Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you recheck screening labs (ESR, BUN/Cr, urinalysis, ANA, etc) for patients with recurrent small vessel vasculitis of unknown origin with each flare?
If the recurrences occur 6 or more months apart, I would recheck the studies to exclude SLE. If the episodes are chronic, I would recheck at least once a year for the same reason or whenever there are new suggestive symptoms of LE.
What prescription or over-the-counter therapies have you found effective for helping vitiligo patients cover active areas?
As Dr. @Dr. First Last mentioned, selecting the correct topical steroid strength based on location is important. We have had patients make great progress (even without nbUVB therapy / xTrac) by alternating every 1-2 weeks with a topical steroid and a non-steroidal (i.e., Pimecrolimus cream or Tacrol...
Do you utilize a constraint for skin/dermatitis in setting of thoracic chemoradiation?
No. This acute toxicity is almost universally reversible in short course and should have essentially no bearing on the decision making when treating a potentially lethal lung cancer; also, I know of no data quantifying skin tolerance doses.
What first-line therapies do you recommend for patients with folliculotropic mycosis fungoides?
Agree with Dr. @Dr. First Last as above. For first-line topical therapies for patients with limited skin disease, you can consider topical steroids or topical nitrogen mustard, although these agents may not penetrate the skin to a sufficient depth to treat the disease at the hair follicle. Other opt...
What timeframe do you recommend for performing imaging in pediatric patients with moderate to high-risk congenital melanocytic nevi?
I tend to favor obtaining an MRI of the CNS before the age of 6 months (based on the work and recommendations of Dr. Veronica Kinsler). Depending on the experience of the radiology department, some are able to obtain this imaging without general anesthesia, using a "soothe and swaddle" technique. Ho...
Is oral lichen planus a contraindication for immunotherapy in a patient with recurrent oral SCC?
I have personally given Pembrolizumab to a patient with an oral SCC who had underlying lichen planus. The patient had a good response to therapy, but I also treated the patient with a conditioning regimen of steroids during treatment so as not to exacerbate the lichen planus. I gave prednisone 40 mg...
Have you had success using resorcinol 15% topically for limited hidradenitis?
I haven't used topical resorcinol, but Joslyn Kirby shared this list of compounding pharmacies that can provide it: Custom Prescriptions of Lancaster Good Day Pharmacy Chambers Apothecary Hazle Compounding Pharmacy Cumberland Apothecary She said it's usually ~$50 for 30 grams of resorcinol from Cu...
Would you consider using a JAK inhibitor in combination with an IL 23 inhibitor in cases of severe psoriasis, psoriatic arthritis, or axial spondyloarthritis that is refractory to multiple biologic DMARDs?
Differential skin and joint responses in psoriasis, PsA and Axial SpA are not uncommon. Many PsA/PsO experts and scientists have postulated the potential benefit of using combination biologic (perhaps in serial fashion or lower doses of each) to treat these cases where there are suboptimal responses...
How do you manage polymorphous eruption of pregnancy (formerly PUPPP)?
A fellow resident assured me that the only thing that gave her some relief was otc itch-x.
What criteria do you use to determine the resectability of mucosal melanoma of the H&N region?
Obviously, the best specialist to answer the posted question would be a H&N surgeon. As a Rad Onc enthusiast who conducted a retrospective study about the subject long ago (Lee et al., PMID 8302112), I’ll provide my own 2-cents here:Mucosal melanoma (MucMlnm) of the H&N is a relatively uncommon mali...