Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you feel PRP is effective in treating androgenetic alopecia?
PRP is an excellent adjunct to medical care. The best response happens in younger patients who have had alopecia for a shorter time interval. I use it most often in androgenetic alopecia although some use it in cases of scarring alopecia. I typically do one session every month for 3 months, then mai...
For how long would you treat Klebsiella aerogenes folliculitis of the face manifesting as a cystic lesion?
My recommendation would be to treat for 7-10 days. It is more typical to see gram-positive organisms causing facial folliculitis so I would choose an antimicrobial that has gram-positive coverage as well if possible, based on sensitivity. Additionally, I would ask the patient (if male, to change to ...
How do you weigh the risks of intraocular eye shields when performing CO2 laser to the eyelids and periocular area?
Eye shields should always be used in such situations.
What treatment regime would you recommend for localized hyperhidrosis affecting the scalp that has failed topical aluminum chloride and oral glycopyrrolate?
I have personally found that oxybutinin is more effective than glycopyrrolate with fewer anticholinergic side effects.
Do you pursue a cardiac evaluation in all patients with an excised cutaneous myxoma?
I'm a dermatopathologist, not a clinician, but would note the following data points: Many things are called myxomas. Those associated with Carney complex, in which atrial myxomas also occur, are a specific variant, superficial angiomyxomas. They usually have inactivation of protein kinase regulator...
What is your experience with using oral deucravacitinib off label for conditions such as recalcitrant facial discoid lupus or recalcitrant lichen planus?
This is an excellent question and importantly highlights the potential for newer therapies to help treat challenging diseases with few if any FDA approved options. In the case of DLE, I have found deucravacitinib to be a good option, sometimes as monotherapy or perhaps in conjunction with other topi...
Do you transition to a topical retinoid after a patient completes a course of isotretinoin?
Yes. I give them the RX and tell them to start 4-6 weeks after completing the isotret course. Most of my acne patients are adult females (my niche), so using the retinoid is integral for anti-aging. I also find it helpful with any leftover scarring or pigmentation. Choice of retinoids depends on ski...
How would you approach management of a patient with longstanding history of SLE, but having active psoriasis?
In addition to above, I would consider deucravicitinib. It has PASI75 scores that are in the 60s, and is in trials for SLE. Its phase 2 trials seemed promising. Other PO JAK inhibitors should be efficacious but may carry worse side effect profile. I have also employed PDE4 inhibitors such as po apre...
Does your institution have formal policies or work flows to reduce unnecessary IGRAs ordered for patients on biologics?
We have developed a multi-specialty working group to implement this as a lot of unnecessary testing is getting done. This will include having a 2-3 question screening pre start of biologics, and then annually to asses risk, that we hope will be incorporated into the visit or an order set.
What protocol do you follow when performing staged excision with paraffin sections for the treatment of cutaneous melanoma?
Our surgical protocol is as follows: Place marking sutures at 12 and 6-o'clock on debulk, margins, and patient (more marking sutures if a big tumor). Take a central debulk with 1-3mm margins around visible tumor (+/- Woods lamp) for breadloaf sections. Depth of excision is down to superficial fat. ...