Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Is there benefit in switching between sonedegib to vismodegib or vice versa for patients with unresectable basal cell carcinoma of the face that progresses on first line hedgehog inhibitor?
Immunotherapy has largely supplanted hedgehog inhibitors for most BCC patients given the toxicity of hedgehog inhibitors and the reliable recurrences seen after initial responses. If I want short term palliative care, I think hedgehog. If I want a real chance at a cure, I think immunotherapy.
Has anyone used radiation to treat a plantar wart not responding to other modalities?
Cutaneous warts are commonly treated with topical salicylic acid and cryotherapy as primary interventions, according to the British Association of Dermatologists' 2014 guidelines for managing cutaneous warts. Should these treatments prove insufficient, additional options include topical immunotherap...
Are there any clinical situations in which checking for anti-chromatin antibodies is helpful?
Chromatin is the native complex of histones and DNA found in the cell nucleus of eukaryotes. The prevalence of anti-chromatin (nucleosome) antibodies in systemic lupus erythematosus (SLE) varies from 50% to 90%, being similar to that of the historic LE cell.The question is whether this provides addi...
Would you avoid the use of a TNF inhibitors in patients with a remote history of melanoma, including those with ocular melanoma?
Clinical trials of TNF inhibitors have identified a small but increased risk of malignancy with the use of TNF inhibitors, and most, but not all, of the follow-up studies done with real-world registries have confirmed this. These registries are of course sometimes affected by the behavior of physici...
Do you recommend on-demand versus fixed-schedule dosing for rituximab maintenance in ANCA vasculitis?
This is a fairly hot question in the field, and one that reflects the success we have had with advancing therapy for ANCA-associated vasculitis; it’s nice to have choices! Although there are data for both approaches, there are more data (larger numbers, etc.), in my opinion, for fixed-dosing. The tr...
What clinical factors do you use to determine timing of on-demand dosing of rituximab in ANCA vasculitis maintenance therapy?
I tend to use scheduled dosing (q 6 months) with RTX for maintenance in my GPA/MPA patients, but will occasionally use "on-demand" dosing in those who are eager to minimize their RTX, do not tolerate the infusions well, or occasionally those who have lower risks of flare (mild disease, no history of...
How would you approach the treatment of a low grade adnexal carcinoma of the scalp in a patient with prior history of WBRT as a child?
Post-op RT and RT alone for the second one, if surgery is not an option. No hypofractionation.
Would the diagnosis of skin-only morphea (localized scleroderma) alter treatment recommendations for localized anal cancer?
There is enough data about the acute and late toxicity from radiation in these patients to be concerned. However, none of it rises to the level of the toxicity of APR. Therefore, my approach would be to involve the patient in the decision, document, and reduce the dose by 10%.
Would you continue TNFi for inflammatory arthritis if the patient develops a solid organ malignancy while on that therapy?
In nearly all cases, I would stop the TNF inhibitor (TNFi). Though there is no evidence that these drugs raise the risk for solid organ tumor, the clinician must tread cautiously. First, the patient may require other potentially immune-suppressive anti-cancer therapies (plus radiation in some cases)...
What is your approach to bladder cancer surveillance in patients who have received cyclophosphamide?
Risk of bladder cancer following cyclophosphamide treatment can be associated with oral therapy and likely also related to cumulative dose (1). Risk of bladder cancer with intermittent IV cyclophosphamide has been reported in some observational studies, but has not been consistently reproduced (2). ...