Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you approach treatment change in patients with psoriasis who have been stable on an IL-17 or IL-23 agent but then begin to have breakthrough skin disease?
It really depends on where the patient is in their treatment journey. Patients who have tried and failed other biologics I try to optimize response by: increasing the biologic dosing frequency if insurance will allow, adding topicals, particularly newer ones like tapinarof or roflumilast, adding ph...
What is your experience managing patients with chronic spontaneous urticaria occurring only at night?
When I have patients with Chronic Spontaneous Urticaria (CSU) that is not responding like CSU should to medications, the first thing I wonder is if this is really CSU. In these situations, I will order additional lab work-up for CSU and conditions mimicking CSU, as discussed in a recent review in JA...
Are you comfortable utilizing Stelara (ustekinumab) as biologic treatment of psoriasis for patients with a history of severe latex allergy?
I don't have a lot of data to go on. On the one hand, I would be comfortable, as I doubt there would be any problem as long as the patient didn't touch the latex in the needle cover. But since we have many products without latex, perhaps it would be prudent to use those first. If other options were ...
What is the youngest age and dose that you would consider for oral minoxidil?
I would consider prescribing oral minoxidil for children as young as 2 years old, but only if the condition is severe and does not respond to topical therapy.
How do you counsel parents of children with atopic dermatitis about preventing recurrent Staph infections?
For recurrent Staph infections, I recommend bathing daily, as well as giving a bleach bath 2-3 nights per week. If they are struggling with multiple or recurrent abscesses, and/or other family members are also having recurrent Staph infections, that is when I recommend intranasal mupirocin. I typica...
How long are you comfortable with keeping pediatric patients on oral antibiotics for acne?
I start all acne patients on a topical retinoid and if they need an oral antibiotic, I will prescribe that with a follow-up at 3 months. It takes about that long for a topical retinoid to kick in. If they need a couple of months longer, that's okay, but I might add topical or oral spironolactone to ...
What oral treatment options would you offer a patient with severe onychomycosis who is also on methotrexate for another condition?
I prefer pulsed terbinafine at 250 mg daily x1 week every other month. Dr. Zaias showed in a comparative study that pulsed terbinafine works as well as giving it daily for 3 months, and since the patient is only taking this for 1 week every other month, risks for hepatotoxicity are minimal.
How have you used Hedgehog pathway inhibitors as neoadjuvant/adjuvant therapies?
I am presuming that the question is directed towards Basal cell cancer. We don't use Hedgehog pathway inhibitors (HHIs) in an adjuvant setting, but sometimes in the neoadjuvant setting, when the risk of getting a positive margin is high. I prefer alternate-day dosing of vismodegib (less muscle cramp...
Do you prescribe fluocinolone in peanut oil in patients with peanut allergies?
Yes. Paller et al., PMID 12664021
How do you manage new-onset vitiligo in a patient on immune checkpoint inhibitors?
Vitiligo is quite often (not always) associated with good long-term clinical outcomes for melanoma patients treated with immune checkpoint therapy. It is an indication of the activity of the drug, as it is due to unleashing of the T-cells’ attack on the bystander melanocytes in addition to melanoma ...