Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are your favorite modalities for preventing hypergranulation tissue?
Although exuberant granulation tissue is not totally preventable nor predictable, persistent inflammatory impetus, such as from hairs embedded in a surgical closure, or spitting suture reactions, can stimulate excess granulation tissue. Careful avoidance of trapped hairs as well as burying absorbabl...
How do you treat gram-negative folliculitis in a transplant patient on sirolimus who cannot use isotretinoin due to drug interactions?
The most critical issue with these infections in the immunocompromised host is the correct identification of the organism and its sensitivities to allow appropriate selection and course of antibiotics. Because the infection is deep in the hair follicle and the patient will shave the area, there is a...
Is keratosis follicularis (Darier disease) a contraindication to the receipt of PMRT?
Thanks for this interesting question. It prompted me to do a bit of literature search and think about how I'd approach this case.For a postmenopausal patient with ER-negative, PR-negative, HER2-negative (triple-negative) pT2N0(sn) breast cancer and unresectable positive surgical margins after mastec...
How have you applied the findings of this trial to your current approach to prescribing rituximab for pemphigus patients?
For the MMF vs MMF + Rituximab trial, the patients received two courses of Rituximab six months apart. The B cells don’t start to recover until about six months after the infusions. The data shows more patients in the rituximab group achieved sustained CRoff pred for 15 weeks or more relative to MMF...
How do you manage lamotrigine or lithium-induced acne?
For Lithium, I have referred patients to dermatology but it seems the interventions suggested such as Doxycycline, Spironolactone, or Bactrim do not fully help. I try to reduce the dose if possible or switch to another mood stabilizer if the acne is severe and bothersome that it is making the patien...
Would you give adjuvant radiation after complete resection of a small primary cutaneous follicular lymphoma of the scalp?
Not a lot of data, but here goes. First, one has to go back decades in the literature to find series of patients with lymphoma rx'd with surgical resection alone. In general addition of RT improved outcome even when ostensibly resected with neg margins. With today's technology risk of additional RT ...
Would you stop bimekizumab in a patient who has severe psoriasis and has responded well to this therapy but is found to have newly diagnosed cirrhosis?
I'd want to know if there was some other cause for the cirrhosis. If there were, I would not stop the bimekizumab. If there was not a clear, obvious cause, I'd want the patient evaluated by a hepatologist. If the hepatologist could find some other reason for the cirrhosis, it might not be necessary ...
How do you manage recurrent scabies in both a patient and their partner when standard therapy fails?
I would recommend 2 weekly treatments with oral ivermectin and topical permethrin. It is also very important to discuss control of fomite exposure as well as possible occult sources e.g., relatives and close friends.
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
That is a good question. Adding on to Dr. @Dr. First Last's response, rituximab has been shown to cause hypogammaglobulinemia that can persist or worsen with ongoing therapy. In a study published by Barmettler and colleagues, 133 patients out of a cohort of 8633 patients had serum IgG levels checked...
How would you manage active severe psoriasis in a patient planning pregnancy, who also has psoriatic arthritis with well-controlled joint symptoms on certolizumab pegol (anti-TNF therapy)?
If the psoriasis was sufficiently limited in area that topicals were a practical solution, I'd first try to assure that the prescribed topical steroids were being used well. Poor adherence is a common issue with topical treatment. Phototherapy might be my next choice. I feel comfortable prescribing ...