Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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.
How is your approach to a patient referred for radiotherapy for keloids with a history of Beals syndrome?
Although of theoretical concern, I am not aware of any contraindication to RT (treatment philosophy similar to Ehlers-Danlos syndrome).
When do you order genetic studies such as comparative genomic hybridization for melanocytic lesions?
In my practice, I confine copy number alteration studies (SNP array testing) for cases where the biological potential of a melanocytic proliferation is in question. I do not perform the testing if the case is diagnostic histopathologically and/or immunohistochemically of a nevus or melanoma.The seco...
Is there a general consensus on margins to use when treating SCCIS or BCC with ED&C?
ED and C is a procedure that is done largely by 'feel'. Tumor is generally softer and more friable than normal skin, and is therefore more susceptible to removal with moderate pressure from a semi-sharpened curette. Generally speaking, I don't obsess over margins when ED and C'ing a low-risk skin ca...
Do you counsel isotretinoin patients to use supplements (fish oil, OTC antihistamines, or Omega 3s) to decrease purging and mucocutaneous dryness?
Agreed with the above on omega-3 fatty acids.I always recommend 2nd gen antihistamines as well (Pandey & Agrawal, PMID 31734672). Harmless addition that seems to not only help some of the symptoms associated with isotretinoin, but also seems to improve efficacy.Finally, if omega-3s don't help with j...
In light of recent measles outbreaks in the US, would you recommend an MMR booster for immunocompetent patients born before 1957?
I would not recommend a measles vaccine for a person born before 1957. This year has been chosen because people before born before 1957 have a very very high likelihood of having had measles because virtually all children got this highly contagious disease. On the other hand, there is no harm to get...
Do you generally treat family members of patients with scabies?
Yes, if "family members" refers to those living in the same household or have had close contact with the affected individual within the past 3-4 weeks. Treating such contacts simultaneously is the best option to help eradicate the infestation.
What is the current role for genetic profile testing (e.g. DecisionDx-SCC) in the treatment paradigm for cutaneous malignancies?
This is a very cool test that has a lot of potential to help us make decisions in practice (full disclosure, I advise Castle and get research support from them, but am not directly compensated by them). The data published thus far shows that it is prognostic to predict nodal or distant mets. However...