Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Can patients receive adjuvant radiation therapy after keloid excision without primary closure, or would radiation impede healing by secondary intention?
I have personally treated several patients where primary closure was not obtained due to the large size of the keloid (back and anterior mid-chest). Due to the limitation of raising a large flap around these regions to close the wound primarily and poor take rates of a skin flap, these resections we...
In a pregnant patient with scarring alopecia (LPP or CCCA), what treatment options are available?
For LPP, LLLT is a good option in pregnancy, also topical and intralesional steroids can be used. For a very severe case, I would discuss Plaquenil with her OGB. For CCCA, topical and intralesional steroids.
When do you refer pediatric patients with eczema to an allergist?
I refer concerns about immediate-type hypersensitivity symptoms (e.g. anaphylaxis, rhinitis, or asthma) to an allergist. Eczema is delayed-type hypersensitivity from contact with an inorganic or a protein allergen. Many dermatologists and allergists perform extended patch testing for these contribut...
How do you determine if a pyoderma gangrenosum lesion is “burned out"?
The first sign is it becomes much less exudative.
How do you approach cosmetic removals of labial melanocytic macules?
Patients respond incredibly well to Q-switched laser either 532 or 755. The picosecond laser is working equally well with these wavelengths. The lowest energy to cause some mild whitening is the endpoint. You can use long-pulse technologies as well, but my favorite is the short-pulsed technologies.
How do you manage eyebrow and eyelash involvement in patients with alopecia areata?
The possible options are bimatoprost (either Latisse or the eyedrops) twice a day and compounded tofacitinib 2% solution twice a day. ILK 2.5 mg/ml every 6 weeks for eyebrows.
What is your approach to monitoring for hepatic fibrosis in chronic methotrexate use?
Historically, in lower-risk patients (e.g. rheumatoid arthritis patients who are less likely to have metabolic syndrome and are treated with lower doses), guidance has been to proceed with liver biopsy if repeated tests show elevated liver enzymes or hypoalbuminemia. In higher risk patients, (e.g. p...
What is your experience with using 5 alpha reductase inhibitors in females of childbearing age for androgenetic alopecia?
I have avoided finasteride in young women with pattern alopecia, though low dose oral minoxidil has been safe/effective in several instances over the past year (for both pattern alopecia and chronic telogen effluvium in women of childbearing age).
After corticosteroids, what second line agent do you select to treat drug induced hypersensitivity syndrome (also known as DRESS syndrome)?
see reference
Do you favor absorbable or non-absorbable sutures for epidermal closures?
I personally find the best results for epidermal closure with prolene. I will, at times utilize fast-absorbing gut sutures but do find there is significantly more erythema around the wound than with prolene. On the lips, I choose 5-0 vicryl for epidermal closure and find that is a less reactive alte...