Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatment regimen do you start for patients who present with mucous membrane pemphigoid?
The treatment plan for mucous membrane pemphigoid (MMP) is individualized based on the disease severity, medical comorbidities, patient preferences, and medication availability/cost. For severe MMP, yes, I commonly use the combination of Rituxan, IVIG along with high dose systemic corticosteroids (...
What therapies have you found most effective in providing rapid improvement in patients with erythrodermic atopic dermatitis?
For me, the most critical part of treating erythrodermic atopic dermatitis is making sure you have the correct diagnosis. While biopsies can be helpful, my pathology colleagues have told me it can be difficult to determine the diagnosis in the biopsy of an erythrodermic patient. Likewise, labs or hi...
What is your preferred topical retinoid for acne?
I generally start with tretinoin 0.025% cream as the first-line for acne. If the patient has a history of eczema or sensitive skin, then I would start with adapalene 0.1% gel/cream and then ramp up from there if they tolerate it for a few months without side effects.
Does IVIG or subcutaneous Ig interfere with monoclonal antibody therapy (i.e. dupilumab, infliximab, rituximab, etc)?
I definitely agree with Dr. @Dr. First Last concerns. For what it’s worth, I use a lot of IVIG in combination with monoclonal medications in my myositis clinic, and have anecdotally noted multiple instances in which I feel that the efficacy of one of those monoclonals seems to have been worse when t...
How would you manage a patient with Takayasu arteritis controlled on TNFi who develops erythema nodosum that is only partially responsive to NSAIDs?
Erythema nodosum and pyoderma gangrenosum (as well as erythema induratum) are well recognized as cutaneous manifestations of TAK. Unfortunately, we do not know how often cutaneous and the vascular disease are decoupled from each other due to a lack of available data. Most case series document associ...
How do you dose oral tranexamic acid for melasma?
I typically do 325 mg BID (1/2 tab of 650mg) during May-Sept then off in the winter. Double layer of sunscreen: chemical then mineral over it. Two favorites are La Roche Posay Cooling Water Lotion SPF60 then Eucerin Sensitive Mineral Agave SPF35 over that every morning regardless of the days activit...
What treatment method do you prefer for the cosmetic removal of benign pigmented moles?
We usually do shave removal, excision or punch excision and send for pathology.
What scented alternatives do you recommend patients with fragrance allergies try to replace perfumes/colognes?
My approach is to initially advise for the first 3 months a strict personal care “product elimination diet” free of fragrances, botanicals, and essential oils for patients who test positive to fragrance-related allergens. “Product elimination diet” is a term coined by expert Canadian dermatologist S...
Is narrow-band ultraviolet B (nbUVB) phototherapy contraindicated or recommended with caution in patients with a personal history of melanoma?
Although it is challenging to be definitive, our current literature suggests that nbUVB does not increase the risk of melanoma or nonmelanoma skin cancer.Previous studies suggesting a possible increased risk with nbUVB included patients with a history of PUVA, which has been shown to increase risk. ...
Do you discontinue IL-17A, IL-17A/F, or IL-23 blockade in pregnant patients with psoriasis?
I always give my patients the option of discontinuing but put it in perspective. For the most part, my patients do end up stopping, with the plan to restart after delivery. We discuss a few topics: Pregnancy doesn't tend to worsen psoriasis in general, in fact in many patients, it gets better. It i...