Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What topical therapies do you find are most effective for treating inverse psoriasis in areas of the body with thinner skin?
I have had excellent results from 1% LCD in 2.5% hydrocortisone cream or 1% LCD in 0.1% TAC. Irwin Braverman
How do you approach longitudinal melanonychia of one fingernail in a pediatric patient?
Unless the history and/or appearance are terribly concerning, I will generally measure, photograph, and follow up in 3 months for a re-check. Unless it has grown or changed dramatically during that time frame, I will usually just monitor clinically until it is stable.
What alternative antibiotics or other therapies do you recommend for patients with papulopustular rosacea and a tetracycline allergy?
PO Ivermectin and PO Niacinamide can be helpful. However, for antibiotics, anything works/is anti-inflammatory, but usually, I’ll do azithromycin.
How do you approach the diagnosis of erythronychia?
Erythronychia has a broad differential including inflammatory diseases (lichen planus), infectious diseases (verruca), and benign (onychopapilloma, glomus tumor), and malignant tumors (SCC, amelanotic melanoma). I approach erythronychia with history and physical examination including measuring width...
What is your treatment approach to persistent chillblains lesions in the absence of systemic lupus?
In idiopathic chillblains/perniosis, I think treatment centered on lifestyle modifications is key. As this is a cold-associated dermatosis, counseling patients to wear warm gloves or socks and avoiding cold exposure is important. Beyond lifestyle modifications, I typically start with a high-potency ...
How would you manage a patient with stage IV EGFR L858R mutation but with a debilitating drug rash from osimertinib?
I'm assuming that all methods of supportive care and dose reduction have been tried at this point (i.e. even with maximal supportive care, Dermatology referral, and osimertinib reduced to 40 mg PO daily), there is still intolerable rash. This is a difficult situation and there isn't much available i...
How do you approach screening for additional malignancies in patients with a history of CTCL?
There is no need to do anything out of ordinary. Usual age-appropriate cancer screening and skin cancer screening (many of these patients received light and radiation therapy) is sufficient. The rest should be guided by presenting symptoms. For smokers and other people with specific risk factors, th...
What workup do you recommend for pediatric patients with telogen effluvium?
If the onset was relatively recent, and there is a history of a known trigger, such as a significant illness (e.g., high fever, surgery, other physical trauma) or other stressful life events, I don't usually do any workup right away. I recommend giving it at least 2-3 months to see if it starts to s...
Do you get routine MRI brain for surveillance on patients with history of stage III melanoma?
Unfortunately, this is an area that doesn't have a lot of data to support recommendations. It is rare to develop CNS/brain metastasis as the only site of metastatic disease (~5% of metastatic patients). Therefore, I try to get an annual MRI brain for stage IIIB-IIID (resected) patients, especially i...
How do you manage long-term xerosis and xerophthalmia in patients who have completed a course of isotretinoin?
Xeropthalmia can be a real problem. In a study in rabbits, we showed that isotretinoin in doses up to 1mg/kg has effects on meibobian glands similar to those on that occur in sebaceous glands. Meibum is responsible for preventing the tear film from evaporating. The third patient I ever treated devel...