Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What recommendations do you make for patients with lower abdomen eczema from nickel in their belt buckle?
This is a common clinical scenario in the United States as there are no legal limits on the use of nickel in objects in contact with the skin. Belt buckle dermatitis on the lower abdomen is almost pathognomonic for nickel allergic contact dermatitis (ACD). There are several consumer test kits to det...
What treatment regimen for UVA-1 have you found most helpful in treating sclerotic diseases (e.g. morphea, scleroderma)?
In our department, we have had success with the following treatment regimen with UVA-1 for sclerotic diseases. The following protocol is for full-body UVA-1 (appropriate for generalized morphea, systemic sclerosis). Low dose is considered 10-30 J/cm2, medium is 30-40 J/cm2 and high is 50-60 J/cm2. W...
What clinical or pathologic features would make you more concerned that a new skin SCC is from metastatic disease or a new cutaneous primary?
Histologic examination should reveal an epidermal connection in a primary SCC. If one cannot be found, the pathologist must raise the possibility of a metastatic lesion and state that alternatively could be a portion of primary SCC (epidermal connection may not be included in biopsy sampling). If th...
What advice do you have for the management of nail toxicity associated with pemigatinib and other FGFR inhibitors?
Pan-FGFR inhibitors as a class can cause significant dermatologic toxic effects (including alopecia, dry skin, nail changes, and stomatitis) anywhere in the range of 20% to 45%, depending on the specific agents (Lacouture et al., PMID 33021006, Bétrian et al., PMID 28538953).Lacouture and colleagues...
How do you counsel patients on preventing nail damage with constant pedicures/manicures and nail polish?
I recommend that patients avoid cuticle or pushing, which makes then prone to both acute and chronic paronychias. The acetone removal process for gel manicures thins the nail plate - this has been shown in scanning electron microscopy studies. There is mounting evidence that UV dryers used to cure...
What treatments have you found helpful in treating recurrent aphthous ulcers?
Recurrent aphthous ulcers can be tricky to manage and recalcitrant to multiple therapies. I usually start with colchicine and topical corticosteroids. If that fails I move on to thalidomide. I have found that therapies in-between are unsuccessful.
What screening recommendations do you provide for patients with a Nevus of Ota with ocular involvement?
Patients with Nevus of Ota are at increased risk of glaucoma. I have patients get a yearly ophthalmology exam.
How do you treat significant keloidal acne scarring on the back of a teenager?
Firstly, their acne needs to be controlled and stable prior to treating the scars themselves unless any of the keloids are particularly symptomatic. My decision-making is shared with the patient and based on many different factors including skin type, pain tolerance, insurance coverage/budget, scar ...
How do you approach treating nail lichen planus?
I would first start be determining the extent of cutaneous and mucosal involvement, as that often is more troublesome to the patient than the nails and may impact choice of treatment. Often, any systemic therapy directed at cutaneous/mucosal LP will also probably improve nail LP. Topical steroids to...
What is your approach to treatment of skin-limited cryoglobulinemic vasculitis in patients with Sjogren's syndrome who lack evidence of neurological or renal involvement?
I have given this patient Rituximab prior with success.