Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What incubation times do you use for PDT?
We have had good success with the zero incubation time + 2 back-to-back illumination cycles method described by Gandy et al. This method involves no pain and an overall shorter visit time compared to standard incubation protocols.Briefly, this method includes the following steps: Prep treatment area...
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...
How do you manage lamotrigine or lithium-induced acne?
For Lithium, I have referred patients to dermatology but it seems the interventions suggested such as Doxycycline, Spironolactone, or Bactrim do not fully help. I try to reduce the dose if possible or switch to another mood stabilizer if the acne is severe and bothersome that it is making the patien...
What treatment options are there for uremic pruritus in an elderly patient with risk of sundowning?
Uremic pruritus is increasingly recognized as a multifactorial condition involving peripheral neuropathy and immune dysregulation, particularly upregulation of type 2 cytokine pathways. Dysregulated opioid signaling further contributes to itch amplification. Accordingly, κ-opioid receptor agonists, ...
What is your approach for workup and management of prurigo nodularis?
For work up of prurigo nodularis, I generally order a CBC/diff, CMP, and TSH to assess for underlying causes of pruritus.For management, I emphasize the importance of avoiding manipulation and suggest covering lesions with band-aids to minimize scratching. I start with topical and intralesional ster...
How do you counsel patients with chronic urticaria on the role of stress management strategies in their treatment plan?
There are certain situations or times of the year when increased aeroallergen exposure is expected. It follows that increased vigilance is a management technique for those who suffer with sensitivity to these aeroallergen-induced symptoms in the areas of environmental control, pharmacotherapy, and, ...
What topical regimens do you recommend for redness related to rosacea in patients who defer laser treatments?
Naturally, laser is the most ideal and best solution. Green-tinted makeup is also a great adjunct. Aside from the usual routine counseling (avoidance of sun, food triggers, etc.), one product that I have found remarkable results with is the compounded SkinMedicinals ET-Rosacea Cream, which contains ...
Is there an age cut off below you would not treat a keloid with radiation post surgical excision?
While radiotherapy is considered an extremely useful modality in the treatment of recurrent keloids in the adult population, most would contend that the risks do not justify the application of adjuvant radiotherapy in the pediatric population (PMID: 10703484) for a benign condition when other modali...
How would you manage a patient with FFA that is refractory to intralesional steroids, dutasteride, hydroxychloroquine, systemic retinoids and methotrexate?
Oral minoxidil (≤5 mg daily) serves as a reasonable adjunctive therapy for refractory FFA, primarily targeting hair regrowth in non-scarred areas rather than reversing follicular destruction, though evidence remains limited to case series and retrospective studies. Low-dose oral minoxidil has demons...
Would you recommend sentinel lymph node biopsy at the time of wide excision for a 3 mm Merkel cell carcinoma of the cheek/lateral canthus?
Unlike melanoma and certainly NMSC, MCC is highly unpredictable in nature, with clinical lesion size having little clinical prognostic value. As such, it appears that SLNB is valuable in many cases for the purposes of prognosis and in determining the need for adjuvant systemic therapy and radiation....