Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
Do you ever offer scalp cooling therapy to metastatic breast cancer patients wishing to avoid alopecia?
I routinely offer scalp cooling to such patients. I do acknowledge to patients that we do not have evidence to support scalp cooling in the metastatic setting, that the best evidence to support its efficacy is with taxane-based regimens, and that we really cannot be sure how or if scalp cooling will...
At what age do you recommend annual skin exams in a patient without a personal or family history of skin cancer?
I don't have a specific age but rather it depends on the risk factors: Male, fair skin, and older age are risk factors, certain occupations Evidence of actinic damage Immunosuppression, especially organ transplants Multiple nevi > 50 History of dysplastic nevi Childhood radiation exposure Chronic l...
How do you monitor a patient with scleroderma during pregnancy?
One of the most important aspects of monitoring scleroderma patients in pregnancy is the preconception visit to review the stage of the disease including getting cardiopulmonary studies before pregnancy and reviewing medications and adjusting any immunosuppressive medications. Although prospective s...
Would you give checkpoint inhibitor therapy to a cancer patient with known dermatomyositis given the association of checkpoint inhibitor associated myocarditis, myasthenia gravis, and myositis?
I think the dermatomyositis could be more paraneoplastic that would actually benefit from controlling the cancer with ICI. I would give the treatment but I would carefully follow-up the patient for any irAEs. I will also document the rheumatological assessment, CPK, and myositis panel before startin...
What is your approach to a young adult patient with significant nail psoriasis and not much cutaneous disease?
This is a great question and honestly it depends on how aggressive the patient wants to be. An algorithm could look like this but ultimately you’d discuss it with the patient and see where they stand: Tazarotene +/- Calcipotriene during the week and clobetasol on weekends vs. taclonex or wynzora ev...
When should you discontinue narrow band UVB when a patient is in clinical remission from patch stage mycosis fungoides?
It depends on the patient, and whether they have a history of flaring after stopping phototherapy. In that setting, maintenance phototherapy (once weekly or sometimes every other week) may be helpful.
What treatment options do you recommend to patients with microstomia secondary to scleroderma?
Perioral and masseter botox 8U upper lip and 4U lower lip. 16U per masseter.
What dressings do you recommend for patients with hidradenitis suppurativa to help prevent friction and collect drainage from open areas?
My favorite is a dressing/garment called Hidrawear. It’s clothing made specifically for HS with pockets to hold bandages for drainage. Patients can pay out of pocket, but it is also covered by some insurances. Order forms are available through the website: https://hidrawear.com/ Otherwise, the pati...
What diet modifications do you recommend for patients with acne to help prevent breakouts?
For those motivated to make dietary changes, I recommend avoiding high-glycemic index food, dairy (especially skim milk), and red meat. I do recommend a Mediterranean diet enriched in vegetables, legumes, fish, as well as vitamin D and zinc.References: Meixiong et al., PMID 35373155 Hasamoh et al.,...
What is your treatment approach for steroid-refractory necrobiosis lipoidica?
I have never had success treating NLD. I have seen rare spontaneous improvement over the course of several years however.