Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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
What is your experience with ritlecitinib and how does it compare to baricitinib for alopecia areata?
I agree with Dr. @Dr. First Last that it’s more similar to 4 mg of bari and I like that makes it simple with one dose only. Their 52-week and beyond data also looks superior to bari but it’s hard to compare across trials I truly think of them as on par. Ultimately though, I have had failure of one r...
Which myositis patients are good candidates for IVIG?
Good candidates for IVIG in myositis include any patient with refractory dermatomyositis, refractory necrotizing myopathy, anti-HMGCR antibody-positive patients, as well as patients with dysphagia, pregnancy, infection or malignancy. In general, it can be added to 1st-, 2nd- or 3rd-line treatment in...
How do your adjuvant treatment recommendations change, if at all, for clinically node positive Stage III desmoplastic melanoma?
We will assume that the diagnosis has been confirmed by an expert pathologist and that surgically adequate local excision and lymphadenectomy have been performed.One area in which adjuvant therapy of desmoplastic melanomas may differ is radiation of the primary. Local recurrence rates are considered...
How do you counsel patients who report a history of a lidocaine allergy?
Actual lidocaine allergy is vanishingly rare. I usually ask if this report is based on an episode at the dentist, which it very frequently is, and then I follow by asking if their "allergy" consisted of rapid heart rate, chest tightness, and an oftentimes intense feeling of anxiety. This report is l...
What is your preferred treatment algorithm for a patient with alopecia universalis who has failed oral and intralesional steroids?
My treatment ladder for severe AA is: Potent topical steroid under occlusion Contact sensitization therapy Oral Jak inhibitor Addition of low-dose oral minoxidil after 3 months if no response I sometimes use oral steroids for acute progressive disease. I do not think ILK is practical for severe d...
Do you offer radiation in the setting of a resected desmoplastic melanoma with negative margins given that several retrospective studies show a local control benefit?
Desmoplastic melanoma represents a minority of cutaneous melanoma lesions and typically occurs in the head and neck region, more commonly in elderly men, and typically diagnosed with an advanced Breslow depth. Historically, the outcomes associated with desmoplastic melanoma following resection were ...
How do you manage patients on biologics peri-operatively?
There was an article in the NEJM Journal Watch in regards to stopping biologics (DMARDs and TNFs) for rheum disease before surgery, and there was no statistically significant benefit in regards to surgical recovery but, as expected, flares of the Rheum disease. In regards to the newer targeted injec...
Do you recommend the HPV vaccine for patients with recalcitrant verruca vulgaris?
Yes, I recommend the HPV vaccine for children and adolescents of eligible age. I have seen warts resolve after vaccine administration. There are reports of dramatic resolution after vaccination. A cross-protective mechanism of action is suggested. Literature suggests there may be an age-dependent re...