Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What dosing range of doxycycline do you recommend for short-term and long-term management of ocular rosacea?
Short term, Doxycycline may be used at 100mg BID for 2-4 weeks, especially in severe cases. It can then be tapered to 100mg QD once a partial clinical response is documented, but where residual disease and symptoms still exist, or to 50mg QD if there is a complete clinical response. Longterm, doses...
What labs do you order to monitor patients on JAK1 inhibitiors (abrocitinib or upadacitinib)?
TB, HepB, and HepC at baseline, never repeated. CBC, CMP, and Lipids at baseline and 3 months, then once a year. CMP is probably unnecessary - no hepatic or renal toxicity - but I still do it. WBC and Hemoglobin often go down a little bit, but always happens in the first 3 months. Have had 2 patient...
How do you recommend tapering IVIG in patients whose inflammatory myositis has achieved remission?
This is a very good question without any right or wrong answer. My practice is to start tapering the IVIG 6 months after the patient has achieved clinical remission. I usually start decreasing the dose of the IVIG, but the other option is to extend the interval between the patient's infusions. The e...
How do you approach management of a patient with lower extremity ulcers from livedoid vasculopathy with a history Sjogren’s and Factor V Leiden?
Assess for additional procoagulant risk factors (smoking, phospholipid Abs, estrogen, paraprotein), and mitigate.Maximize pain management and wound care.In Sjogren's with vasculopathy, pts have responded to hydroxychloroquine, aspirin, and pentoxifylline. When lesions resolve, have continue hydroxyc...
What lab monitoring do you perform for patients taking isotretinoin?
I am a lab minimalist. I do ALT(past months have eliminated the AST) and fasting TGs at the start. Then at month 2 or max dose 1 mg/kg, I check ALT and fasting TGs. If there are any elevations at baseline, will check at month one which is usually 0.5mg/kg for me, and then month 2 (at the max dose) a...
What therapies have you found most effective for treating lower extremity DSAP?
I have had patients improve significantly with niacinamide 500mg po bid, and/or topical cholesterol/lovastatin. I have not had significant response to PDT.
What recommendations do you make for patients with lower abdomen eczema from nickel in their belt buckle?
This is a common clinical scenario in the United States as there are no legal limits on the use of nickel in objects in contact with the skin. Belt buckle dermatitis on the lower abdomen is almost pathognomonic for nickel allergic contact dermatitis (ACD). There are several consumer test kits to det...
What treatment regimen for UVA-1 have you found most helpful in treating sclerotic diseases (e.g. morphea, scleroderma)?
In our department, we have had success with the following treatment regimen with UVA-1 for sclerotic diseases. The following protocol is for full-body UVA-1 (appropriate for generalized morphea, systemic sclerosis). Low dose is considered 10-30 J/cm2, medium is 30-40 J/cm2 and high is 50-60 J/cm2. W...
What clinical or pathologic features would make you more concerned that a new skin SCC is from metastatic disease or a new cutaneous primary?
Histologic examination should reveal an epidermal connection in a primary SCC. If one cannot be found, the pathologist must raise the possibility of a metastatic lesion and state that alternatively could be a portion of primary SCC (epidermal connection may not be included in biopsy sampling). If th...
What advice do you have for the management of nail toxicity associated with pemigatinib and other FGFR inhibitors?
Pan-FGFR inhibitors as a class can cause significant dermatologic toxic effects (including alopecia, dry skin, nail changes, and stomatitis) anywhere in the range of 20% to 45%, depending on the specific agents (Lacouture et al., PMID 33021006, Bétrian et al., PMID 28538953).Lacouture and colleagues...