Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Is there a role for adjuvant RT in a pleomorphic dermal sarcoma after WLE?
Adjuvant radiotherapy (RT) should be considered for pleomorphic dermal sarcoma on a case-by-case basis. There is no clear data to support the use or omission of radiotherapy in this disease, but we base our clinical decision-making on three factors: Estimated local recurrence risk Morbidity of treat...
What threshold do you use to escalate to a multidisciplinary child sexual abuse evaluation when a child with newly diagnosed lichen sclerosus also has persistent/recurrent vulvovaginal symptoms despite appropriate lichen sclerosus therapy?
Several variables need to be explored. What "appropriate" LS therapy has been utilized and, equally important, over what duration of time for this "newly diagnosed" case? Clobetasol ointment is to date the most effective treatment, but often requires months of continuous use; prescribing physicians ...
Would you recommend adjuvant radiation for an atypical fibroxanthoma of the scalp that is completed resected with +PNI and +LVI?
Atypical fibroxanthoma (AFX) is a rare cutaneous neoplasm. Diagnosis is often difficult, and may require the input of an expert soft tissue or dermatologic pathologist. I have seen many of these cases diagnosed elsewhere as AFX, and upon re-review, the diagnosis is changed to cutaneous squamous cell...
What has been your experience with tecovirimat for monkeypox?
I thought it worked well in 2 patients of mine with rectal Mpox. However, the clinical trial did not confirm this, and it was a lot of trouble to get TPOXX going with consent, investigational drug, etc so we have abandoned use here.
What laboratory studies do you routinely order when evaluating a patient with interface dermatitis on biopsy?
Rule out lupus.
When do you recommend HLA testing prior to prescribing lamotrigine, carbamazepine, or oxcarbazepine to patients of Asian descent?
I never use carbamazepine, given how it’s a pan-inducer and often lowers the level of other medications that may be in the regimen, such as quetiapine and haloperidol, since they are mainly metabolized by CYP3A4.Oxcarbazepine has a 50% reduction in the induction of carbamazepine, so I use that somet...
Is there a preferred JAK inhibitor for the treatment of alopecia associated with childhood-onset systemic lupus erythematosus?
Unfortunately, this question likely comes down to FDA and insurance approval and not scientific evidence. Since only one JAKi is approved for alopecia right now and and 2 for poly JIA and none for SLE currently in any age, it will come down to which diagnosis you are going to use to get coverage.
Have you used itraconazole as a primary or adjunct therapy for individuals with numerous BCCs?
Yes. I use itraconazole 100 mg daily with sonidegib 200 mg (daily or less frequently, depending on tolerance, but no less than twice a week) in every patient who shows a resistant SMO mutation on an NGS panel. I test all patients at baseline and at recurrence to determine what treatment to offer.
For patients on medications that are known to cause photosensitivity, would you counsel them to avoid laser hair removal or laser therapies?
"Known to cause photosensitivity" is almost every drug, but actually isn't all that common. I Rx doxycycline all summer and maybe see a possible reaction every few years. Variables are the dose of the drug and the amount and wavelength of light, but mostly studies are lacking. A test spot might giv...
What is your escalation strategy for chronic GvHD?
There are now several available options for steroid resistant cGVHD. The old standbys - ECP and rituxan are useful in about 30% of patients. Ibrutinib was the first new drug to get FDA approval. Unfortunately, I don't think the real-world experience is anywhere near as good as the trial (Chin et al....