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General Internal Medicine

Dermatology   

Questions discussed in this category

What treatment combination approach would you recommend for mucous membrane pemphigoid?
2 Answers available
How does trimethoprim-sulfamethoxazole's efficacy against S. pyogenes influence your empirical treatment of skin infections in regions with high resistance rates?
McCreary et al., PMID 37310038
2 Answers available
What laboratory workup do you perform in patients with symptoms consistent with erythromelalgia?
2 Answers available
What treatment would you offer a patient with extensive lymphangioma circumscriptum intermittently covering the entire abdomen?
1 Answer available
How soon after excising a keloid do you inject kenalog?
Any particular concentration?  Hayashi et al., PMID 22272655 Ekstein et al., PMID 32905614
8 Answers available
Do you pursue a cardiac evaluation in all patients with an excised cutaneous myxoma?
1 Answer available
How do you determine if a pyoderma gangrenosum lesion is “burned out"?
What changes do you make to your treatment approach to adapt to this altered disease state?
1 Answer available
After corticosteroids, what second line agent do you select to treat drug induced hypersensitivity syndrome (also known as DRESS syndrome)?
1 Answer available
How would you manage a patient with Takayasu arteritis controlled on TNFi who develops erythema nodosum that is only partially responsive to NSAIDs?
Would you view this as a sign that disease is not adequately controlled despite labs and imaging suggesting no active vasculitis? 
1 Answer available
What work up do you pursue for splinter hemorrhages in an otherwise healthy patient?
1 Answer available
Do you continue methotrexate in patients with inflammatory arthritis who develop non-melanomatous skin cancer while on therapy?
1 Answer available
What is your approach to management of radiation-induced bullous pemphigoid?
1 Answer available
How do you approach managing perioperative anxiety in Mohs patients?
1 Answer available
What is your approach to managing pyoderma gangrenosum recalcitrant to oral steroids?
When do you switch to steroid-sparing medications? What steroid-sparing therapies do you prefer?
7 Answers available
Would you switch azathioprine to a different immunosuppressant if a controlled patient with SLE develops melanoma and/or non-melanoma skin cancer?
2 Answers available
How do you approach the workup of clinically diagnosed cutaneous vasculitis in healthy young individuals without systemic symptoms?
1 Answer available
How do you approach work up for underlying rheumatologic disease in patients referred for chronic urticaria?
2 Answers available
How often do you pursue malignant transformation screening In patients with lymphomatoid papulosis or pityriasis lichenoides?
And what workup do you pursue?
1 Answer available
How would you approach management of a patient with rapidly progressive systemic sclerosis with worsening skin disease, myositis, arthritis, dysphagia and failure to thrive developing within 6 months?
The patient is a young African American female of reproductive age with positive Fibrillarin antibody and nucleolar antibody. No ILD.
1 Answer available
How would you treat pemphigus foliaceous in an elderly patient intolerant to oral steroids?
2 Answers available
How would you work up a patient with cutaneous mastocytosis?
Is a BM biopsy a must when there is skin involvement? If tryptase level is mildly elevated but less than 20 would you recommend a BM biopsy?
1 Answer available
Is a biopsy of either skin or muscle always indicated in the diagnosis of dermatomyositis?
1 Answer available
How do you screen dermatomyositis patients for malignancy if they have a high risk antibody profile (NXP-2/TIF1gamma positive) and their initial screen is negative?
1 Answer available
Is there a role for monitoring serum ANCAs to assess ANCA associated vasculitis disease activity?
This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).
2 Answers available
How would you interpret a positive single specific markers like SSA or SSB in setting of working up an connective tissue disease, especially when ANA is negative?
1 Answer available
Does IVIG or subcutaneous Ig interfere with monoclonal antibody therapy (i.e. dupilumab, infliximab, rituximab, etc)?
How should IVIG and either biologic injections or infusions be spaced?
2 Answers available
Would you avoid combining JAK inhibitors with IVIG given the risk of thromboembolism?
4 Answers available
Do you have a preference between Quantiferon Gold and T-spot TB for screening in patients starting immunosuppressive agents?
1 Answer available
What is your approach to evaluation in patients who present with erythromelalgia?
1 Answer available
Have you seen drug induced SCLE from IL-17 inhibitors?
And if so, what is your approach to the diagnosis?
1 Answer available
How do you recommend tapering IVIG in patients whose inflammatory myositis has achieved remission?
4 Answers available
What initial workup do you perform when there is a concern for porphyria?
1 Answer available
How long can you treat dermatomyositis with IVIG?
3 Answers available
How do you approach treating patients with lupus profundus?
Do you typically start the patient on hydroxychloroquine?  What work-up do you perform?
1 Answer available
What labs do you order to monitor patients on JAK1 inhibitiors (abrocitinib or upadacitinib)?
How often do you order labs?
1 Answer available
How do you approach the diagnosis of erythronychia?
1 Answer available
Do you screen for interstitial lung disease in patients with newly diagnosed polymyositis or dermatomyositis in the absence of respiratory symptoms?
3 Answers available
What are your preferred treatment options for patients with cholestatic pruritus who do not respond to light therapy?
3 Answers available
How do you approach management of a patient with lower extremity ulcers from livedoid vasculopathy with a history Sjogren’s and Factor V Leiden?
4 cutaneous biopsies with no evidence of vasculitis. Sjogren’s diagnosis based prominent sicca symptoms and a significantly elevated SSA. 
2 Answers available
Do you feel comfortable using azathioprine for dermatomyositis in patients with cirrhosis?
For example, in the setting of cirrhosis incidentally found on imaging.
2 Answers available
Do you routinely check G6PD level prior to initiation of hydroxychloroquine?
6 Answers available
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?
1 Answer available
How do you approach the management of patients on lamotrigine who develop a minor rash?
Should one restart lamotrigine or look for an alternative? If no other alternative available, is slow titration vs regular titration preferred?
4 Answers available
How do you manage patients on biologics peri-operatively?
Are there any medications that surgeons like discontinued before their procedure?
1 Answer available
How do you evaluate livedo reticularis (not livideo racemosa)?
Does your evaluation hinge on nonresolution with warming? How extensive is your workup?
1 Answer available
What is your work-up for acquired keratoderma?
Does morphology guide your workup?
1 Answer available
What is the negative predictive value of a negative extended myositis panel in dermatomyositis patients?
2 Answers available
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?
Especially in the setting of these being more narrow acting than tofacitinib, should we consider them safer than our old drugs?
2 Answers available
If you have clinical suspicion for a paraneoplastic process (e.g. dermatomyositis or pemphigus), what work-up do you pursue?
1 Answer available
How do you approach treating cutaneous PAN?
Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease? 
1 Answer available
Does calcinosis appear differently in patients with dermatomyositis compared to systemic sclerosis?
1 Answer available
How do you think about biologic use in patients with underlying HIV infection?
2 Answers available
How do you approach the use of commercial testing such as AVISE CTD in clinical practice?
1 Answer available
How do you clinically distinguish between cutaneous lupus with photosensitivity and polymorphic light eruption-like reactions?
1 Answer available
What is the role for angiography in the workup of digital ischemia?
Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?
1 Answer available
Should the use of avacopan be limited to those patients at increased risk of steroid toxicity given the anticipated high cost of this medication?
ADVOCATE trial
1 Answer available
When is it necessary to monitor the QTc interval in patients on hydroxychloroquine?
2 Answers available
Is it okay to use medications associated with drug-induced lupus in patients with SLE?
1 Answer available
How would you approach refractory gangrenous Raynaud's secondary to type one cryoglobulins?
What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?
1 Answer available
Are there particular concerns related to the use of B-cell depletion therapies such as rituximab for rheumatic disease during the COVID-19 pandemic?
1 Answer available
Is there a role for measuring hydroxychloroquine blood levels in clinical practice?
If so, are there specific patient populations for which you would use this metric?
1 Answer available
What is considered an adequate treatment period to assess response of AAV induction therapy with rituximab or cyclophosphamide? 
1 Answer available
Should venous thrombosis in a patient with Behcet syndrome be treated with both immunosuppression and anticoagulation?
1 Answer available
How do you handle hypogammaglobulinemia detected in patients prior to maintenance rituximab infusion?
2 Answers available
Which immunosuppressed patients with SLE would benefit from antibiotic prophylaxis to prevent pneumocystis pneumonia?
1 Answer available
Is it ever appropriate to use hydroxychloroquine temporarily in higher doses (more than 5mg/kg) to control lupus activity such as skin manifestations?
1 Answer available
How does your treatment algorithm differ for drug-induced ANCA vasculitis compared to non drug-induced ANCA vasculitis in cases with severe/organ-threatening manifestations?
1 Answer available
Are there certain subsets of ANCA vasculitis patients for whom you would consider life long maintenance therapy?
2 Answers available
What is your first treatment of choice in patients with dermatomyositis sine myositis?
1 Answer available
How do you assess transaminitis in a patient with sarcoidosis with known liver involvement being treated with methotrexate?
1 Answer available
Do you continue hydroxychloroquine in lupus patients who develop cardiomyopathy?
1 Answer available
When is a biopsy necessary to diagnose relapsing polychondritis?
1 Answer available
What is your approach to bladder cancer surveillance in patients who have received cyclophosphamide?
1 Answer available
Would you avoid the use of a TNF inhibitors in patients with a remote history of melanoma, including those with ocular melanoma?
1 Answer available
Are there any clinical situations in which checking for anti-chromatin antibodies is helpful?
1 Answer available
Is there a minimum work-up necessary in patients with an ANA greater than 1:160 and no clinical symptoms suggestive of lupus (i.e., specific antibodies, UA)?
2 Answers available


Papers discussed in this category

,
Systemic Treatment for Clinically Amyopathic Dermatomyositis at 4 Tertiary Care Centers.
, 2016 Aug 30
Treatment of clinically amyopathic dermatomyositis in adults: a systematic review.
Arthritis and rheumatism, 1982-11
The 1982 revised criteria for the classification of systemic lupus erythematosus.
Arthritis and rheumatism, 2012-08
Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus.
, 2019 Aug 06
2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Systemic Lupus Erythematosus.
Arthritis Rheum.,
Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus.
Medicine, 1976-05
Relapsing polychondritis: prospective study of 23 patients and a review of the literature.
Arthritis and rheumatism, 2010-01
Incidence and prevention of bladder toxicity from cyclophosphamide in the treatment of rheumatic diseases: a data-driven review.
J. Rheumatol., 2019 Sep 01
Malignancies in Patients with Antineutrophil Cytoplasmic Antibody-associated Vasculitis: A Population-based Cohort Study.
Ann. Rheum. Dis., 2018 May 03
Long-term efficacy of remission-maintenance regimens for ANCA-associated vasculitides.
Ann. Rheum. Dis., 2018 Apr 25
Comparison of individually tailored versus fixed-schedule rituximab regimen to maintain ANCA-associated vasculitis remission: results of a multicentre, randomised controlled, phase III trial (MAINRITSAN2).
JAMA ophthalmology, 2014-12
The risk of toxic retinopathy in patients on long-term hydroxychloroquine therapy.
Can J Ophthalmol,
Retinal toxicity of high-dose hydroxychloroquine in patients with chronic graft-versus-host disease.
J Am Acad Dermatol, 2016 Feb 03
The effect of increasing the dose of hydroxychloroquine (HCQ) in patients with refractory cutaneous lupus erythematosus (CLE): An open-label prospective pilot study.
JAMA network open, 2018-11-02
Association of Immunoglobulin Levels, Infectious Risk, and Mortality With Rituximab and Hypogammaglobulinemia.
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases, 2008-10
Prophylactic antibiotic usage for Pneumocystis jirovecii pneumonia in patients with systemic lupus erythematosus on cyclophosphamide: a survey of US rheumatologists and the review of literature.
Clin Rheumatol, 2006 Dec 21
Infection-related morbidity and mortality in patients with connective tissue diseases: a systematic review.
Rheumatol Int, 2020 Sep 18
High rates of severe disease and death due to SARS-CoV-2 infection in rheumatic disease patients treated with rituximab: a descriptive study.
Nat Rev Dis Primers, 2018 Aug 02
Cryoglobulinaemia.
N Engl J Med, 2021 Feb 18
Avacopan for the Treatment of ANCA-Associated Vasculitis.
British journal of cancer, 2023 Feb 04
Use of methotrexate and risk of skin cancer: a nationwide case-control study.
Int J Clin Pract, 2021 Mar 24
Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey.
Mod Rheumatol, 2021 Feb 09
QTc interval prolongation in patients with systemic lupus erythematosus treated with hydroxychloroquine.
Heart Rhythm, 2020 Jun 28
Effects of hydroxychloroquine treatment on QT interval.
Arthritis care & research, 2018-03
Examination of Hydroxychloroquine Use and Hemolytic Anemia in G6PDH-Deficient Patients.
J Clin Rheumatol, 2020 Sep 18
Association of Hydroxychloroquine use and Hemolytic Anemia in Patients With Low Levels of Glucose-6-Phosphate Dehydrogenase.
Cureus, 2020 Aug 02
A Study on the Relevance of Glucose-6-Phosphate Dehydrogenase Level Screening in Patients with Rheumatic Diseases Prior to Initiating Treatment With Hydroxychloroquine.
Radiographics : a review publication of the Radiological Society of North America, Inc, 2001
Polyarteritis nodosa: spectrum of angiographic findings.
International journal of clinical rheumatology, 2010
Raynaud's phenomenon and digital ischemia: a practical approach to risk stratification, diagnosis and management.
Lupus science & medicine, 2014
Cell-bound complement activation products in systemic lupus erythematosus: comparison with anti-double-stranded DNA and standard complement measurements.
The Journal of rheumatology, 2015-11
Hydroxychloroquine Blood Levels in Systemic Lupus Erythematosus: Clarifying Dosing Controversies and Improving Adherence.
Ophthalmology, 2016-06
Recommendations on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision).
Lupus science & medicine, 2017
Cell-bound complement activation products in SLE.
Journal of immunology research, 2017
Performance Characteristics of Different Anti-Double-Stranded DNA Antibody Assays in the Monitoring of Systemic Lupus Erythematosus.
Lupus science & medicine, 2018
Erythrocyte-bound C4d in combination with complement and autoantibody status for the monitoring of SLE.
Arthritis care & research, 2019-07
Area-Level Predictors of Medication Nonadherence Among US Medicaid Beneficiaries With Lupus: A Multilevel Study.
Clin Pharmacol Ther, 2018 Jun
A Prospective International Study on Adherence to Treatment in 305 Patients With Flaring SLE: Assessment by Drug Levels and Self-Administered Questionnaires.
Lupus Sci Med, 2016
Reduction in erythrocyte-bound complement activation products and titres of anti-C1q antibodies associate with clinical improvement in systemic lupus erythematosus.
Rev Med Interne, 2016 Oct 13
[Blood concentration of hydroxychloroquine in systemic lupus erythematosus care: Usefulness and limits].
JAMA Dermatol,
Hydroxychloroquine-induced pigmentation in patients with systemic lupus erythematosus: a case-control study.
Lupus Sci Med, 2016 Feb 01
Systemic lupus erythematosus and primary fibromyalgia can be distinguished by testing for cell-bound complement activation products.
Lupus Sci Med,
A multianalyte assay panel with cell-bound complement activation products demonstrates clinical utility in systemic lupus erythematosus.
ACR Open Rheumatol, 2020 Oct 12
Evaluation of the Economic Benefit of Earlier Systemic Lupus Erythematosus (SLE) Diagnosis Using a Multivariate Assay Panel (MAP).
Arthritis Rheumatol, 2021 May 02
Association of Higher Hydroxychloroquine Blood Levels With Reduced Thrombosis Risk in Systemic Lupus Erythematosus.
Ann Rheum Dis, 2012 Nov 10
Hydroxychloroquine in systemic lupus erythematosus: results of a French multicentre controlled trial (PLUS Study).
Arthritis Rheum,
Low blood concentration of hydroxychloroquine is a marker for and predictor of disease exacerbations in patients with systemic lupus erythematosus.
Lupus,
Hydroxychloroquine use predicts complete renal remission within 12 months among patients treated with mycophenolate mofetil therapy for membranous lupus nephritis.
Arthritis Rheumatol, 2020 Jan 07
Hydroxychloroquine Blood Levels Predict Hydroxychloroquine Retinopathy.
Acta Gastroenterol Belg,
Cholestatic pruritus : an update.
J Dermatol,
Cutaneous polyarteritis nodosa: a clinical and histopathological study of 20 cases.
Minerva Gastroenterol Dietol, 2016 Sep 07
Glutathione in the treatment of liver diseases: insights from clinical practice.
Free Radic Biol Med,
Effect of liver cirrhosis and age on the glutathione concentration in the plasma, erythrocytes, and gastric mucosa of man.
Rheum Dis Clin North Am, 2020 Aug
Risk Factors and Cancer Screening in Myositis.
Rheumatology (Oxford),
A systematic review and meta-analysis to inform cancer screening guidelines in idiopathic inflammatory myopathies.
The British journal of dermatology, 2019-11
Utilization patterns and performance of commercial myositis autoantibody panels in routine clinical practice.
Frontiers in immunology, 2019
Comparison of Three Immunoassays for the Detection of Myositis Specific Antibodies.
J Am Acad Dermatol, 2020 Sep 04
Accuracy of commercial panels to evaluate myositis autoantibodies: A single-institution perspective.
Rheumatology (Oxford),
The reliability of immunoassays to detect autoantibodies in patients with myositis is dependent on autoantibody specificity.
Am J Clin Dermatol,
Acquired palmoplantar keratoderma.
Eur J Dermatol,
Telangiectasia macularis eruptiva perstans: a neglected type of mastocytosis with exclusively cutaneous involvement? A case series.
Clinical pharmacokinetics, 2018-12
Infliximab Pharmacokinetics are Influenced by Intravenous Immunoglobulin Administration in Patients with Kawasaki Disease.
Frontiers in immunology, 2018
Reversing Autoimmunity Combination of Rituximab and Intravenous Immunoglobulin.
Clinical immunology (Orlando, Fla.), 2020 Jul 15
The potential impact of timing of IVIG administration on the efficacy of rituximab for immune tolerance induction for patients with Pompe disease.
The Pediatric infectious disease journal, 2018 Oct
Infliximab Plus Intravenous Immunoglobulin (IVIG) Versus IVIG Alone as Initial Therapy in Children With Kawasaki Disease Presenting With Coronary Artery Lesions: Is Dual Therapy More Effective?
Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology, 2017 Nov 03
Successful IVIG treatment without discontinuation of TNF-α blocker in Guillain-Barre syndrome induced by adalimumab in patient with Crohn's disease.
Ann Acad Med Singap, 2012 Sep
A ten-year retrospective study on livedo vasculopathy in Asian patients.
Ann Afr Med, 2020 Jul-Sep
Refractory lupus panniculitis treated successfully with rituximab: Two cases.
Arch Dermatol, 2006 Mar
Lupus erythematosus profundus successfully treated with dapsone: review of the literature.
Clin Rev Allergy Immunol, 2010 Apr
Intravenous immunoglobulin in lupus panniculitis.
Lupus, 2020 Mar 19
Successful treatment of refractory lupus erythematosus profundus with the interleukin-6 antagonist tocilizumab: a case report.
N Engl J Med, 2022 Oct 06
Trial of Intravenous Immune Globulin in Dermatomyositis.
Clinical and experimental dermatology, 2021 Mar 09
Brodalumab-induced subacute cutaneous lupus erythematosus.
JAAD case reports, 2019 Mar 01
Ustekinumab-induced subacute cutaneous lupus.
Dermatologic therapy, 2020 May 03
Secukinumab-induced subacute cutaneous lupus erythematosus.
The Journal of allergy and clinical immunology, 2012 Feb 14
Chronic urticaria and autoimmunity: associations found in a large population study.
American journal of clinical dermatology, 2020 Aug
Dermatologic Sequelae Associated with Radiation Therapy.
Plastic and reconstructive surgery. Global open, 2021 Aug 04
The Effectiveness of Immediate Triamcinolone Acetonide Injection after Auricular Keloid Surgery: A Prospective Randomized Controlled Trial.
Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society, 2019 Oct 21
Imiquimod to prevent keloid recurrence postexcision: A systematic review and meta-analysis.
Open forum infectious diseases, 2017
Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2014 Jul 15
Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023 Oct 13
Antibiotic Myths for the Infectious Diseases Clinician.
Antimicrobial agents and chemotherapy, 2014 Feb 03
Factors that cause trimethoprim resistance in Streptococcus pyogenes.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2013-06
Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial.

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