Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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...
With the approval of oral JAK inhibitors such as Upadacitinib for atopic dermatitis, how are you considering its safety profile in comparison to traditional immunosuppressants such as prednisone, methotrexate, azathioprine, and mycophenolate?
In every treatment situation, we need to help the patient understand the potential benefits and potential risks of a medication. In my opinion, Upadacitinib is in a completely different category than traditional immunosuppressants such as prednisone, methotrexate, azathioprine, and mycophenolate, si...
With the increasing reports of correlation of frontal fibrosing alopecia and titanium dioxide sunscreens, do you advise patients against the use of micronized sunscreens on the face?
Yes, I believe titanium nanoparticles can be a trigger, and I advise avoiding this ingredient in sunscreens and foundations.
Is there a role for IVIG in the treatment of active morphea refractory to immunosuppressive agents?
While the exact mechanism of action remains unclear, IVIg therapy has demonstrated good efficacy in several rheumatic conditions including Inflammatory myositis, refractory cutaneous lupus, and also in sclerotic conditions like Systemic sclerosis where it is believed to work by increasing regulatory...
How do you approach treating necrobiosis lipoidica, especially cases that have ulcerated?
ILK for early lesions, Pentoxyphylline helps with pain, optimize glycemic control, doxycycline, unna boot/wound care.
What is the negative predictive value of a negative extended myositis panel in dermatomyositis patients?
The short answer is "not great, but it depends" since the more nuanced answer is contingent on: the constellation of myositis-specific antibodies (MSA) included on the panel, the nitty-gritty of how the commercial lab is checking the MSA included (this detail can change between vendors, or even ...
Is there a role for cyclophosphamide in refractory digital ischemia in patients with scleroderma?
Great question! The vascular disease in Scleroderma (Systemic sclerosis/SSc) is characterized by vasospasm, a proliferative vasculopathy with intimal hyperplasia, thrombosis and/or occlusive (fibro-obliterative) arterial disease with near blockage of the vascular lumen in many cases and impaired ang...
Do you routinely provide GI protection in the form of a PPI or histamine blocker for patients with immunobullous disease initiated on high doses of oral corticosteroids?
I honestly don’t unless a patient brings up GI symptoms during the visit. However, the literature does have clear recommendations. A recent JAAD CME stated that on any dose of prednisone for 3 months or greater, GI prophylaxis is needed for those who must be on a concomitant NSAID. It also recommend...
What is your approach to diagnosing and managing suspected dental amalgam-triggered lichen planus?
Suspected dental amalgam-triggered oral lichen planus occurs when oral lichenoid lesions are topographically in close proximity to the dental amalgam. Patch testing can support this diagnosis. Common metals to test include palladium, gold, mercury, tin, copper, nickel, and amalgam powder. A recent a...
What is your work-up for acquired keratoderma?
The differential diagnosis for acquired keratoderma is broad and includes categories such as inflammatory skin disorders (such as pityriasis rubra pilaris, cutaneous T cell lymphoma, etc), infections (syphilis, crusted scabies, HIV, etc), medications (tyrosine kinase inhibitors, etc), nutritional de...