Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What are the best biologics for a pediatric patient with extensive guttate psoriasis that is poorly controlled on topicals?
Fortunately, we have a number of options for treatment of pediatric psoriasis that work well. With a guttate presentation, I would always recommend sending a throat swab and checking perianal skin to rule out Group A Strep as clearing this is an important step in getting the psoriasis under control....
What concentration of TCA is typically used to treat porokeratosis on the arms and legs?
I learned this on RXderm and apparently, it is a miracle and I have no idea how it works and who figured it out: compound lovastatin and cholesterol cream. Available on Chemistry Rx and Skin Medicinals. When I did peels, I used 20%. Nothing I had ever tried topically worked well. Some have used ...
What is your standard diagnostic workup to confirm GVHD in a patient post-BMT with skin rash and jaundice?
I assume there is no diarrhea, so sigmoidoscopy would not be helpful. Gut and liver pathology are useful. Skin biopsy is less helpful. It can be fairly nonspecific, but we do it to rule out other diagnoses that have more definitive pathology. Ultimately, it is a clinical diagnosis. Liver biopsy woul...
What is your preferred regimen for remission induction and maintenance in EGPA with cardiac involvement?
Cardiac involvement in EGPA is associated with a poor prognosis and is an independent predictor of mortality. Therefore, it needs to be treated aggressively. Depending on the study, between 15-30% of EGPA patients present with or develop cardiac manifestations. The manifestations are highly variable...
How do you utilize anifrolumab for SLE in your practice?
The answer to this SLE question involves a complex decision-making process. It is such an important question! I apologize in advance for the long answer. I am in the camp of achieving remission in my SLE patients and getting them off prednisone in the safest ways possible (Fanouriakis et al., PMID 3...
How do you approach symptom control in a patient with diffuse cutaneous systemic sclerosis (dcSSc) and rapidly progressive skin disease?
This patient clearly seems to be on the uphill trajectory for skin involvement in RNA Pol III+ dcSSc which can progress quite rapidly over 6-12 months. Pain, burning, tightness and pruritus are quite intense during this period, and can be very difficult to treat. It does improve somewhat with time, ...
How would you approach treatment failures with squamous cell carcinoma-keratoacanthoma-type lesions that did not respond to a standard SRT regimen after many sessions?
Most keratoacanthoma-type cutaneous squamous cell carcinomas that I see are bulky, and superficial radiotherapy (SRT) would not provide an adequate depth of radiation penetration to eliminate the carcinoma cells. If radiotherapy is being used for a bulky tumor like this, a higher energy form of more...
What is your treatment algorithm for treating patients with lichen planopilaris?
LPP can be localized and smoldering or widespread like a wildfire. All patients are treated with a potent topical steroid solution. For some that is all that is required. For those with severe or active disease I will start an oral agent such as doxycycline or hydroxychloroquine and consider intrale...
How do you approach nail surgery to diagnose NUBs (neoplasms of uncertain behavior)?
I tend to opt for punch biopsy to diagnose nail tumors. A larger punch (i.e. 4-6mm) can be used to remove the nail plate. Then, a slightly smaller punch (i.e. 3-5mm) can be used to biopsy the tumor. If there is no concern for involvement or relevant pathology of the nail plate, it can be secured bac...
What’s your approach to treating multiple facial BCCs in gorlin syndrome?
Patients get surgically exhausted, and often fearful of radiation or is not acceptable, I use twice weekly erivedge even with multiple comorbidities not only suppresses but often complete resolution of lesions. Intermittent dosing has a 12 day half-life and I take advantage of that.