Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What treatment options are available for patients with spondyloarthritis who develop biologic-induced psoriasis?
Management of patients in these situations is quite challenging and the approach should be individualized. Biologic induced psoriasis is most commonly seen with TNF-α inhibitors as a paradoxical response. However, this has also been rarely described with other biologic agents: Interleukin-6 blockers...
Is it okay to use medications associated with drug-induced lupus in patients with SLE?
In the current era, I find it useful to divide drug-induced lupus into two classes. First, the traditional medications such as procainamide and hydralazine that are associated with ANA by IFA, anti-histone antibodies, and a type of drug induced lupus not characterized by certain clinical features su...
How do you clinically distinguish between cutaneous lupus with photosensitivity and polymorphic light eruption-like reactions?
Polymorphous light eruption (PMLE) typically occurs at the onset of Spring or Summer when patients have been exposed to light for the first time that season. Because patients' faces are usually not covered up, even in the winter (in non-COVID times), they usually continue to get sun on their faces. ...
Is there a role for adjuvant systemic therapy (in addition to adjuvant radiation) in an early-stage, resected cutaneous angiosarcoma of the head/neck?
Angiosarcomas have a high rate of local (or distant) recurrence, but with all tumor resected and if there were wide surgical margins then radiation may be sufficient for a small superficial tumor, followed by close surveillance. If there is a recurrence, then our practice is to give neoadjuvant chem...
How would you approach treatment of a patient with asymptomatic, oligometastatic basal cell carcinoma?
This is an unusual situation. I would want to clarify whether this is regional versus distant metastasis, and what is meant by "oligometastatic". I would also want the diagnosis of metastatic basal cell carcinoma confirmed histopathologically (and possibly even molecularly) for both a putative prima...
How would you treat a patient with an keratoacanthoma of the right nasal ala?
In my experience, these patients are treated surgically and radiation does not play a role.
How would you approach refractory gangrenous Raynaud's secondary to type one cryoglobulins?
Type I cryoglobulins are monoclonal immunoglobulins, and typically occur in the context of a hematologic disorder such as MGUS, multiple myeloma, Waldenstrom macroglobulinemia, or lymphoma. Vascular occlusions due to the cryoglobulins may occur and lead to digital ischemia.The patient should be eval...
Would you offer adjuvant radiation therapy for a Merkel cell carcinoma limited to the epidermis with close margins?
I would review this case with a dermatopathology expert before making any decisions. The reason is that normal Merkel cells usually lie in very close proximity to the basement membrane. My understanding is that a skin neoplasm that is limited to the epidermis does not broach the basement membrane, a...
How would you manage a patient with cutaneous SCC of the lower extremity with isolated inguinal nodal involvement?
Good timing for this question, since I’m currently treating a similar case of Merkel Cell Carcinoma (MCC) on dorsal skin of wrist with isolated axillary nodal involvement. The same oncologic principles should apply for SqCC as well: As far as surgery is concerned, wide local excision (WLE) for the ...
What therapies have you had the most success with for calcinosis cutis in dermatomyositis patients?
Treatment of calcinosis cutis is difficult with therapy aimed at the underlying condition. Many of the treatments that have been tried in the literature have been reported in small case reports/series and have had variable success rates. I have tried diltiazem (limited by lightheadedness and fatigue...