Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How would you manage a patient with essential thrombocythemia and persistent pruritus despite adequate control of CBC with hydroxyurea and aspirin?
First, I'd make sure to exonerate any other causes of itching. Second, would make sure that supportive treatments like good skin care, anti-histamines, anti-depressants have been tried. I'd then consider if this patient truly has ET, as itching is more common in PV. Ruxolitinib is approved for patie...
How do you manage patients with chemotherapy-induced paronychia?
I manage patients with chemotherapy-induced paronychia with a few tricks: First, ensure that there is no infection (active drainage, especially purulent) is more indicative of infection, as well as appropriate hygiene. Topical steroids and soothing soaks (such as Domeboro or diluted distilled white ...
How do you manage patients with cicatricial pemphigoid refractory to doxycycline and dapsone?
In general, I’m rather aggressive about treating cicatricial pemphigoid given its ability to cause long-lasting sequela if left untreated and active. Pre-pandemic, rituximab was a common agent given its ability to put patients into a remission for extended periods of time. Now, given the data about ...
How do you manage anti-Mi-2 positive dermatomyositis with predominantly cutaneous manifestations?
Anti-Mi-2 usually has a good prognosis. So, if patients only have skin manifestations with anti-Mi-2, I would give methotrexate either without steroids (if symptoms are currently tolerable and the patient can wait for a few months) or with steroids (if intolerable symptoms). If this fails, I would g...
How do you manage patients with recurrent periorificial dermatitis?
I typically use oral doxycycline, whenever possible, and often the low subantimicrobial doses work as well as higher doses and are much more tolerable for patients. If they can't take antibiotics or prefer to avoid oral ones, I will use some combination of topical metronidazole, clindamycin, and top...
How do you manage patients with Dercum's disease?
Fortunately, I haven't had too many patients with Dercum's Disease (Adiposis Dolorosa). I had a patient with a few tumors that were particularly painful. We excised those tumors, which helped her. I've never tried an intralesional steroid injection, but I know it's been reported. In terms of systemi...
How do you approach treating patients with trigeminal trophic syndrome?
Very difficult to treat but I have found some success with compounded topical gabapentin (I use gabapentin, amitriptyline, lidocaine from skinmedicinals) +/- PO neuromodulator drugs (gabapentin, TCA) followed by reconstructive surgery with a flap of innervated skin as a last-line. For an itching ...
What IHC stains do you routinely use for identifying invasive squamous cell carcinomas?
In the skin, special stains are generally not needed for the vast majority of SCC. In poorly differentiated tumors or spindle cell tumors, cytokeratin stains or p63 are beneficial (and other stains to exclude other diagnoses). Also, for some SCC, S100-keratin double stain may be helpful in identifyi...
Do you feel comfortable using azathioprine for dermatomyositis in patients with cirrhosis?
Azathioprine can cause liver damage, albeit this is a rare complication and usually asymptomatic. Therefore, I would probably avoid it in cases of liver cirrhosis and try other medications, like mycophenolate, IVIG, tofactinib. In either case, I would consult at the same time with the patient's hepa...
How do you differentiate erythrodermic mycosis fungoides and Sezary syndrome - is it primarily based on the burden of blood involvement of malignant cells?
You are correct: Sezary and erythrodermic MF are not the same things, and Sezary is erythroderma (defined as 80% BSA or more) right from the start. But our current definition of Sezary also requires Stage B2 blood involvement, and specifically that the sum of CD4+ CD7- and CD4+CD26 - cells is > 1000...