Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Is oral lichen planus a contraindication for immunotherapy in a patient with recurrent oral SCC?
I have personally given Pembrolizumab to a patient with an oral SCC who had underlying lichen planus. The patient had a good response to therapy, but I also treated the patient with a conditioning regimen of steroids during treatment so as not to exacerbate the lichen planus. I gave prednisone 40 mg...
Have you had success using resorcinol 15% topically for limited hidradenitis?
I haven't used topical resorcinol, but Joslyn Kirby shared this list of compounding pharmacies that can provide it: Custom Prescriptions of Lancaster Good Day Pharmacy Chambers Apothecary Hazle Compounding Pharmacy Cumberland Apothecary She said it's usually ~$50 for 30 grams of resorcinol from Cu...
Would you consider using a JAK inhibitor in combination with an IL 23 inhibitor in cases of severe psoriasis, psoriatic arthritis, or axial spondyloarthritis that is refractory to multiple biologic DMARDs?
Differential skin and joint responses in psoriasis, PsA and Axial SpA are not uncommon. Many PsA/PsO experts and scientists have postulated the potential benefit of using combination biologic (perhaps in serial fashion or lower doses of each) to treat these cases where there are suboptimal responses...
How do you manage polymorphous eruption of pregnancy (formerly PUPPP)?
A fellow resident assured me that the only thing that gave her some relief was otc itch-x.
What criteria do you use to determine the resectability of mucosal melanoma of the H&N region?
Obviously, the best specialist to answer the posted question would be a H&N surgeon. As a Rad Onc enthusiast who conducted a retrospective study about the subject long ago (Lee et al., PMID 8302112), I’ll provide my own 2-cents here:Mucosal melanoma (MucMlnm) of the H&N is a relatively uncommon mali...
What dosing range of doxycycline do you recommend for short-term and long-term management of ocular rosacea?
Short term, Doxycycline may be used at 100mg BID for 2-4 weeks, especially in severe cases. It can then be tapered to 100mg QD once a partial clinical response is documented, but where residual disease and symptoms still exist, or to 50mg QD if there is a complete clinical response. Longterm, doses...
What labs do you order to monitor patients on JAK1 inhibitiors (abrocitinib or upadacitinib)?
TB, HepB, and HepC at baseline, never repeated. CBC, CMP, and Lipids at baseline and 3 months, then once a year. CMP is probably unnecessary - no hepatic or renal toxicity - but I still do it. WBC and Hemoglobin often go down a little bit, but always happens in the first 3 months. Have had 2 patient...
How do you recommend tapering IVIG in patients whose inflammatory myositis has achieved remission?
This is a very good question without any right or wrong answer. My practice is to start tapering the IVIG 6 months after the patient has achieved clinical remission. I usually start decreasing the dose of the IVIG, but the other option is to extend the interval between the patient's infusions. The e...
How do you approach management of a patient with lower extremity ulcers from livedoid vasculopathy with a history Sjogren’s and Factor V Leiden?
Assess for additional procoagulant risk factors (smoking, phospholipid Abs, estrogen, paraprotein), and mitigate.Maximize pain management and wound care.In Sjogren's with vasculopathy, pts have responded to hydroxychloroquine, aspirin, and pentoxifylline. When lesions resolve, have continue hydroxyc...
What lab monitoring do you perform for patients taking isotretinoin?
I am a lab minimalist. I do ALT(past months have eliminated the AST) and fasting TGs at the start. Then at month 2 or max dose 1 mg/kg, I check ALT and fasting TGs. If there are any elevations at baseline, will check at month one which is usually 0.5mg/kg for me, and then month 2 (at the max dose) a...