Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What has been your experience using gene expression profiles (GEPs) to predict treatment response in atopic dermatitis?
Thanks for your request. I don't use GEPs to predict treatment response in AD. I advise against using similar tests in general, as they tend to add cost without improving treatment outcomes.
What circumstances would drive you to consider using an oral IL-23 inhibitor over parenteral options for the management of psoriasis and/or psoriatic arthritis?
Psoriatic arthritis is a heterogeneous disease and the choice of therapy is driven by many factors.The most important factors in the decision tree are whether the patient has 1) axial disease and/or 2) severe psoriasis.Additional Considerations include: prior therapies, extramusculoskeletal manifest...
What methods do you use to prophylactically reduce radiation dermatitis for head and neck irradiation?
My approach has been: Start Remedy (less greasy but less effective) and/or Aquaphor (more greasy but more effective) 3-4x daily at beginning of RT. Try to use Aquaphor at least at night when the greasiness is less bothersome. If patients have some other alcohol-free/non-anti-oxidant product they re...
What treatment and management recommendations do you have for amphetamine-induced skin picking disorder without insight?
Assuming the stimulant is prescribed for ADHD, I recommend dose reduction or switching to a different medication, or, rarely, I recommend the patient consider a "stimulant holiday" for at least 1-2 months. I explain that most of my patients notice improvement with adjustments or breaks from their st...
Do you attempt to taper or discontinue a JAK inhibitor in a patient with severe alopecia areata who has maintained complete scalp hair regrowth for at least one year?
I do not routinely attempt to discontinue a JAK inhibitor in a patient with severe alopecia areata (AA) who has achieved complete regrowth. There has to be a compelling reason for me to stop the medicine, such as cost, pregnancy, or adverse events. Since severe AA behaves more like a chronic immune-...
What role do you feel topical steroids play in the management of atopic dermatitis with the growing availability of non-steroid topicals?
Corticosteroids remain my first-line topical treatment for atopic dermatitis due to their availability, cost, and efficacy. Obviously, topical corticosteroids are not an ideal long-term treatment for continuous use due to their cumulative local toxicity. Calcineurin inhibitors are more sustainable i...
How do you counsel patients who inquire about benzene exposure and carcinogenic risk from BPO containing acne and rosacea products?
This question is easier to answer after this recent report from the FDA: Limited number of voluntary recalls initiated after FDA testing of acne products for benzene; findings show a small number of products with elevated levels of benzene contamination It supports the overall safety of BP. More t...
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 ...
When do you consider adding steroids alongside intravenous antibiotics for patients with orbital cellulitis?
If the orbital cellulitis is infectious, I never add steroids. There is no literature or proof that they do anything, and decreasing immunity, in my opinion, is simply a bad idea. If it is inflammatory, then absolutely. Most infectious orbital cellulitis is from the sinuses and is more common in chi...
What’s your favorite topical OTC moisturizer that you recommend, and why?
There is no easy answer to this question as recommendations for moisturizers are quite patient and location specific and depend on degrees of dryness. The best moisturizer is one that feels good to the individual patient and is one that he/she will then use. For example, someone with mild facial dry...