Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Would you give lung SBRT to a patient with bullous pemphigoid on the chest and torso?
If this patient has a clinically relevant lung cancer (which, by the clinical description, it sounds like it is felt they do) then I would feel comfortable treating them with SBRT. The very focal nature of SBRT makes this a very different scenario than large-field radiation. There is minimal data ov...
Is there a role for phenotyping patients with CSU outside of a research setting by ordering IgG-anti-TPO, IgG-anti-FceRI , total IgE, total IgA etc.?
I do think it can be helpful in patients who have difficult-to-control disease. Many of these (e.g. IgG-anti-TPO, total IgE, anti-thyroglobulin antibody) have been shown to help predict responsiveness to omalizumab treatment or have been associated with disease activity (Højgaard Pedersen et al., PM...
Would you be comfortable using isotretinoin in a female teenage patient who has a history of depression that is now stable but with a prior suicide attempt two years ago?
Yes. There is ample evidence that isotretinoin does not cause depression. In the large Canadian study, there was a slightly negative association with suicide. As the good doctors noted above, using appropriate step therapy, with informed consent (especially regarding pregnancy and birth defects), is...
What’s your immediate post-procedure protocol for fractionated laser resurfacing (i.e., Sciton Pro-fractional Laser)?
My immediate post procedure protocol for fractionated laser resurfacing is to decrease stinging with the Zimmer chiller (approximately 10-30 minutes followed by the application of Vaseline. I have not seen significant pinpoint bleeding while treating acne scarring (Lumenis Encore laser) but have see...
What treatment combination approach would you recommend for mucous membrane pemphigoid?
First, it is important to know the extent and severity of the disease (oral, ocular, esophageal); the type of inflammatory infiltrate on histopathology (neutrophils, eosinophils, or cell-poor); and the results of salt split skin and antibody titers on monkey esophagus and/or target antigens (collage...
How do you treat molluscum on the eyelid in a child or an adult?
Usually, I don't treat molluscum in this area due to sensitivity, especially in kids. It's been decades since I encountered MC on the eyelid of an adult, but if bothersome, and the patient is cooperative, I would numb the sites and remove larger lesions with an iris scissors. Last week, Zelsuvmi top...
What therapies have you found most effective in treating teenagers with recurrent CARP?
I have found CARP to be uniformly responsive to minocycline. In my experience, the incidence of recurrence is low and normally responds to minocycline.
What patient factors do you feel are most important when considering reduced dosing regimens of IL17a inhibitors such as secukinumab and ixekizumab for psoriasis?
If the psoriasis is completely clear, the patient may wonder if they need to continue treatment. If they want to spread out the doses to see how little they need, I usually have no objection.
How do you counsel patients with AKs such that they are motivated to improve or optimize sun protection behaviors?
Some thoughts and approaches that may help: It is very challenging (possibly close to impossible!) to induce behavior change in anyone, much less someone not motivated to change, so recognize your role as being a teacher/provider of information and do not assume a sense of personal responsibility f...
How do you avoid epilation in patients hoping to preserve their facial hair during radiotherapy?
Interesting question. I have not created an avoidance. It’s my experience that doses of about 50 Gy+ commonly cause permanent hair loss. It’s hard to avoid hair loss in areas where elective nodal or mucosal/skin coverage is needed. It’s certainly disappointing for some patients. In many scenarios of...