Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatment options do you recommend to patients with microstomia secondary to scleroderma?
Perioral and masseter botox 8U upper lip and 4U lower lip. 16U per masseter.
What dressings do you recommend for patients with hidradenitis suppurativa to help prevent friction and collect drainage from open areas?
My favorite is a dressing/garment called Hidrawear. It’s clothing made specifically for HS with pockets to hold bandages for drainage. Patients can pay out of pocket, but it is also covered by some insurances. Order forms are available through the website: https://hidrawear.com/ Otherwise, the pati...
What diet modifications do you recommend for patients with acne to help prevent breakouts?
I'm not too crazy about recommending a restrictive diet for acne patients but I always ask about protein shakes, whey, creatine and recommend a vegan powder if possible. Skim milk and low GLYCEMIC index diet if anyone is willing to change their behaviors.
What is your treatment approach for steroid-refractory necrobiosis lipoidica?
I have never had success treating NLD. I have seen rare spontaneous improvement over the course of several years however.
Do you hold histone deacetylase (HDAC) inhibitors for patients receiving palliative radiation therapy for cutaneous lymphomas?
Histone deacetylase (HDAC) inhibitors are often used in the management of mycosis fungoides, the most common cutaneous lymphoma. NCCN guidelines include two HDAC inhibitors in their list of recommended systemic therapies- romidepsin and vorinostat. Romidepsin was FDA approved for CTCL in 2009 and vo...
How do you treat non-melanomatous skin cancers in poorly vascularized tissue?
BCC/SCC? An unusual differential. Was it biopsied? If it meets anatomic, size, and depth criteria, radiation oncology options would include electronic brachytherapy. Would likely offer 40 Gy in 10 fractions, twice weekly. Of course, would need to travel to an appropriate facility.
Do you offer finasteride to teenagers with androgenetic alopecia?
Finasteride can prevent the development of the beard, so I never offer it if the beard is not completely grown.
How would you approach an ulcerative non-melanomatous skin cancer of the lower extremity s/p Mohs surgery with gross disease left behind?
If there is gross disease, then the wound is less likely to heal. Need to explore surgery with flap or RT as definitive management.
Do you commonly recommend oral minoxidil, dutasteride, or a combination of both for patients with androgenic alopecia?
Neither of these medications are approved for AGA, and treatment considerations are different in men vs. women. Oral minoxidil at low doses is very safe and generally well tolerated, and a great option for patients with irritation from topical use. It avoids potential side effects of finasteride, wh...
How would you evaluate and treat an older teenage patient with severe perioral dermatitis with histology demonstrating a granulomatous dermatitis and all stains have come back negative?
Minocycline (rarely use but for this, I would) with weekly ivermectin and Elidel. I have done a prednisone taper as well to calm it down. Isotretinoin or dapsone...