Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Should the use of avacopan be limited to those patients at increased risk of steroid toxicity given the anticipated high cost of this medication?
Once Avacopan is available for clinical use in the treatment of patients with AAV, providers will need to carefully weigh risks and benefits of the medication while considering other factors including cost.The ADVOCATE trial used a novel glucocorticoid toxicity index that captures common GC-related ...
What would prompt you to obtain IGRA in a patient starting an IL-17 inhibitor for psoriasis who is also on concomitant immunosuppression despite the ‘no routine testing’ recommendations before initiating this class of biologic?
If the IGRA was indicated for the concomitant immunosuppressive drug, that would prompt me to obtain the IGRA. Also, more commonly, if the insurer required the IGRA, I would order it.
How do you decide when to biopsy a patient with overlapping signs of female-pattern hair loss and possible early central centrifugal cicatricial alopecia?
Biopsy is indicated when the diagnosis is uncertain, particularly when distinguishing between female-pattern hair loss (FPHL) and central centrifugal cicatricial alopecia (CCCA), as these conditions can have overlapping clinical presentations. Our T-shirt should also represent fibrosing alopecia and...
Do you recommend a workup for POEMS and/or amyloidosis for IgM monoclonal gammopathies associated with neuropathy?
While IgM monoclonal disorders, amyloidosis, and POEMS syndrome may all be associated with peripheral neuropathy, they are not often confused with one another. A patient with a peripheral neuropathy can be diagnosed most simply by a serum protein electrophoresis. The presence of a monoclonal IgM spi...
With emerging therapies, what is your general treatment ladder for chronic spontaneous urticaria (CSU)?
Antihistamines remain the first-line therapy for chronic spontaneous urticaria (CSU), and doses should be optimized before turning to other therapies. If patients fail a trial of adequately dosed first- and second-generation antihistamines, montelukast is a reasonable adjunct. For patients with high...
What data exist regarding treatment for facial erythema from dupilumab in children <5 years of age?
In AD patients >6 years, the incidence of facial erythema for dupilumab was 1% vs placebo 0.7% (Paller et al., PMID 41163262). The placebo-controlled LIBERTY AD PRESCHOOL trial (Paller et al., PMID 36116481) and the subsequent open-label trial up to 2 years (Paller et al., PMID 41926052) for 6-month...
Do you routinely screen for cardiovascular risk factors in a patient with moderate-to-severe psoriasis?
Review of systems. Depending on age, consider lipids and HbA1c if no data for the past year.
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 therapies do you most commonly recommend for prevention of NMSC in organ transplant patients?
First and foremost, we assess transplant patients and circle, number, and label all their skin cancers so we can catalogue them. We then prioritize their skin cancers in order to remove them in order of "worst first". We immediately start field therapy with calcipitrione and 5-FU twice a day for a w...
How would you manage a patient who presents with hair loss that began after they started a GLP-1 inhibitor?
If it fits with telogen effluvium, I recommend monitoring. Many patients will improve after this initial shedding and will not have long-term shedding or long-term thinning. If there is any underlying androgenetic alopecia or pattern hair loss, then starting treatment as you normally would is also r...