Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you manage worsening cutaneous dermatomyositis when muscle disease appears controlled?
The fact that the patient still has an active pruritic rash while tapering steroids suggests that the current regimen isn't fully controlling the disease, and it can affect quality of life. I would consider adjusting immunosuppression, either adding another agent or switching therapies. The specific...
What cosmetic options can you provide to patients with facial discoid lupus that seems stable?
Procedures such as botulinum toxin A, fillers, and autologous fat grafting can be considered in patients with discoid lupus if the disease has been clinically stable, typically meaning no new lesions or active inflammation for about a year. Light-based vascular treatments such as pulsed dye laser ca...
In which type of patient do you recommend a JAK inhibitor as first-line systemic therapy (biologic-naive) with moderate-to-severe atopic dermatitis?
A JAKi is almost never my first-line systemic therapy for AD. I generally reach for biologics targeting IL4/13 first and move to JAKi if those are ineffective or not tolerated. The main scenario where I would choose a JAKi first would be someone who had needle phobia or refused biologics.
What approaches can we take to initiate therapy and improve survival rates in patients with HLH?
At our institution, we have comprised a multidisciplinary team to help treat these patients. The team or "HLH task force" as we like to call ourselves is comprised of a clinical immunologist, rheumatologist, dermatologist, critical care physician, hepatologist, BMT attending/hematologist, infectious...
What procedures do you recommend for patients interested in xanthelasma removal?
I have had success treating xanthelasma with both hyfrecation (particularly for very small lesions) and fully ablative laser (both CO2 and Erb-YAG).
What’s your favorite topical OTC moisturizer that you recommend, and why?
There is no easy answer to this question as recommendations for moisturizers are quite patient and location specific and depend on degrees of dryness. The best moisturizer is one that feels good to the individual patient and is one that he/she will then use. For example, someone with mild facial dry...
What topical regimens do you recommend for redness related to rosacea in patients who defer laser treatments?
Naturally, laser is the most ideal and best solution. Green-tinted makeup is also a great adjunct. Aside from the usual routine counseling (avoidance of sun, food triggers, etc.), one product that I have found remarkable results with is the compounded SkinMedicinals ET-Rosacea Cream, which contains ...
Do you anticipate trying nemolizumab in patients with other difficult to treat pruritic conditions?
I have already used this drug in a multitude of off-label indications, including but not limited to lichen simplex chronicus, acne keloidalis nuchae, keloids secondary to acne fulminans, delusions of parasitosis, itch of unknown origin, nostalgia parasitic, scrotal pruritus, and occipital neuralgia.
If a patient has chronic spontaneous urticaria refractory to Xolair and is already on plaquenil, do you stop plaquenil and then initiate cyclosporine or do you co-administer and then gradually stop plaquenil over time?
I would first increase the dose of Xolair, actually, up to 600 mg every 2 weeks.
What therapies have you found most effective for managing patients with Darier disease?
Because of the amazing bench-to-bedside paper below, my most severe Darier's patient started on an IL17 inhibitor, and it is the closest thing I've seen to a miracle in ages. She was refractory to everything we tried, and is now 80+% clear. What a joy to see science change people's lives!Ettinger et...