Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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 ...
How often do you draw screening ANAs for discoid lupus?
Because a positive ANA is associated with an increased risk of progression to SLE in patients with discoid lupus, I routinely check an ANA at the initial visit in virtually all patients. If negative, I repeat it only if new symptoms concerning systemic involvement arise (e.g., joint pain, cytopenias...
Can any superficial chemical peels be safely used for patients with preadolescent comedonal acne which is not responding to typical topical therapies?
Yes, salicylic acid chemical peels can be used in this age group and are both safe & effective.
How do you choose between various JAK inhibitors in the management of alopecia areata?
Mostly, the first line is baricitinib as it has been approved the longest. However, if a patient has lipid abnormalities at baseline, you could consider ritlecitinib, which does not impact the lipid profile. At the same time, however, ritlecitinib interacts with statins and other CYP3A and 1A2 medic...
For large infantile hemangiomas treated with timolol, do you have any concerns about systemic absorption?
For a large infantile hemangioma, I would opt to treat with oral propranolol instead of topical timolol, as it has better and more consistent efficacy. Additionally, oral propranolol is a weight-based medication with well-established dosing, while topical timolol applied to large hemangiomas may hav...
How do you choose between Grenz ray in a short course (e.g., ~5–7 fractions) versus longer-course superficial/megavoltage external beam regimens for large, ill-defined lentigo maligna on the cheek when surgery is not feasible?
The practical answer to this question is based on resource availability. There is a significant body of literature from Europe demonstrating the efficacy of Grenz ray therapy (albeit in retrospective, observational studies, with all of the usual caveats). To my knowledge, Grenz ray therapy is not wi...
What criteria are used to select patients who have locally advanced BCC patients for treatment with sonidegib?
Patients with locally advanced BCC are candidates for sonidegib when 1) the BCC is not manageable with curative surgery or radiation, 2) there’s recurrence after prior surgery or radiation, or 3) when treatment would cause significant morbidity for the patient. It can also be used as a neoadjuvant o...
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 typically excise Spitz nevus/nevi?
I excise Spitz nevi in patients 12 years of age or older.
Would you consider proceeding with a sentinel lymph node biopsy after wide excision revealed 1.2 mm residual non-ulcerated T2a melanoma on the upper back?
Any melanoma with Breslow’s depth of more than 0.8 mm (more than T1a) needs a sentinel lymph node biopsy for complete staging, due to higher chance of lymph node metastasis. Ideally, it should be done at the time of wide local excision, as doing the sentinel lymph node biopsy afterwards may be more ...