Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What topical therapies and procedures do you recommend for improving facial pore size?
Ablative CO2 or Erb:YAG fractionated resurfacing laser would provide the best and most durable treatment for large pores. Topical neuromodulators don't have a particular role in reducing pore size. Topical exfoliants (AHA/BHA and retinoids) can be beneficial with chronic, consistent use by removing ...
What treatments do you consider for cholinergic urticaria refractory to high dose H1 blockers and omalizumab?
Generally, my initial approach to cholinergic urticaria (CholU) is the same for chronic spontaneous urticaria and other forms of chronic inducible urticaria [1]. Most patients with antihistamine-refractory cholinergic urticaria (CholU) will respond to omalizumab 300 mg monthly. Those individuals wit...
Do you typically excise clear cell acanthomas?
Clear cell acanthomas are benign. Shave excision/shave removal, or electrofulguration and curettage are usually adequate treatment options.
What is your preferred oral regime with duration for treatment of onychomycosis?
Back in the old days of the "toenail wars" between terbinafine and itraconazole, I was a speaker for both and learned that the pharmacodynamics of the two drugs favored pulsing for the latter but NOT for the former. Terbinafine does NOT leave the blood for weeks, unlike itraconazole (days), so if th...
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 criteria do you prioritize when trying to select the most effective exosome products for your patients?
I do not use exosome products. The evidence doesn’t yet support the use and expense.
How do you approach sequentially tapering combination therapy (i.e., IVIG, mycophenolate, rituximab) for dermatomyositis that is in remission?
This process involves trial and error and requires collaboration between the physician and the patient to determine the most appropriate tapering strategy. My personal preference is to begin tapering medications with the highest risk of side effects. Among IVIG, mycophenolate, and rituximab, I would...
What treatment regimen would you recommend for a patient with biopsy-proven giant cell arteritis and diffuse cutaneous systemic sclerosis?
This is a challenging situation in which you must weigh the well-known high risk of irreversible blindness in untreated GCA with the known increased risk (but not necessarily 100% risk) of scleroderma renal crisis with steroid exposure >=15mg (Steen and Medsger, PMID 9751093). It is important to und...
Why is it recommended that patients not apply moisturizer in the radiation field immediately prior to daily treatment?
The received wisdom of Radiation Oncology that patients should not apply topical agents before radiation treatment was promulgated out of concern that said topical agents would act as "bolus" of sorts, and increase the radiation dose to the skin in a way that would enhance radiation dermatitis. For ...
How do you reassure families that no allergy testing is needed for urticaria?
There used to be a Choosing Wisely message about this. Here is a video on it. Diagnostic Testing and Chronic Urticaria Video - AAAAI The 2014 practice parameters on chronic urticaria also discuss this. The practice parameter update is looking at this in a GRADE fashion and will likely have even mo...