Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What would prompt you to obtain IGRA in a patient starting an IL-17 inhibitor for psoriasis who is also on concomitant immunosuppression despite the ‘no routine testing’ recommendations before initiating this class of biologic?
If the IGRA was indicated for the concomitant immunosuppressive drug, that would prompt me to obtain the IGRA. Also, more commonly, if the insurer required the IGRA, I would order it.
How long do you apply patch testing before interpreting the results?
In most instances, patches are removed after 48 hours (2 days). This timeframe is specifically chosen to allow sufficient time for the allergen to penetrate the stratum corneum and trigger a T-cell-mediated response, while simultaneously reducing the potential for significant skin irritation that ca...
Have you used topical rapamycin/sirolimus for TSC-related angiofibromas?
I used it before it was approved for the treatment of vascular lesions and noted that it was effective and safe.
How would you approach diagnosis of a patient with recurrent episodes of abdominal pain, severe myalgias, low grade fevers and urticaria?
Without the mEFV variant, from a rheumatologist viewpoint, the differential includes IBD, a periodic fever syndrome such as FMF or FCAS, and MCAS. Therefore, I would consider that workup with genetic testing (anyone can send!), fecal calprotectin, and MCAS eval with A/I. I don't think of urticarial ...
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...
How do you manage dyshidrotic eczema in children during the winter months?
I typically use class 3 topical steroids, i.e., mometasone 0.1% ointment for flares and then tacrolimus ointment for maintenance if needed. Occasionally, higher potency topical steroids are needed for flares. I encourage frequent emollients, at least 3 times per day (before school, when home from sc...
Does the presence of paraneoplastic pemphigus influence your treatment options in CLL?
Paraneoplastic pemphigus is often difficult to treat, and if traditional measures do not control it, I often will use continuous therapy for CLL to both eliminate the disease and continue suppressing the autoimmune source of this paraneoplastic complication.
How would you treat a late local recurrence of extramammary Paget's disease of the vulva, not amenable to resection?
If the patient does not have any invasive disease, or underlying malignancy or nodes, then I would consider treating this with radiation, specifically superficial brachytherapy. At our institution, we routinely treat similar patients with large perineal, inguinal EMPD patients with 3D custom printed...
What clinical scenarios warrant the use of a skin substitute?
Chronic wounds like diabetic and venous leg ulcers are the most common clinical indication, especially when healing fails to progress after standard wound care. Extensive full-thickness burns are also a primary indication, particularly when there is insufficient donor skin available for autografts o...
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
A network of specialists familiar with cSCC is necessary to optimize care that is tailored and appropriate for each unique case. Avoiding under-treatment and over-treatment is important, but also challenging, given the high volume of cSCC tumors with variable patterns of presentation and numerous cr...