Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your preferred management for eruptive vellus hair cysts?
I have not found any topical medication that helps to clear these and often end up doing quick electrodessication one by one for these small cysts.
How do you approach treating acute and chronic Demodex folliculitis?
Demodex folliculitis is often a diagnosis of exclusion and is considered when treating refractory rosacea, bacterial or fungal folliculitis. The organism can be found on normal skin and is seen on KOH prep of a skin scraping. Combination treatments with oral and topical medications have been found t...
How do you manage patients with rapidly progressing vitiligo?
I treat rapidly progressing vitiligo very similarly to rapidly progressing alopecia areata. Sort of like a medical emergency. Literature review suggests one should suspect rapid progression when the patient is developing new spots every month. This is especially distressing in patients of ethnic b...
How would you approach the post-operative radiation treatment volumes for a Merkel cell carcinoma of the hand?
Get a PET-CT. Treat the primary site, axillary, and probably epitrochlear nodes electively.
How do you approach patients with very low risk stage IIIA cutaneous melanoma for adjuvant immunotherapy?
Although it may seem that Stage 3A is a higher stage than Stage 2B and 2C, it must be kept in mind that according to AJCC 8 criteria, 2B and 2C melanomas are thicker (with to without ulceration), and a 3A melanoma is by definition a thinner melanoma. A thin melanoma (<2mm) is called a 3A melanoma be...
What treatments would you recommend for rosacea patients with persistent, soft/non-fibrotic cysts on the dorsal nose recalcitrant to chronic doxycycline and topical therapies?
Can consider a trial of a different oral antibiotic (such as a macrolide), or intralesional triamcinolone if lesions are discrete. However, I would likely proceed with a course of oral isotretinoin if there are no contraindications, given the recalcitrant nature of the disease. Doses usually range b...
What treatments and resources have you found helpful for ichthyosis vulgaris patients?
I also make sure to get my patients enrolled in Beiersdorf's free Aquaphor/Eucerin program. They help patients with ichthyosis by providing free products to them. Here's how to do it: Beiersdorf/Eucerin – Aquaphor has a program for families that use large amounts of Aquaphor. The company will send ...
Is there an effective treatment for severe radiation fibrosis of the skin after radiotherapy to the breast or other areas?
I have used this regimen occasionally with moderate success. Worth a try. Topical Vitamin E as well can help.
Do you treat fully resected squamous cell carcinoma of the ear with cartilage invasion with adjuvant radiation?
What were the margins? If sufficient (8-10 mm), I probably would not. I would certainly monitor the patient for lymph node metastases. Cartilage invasion is difficult to avoid for squamous cell cancer of the ear, so it is not surprising. Surgery is a better choice than radiation, unless so much cart...
When does perineural invasion for a squamous cell carcinoma of the skin of the head and neck merit adjuvant radiotherapy?
In cutaneous squamous cell carcinoma, the presence (vs absence) of perineural invasion is associated with a higher likelihood of local tumor recurrence after a margin negative excision. However, several recent studies have shown that for small caliber perineural invasion (invasion of a nerve <0.1 mm...