Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
For patients on medications that are known to cause photosensitivity, would you counsel them to avoid laser hair removal or laser therapies?
"Known to cause photosensitivity" is almost every drug, but actually isn't all that common. I Rx doxycycline all summer and maybe see a possible reaction every few years. Variables are the dose of the drug and the amount and wavelength of light, but mostly studies are lacking. A test spot might giv...
What is your escalation strategy for chronic GvHD?
There are now several available options for steroid resistant cGVHD. The old standbys - ECP and rituxan are useful in about 30% of patients. Ibrutinib was the first new drug to get FDA approval. Unfortunately, I don't think the real-world experience is anywhere near as good as the trial (Chin et al....
How would you treat pattern hair loss in a woman on aromatase inhibitors for breast cancer?
I treat with topical or oral minoxidil. Spironolactone is considered safe. I avoid 5alpha reductase inhibitors, both topical and oral, in patients with a history of estrogen receptor-positive breast cancer. Topical 5α reductase inhibitors must be absorbed systemically for any benefit. Other tools fo...
How do you reconcile the differing results of the C-POST and KEYNOTE-630 trials when discussing treatment options with high-risk CSCC patients?
I explain that the two trials enrolled different risk populations, which likely accounts for the apparent discrepancy in outcomes — but when you look closely, they actually lead to the same clinical conclusion. C-POST deliberately enriched for very-high-risk patients (using well-established adverse ...
Do you prefer Cantharidin Plus or Y-canth for management of pediatric molluscum?
I don't like cantharadin plus over Y-canth because I don't like the plus. I still prefer plain cantharadin by a large margin over both.
Have you used topical rapamycin/sirolimus for TSC-related angiofibromas?
I used it before it was approved for the treatment of vascular lesions and noted that it was effective and safe.
What is the value of resection in high risk (but small or early stage) skin cancers at the medial canthus?
The value of resection of a high risk small or early stage skin cancer at the medial canthus is potential assurance of complete removal of the skin cancer by confirmation of negative margins. Depending on the extent of disease and surgical approach, this may or may not be straightforward. There are ...
How do you manage dyshidrotic eczema in children during the winter months?
I typically use class 3 topical steroids, i.e., mometasone 0.1% ointment for flares and then tacrolimus ointment for maintenance if needed. Occasionally, higher potency topical steroids are needed for flares. I encourage frequent emollients, at least 3 times per day (before school, when home from sc...
Does the presence of paraneoplastic pemphigus influence your treatment options in CLL?
Paraneoplastic pemphigus is often difficult to treat, and if traditional measures do not control it, I often will use continuous therapy for CLL to both eliminate the disease and continue suppressing the autoimmune source of this paraneoplastic complication.
How would you treat a late local recurrence of extramammary Paget's disease of the vulva, not amenable to resection?
If the patient does not have any invasive disease, or underlying malignancy or nodes, then I would consider treating this with radiation, specifically superficial brachytherapy. At our institution, we routinely treat similar patients with large perineal, inguinal EMPD patients with 3D custom printed...