Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
What is your approach to a patient with undetectable MMR titers checked prior to or during immunosuppression and a history of MMR vaccination in childhood?
MMR titers are good correlates of protection. If any titer is undetectable it could be one of these situations: Primary failure. The components of the MMR have different efficacy. Two doses of appropriately given MMR will have 96+% against measles, but only 88% for mumps. Thus 1 in 10 appropriately...
Should the use of avacopan be limited to those patients at increased risk of steroid toxicity given the anticipated high cost of this medication?
Once Avacopan is available for clinical use in the treatment of patients with AAV, providers will need to carefully weigh risks and benefits of the medication while considering other factors including cost.The ADVOCATE trial used a novel glucocorticoid toxicity index that captures common GC-related ...
What is the appropriate pediatric dose of litfulo for a preadolescent with refractory alopecia areata?
Given that Litfulo is not yet approved for preadolescents and data from clinical trials in this age group are not yet available, it's hard to know the optimal dosing. With that said, typically I would treat a preadolescent with refractory alopecia areata off-label with Litfulo 50 mg (i.e., the same ...
What are your top takeaways from AAD 2026?
Cutaneous lupus erythematosus - the pipeline is very exciting and many mentions of the FDA breakthrough status of litifilimab. Also, talks on potentially using anifrolumab sooner in the treatment ladder to prevent scarring, which is approved for SLE and currently in trials for CLE. The clinical tri...
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...
Are there particular subsets of AAV patients in which avacopan is more effective?
The following answer was jointly drafted by Dr. Peter Merkel and Dr. David Jayne:Patients in the ADVOCATE trial were stratified at entry according to time of diagnosis (new/relapsing), diagnosis (GPA/MPA), ANCA serotype (PR3/MPO), and background immunosuppressive (cyclophosphamide/rituximab) with re...
What chemoprophylaxis, if any, would you consider in a transplant patient with numerous KC/NMSCs?
Besides treating actinic keratoses with all methods available to try to prevent their progression, acitretin is #1 in my book for these patients. It’s best to get them on it before they reach the point of developing big, bad SCCs. Dosing is based on patient size and tolerance. Start with 10 mg per d...
How do you clinically and diagnostically distinguish stiff skin syndrome from scleroderma?
They are distinct conditions, with scleroderma primarily manifesting as skin thickness, fibrosis, and Raynaud's, while stiff person syndrome is a neurological condition manifesting as rigidity and with muscle spasms. The latter serologically has anti-GAD antibodies, compared to scleroderma, which ha...
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.
What topical therapies have you found most effective for managing scarring alopecias?
I use a lot of clobetasol shampoo 1-2 times weekly, which is easier and tends to cause less atrophy. Overall, any of the steroid-sparing agents can be helpful: tacrolimus ointment (or compounded as a solution), roflumilast foam, or topical JAK inhibitors. For maintenance.