Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
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...
Do you reduce the dose of hydroxychloroquine in patients with skin graying if they are not particularly bothered by this side effect?
I wouldn't if they're not bothered, but I would think to look into their HCQ blood levels... we know that certain doses of HCQ are more effective in controlling disease activity than others, and that of course, higher levels may be associated with adverse effects, not just in the skin.
If methotrexate is contraindicated or not tolerated, what systemic treatments do you use for generalized morphea?
I assume they failed hydroxychloroquine.
Which serologic tests are most helpful when evaluating for suspected drug-induced lupus?
If I suspect drug-induced lupus, I typically order the following laboratory testing: ANA/IFA Anti-histone antibody, usually positive in drug-induced lupus Anti-Ro antibody, usually positive in drug-induced subacute cutaneous lupus Anti-dsDNA, usually negative in drug-induced lupus vs positive in id...
What are your preferred treatment options for patients with chronic non-healing leg ulcers?
In addition to all the typical things (decreasing edema with meds, compression, etc + treating superinfection, critical colonization, or debriding eschars), there is some evidence for pentoxifylline 400 mg TID or 800 BID in ulcerations of any etiology. There is also newer evidence for using topical ...
Do you screen for interstitial lung disease in patients with newly diagnosed polymyositis or dermatomyositis in the absence of respiratory symptoms?
I do screen all newly diagnosed IIM patients with PFTs and chest CT. This has a double purpose: establishing a baseline of lung function and, screening for lung cancer. While the patient might not have lung symptoms on presentation, respiratory involvement can manifest later on the course of the d...
How do you optimize retinopathy screening schedules for patients on hydroxychloroquine while also prioritizing cost-effectiveness?
I'll approach this from the cost-effectiveness standpoint as I agree with Drs. @Dr. First Last and @Dr. First Last on their excellent points.Patients with SLE have remarkably high costs when you add up copays, medications, imaging studies, travel, missing work, etc. Anything we can do to help reduce...
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.
What cosmetic options can you provide to patients with facial discoid lupus that seems stable?
Procedures such as botulinum toxin A, fillers, and autologous fat grafting can be considered in patients with discoid lupus if the disease has been clinically stable, typically meaning no new lesions or active inflammation for about a year. Light-based vascular treatments such as pulsed dye laser ca...
What clinical criteria do you use to decide when to start oral nicotinamide for chemoprevention?
Consider oral nicotinamide (500mg bid) for chemoprevention in patients with several non-melanoma skin cancers in the past 5 years or those with high-risk features such as extensive actinic damage or field cancerization. Studies show the strongest evidence for its use in immunocompetent patients with...