Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
In difficult cases, what is your approach to find a causative agent of fixed drug or fixed food eruption?
I don't think there is any answer other than advising the patient of the natural course/behavior of the eruption and having them keep a strict journal of all intake until the culprit is determined. Data on testing has been mixed at best (Jayasundera & Watts, PMID 38336399) -- though there may be a r...
Do you continue methotrexate in patients with inflammatory arthritis who develop non-melanomatous skin cancer while on therapy?
Data on methotrexate use and the increased risk of non-melanomatous skin cancers has been conflicting, suggesting an increased risk or a neutral risk. A recent case-control study published in the British Journal of Cancer (Polesie et al., PMID 36739322) did suggest an increased risk of both squamous...
How does omalizumab play a role in the armamentarium of atopic dermatitis?
There are various reports (>30 citations) in the literature documenting Xolair efficacy in atopic dermatitis. The study designs include randomized placebo-controlled trials, retrospective case series, and case studies.A review of the literature published in 2019 by Holm & Thomsen, PMID 30717578 prov...
What is your approach to management of radiation-induced bullous pemphigoid?
Bullous Pemphigoid (BP) is a pruritic autoimmune blistering disease characterized by tense bullae that is rarely caused by radiotherapy. There have been >30 reports in the literature related to RT with most being localized to the radiated location, with rare reports of BP at non-irradiated sites or ...
Do you caution against starting biologics for psoriasis if patient has hepatitis A antibodies?
No
Do you recommend patients discontinue spironolactone after a certain number of years?
In general, I think Spironolactone is a fabulous treatment for women with hormonal/stress-induced acne. I am cautious in women with reproductive potential. I also have been careful in prescribing it to women with a history of breast cancer.
How do you manage acne relapses after isotretinoin?
This is a good question, and the answer depends on several factors, the most notable of which is the severity of the relapse. Oftentimes, the relapse is not as severe as the original outbreak for which the original isotretinoin course of therapy was prescribed. When this is the case, I start with co...
In your experience, what has been the most effective form of field therapy for your patients with higher burdens of actinic keratoses?
In my experience, topical 5-Fluorouracil 5% cream has been the most effective form of field therapy for my patients with higher burdens of actinic keratoses. I typically have my patients apply to the face and neck twice daily up to 2-3 weeks, and to the scalp, dorsal hands, extensor arms, and lower ...
Have you seen drug induced SCLE from IL-17 inhibitors?
Fortunately, drug-induced subacute cutaneous lupus erythematosus (diSCLE) induced by IL-17 inhibitors is rare. I have never seen a case, but there are at least 3-4 cases in the medical literature (from brodalumab, ustekinumab, and secukinumab: Ang et al., PMID 33511692, Tierney et al., PMID 30891478...
How do you manage patients with hand dermatitis recalcitrant to potent topical steroids?
Strictly dorsal/interdigital = irritant contact derm Purely palmar = atopic (should not be using the term "dyshidrosis" any longer Both palmar and dorsal = allergic contact derm If irritant, most important things, according to data from Covid, are: Washing hands in cold water Avoiding soap and wa...