Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How soon after excising a keloid do you inject kenalog?
I ran into this issue in clinic a few months ago when I started doing keloid excisions on patients' ears - there's some decent data in the following article for doing immediate kenalog injections without impairing wound healing.Burusapat et al., PMID 34367855
What orals or biologics do you reach for in a child with recalcitrant inverse psoriasis in the groin who has tried and failed topical including steroids, pimecrolimus, zoryve, ketoconazole, and tacrolimus?
I would first ensure that we couldn't get it under control with even higher potency topical corticosteroids for a short period of time and then maintenance with lower potency topical corticosteroids and steroid-sparing agents or sometimes along with the higher potency topical corticosteroids twice p...
How would you manage a patient with severe Hurley Stage 3 active, draining, HS who is also currently requiring Rituxan for management of vasculitis?
This case might be best discussed through oral conversation rather than this format, but here it goes.I try hard NOT to combine a TNFi with Rituxan. The additive immunosuppression will significantly increase the risk of severe infection to a level that is uncomfortable for me. I have done similar co...
Do you wait on initiating biologic therapy for guttate psoriasis?
First, and foremost, it is important to identify the trigger for guttate psoriasis, which is often caused by step (which requires antibiotics). For most patients, a guttate flare will resolve on its own. When using biologics, we can help clear guttate psoriasis (note, this is largely based on anecd...
What is your approach in counseling a patient with delusions of parasitosis?
Delusions of parasitosis (DOP) or delusions of infestation (DOI) are among the most challenging conditions we treat as dermatologists. I am not sure there is one approach to treating these patients and it can often feel very frustrating and unsatisfying. Nonetheless, we all will encounter these pati...
Can Xolair (omalizumab) be safely used in combination with biologics for patients with rheumatic disease?
Ghazanfar & Thomsen, PMID 30132352 The above article addresses combined Xolair and Enbrel. Keep in mind, if RA flares or worsens after starting Xolair, it could be SE as it is well known to have a polyarticular small joint pattern similar to RA. So, the timing of Xolair initiation to RA loss of cont...
Have you considered intralesional cempilumab for locally advanced NMSC/KCs prior to surgery?
There is an active clinical trial, NCT03889912 using IL-cemiplimab prior to surgery. Otherwise, nearly impossible to get covered. More importantly, have considered systemic neoadjuvant immunotherapy for large cutaneous SCCS prior to surgery.
What is your preferred protocol for squaric acid (SADBE) treatments for alopecia areata/totalis?
Based on a few series published showing that sensitization is not necessary for contact immunotherapy, I tend to do one of two things: Start patients at squaric acid 0.001% solution every other day at home and increase the concentration by 10 (0.01%, then 0.1%, then 0.5%) monthly if not reacting. ...
What is your treatment algorithm for managing scalp vitiligo?
It is reasonable, safe, and effective to start with topical steroids and topical calcineurin inhibitors.
How would you manage a patient with progressive/refractory molluscum contagiosum who is well controlled on methotrexate for seropositive rheumatoid arthritis?
Molluscum can be more challenging to treat when a pt is taking any immunosuppressive. In treating that patient, I would attempt to use cimetidine 400 mg TID along with a topical retinoid such as Retin A 0.1% bid to each individual molluscum. If there are only a few remaining, recalcitrant lesions, I...