Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you approach treating disseminated granuloma annulare?
I have not found disseminated GA associated with diabetes in my clinical experience even though it has been reported in the literature. Similarly, disseminated GA has been reported with SLE in the literature and I have seen that once in my experience. I would only check for diabetes or SLE if there ...
What is your approach to tapering treatments for patients with bullous pemphigoid?
Oral steroids are generally for acute management and can be tapered as other drugs like doxycycline kick in...typically over a month. Doxy controls most patients pretty well and is safe for long-term Rx. I generally try to taper doxy after a few months without symptoms. Dupilumab is also useful when...
Do patient co-morbidities impact when you prescribe oral jak inhibitors?
Great and pertinent question in our field. Autoimmunity doesn’t make me less likely to prescribe, actually more likely as there is plenty of case report and case series data on JAKi being used in a variety of autoimmune conditions. Certainly, dyslipidemia (think MACE), VTE risk, and malignancy risk ...
What is your approach to managing the initial acne purge while on isotretinoin?
Just start at a lower dose. Add prednisone if really needed. And please don't call it a purge.
Would you recommend continuing Accutane in a teenage female who has experienced a drop in calcium to 8.8 and reductions in albumin and protein levels one month into therapy?
I am curious to know why these labs were checked? And isn't 8.8 a relatively normal calcium level?
What is your experience with using dupilumab for alopecia areata?
Why would you use an unproven, off-label drug when there are proven and effective on-label drugs?
What would be your next step in management of a dermatomyositis patient on hydroxychloroquine and methotrexate whose skin is still active?
There are many different options for this kind of scenario. Depending on the physician's preference, patient's lifestyle, and insurance coverage, one could switch to mycophenolate, which seems to be more effective for skin manifestations, or azathioprine. If the patient did have a partial response t...
How do you decide between IL-4/IL-13 blockade (dupixent) versus IL-13 blockade only (Adbry) as treatments for Atopic Dermatitis?
First, disclosure that I work closely with all companies in the systemic atopic dermatitis space. The best data we have says that dupilumab is more effective at 16 weeks but that the drugs are equally effective at 32 weeks. The caveat is that there are no head-to-head trials, this is based on review...
What is your recommended dosing regimen for propranolol in treating an infantile hemangioma after the proliferative phase?
Generally, in most infants/toddlers that have infantile hemangiomas that are already in the involution phase, I do not start propranolol, but rather wait until the end of the involution phase and then consider PDL or surgery if needed, based on the location/size/appearance of the residual lesion. Pr...
When performing a closure with deeps then applying dermabond or glue, do you bill for a simple or intermediate closure?
Intermediate.