Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What’s your favorite topical OTC moisturizer that you recommend, and why?
There is no easy answer to this question as recommendations for moisturizers are quite patient and location specific and depend on degrees of dryness. The best moisturizer is one that feels good to the individual patient and is one that he/she will then use. For example, someone with mild facial dry...
Would you start glycopyrrolate in elderly population and how do you counsel the patient?
The short answer is no, I would not start systemic glycopyrrolate in the elderly population. Of course, more information is needed to thoroughly answer this question. For simplicity, I will assume glycopyrrolate is being considered for excessive sweating. A complete history and physical exam are nec...
How would you sequence medications in a young patient with history of VTE and severe atopic dermatitis after failure of dupilumab?
We can assume this is not exclusively Th2-driven based on the failure of dupilumab. Consider patch testing prior to starting new treatment, using a short-course cyclosporine to clear skin if needed. Consider nbUVB phototherapy (home or office-delivered). Consider off-label oral roflumilast (antiplat...
Do you routinely prescribe oral antifungals for seborrheic dermatitis?
The most common indication when I have prescribed an oral anti fungal is when the seborrheic dermatitis extends beyond the scalp, such as on the sternum and/or face (petaloid), and has failed topicals. With that much widespread distribution, adequate application of topical treatments can be very cha...
Under what circumstances would brachytherapy be preferred over electron therapy for treating skin cancers?
For small (<2 cm) nonmelanoma skin cancers, I would say that brachytherapy is preferred for these reasons: Better cosmesis - 90-95% report excellent, which is better than electron series, particularly at the edge. Better for curved surfaces like the nose b/c applicator is flush on the skin with no ...
What treatment modalities have you had success with for treating extensive molluscum in the pediatric population?
I've had very good success with the use of oral cimetidine, 400 mg PO tid in children. Usually, they remain on this tx for 4-6 weeks with sig clearing beginning by the 1st 2-3 weeks. I also use tretinoin gel 0.1% qd-bid to the more stubborn lesions if necessary.
Is there a role for resection of the cutaneous primary in a patient on dual-agent immunotherapy for metastatic melanoma?
Yes. The location and size (width, length) should be noted. The patient should first be treated with dual ICI. If the patient with metastatic melanoma, who has the primary intact, undergoes successful dual ICI therapy and has a documented CR, near CR, or excellent PR, which is typically noted within...
What nutritional supplements do you recommend for patients with hair loss?
Protein 30-40 grams a day. These skinny dieters who only eat fish aren't getting enough. I do check iron and ferritin and get ferritin to at least 50, even 60-70 for shedding hair. I really like untangled by foundation skincare.
What initial workup do you perform when there is a concern for porphyria?
This is a terrific question. But a broad question. Porphyria refers to a defect in heme biosynthesis leading to the accumulation of porphyrins and porphyrin precursors. We should remember that there are three general categories of porphyria based on clinical manifestations: acute hepatic porphyria (...
How do you counsel patients who ask if there are any dietary modifications they can make to help control their autoimmune disease?
I send patients to a website called nutritionfacts.org. This is a non-profit website that reviews medical literature related to nutrition and diseases. It was founded by Dr. Greger and he is not trying to sell anything which I appreciate. He has bite-sized videos on anything you can think about rela...