Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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...
Are you managing chronic urticaria/angioedema any differently if the patient is only/predominantly presenting with urticaria or angioedema?
The mechanism is similar for urticaria and histamine-induced angioedema, so I would expect a similar response. The evidence to support the use of montelukast for U/A is slim, but there are some supporting data. Nonetheless, the newest WAO guideline does not suggest an addition to the therapeutic pyr...
What resources do you provide patients with alopecia areata?
For any patient with alopecia areata, I recommend the National Alopecia Areata Foundation for them and their family. NAAF provides lots of resources and have a yearly patient meeting that is always a hit for patients and their families. In addition, we discuss all appropriate treatment options for t...
For a positive anti-TPO and normal TSH in the workup of CSU, are you referring to endocrinology?
I typically do not refer these patients to endocrinology. I do provide the patient with these results and have them communicate this with their PCP and/or communicate with the PCP myself so they can monitor for any symptoms associated with thyroid dysfunction.
When do you order genetic studies such as comparative genomic hybridization for melanocytic lesions?
In my practice, I confine copy number alteration studies (SNP array testing) for cases where the biological potential of a melanocytic proliferation is in question. I do not perform the testing if the case is diagnostic histopathologically and/or immunohistochemically of a nevus or melanoma.The seco...
In light of recent measles outbreaks in the US, would you recommend an MMR booster for immunocompetent patients born before 1957?
I would not recommend a measles vaccine for a person born before 1957. This year has been chosen because people before born before 1957 have a very very high likelihood of having had measles because virtually all children got this highly contagious disease. On the other hand, there is no harm to get...
Do you generally treat family members of patients with scabies?
Yes, if "family members" refers to those living in the same household or have had close contact with the affected individual within the past 3-4 weeks. Treating such contacts simultaneously is the best option to help eradicate the infestation.
What therapies do you recommend for patients with recalcitrant seborrheic dermatitis?
Topical roflumilast is easily the most effective thing I've ever seen. Prior to that being available, here were the go-to drugs for difficult seb derm: Itraconazole 200 mg qd until better, then 200 mg qd on weekends long term Fluconazole, exact same regimen if itraconazole not accessible Oral Roflu...
How do you manage patients with erosive pustular dermatosis?
First of all, it is very important not to miss underlying squamous cell carcinoma in cases labeled with erosive pustular dermatosis. I diagnosed moderately to poorly differentiated squamous cell carcinoma underneath the crusts in a couple of patients with known erosive pustular dermatosis of the sca...