Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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...
Do you divide interpolation flaps 2 or 3 weeks after the initial surgery?
When deciding when to divide a paramedian forehead flap, these are the concepts to think about: How aggressive will you need to be when contouring the recipient site at division and inset? How much quality of life is being impacted by the pedicle? What are the aesthetic wishes of the patient? Do the...
What is your approach to severe discoid lupus refractory to conventional topical and systemic therapies?
Agree with Dr. @Dr. First Last's comprehensive answer regarding the treatment of refractory DLE. However, would add two biological options, Belilumab and anifrolumab. In fact, just now evaluated with a fellow a patient in Lupus clinic with refractory DLE to intralesional steroids, Chloroquine after ...
Do you recommend an additional procedure for melanomas if there is tumor within 1-2mm of the margin?
Yes, for most invasive melanomas. For melanoma in situ, I often measure the distance between the tumor and the margin and add that information to the dermatopathology report. In certain anatomical locations (near eye, nose, ears, digits, genitals) or certain clinical situations, 2mm of clear margin ...
What recommendations do you offer for patients who have nail longitudinal ridging?
Nail longitudinal ridging is also called onychorrhexis. Onychorrhexis may become more prominent with age and is a diagnostic feature of brittle nail syndrome, along with onychoschizia, or nail peeling. For onychorrhexis, I recommend moisturizers around the nailfolds, clear nail protectants to the na...
What biologic (e.g. porcine xenografts) or alternative dressings have you found helpful for second-intention wound healing?
Over the last 6 years, I have utilized a number of allograft/xenograft options for select wounds where linear/flap closure is not ideal and an FTSG/STSG/Burow's Graft is not preferred. They range from Animal derived Collagens, Placental, and Amniotic products, and Cadaver skin grafts (i.e. Theraskin...
Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?
TSpot testing has better performance than Quantiferon Gold in patients with low lymphocyte levels, and/or on glucocorticoids (especially moderate to high doses). This is partially related to the way the essay is performed, and as such the Tspot is much less likely to result in an indeterminate or fa...
What are some techniques you’ve used in the past to manage medial canthal webbing after surgery?
Z-plasty