Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Which serologic tests are most helpful when evaluating for suspected drug-induced lupus?
If I suspect drug-induced lupus, I typically order the following laboratory testing: ANA/IFA Anti-histone antibody, usually positive in drug-induced lupus Anti-Ro antibody, usually positive in drug-induced subacute cutaneous lupus Anti-dsDNA, usually negative in drug-induced lupus vs positive in id...
Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?
This is a very good question with direct clinical practice implications. I do not check or follow anti-drug antibodies when using TNF inhibitors for the treatment of rheumatoid arthritis or psoriatic arthritis. There are reports that suggest, on a group level, that these antibodies, if present, impa...
Would you offer upfront radiation for a large painful keloid of the chest that has arisen from an irritated pyoderma gangrenosum lesion?
Radiation therapy is actually used (rarely) for pyoderma gangrenosum that has been unresponsive to medical management via immunosuppression [1]. Single fraction doses of 400 to 800 cGy have been used with slow regression of the lesions. In the case report cited, the lesion started fading after 3 mon...
Does baseline facial dermatitis in a patient with AD cause hesitation when starting Dupixent due to conjunctivitis-related complications, especially when there are many available options?
Yes, I definitely do consider this. Not necessarily because of conjunctivitis but because I’ve seen a significant number of patients with “dupilumab facial redness or reaction” with out-of-proportion head/neck flaring in AD patients. In patients with significant facial involvement at baseline, I pre...
How do you tailor rituximab dosing for mucosal-predominant vs mucocutaneous pemphigus?
No, I do not dose cutaneous vs mucocutaneous patients with pemphigus differently with rituximab. I am more likely to recommend rituximab as first-line therapy if a patient has severe oral or genital disease, as this can be very quality-of-life limiting. Furthermore, relapse assessment can be challen...
If a BRAF-mutated melanoma patient developed metastatic disease progression on adjuvant anti-PD-1 monotherapy, do you recommend switching to BRAF/MEK targeted therapy or combination immunotherapy?
The developing pre-clinical and clinical data is clear on this and I believe it becomes even more clear with time. While the DREAMseq study did not enroll patients following adjuvant therapy as the patient in the case, the overall evidence clearly shows that BRAF/MEK inhibitor resistant melanomas ar...
Are there any special considerations for treatment of metastatic acral melanoma?
In general, acral melanoma is a higher-risk disease. There are higher rates of acquired and primary resistance. Given this, I favor ipi-nivo since the overall risk is higher and response rates to single-agent PD-1 or nivo-rela tend to be lower. Emerging data suggest TIL therapy can work reasonably w...
How do you feel the oral IL-23 (Icotyde) will shape psoriasis management?
As a first oral option with a specific targeted pathway differing from apremilast, minimal to no blood lab needs, no needle involvement, and once daily dosing, this medication is a dramatic shift for patients. Personally, I am hopeful for lower-age pediatric dosing. Looking forward to how this medic...
What are your top takeaways from AAD 2026?
Cutaneous lupus erythematosus - the pipeline is very exciting and many mentions of the FDA breakthrough status of litifilimab. Also, talks on potentially using anifrolumab sooner in the treatment ladder to prevent scarring, which is approved for SLE and currently in trials for CLE. The clinical tri...
How would you manage treatment of keloid that is so large it requests a graft?
16 Gy/4 fractions