Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you counsel patients on preventing nail damage with constant pedicures/manicures and nail polish?
I recommend that patients avoid cuticle or pushing, which makes then prone to both acute and chronic paronychias. The acetone removal process for gel manicures thins the nail plate - this has been shown in scanning electron microscopy studies. There is mounting evidence that UV dryers used to cure...
What treatments have you found helpful in treating recurrent aphthous ulcers?
Recurrent aphthous ulcers can be tricky to manage and recalcitrant to multiple therapies. I usually start with colchicine and topical corticosteroids. If that fails I move on to thalidomide. I have found that therapies in-between are unsuccessful.
What screening recommendations do you provide for patients with a Nevus of Ota with ocular involvement?
I refer them to ophthalmology.
How do you treat significant keloidal acne scarring on the back of a teenager?
Firstly, their acne needs to be controlled and stable prior to treating the scars themselves unless any of the keloids are particularly symptomatic. My decision-making is shared with the patient and based on many different factors including skin type, pain tolerance, insurance coverage/budget, scar ...
How do you approach treating nail lichen planus?
I would first start be determining the extent of cutaneous and mucosal involvement, as that often is more troublesome to the patient than the nails and may impact choice of treatment. Often, any systemic therapy directed at cutaneous/mucosal LP will also probably improve nail LP. Topical steroids to...
What is your approach to treatment of skin-limited cryoglobulinemic vasculitis in patients with Sjogren's syndrome who lack evidence of neurological or renal involvement?
I have given this patient Rituximab prior with success.
Do you consider downstaging neoadjuvant cemiplimab for borderline resectable CSCC in order to facilitate surgical resection?
The answer is yes, since the publications of the neoadjuvant cemiplimab study in the NEJM (Gross et al., PMID 36094839/). However, this is a change of standard of care, not yet vetted in the NCCN guidelines (Guideline SCC4), nor FDA approved for this indication. Thus, off label cemiplimab or pembrol...
Are you routinely using neoadjuvant cemiplimab for cutaneous squamous cell carcinoma of any site?
No
How do you utilize PRAME for melanocytic biopsies?
PRAME is useful as one piece of information to help me decide if I have enough criteria for melanoma in situ. Like most IHC stains it is just a piece of the puzzle to me. In my experience, positivity of MIS is about 7-8/10, so I do not require PRAME positive to diagnose MIS. But positive PRAME helps...
When do you prescribe topical JAK inhibitors for adult patients with atopic dermatitis?
For adult patients with atopic dermatitis, I typically start with topical steroids with or without topical calcineurin inhibitors as maintenance therapy. If minimal improvement with topical steroids/calcineurin inhibitors, then I turn to other topicals including topical JAK inhibitors and/or crisabo...