Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your preferred steroid sparing therapy in a patient experiencing a severe checkpoint inhibitor toxicity and not responding to high dose IV steroids?
There are likely two different questions here: 1) For patients who have responded to steroids, but are unable to taper off (or to a minimally acceptable chronic dose), I have favored mycophenolate as a steroid sparing agent. 2) For patients with severe pneumonitis that is refractory to steroid ther...
What topical and oral therapies do you prescribe for patients with papulopustular rosacea?
Over the years, metronidazole cream/gel monotherapy has been less effective in the patients we see. Skin Medicinals has a triple rosacea cream with ivermectin/itraconazole/azeleic acid and has been quite effective as well as cheaper than getting all 3 separately. Doxycycline at doses between 40mg - ...
What is your treatment algorithm for patients with lichen planus?
There are many potential approaches depending on the severity, subtype, comorbidities, and impact on QOL. For "classic" LP (no symptomatic or significant oral involvement)" Typically itch is the primary complaint although the appearance can be understandably upsetting to some patients. Depending on ...
What is your treatment approach to patients with confluent actinic keratoses on lower extremities?
I find these patients can be very challenging to treat. It is difficult to completely clear the AKs and even if there is success initially, these patients will often develop new adjacent lesions or recurrent lesions within a short time. Nonetheless, we have used various approaches to treating these ...
Do you ever offer scalp cooling therapy to metastatic breast cancer patients wishing to avoid alopecia?
I routinely offer scalp cooling to such patients. I do acknowledge to patients that we do not have evidence to support scalp cooling in the metastatic setting, that the best evidence to support its efficacy is with taxane-based regimens, and that we really cannot be sure how or if scalp cooling will...
At what age do you recommend annual skin exams in a patient without a personal or family history of skin cancer?
I don't have a specific age but rather it depends on the risk factors: Male, fair skin, and older age are risk factors, certain occupations Evidence of actinic damage Immunosuppression, especially organ transplants Multiple nevi > 50 History of dysplastic nevi Childhood radiation exposure Chronic l...
How do you monitor a patient with scleroderma during pregnancy?
One of the most important aspects of monitoring scleroderma patients in pregnancy is the preconception visit to review the stage of the disease including getting cardiopulmonary studies before pregnancy and reviewing medications and adjusting any immunosuppressive medications. Although prospective s...
Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?
I think the dermatomyositis could be more paraneoplastic that would actually benefit from controlling the cancer with ICI. I would give the treatment but I would carefully follow-up the patient for any irAEs. I will also document the rheumatological assessment, CPK, and myositis panel before startin...
What is your approach to a young adult patient with significant nail psoriasis and not much cutaneous disease?
This is a great question and honestly it depends on how aggressive the patient wants to be. An algorithm could look like this but ultimately you’d discuss it with the patient and see where they stand: Tazarotene +/- Calcipotriene during the week and clobetasol on weekends vs. taclonex or wynzora ev...
When should you discontinue narrow band UVB when a patient is in clinical remission from patch stage mycosis fungoides?
It depends on the patient, and whether they have a history of flaring after stopping phototherapy. In that setting, maintenance phototherapy (once weekly or sometimes every other week) may be helpful.