalysis, ANA, etc) for patients with recurrent small vessel vasculitis of unknown origin with each flare?
If the recurrences occur 6 or more months apart, I would recheck the studies to exclude SLE. If the episodes are chronic, I would recheck at least once a year for the same reason or whenever there are new suggestive symptoms of LE.
What recommendations do you provide to patients who develop ocular side effects with Dupixent?
I would start with over-the-counter artificial tears without preservative and then refer to an ophthalmologist, ideally a corneal specialist who is experienced in the nuances of treating this condition. I have also had success switching from Dupixent to Adbry, although JAK inhibitors are a better o...
What prescription or over-the-counter therapies have you found effective for helping vitiligo patients cover active areas?
As Dr. @Dr. First Last mentioned, selecting the correct topical steroid strength based on location is important. We have had patients make great progress (even without nbUVB therapy / xTrac) by alternating every 1-2 weeks with a topical steroid and a non-steroidal (i.e., Pimecrolimus cream or Tacrol...
Do you utilize a constraint for skin/dermatitis in setting of thoracic chemoradiation?
No. This acute toxicity is almost universally reversible in short course and should have essentially no bearing on the decision making when treating a potentially lethal lung cancer; also, I know of no data quantifying skin tolerance doses.
What first-line therapies do you recommend for patients with folliculotropic mycosis fungoides?
Agree with Dr. @Dr. First Last as above. For first-line topical therapies for patients with limited skin disease, you can consider topical steroids or topical nitrogen mustard, although these agents may not penetrate the skin to a sufficient depth to treat the disease at the hair follicle. Other opt...
What timeframe do you recommend for performing imaging in pediatric patients with moderate to high-risk congenital melanocytic nevi?
I tend to favor obtaining an MRI of the CNS before the age of 6 months (based on the work and recommendations of Dr. Veronica Kinsler). Depending on the experience of the radiology department, some are able to obtain this imaging without general anesthesia, using a "soothe and swaddle" technique. Ho...