Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are your preferred treatment options for patients with chronic non-healing leg ulcers?
In addition to all the typical things (decreasing edema with meds, compression, etc + treating superinfection, critical colonization, or debriding eschars), there is some evidence for pentoxifylline 400 mg TID or 800 BID in ulcerations of any etiology. There is also newer evidence for using topical ...
How would you approach diagnosis of a patient with recurrent episodes of abdominal pain, severe myalgias, low grade fevers and urticaria?
Without the mEFV variant, from a rheumatologist viewpoint, the differential includes IBD, a periodic fever syndrome such as FMF or FCAS, and MCAS. Therefore, I would consider that workup with genetic testing (anyone can send!), fecal calprotectin, and MCAS eval with A/I. I don't think of urticarial ...
What is your late or no-show policy for patients?
I'm really interested in reading answers by those of you who have punitive policies for these patients. I wrestle with these problems several times per week, as I have Mohs surgery patients either no-show or cancel/reschedule with less than 24 hours' notice. On the one hand, I find that most patient...
What clinical scenarios warrant the use of a skin substitute?
Chronic wounds like diabetic and venous leg ulcers are the most common clinical indication, especially when healing fails to progress after standard wound care. Extensive full-thickness burns are also a primary indication, particularly when there is insufficient donor skin available for autografts o...
What psychiatric medications do you feel comfortable prescribing as a dermatologist?
How do you approach Pityriasis rubra pilaris that is retinoid resistant?
I find most PRPs to respond, at best, incompletely to retinoids - they are not my first line. Any TNF-alpha or IL-12/23 inhibitor is reasonable to try, and there are no head-to-head trials to my knowledge to endorse one other. Mtx may need to be added. IL-17s likely work too for some patients. Depen...
How do you bill cosmetic follow-up appointments?
Most of these are no-charge visits unless a new problem is presented.
What should be done for a patient with biopsy-proven seborrheic dermatitis on the scalp and central forehead (presenting as a large annular scaly thin plaque) who has failed treatment with fluconazole, antifungal creams, and Zoryve (which is too expensive)?
I don't think dupilumab is reasonable for seborrheic dermatitis. For seborrheic dermatitis, I'd typically prescribe a potent topical steroid in a vehicle the patient prefers and have them use it twice a day for just 3 days (along with ketoconazole or other medicated shampoo). Adherence to topical tr...
How reliable are the expiration dates of patch test allergens?
An AI search of this question revealed the following: "Expiration dates for patch test allergens are generally considered reliable and should be strictly honored to ensure diagnostic accuracy. While some allergens remain stable for years, others degrade rapidly, and using expired materials significa...
Which patient factors drive you to pursue patch testing in the workup of chronic hand eczema?
Seasonal hand eczema occurring only during the cold season is usually irritant and best addressed by minimizing hand washing and using cotton under occlusive gloves with frequents changes for wet work. Careful examination for signs of psoriasis and anti-synthetase syndrome is important. Next step is...