Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What factors do you weigh most heavily in the selection of radiotherapy versus topical treatments for lentigo maligna in a patient who is not a surgical candidate?
The ability of a patient to travel to multiple sessions of radiotherapy would play a major role in making this decision. If the patient is frail and has someone who could reliably to topical therapy, it might make me lean towards topical therapy.
How do you think about biologic use in patients with underlying HIV infection?
This is always a difficult problem, and a tough clinical call. However, over the years of seeing these people, I have come to realize that following their viral load and CD4 counts while looking for immunologic recovery allows us as Rheumatologists a lot of opportunities to treat. While I have class...
In your practice or during fellowship training, do you perform curettage of cutaneous carcinomas to define subclinical borders prior to Mohs?
RCT trial done by Huang et al., PMID 15389195 many years ago showed that curettage decreases layers and increases the size of defect but does not increase the number of flaps/grafts (this is all off memory, someone may want to check). So I curettage if I don't think a larger initial layer will chang...
How do you manage alopecia areata in children with >50% of hair loss that is unresponsive to intralesional or topical steroids?
Treatment typically varies depending on the age of the child and the impact on the child's quality of life. Some options include adding topical minoxidil or compounded topical JAK inhibitors such as topical tofacitinib. In more severe cases, I offer oral minoxidil, monthly pulse prednisone, systemic...
How do you counsel male patients with Androgenetic Alopecia who are trying to conceive about using dutasteride or finasteride?
I advise against dutasteride for those trying to conceive or who might have unprotected intercourse with pregnant women since dutasteride is in the semen. For 5 alpha-reductase inhibitors in general, the effects on sperm count and sperm motility are very well characterized. There is a reduction in s...
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...