Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are best practices for dermatologists and oncologists to collaborate in order to optimize multidisciplinary care of patients with high risk CSCC?
A network of specialists familiar with cSCC is necessary to optimize care that is tailored and appropriate for each unique case. Avoiding under-treatment and over-treatment is important, but also challenging, given the high volume of cSCC tumors with variable patterns of presentation and numerous cr...
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.
What treatments have you found to be most effective in treating oral lichen planus?
Agree, have had good response with oral tacrolimus solution. Patients can work in nystatin mouthwash or clotrimazole troches +/- chlorhexidine gluconate oral rinse 0.12%. Dexamethasone solution may be rotated with the tacrolimus if desired (I've just used the lower strength 0.5mg/5mL, dose: 10cc, sw...
What therapies have you found most effective for JAK-induced/associated acne (JAKcne)?
Doxy will work quickly and is pretty safe. If all goes well, you can taper the dose of the oral antibiotic and use topical agents.
Should JAK inhibitors be avoided in patients with a recent history of melanoma?
Given the FDA-boxed warning about risk of malignancy, JAK inhibitors should be used with extreme caution in patients with a recent history of malignancy, including melanoma. It would be important to have an extensive conversation with the patient to ensure understanding of the potential risks, with ...
How do you approach treating patients who develop psoriasis while on Dupixent?
Stop the Dupixent. These patients likely had a non-Th2 driven type of dermatitis e.g. Malassezia yeast hypersensitivity, which is Th17 driven, or stasis dermatitis with autoeczematization, or eczematous drug reaction. Revisit the Diagnostic Checklist for Generalized Dermatitis.
What treatment strategies are effective for senile gluteal dermatosis when patients do not improve with standard lifestyle modifications and emollients?
Senile gluteal dermatosis is very difficult to treat, as you know. What I have tried to do is methodically go through each lifestyle modification, such as sitting position and having the patient move frequently - be as sure as you can - that they are able to achieve these modifications to some degre...
How have you incorporated gene expression profiling tests for melanoma or SCC into your practice and has it changed your approach to treatment and/or monitoring?
This is a controversial topic for sure, but most emerging technologies in medicine are. I do use gene-expression profiling in the treatment of cutaneous SCC and invasive melanoma. My theoretical framework for using GEP testing is that it is a forward looking test, while clinical staging is backward...
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...
Do you scale up 2nd generation anti-histamines to 4x daily in acute urticaria in the pediatric population as you do in adults?
Severe urticaria is certainly a therapeutic challenge. Updosing 2nd generation antihistamines in children has been studied, more trials need to be done. For refractory urticaria in children, I will often recommend 2X the recommended dose of a 2nd generation antihistamine in the morning and maximize ...