Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you prefer Cantharidin Plus or Y-canth for management of pediatric molluscum?
I don't like cantharadin plus over Y-canth because I don't like the plus. I still prefer plain cantharadin by a large margin over both.
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 long do you apply patch testing before interpreting the results?
In most instances, patches are removed after 48 hours (2 days). This timeframe is specifically chosen to allow sufficient time for the allergen to penetrate the stratum corneum and trigger a T-cell-mediated response, while simultaneously reducing the potential for significant skin irritation that ca...
Have you used topical rapamycin/sirolimus for TSC-related angiofibromas?
I used it before it was approved for the treatment of vascular lesions and noted that it was effective and safe.
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...
How do you manage dyshidrotic eczema in children during the winter months?
I typically use class 3 topical steroids, i.e., mometasone 0.1% ointment for flares and then tacrolimus ointment for maintenance if needed. Occasionally, higher potency topical steroids are needed for flares. I encourage frequent emollients, at least 3 times per day (before school, when home from sc...
Does the presence of paraneoplastic pemphigus influence your treatment options in CLL?
Paraneoplastic pemphigus is often difficult to treat, and if traditional measures do not control it, I often will use continuous therapy for CLL to both eliminate the disease and continue suppressing the autoimmune source of this paraneoplastic complication.
How would you treat a late local recurrence of extramammary Paget's disease of the vulva, not amenable to resection?
If the patient does not have any invasive disease, or underlying malignancy or nodes, then I would consider treating this with radiation, specifically superficial brachytherapy. At our institution, we routinely treat similar patients with large perineal, inguinal EMPD patients with 3D custom printed...
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
I find the biggest gains come from having clear and consistent communication around patient identification and treatment planning. Aligning on what constitutes “high risk” — both for local recurrence and metastasis — and which patients truly fall into the very-high-risk category is essential. It’s c...
What is your approach to using intraperitoneal sodium thiosulfate for a patient with ESKD on peritoneal dialysis who develops calciphylaxis?
I believe if the patient has calciphylaxis, PD should not be continued, and more efficient IHD or HHD with the addition of sodium thiosulfate is better.