Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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.
Do you consider downstaging neoadjuvant cemiplimab for borderline resectable CSCC in order to facilitate surgical resection?
Very good question. Data from use of neoadjuvant therapy in many solid tumors has shown that when they clinically regress, actual pathologic response is more heterogeneous. Although an area can appear to have a complete clinical response- random biopsies can show areas of viable microscopic tumor st...
Are you routinely using neoadjuvant cemiplimab for cutaneous squamous cell carcinoma of any site?
No
How do you utilize PRAME for melanocytic biopsies?
PRAME is useful as one piece of information to help me decide if I have enough criteria for melanoma in situ. Like most IHC stains it is just a piece of the puzzle to me. In my experience, positivity of MIS is about 7-8/10, so I do not require PRAME positive to diagnose MIS. But positive PRAME helps...
When do you prescribe topical JAK inhibitors for adult patients with atopic dermatitis?
For adult patients with atopic dermatitis, I typically start with topical steroids with or without topical calcineurin inhibitors as maintenance therapy. If minimal improvement with topical steroids/calcineurin inhibitors, then I turn to other topicals including topical JAK inhibitors and/or crisabo...
What are your top takeaways from AAD 2023?
Top 3 takeaways: Confirmatory testing for onychomycosis is our responsibility as dermatologists and is cost-effective. Options for mycologic confirmation include KOH with microscopy, fungal culture, PCR, and histopathology. Terbinafine failures for onychomycosis may be due to non-compliance with tr...
Is close observation a reasonable option for elderly patients with a small basal cell carcinoma of the face?
Yes, depending on life expectancy, logistics, and morbidity of treatment which would be minimal with RT.
What oral therapies do you most commonly recommend for skin cancer prevention?
I don't use a lot of oral medications for this problem. The one I use most is Nicotinamide and I think the data is really only supported for SCCs, not BCC. In the past, I have used low-dose oral retinoids but this can be challenging depending on co-morbid conditions and lesions tended to spring up w...
How do you manage pityriasis lichenoides chronica (PLC)?
If you are confident in the diagnosis of PLC, which isn't always easy to be, then no systemic workup is needed. The issue is the spectrum of disease and feeling confident you are truly dealing with PLC and not a related disorder with a possible risk of progression (LyP et al). Given that oftentimes ...
What is your approach to the use of intravenous sodium thiosulfate for the management of calciphylaxis in a patient with end stage kidney disease and on hemodialysis?
We have sodium thiosulfate 25gm IV each dialysis given during the last hour of treatment as a standard order in our dialysis order set. We have seen a useful response in some patients after several weeks, but there are no clear trial-based data to support the use of this treatment. I would certainly...