Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How reliable are the expiration dates of patch test allergens?
An AI search of this question revealed the following: "Expiration dates for patch test allergens are generally considered reliable and should be strictly honored to ensure diagnostic accuracy. While some allergens remain stable for years, others degrade rapidly, and using expired materials significa...
How do you manage severe chronic scalp pruritus in older women when biopsies and exams show no primary skin disease and standard therapies fail?
I use gabaergic drugs like Pregabalin and Gabapentin in high doses up to 300 mg and 3600 mg, slowly tapering up as many of these cases are neuropathic. I use compounded topical KAL cream 10% ketamine, lidocaine 5, and amitriptyline 5, or foam formulation or pramoxine lotion bid or topical compounded...
What are your vaccine recommendations while patients are on biologics?
Live vaccines are best completed at least a month before initiation of biologics when these are appropriate (e.g., MMR, chickenpox, yellow fever). The data on non-live vaccines is limited. I personally think that some degree of protection is better than none. I will not interrupt biological therapy ...
Which patient factors drive you to pursue patch testing in the workup of chronic hand eczema?
Seasonal hand eczema occurring only during the cold season is usually irritant and best addressed by minimizing hand washing and using cotton under occlusive gloves with frequents changes for wet work. Careful examination for signs of psoriasis and anti-synthetase syndrome is important. Next step is...
Are you managing chronic urticaria/angioedema any differently if the patient is only/predominantly presenting with urticaria or angioedema?
The mechanism is similar for urticaria and histamine-induced angioedema, so I would expect a similar response. The evidence to support the use of montelukast for U/A is slim, but there are some supporting data. Nonetheless, the newest WAO guideline does not suggest an addition to the therapeutic pyr...
How frequently do you recommend skin exams in patients with multiple AKs?
I generally do complete skin exams on patients with multiple AKs annually, however, areas of involvement are checked more frequently. If there is marked involvement, we recommend field therapy generally with PDT or topical preparations such as 5-fluorouracil with calcipotriene. If there is a history...
What resources do you provide patients with alopecia areata?
For any patient with alopecia areata, I recommend the National Alopecia Areata Foundation for them and their family. NAAF provides lots of resources and have a yearly patient meeting that is always a hit for patients and their families. In addition, we discuss all appropriate treatment options for t...
If a patient has chronic spontaneous urticaria refractory to Xolair and is already on plaquenil, do you stop plaquenil and then initiate cyclosporine or do you co-administer and then gradually stop plaquenil over time?
I would first increase the dose of Xolair, actually, up to 600 mg every 2 weeks.
How do you counsel patients with chronic urticaria on the role of stress management strategies in their treatment plan?
There are certain situations or times of the year when increased aeroallergen exposure is expected. It follows that increased vigilance is a management technique for those who suffer with sensitivity to these aeroallergen-induced symptoms in the areas of environmental control, pharmacotherapy, and, ...
For a positive anti-TPO and normal TSH in the workup of CSU, are you referring to endocrinology?
I typically do not refer these patients to endocrinology. I do provide the patient with these results and have them communicate this with their PCP and/or communicate with the PCP myself so they can monitor for any symptoms associated with thyroid dysfunction.