Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you determine if a positive thimerosal patch test isn't a false positive?
Thimerosal is commonly positive on patch testing and frequently not relevant. In fact, it was voted (non) Allergen of the Year by the American Contact Dermatitis Society. While small amounts are used in some influenzae vaccines, there is not much else that contains this. At one time, it was a preser...
What is your workup for patients presenting with hypopigmented macules?
None
How would you manage a patient with nonspecific clinical symptoms and pathology consistent with spongiotic and psoriasiform dermatitis other than oral JAK inhibitors?
Vast majority of these patients will not have any diagnosable underlying cause (like 99% in a non-academic setting) and the longer and more you look before you treat, the longer and worse they suffer. Take your best guess if more psoriasiform or more eczematous. If guess psoriasiform give them sampl...
In what situations would you treat elective regional lymph nodes for a squamous cell carcinoma of the skin on the extremity/trunk that was clinically node negative?
Nodal metastasis from small, to medium size [up to 3 cm in diameter] squamous cell carcinoma on the extremity is not that common. Considering the morbidity of nodal treatment in a patient with clear margins of resection I would not prophylactically treat the nodes. If the tumor shows perineural or l...
How often do you recommend ophthalmologic screening exams for patients with sarcoidosis?
The American Academy of Ophthalmology has guidelines for routine eye exams for an asymptomatic, healthy individual (not someone with sarcoidosis). These guidelines include a complete, dilated eye exam at age 40, interim exams at the discretion of the patient and one's ophthalmologist, and an exam ev...
What treatments would you recommend for patients with chronic urticaria who have minimal improvement with anithistamines and Xolair?
Cyclosporine, no question about it. I start at about 3 mg/kg/d of modified cyclosporine if omalizumab been failed, then try to taper once it is well controlled. I also want to give glucosamine at about 25 mg/kg/d - which has been shown in a randomized double-blind placebo-controlled clinical trial t...
How do you evaluate livedo reticularis (not livideo racemosa)?
Livedo reticularis appears as an interrupted vascular network on the lower limbs. One does not need to warm up the affected area in order to make this diagnosis. The response to heat usually occurs in cutis marmorata that is found in children. Livedo reticularis when it is acquired in teenage and la...
Any role for adjuvant systemic therapy for resected sebaceous skin carcinoma?
There is no data about this situation.I would probably treat adjuvantly if margins are positive or if there are localized metastatic lesions that were resected with the primary surgery. I strongly recommend genomic studies to look at mismatch repair, as 25 to 30% of cases could have a deficiency and...
How do you treat patients with Linear IgA that are deficient in G6PD?
Quite a unique clinical situation! One in which the diagnosis is rather rare, but with an added wrinkle where the most classic textbook therapy, dapsone, cannot be used.A few case reports have shown that omalizumab and dupilumab have been reported to effectively treat LABD: Almuhanna et al., PMID 37...
What is your approach to treating patients with dupilumab induced facial redness?
Literature is quite clear that the majority of these patients have Malassezia hypersensitivity as the etiology and the pathophysiology is essentially the same as seborrheic dermatitis. The IL-4 blockade allows upregulation of Th17 activity, which is the inflammatory pathway for seborrheic dermatitis...