Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How will you sequence therapies in dermatomyositis given the results of the ProDERM trial?
I will try oral immunosuppressants first, either methotrexate, azathioprine, or mycophenolate first; and then add IVIG if there is no response or even minimal response.
How do you manage docetaxel or other taxane-induced nail toxicity?
A variety of nail conditions have been reported with chemotherapy, particularly with docetaxel. There are no proven prevention strategies for taxane-induced nail toxicity. However, there are limited data that the cooling of extremities may help prevent nail complications (Scotte, F, Cancer 2008) but...
How do you approach patients with onychomycosis that does not respond to terbinafine and prolonged courses of fluconazole?
Terbinafine is usually effective in the treatment of the most common nail infections. Failure of treatment with terbinafine and fluconazole should make us consider bacterial co-infection or other non-dermatophyte organisms (i.e., aspergillus or non-C albicans). Fungal cultures are often falsely nega...
How do you monitor patients with cutaneous lupus for progression to SLE?
I think it is prudent to check patients with a new diagnosis of cutaneous lupus for any signs of SLE, typically with CBC, CMP, UA, complement levels, and ANA by IFA. If negative, I just screen with review of systems and check labs if something comes up.
What is your experience with iontophoresis for hyperhidrosis?
I always offer iontophoresis as a choice for my patients. One of the major roadblocks is affording the unit. In my experience, insurance does not uniformly cover the unit. Patients who have used it have had mixed success, mostly they report it was not effective in controlling their hyperhidrosis.
How do you approach treating younger patients with early female pattern hair loss?
I approach most younger patients similarly to older women with androgenetic alopecia. In younger patients, I try to do a more detailed history/exam to make sure they have no evidence of androgen excess, PCOS, and to identify if they have a strong family history of AGA. Spironolactone can be a good o...
What is the incidence of melanoma arising from vitiliginous patches, and do they develop from different mechanisms than melanomas arising from normal skin?
The exact incidence of melanoma arising within established vitiligo lesions has not been well defined. Generally, patients with vitiligo develop melanoma (as well as non-melanoma skin cancers) in the areas of their normal skin compared to their de-pigmented lesions [1, 11].That being said, there are...
When do you prescribe clascoterone cream for your acne patients?
Clascoterone cream can be beneficial in anyone who has acne. I do believe it should be used BID and I generally couple it with a topical retinoid. Remember that we are always trying to hit all four of the pathogenic targets in acne. Those targets are follicular hyperkeratinization, inflammation, C a...
Do you routinely check G6PD level prior to initiation of hydroxychloroquine?
No, we do not routinely check G6PD levels prior to initiation of hydroxychloroquine (HCQ). The American College of Rheumatology does not recommend routine testing for G6PD prior to initiation of hydroxychloroquine (HCQ), but interestingly, package inserts often recommend caution in these patients. O...
Do you routinely collect debulking specimens for paraffin-embedded or frozen section staining prior to taking a Mohs layer for all skin cancers?
There should rarely be a need to send debulked specimens for paraffin sections. Tumors that can be histologically challenging can be debulked and processed as positive controls when doing Mohs micrographic surgery. However, when a frozen section, whether a layer or a debulked specimen, is processed ...