Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you decide whether to locally excise vs deroof a persistent draining tunnel in a patient with otherwise medically optimized HS?
Great question. Both are great options. I usually try for a deroofing since it's a shorter healing time, but it doesn't always work out. If you can find an opening to the tunnel, that helps a lot. It gives you the opportunity to probe and a place to begin your incision. Both of those help you get in...
Do you have to remove gold dental crowns if patch testing reveals a gold allergy?
Not all positive patch tests are relevant. I would only recommend removing the dental crowns if there was some evidence that the gold exposure was contributing to the patient's dermatitis or mucosal inflammation that does not have a better explanation.
How do you differentiate between allergic and irritant contact dermatitis in patients using topical minoxidil?
While it can be hard to be certain, irritant contact dermatitis typically occurs faster, earlier in the course than an allergic contact dermatitis which, of course, is a delayed type hypersensitivity reaction. The most common reaction is to the propylene glycol in the solution formulations, so tryin...
Do you consider JAK inhibitors, such as baricitinib, a reasonable option for FFA?
In general, I think that use of JAK inhibitors is reasonable for FFA after discussion with patients about the potential risks/boxed warning and the fact that it's an off-label treatment. Particularly for patients who don't respond to first-line treatments, JAK inhibitors can be effective in reducing...
Have you seen CD30+ lymphoproliferative skin lesions with Upadacitinib treatment of atopic dermatitis?
I have seen this occur in the setting of atopic dermatitis in one instance with a patient on dupilumab who developed head and neck CD30+ disease. It is certainly possible with upadacitinib but I think most if not all cases of CTCL in the setting of AD were always CTCL from the beginning and just mis...
In what clinical scenarios do you consider pre- or post-treatment with Imiquimod for cutaneous melanoma?
In short, never. I can think of hypothetical situations but in reality I've never done it. I do Mohs for melanoma on the head and neck so no need for adjuvant imiquimod ("out is out"). For melanomas of trunk or extremities, I use WLE. In the rare case of positive margins after excision, I would then...
Will you offer patients urea-based creams or topical diclofenac for hand-foot prophylaxis with capecitabine after the D-TORCH trial results?
This study was presented at ASCO, Abstract 12005. Patients with breast or GI cancers treated with single agent capecitabine (1,000 mg/m2 bid) were randomized to treatment with prophylactic diclofenac cream bid x 12 weeks vs placebo. Primary endpoint was incidence of grade 2 or greater HFS. HR for th...
What clinical outcomes or measures of success do you prioritize in your patients with ichthyosis?
Control of ichthyosis is important to ensure quality of life issues associated with comfort, scale, insensible water loss, and clinical appearance. Control of dryness, pruritus, and pain is important to allow for quality of life issues, too. This requires important collaboration with family and the ...
What is your preferred radiotherapy regimen for palliative treatment of cutaneous T cell lymphoma?
Cutaneous T-cell lymphomas (CTCLs) comprise numerous distinct entities in the WHO classification of hematologic malignancies. The most common CTCL is mycosis fungoides (MF) followed by primary cutaneous anaplastic large cell lymphoma. As with most hematologic malignancies, both diseases are particul...
What is your treatment approach to non-uremic calciphylaxis?
Assess renal function since renal failure can be associated with elevated calcium that can trigger calciphylaxis. Assessment of parathyroid hormone and vitamin D can also be associated with similar findings.