Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you decide when to biopsy a patient with overlapping signs of female-pattern hair loss and possible early central centrifugal cicatricial alopecia?
Biopsy is indicated when the diagnosis is uncertain, particularly when distinguishing between female-pattern hair loss (FPHL) and central centrifugal cicatricial alopecia (CCCA), as these conditions can have overlapping clinical presentations. Our T-shirt should also represent fibrosing alopecia and...
Do you typically recommend initial therapy with a JAK inhibitor or systemic corticosteroids in acute extensive alopecia areata?
I typically treat acute extensive alopecia areata with a JAK inhibitor (at the highest relevant dose) rather than systemic corticosteroids, as I have found that patients tend to respond well with this approach. The JAK inhibitors work very quickly to reduce the inflammatory processes underlying alop...
Do you reduce the dose of hydroxychloroquine in patients with skin graying if they are not particularly bothered by this side effect?
1. I would check a trough whole blood HCQ level. Nathalie Costedoat-Chalumeau and her colleagues found higher levels in patients who developed skin pigmentation (Jallouli et al., PMID 23824340), but actual levels were not reported. Petri et al also showed that levels above 1200 ng/mL were associated...
How long do you apply patch testing before interpreting the results?
In most instances, patches are removed after 48 hours (2 days). This timeframe is specifically chosen to allow sufficient time for the allergen to penetrate the stratum corneum and trigger a T-cell-mediated response, while simultaneously reducing the potential for significant skin irritation that ca...
What is your preferred method of wound closure after wide excision for hidradenitis suppurativa?
My favorite is always secondary intention healing. It has the best outcomes and the least risk of recurrence, plus it's the easiest since you don't have to do anything. It is important to counsel patients ahead of time, and I find it helpful to show them some photos. When they see the open wound, it...
For patients with xanthelasma, aside from a lipid panel, do you perform any additional lab workup or send referrals?
Agree that recurrence is common, but there are no data that a high cholesterol or increased serum lipid is associated with them.
Do you offer prophylactic antibiotics or valacyclovir prior to ablative laser therapy?
All ablative resurfacing, especially perioral region, should be prescribed valacyclovir as outbreaks can be devastating, especially if it's their first one.
For microneedling to treat boxcar scars, how should the needle be oriented?
Boxcar facial scars are difficult to treat because the dermis is fibrous, the sides are fixed, and they can range in size from several millimeters. The purpose of microneedling is to improve the underlying dermis, so it would make the most sense to aim the needle directly under the deepest part of t...
Do you typically excise cellular dermatofibromas?
I don't see a reason to remove them beyond cosmetic reasons or patient preference.
Is anyone doing Nemluvio q3 weeks?
There is no contraindication to more frequent dosing than every 4 weeks, assuming you can get coverage. It's a tad easier for flex dosing using the PN indication and documenting weight >90 kg. In that case, the patient can get two 30 mg injections every 4 weeks, but what I've done for patients that ...