Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What do you view as the optimal use and timing of cemiplimab in high risk CSCC?
Increasingly, neoadjuvant cemiplimab has become our preferred approach for many patients with resectable high-risk CSCC, and this is consistent with what several high-volume centers are now doing. The high pathologic response rates, durable recurrence-free survival in responders, and meaningful surg...
What is your approach for female patients with severe atopic dermatitis well controlled on Dupixent planning to conceive or already pregnant?
Based on published data, I have a few concerns. However, the clinical trials of Dupixent failed to study effects on learning and memory.IL-4 and IL-13 are known to be important for learning and memory in mice. IL-4-producing T cells accumulate in the meningeal spaces, and acute depletion of these ce...
How do you clinically and diagnostically distinguish stiff skin syndrome from scleroderma?
One other disease consideration that one should differentiate is diabetic cheiroarthropathy, or "diabetic stiff hand syndrome." These patients can see decreased extension of the digits (often referred to as "Prayer sign" changes) and thickening of the skin in the digits. This can be present in 50% o...
What's your therapeutic approach for patients with severe cystic acne who have a history of inflammatory bowel diseases?
Persons with IBD and severe cystic acne warrant therapy with Accutane. I have successfully treated several cases with no exacerbation of IBD, publishing a case report in 1985: Oral isotretinoin and inflammatory bowel disease.A more recent study reached a similar conclusion: Does taking isotretinoin ...
In patients treated with infliximab, do rates of immunogenicity vary based on underlying disease (RA, IBD, sarcoidosis, etc) and/or baseline disease activity?
Yes, rates of infliximab immunogenicity appear to vary based on underlying disease, with evidence showing higher rates for RA than IBD and spondyloarthritis, and tend to increase with higher baseline disease activity. Most patients tend to develop anti-drug antibodies within the first year, but this...
What is the current role for genetic profile testing (e.g. DecisionDx-SCC) in the treatment paradigm for cutaneous malignancies?
This is a very cool test that has a lot of potential to help us make decisions in practice (full disclosure, I advise Castle and get research support from them, but am not directly compensated by them). The data published thus far shows that it is prognostic to predict nodal or distant mets. However...
How do you manage severe chronic scalp pruritus in older women when biopsies and exams show no primary skin disease and standard therapies fail?
I use gabaergic drugs like Pregabalin and Gabapentin in high doses up to 300 mg and 3600 mg, slowly tapering up as many of these cases are neuropathic. I use compounded topical KAL cream 10% ketamine, lidocaine 5, and amitriptyline 5, or foam formulation or pramoxine lotion bid or topical compounded...
How frequently do you recommend skin exams in patients with multiple AKs?
I generally do complete skin exams on patients with multiple AKs annually, however, areas of involvement are checked more frequently. If there is marked involvement, we recommend field therapy generally with PDT or topical preparations such as 5-fluorouracil with calcipotriene. If there is a history...
Do you read contact patch tests on removal at 48 hours, and do those results matter if negative at 72 or 96 hours?
Great question, and one that comes up frequently in clinical practice. I remove patches at 48 hours, and at that point I do perform a quick read or, at a minimum, have the tested areas thoroughly photographed. While it is difficult to draw firm conclusions from a 48-hour read alone, it is genuinely ...
How soon after stopping oral steroids can patch testing be performed?
Dose strength and duration of oral steroid therapy should factor into the equation. I would say at least 2 weeks to be on the less cautious side and up to 1 month if there is no urgency to patch test.