Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What nutritional supplements do you recommend for patients with hair loss?
Protein 30-40 grams a day. These skinny dieters who only eat fish aren't getting enough. I do check iron and ferritin and get ferritin to at least 50, even 60-70 for shedding hair. I really like untangled by foundation skincare.
How would you approach a 2 cm malignant primary cutaneous adnexal adenocarcinoma of the axilla s/p resection with positive margin who is unable to undergo additional surgery?
I would consider imaging of the regional node basin (axilla) first. If there was evidence of regional lymph node metastasis, I would image the body to evaluate for distant metastases. If there was distant metastasis, I would probably refer for systemic therapy. If there was no distant metastasis, ...
Which ANCA vasculitis patients are better candidates for cyclophosphamide rather than rituximab?
Both can be used for induction in GPA/MPA vasculitis. I would use rituximab (RTX) if the patient has previously been treated with cyclophosphamide (CYC) and developed a relapse/flare and in patients who are young and with fertility concerns. In GPA/MPA, I tend to use RTX most of the time for inducti...
What approach, or dosing interval, do you find is most effective reducing side effects of Hedgehog Inhibitors (i.e., vismodegib) for patients with numerous BCC?
I have scarcely used hedgehog inhibitors as a preferred treatment in BCC. I rely more on Immunotherapy or clinical trials or even prefer local RT for a non-IO responsive BCC. Having said that, I usually begin at full dose and go down to alternate day dosing if patients have terrible side effects. I ...
How do you go about switching from one DMARD to another In patients with dermatomyositis that remains active?
Typically, we are adding additional drugs in combination to get response. Once we get response then we try to taper down the first DMARD slow until off. If first DMARD, didn't work at all, then we would stop the first and quickly untitrate another one, but that scenarios is uncommon.
What prescription or over-the-counter therapies do you recommend for patients with side effects from vismodegib?
For muscle cramps, L-carnitine supplements most definitely, and sometimes a lower dose regimen of a calcium channel blocker like amlodipine if needed. The vismo dosing can be adjusted to allow for breaks as well. For nausea, Zofran can be helpful as well as medical cannabis (which can also help with...
How do you approach the workup of clinically diagnosed cutaneous vasculitis in healthy young individuals without systemic symptoms?
As with all of medicine this answer depends on the presentation. A thorough review of systems and exam is needed to stratify workup. If we are talking about classic LCV below the knee in an otherwise healthy person, with no other concerning s/sx (as sounds like you are asking), I do generally confir...
Do you always excise down to the fascia when treating invasive melanomas and does body site location influence the depth of excision?
This a great question.Recommendations for the width and depth of cutaneous melanoma excisions aim to prevent local and satellite/in-transit recurrence. Results of randomized controlled trials (RCT) currently guide the recommendations for the width of excision, however, RCTs that evaluate the ideal d...
What would be the main indications for opting for biosimilars over an original biologic, outside of insurance barriers?
A timely question, as we head to 2023! The only reason to use biosimilars is for the broad purpose of resource stewardship. There isn't a medical reason to prefer a biosimilar over a reference product (or vice versa), because if a product were found to have a significantly different therapeutic effe...
In patients with multiple basal cell carcinoma lesions on vismodegib, would you hold vismodegib while delivering radiation therapy to one locally advanced BCC lesion that was not amenable to surgery?
I agree. Based on the recently published paper in JCO (Barker et al., PMID 38630954), vismodegib can be safely administered with radiation therapy for locally advanced BCC. RT + vismodegib yielded high rates of control and progression free survival.