Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How does your treatment algorithm differ for drug-induced ANCA vasculitis compared to non drug-induced ANCA vasculitis in cases with severe/organ-threatening manifestations?
When end-organ manifestations are present, my initial treatment approach is similar for drug-induced and non-drug induced AAV and typically consists of glucocorticoids and rituximab, including pulse glucocorticoids with severe end-organ involvement. Common drug culprits such as PTU, hydralazine, min...
Would you recommend post-op RT for an ulcerated Clark's level IV melanoma of the zygomatic/preauricular region following a WLE with diffuse melanoma in-situ at the margins?
Yes.
Is it ever appropriate to use hydroxychloroquine temporarily in higher doses (more than 5mg/kg) to control lupus activity such as skin manifestations?
The risk of retinal toxicity with long-term use of doses higher than 5mg/kg was shown by Melles and Marmor; PMID 25275721. There are reports of developing retinal toxicity even with short-term use of HCQ mostly coming from oncology literature (e.g. Navajas et al., PMID 26651304).There is some publis...
Which immunosuppressed patients with SLE would benefit from antibiotic prophylaxis to prevent pneumocystis pneumonia?
Starting PCP prophylaxis in patients with lupus is controversial. We typically start lupus patients on PCP prophylaxis if they have underlying ILD and are on doses of steroids of 20 mg or higher. I also consider starting PCP prophylaxis in lupus patients while they are receiving cyclophosphamide and...
Should venous thrombosis in a patient with Behcet syndrome be treated with both immunosuppression and anticoagulation?
They should be treated with immunosuppressive medications, however, the additional benefit of anticoagulation is much debated. Various studies and metaanalysis have shown that anticoagulation, on average, does not add any benefit. There may be exceptions to this in the early part of treatment for so...
How would you manage a small recurrent melanoma of the lower eyelid in a patient deemed inoperable?
RT. 70Gy/35 fractions or its equivalent with orthovoltage, which I would prefer.
Would you offer definitive radiation therapy for a Merkel cell carcinoma in which surgical resection would be disfiguring or result in significant dysfunction?
I would, but after an appropriate discussion. First, I favor full staging of all Merkel cell patients with a PET/CT (though many would argue this is not mandatory for small tumor, node-negative patients). I would also recommend a sentinel node procedure because the risk of nodal disease is significa...
Are there particular concerns related to the use of B-cell depletion therapies such as rituximab for rheumatic disease during the COVID-19 pandemic?
The attendant depletion of CD20+ B cells associated with treatment with rituximab likely results in impaired development of host immunity to previously unrecognized microbial pathogens. This has, therefore, been of concern in the context of the Covid-19 pandemic due to potential greater adverse outc...
How would you counsel a patient with extragenital lichens sclerosis on the acute and long term risks of post-lumpectomy radiotherapy?
Lichen sclerosis (LS) is a rare entity, however, there are reports of successful treatment with radiation for various cancers associated with this condition. (Wang et al., PMID 33356763). There is also a suggestion of worse LC in women with vulvar cancer and preexisting LS (Fokdal et al., PMID 34392...
What is the biologic of choice in a patient with RA and history of non-melanoma skin cancer?
We have long known that patients treated with TNF inhibitors (TNFi) have a higher risk of developing non-melanoma skin cancers. For this reason, all patients prescribed these drugs should undergo annual full-body dermatology skin exams. If this recommendation is followed, there should be no contrain...