Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you manage recurrent urticarial lesions in a patient with underlying connective tissue disease that is otherwise well-controlled?
Similar to other cases of chronic urticaria - skin-directed therapy with TCS + high dose daily antihistamines (e.g. fexofenadine 180 mg bid + doxepin 10 mg qhs). Then in recalcitrant cases, you can use urticaria drugs (can go for dapsone, MTX or MMF if you want to also target underlying CTD or can g...
How do you counsel patients on the risks versus benefits of JAK inhibitors for the treatment of alopecia?
Because alopecia areata is a chronic condition that often occurs in healthy patients, risks of immunosuppressant medications need to be considered. Safety comparisons must be individualized based on the limited data available. Medications such as JAK inhibitors, which can yield immediate results, ma...
How do you utilize JAK inhibitors in combination with other therapies to manage alopecia?
In general, JAK inhibitors can be considered a first-line treatment for many patients with severe alopecia areata, so they are often the primary treatment that I use for this condition. In almost all patients, however, I also add oral minoxidil to the treatment regimen (depending on the person, typi...
What is your approach to treating genital lichen sclerosus that is not responding to super-potent topical steroids?
Biopsy is the next step if it was never done to rule out SCC or another alternative process since clobetasol typically works in these cases. Traditionally, methotrexate has been a standard treatment. However, more recently, I've started using Rinvoq off-label with great efficacy.
What treatment modalities have you had success in treating perioral or periorbital dermatitis when they have failed Topical calcineurin inhibitor and oral antibiotics?
The first line is typically metronidazole and/or clindamycin. Topical ivermectin is also a very reasonable approach, and sulfacetamide can help as well. I typically use these before topical calcineurin inhibitors. Rarely TCIs can worsen demodex as has been reported. Which oral antibiotics? Doxycycli...
What's your treatment algorithm for notalgia paresthetica?
Topical steroids + dermeleve (otc anti-pruritic) cream ILK versus other OTC topicals (capsaicin, Sarna, pramoxine) versus compounded gabapentin, amitriptyline, lidocaine (my main go-to second line) Oral - gabapentin vs doxepin vs desipramine Recalcitrant cases I’ve added dupilumab or phototherapy w...