Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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)?
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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...
Do you recommend testing for HPV in patients with oral lichen planus?
When I read this question I, too, thought the poster meant HSV; however I was surprised to find that there is actually some literature on HPV in LP, specifically in the etiology of LP-associated carcinoma. However, given that the role of HPV is still not clear and that the failure to recognize a mal...
Would you recommend SLNBx in a patient with moderately differentiated SCC on the scalp?
Role of SLNBX in SCC is up in the air. We will present these high-risk patients at tumor board, but our recommendation for SLNBX is not consistent and rare. Just for "mod diff SCC on scalp" we would not. If it were 5 cm, down to bone with perineural, maybe...
How do you approach the management of patients on lamotrigine who develop a minor rash?
Lamictal rash can be dangerous but if we stop or switch lamictal for any rash during treatment we can run out of options soon. Get a good history and pictures, if possible. How long have they been on lamictal and was there a recent dose change or did the pharmacy change their generic brand? Have an...
Do you have concerns with the use of oral contraceptives in patients on JAK inhibitors given the black box warning for thromboembolic events?
I would be concerned with the use of estrogen-containing OC especially in patients who are smokers, obese, and/or with a strong family history of CV disease. However, I know many rheumatologists who would still cautiously prescribe JAK inhibitors to these patients, particularly in the absence of add...
What are the benefits and potential risks of using bisphosphonates for pseudoxanthoma elasticum?
There are not a lot of data regarding the use of bisphosphonates in pseudoxanthoma elasticum (PXE). The major pathogenic event in PXE is ectopic mineralization of elastic tissue in middle-size arteries, Bruch’s membrane of the choroid (predisposing to choroidal neovascularization and retinal bleeds ...
How would you approach management of a young male patient with discoid lupus who has had minimal response to hydroxychloroquine (and subtherapeutic whole blood levels) who continues to use tobacco products?
First, is he taking his HCQ (55% chance he is not)? Check a trough whole blood HCQ drug level and you want it to be 1000 - 1200 ng/mL (that is my goal in uncontrolled lupus; 750 - 1200 is fine in lupus under remission per Garg et al., PMID 37667434). Thanks, @Dr. First Last for reminding me. :-) Wh...
How long can you continue chronic low dose isotretinoin for refractory acne or other conditions?
I agree that there is not a time limit for the use of low-dose, long-term isotretinoin for the treatment of refractory acne or other conditions, but monitoring issues need to be considered. If dosing is intermittent, then minimal monitoring is required (an annual check of standard labs is probably f...