Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Is there a role for patients who have a strong familial history of HS to receive a genetics evaluation or referral to clinical trials?
Unfortunately, there isn't yet a genetic test to determine the risk of HS. There are multiple centers working on genome-wide association studies looking for genetic markers. You can refer any HS patient to participate in those trials. Here are links to some of those studies: Chicago: NCT05710393 Sa...
How would you approach treating patients with biopsy-proven Hailey-Hailey disease refractory to multiple oral therapies (i.e. tetracyclines, naltrexone, apremilast, glycopyrrolate, Cellcept), and requiring monthly steroid tapers for disease flares?
Botulinum toxin would be my next choice.
What role does oral roflumilast play in dermatology?
Cheap alternative to otezla for when insurance won't pay. Only about $20 with goodrx. Similar side effect profile.
How have you incorporated biologics targeting the IL-36 pathway (e.g. Spevigo) into your treatment algorithm for psoriasis?
I would use Spevigo for generalized pustular psoriasis. For more common forms of psoriasis, I prescribe biologics approved for plaque-type psoriasis.
How do you approach ongoing screening for TB in patients with a history of treated latent TB, but who have ongoing use of DMARDs and/or biologics given Quantiferon testing and PPD can remain positive?
Interferon-release assays (such as Quantiferon) and PPD testing do not discriminate between infection, reinfection, and prior infection with TB. However, in most developed countries, the likelihood that a patient who has once been treated for LTBI becomes reinfected and develops LTBI again is low, i...
What is your approach to managing pyoderma gangrenosum recalcitrant to oral steroids?
Pyoderma gangrenosum is notoriously difficult to treat. The first thing I'd recommend in a case refractory to steroids is to reconsider the diagnosis. Notably, a high percentage of PG is misdiagnosed, so lack of response may indicate that you are dealing with a mimicker (e.g., infection, neoplasm, v...
How have you incorporated LED light therapies in your practice?
High quality evidence is nearly nonexistent, thus I have not incorporated this into my practice.
What is your approach to treating patients with chronically brittle nails?
Brittle nails is a relatively common condition, but pathophysiology of this nail condition is poorly understood. Thus, there is limited clinical trial data of treatments. Inflammatory, infectious, and systemic and traumatic conditions should be ruled in/out before starting treatment. For all patient...
How would you manage a large area of multiple, recurrent cutaneous squamous cell carcinomas of the scalp with ulcerations and non-healing areas despite cryotherapy, multiple Mohs procedures, and 5-FU?
Consider sending the patient to medical oncology for evaluation for cemiplimab. Large areas of the scalp can also be treated by making a 1 cm "cap" of bolus and utilizing VMAT to cover scalp soft tissues, with elective coverage of nodes and perineural pathways if indicated.
Would you switch to a TNFi if a patient developed squamous cell skin cancer on abatacept after failure of methotrexate for seropositive RA?
All biologics or immunosuppressants have been associated with various rates of skin cancers. The decision to change or continue biologics should be based on disease activity through shared decision-making with the patient. The need for frequent skin examinations and treatment through their dermatolo...