Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What systemic therapy would you offer a patient with metastatic melanoma who is BRAF WT and developed metastases while on adjuvant nivolumab?
Adding an anti-CTLA4 agent after progression on anti-PD1 (even in the adjuvant setting) should be a reasonable choice for patients who are ineligible for clinical trials. In our practice, we recommend using the CheckMate 067 dose (Ipi 3 and Nivo 1) when faced with such a situation. Zimmer et al., PM...
What treatment would you offer a patient with extensive lymphangioma circumscriptum intermittently covering the entire abdomen?
I would consider sirolimus (rapamycin) to shrink the lesion to a size that could be surgically excised.
Have you come across JAK treatment failure in severe alopecia areata?
I’ve considered Dupilumab, but first try to switch the JAK inhibitor, add minoxidil if not already on it, and add some type of steroid, less often systemic.
What is your approach for severe SCLE in patients unable to tolerate HCQ?
30% of subacute cutaneous lupus erythematosus (SCLE) is worsened by or caused by drugs, especially PPIs, calcium channel blockers (CCBs), thiazides, minocycline, and anti-fungal meds. Very different from other drug-induced disorders, the culprit drug could have been started months to years (as long...
How do you approach a patient with stoma bag adhesive allergic contact dermatitis?
To keep the area dry, I have patients use Cavilon spray and Skins, an antimicrobial spray.
What dosing range of spironolactone do you prescribe for hormonal acne?
I most commonly prescribe 50-100mg daily, but I may titrate up to 150mg occasionally as needed. I prefer QAM dosing to minimize diuresis in the evening. I find that starting at 25mg and up-titrating by 25mg weekly leads to better tolerability, especially when it comes to orthostasis and dizziness.
How do you manage perineural inflammation when encountered on Mohs?
Chronic inflammatory cell (lymphocytes, histiocytes) perineural inflammation is a sign of potential perineural invasion nearby. If there is perineural invasion elsewhere on Mohs sections, one should be particularly wary of chronic perineural inflammation and consequently carefully examine multiple s...
How often do you pursue malignant transformation screening In patients with lymphomatoid papulosis or pityriasis lichenoides?
In the case of patients with lymphomatoid papulosis (LyP) or pityriasis lichenoides, regular follow-up and monitoring for signs of malignant transformation is important, given the potential (though generally low) risk of progression to lymphoma, especially cutaneous T-cell lymphoma. For LyP, follow-...
What work up do you pursue for splinter hemorrhages in an otherwise healthy patient?
I would take a good history, ask for a thorough review of systems, review their medications, etc., and do a physical exam to rule out signs of a systemic illness. The workup (for endocarditis, etc.) can be directed by those findings, if present. Otherwise, the most common cause of splinter hemorrhag...
How do you manage polymorphic light eruption (PMLE)?
It depends on the severity and frequency of the case but typically: strict photoprotection with sunscreen, UPF clothing, etc., topical steroids bid starting the day before planned sun exposure and continuing for a week or two, intermittent prednisone course (best for my patients who flare the same ...