Dermatology
Clinical insights on skin conditions, dermatologic procedures, and treatment approaches from practicing dermatologists.
Recent Discussions
How do you manage worsening cutaneous dermatomyositis when muscle disease appears controlled?
The fact that the patient still has an active pruritic rash while tapering steroids suggests that the current regimen isn't fully controlling the disease, and it can affect quality of life. I would consider adjusting immunosuppression, either adding another agent or switching therapies. The specific...
What has been your experience in using topical hydroquinone prior to a chemical peel for melasma to reduce post-inflammatory hyperpigmentation?
Topical hydroquinone, in patients not sensitive to it, as well as sunscreen, are routinely used in this situation.
Would you consider topical estrogen for facial anti-aging?
Before I put anything on my skin, I want to know what it does, whether it is safe, and whether there are clinical trials on humans that show it works. Topical estrogen, like estriol, may be an option for postmenopausal skin, as it has the potential to increase collagen, hydration, and elasticity. Ho...
How would you manage a patient who developed stage III melanoma while receiving cemiplimab (cycle 10) for locally advanced cutaneous squamous cell carcinoma?
That depends on whether you want to manage the stage III melanoma in the adjuvant vs neoadjuvant setting. If adjuvant, can likely continue cemiplimab (off-label for melanoma) as it has the same MoA as other anti-PD-1 ICI. If intending to manage stage III melanoma in neoadjuvant setting, consider swi...
What recommendations or protocol do you have in reducing pain when using levulan with blue light for field therapy to treat AKs?
Applying the blue light directly after the application of Levulan without an incubation period practically eliminates all of the discomfort associated with this type of field therapy for actinic keratoses. You may choose to double the usual exposure time to 34 minutes, but this is not necessary.
What have you found more effective, blue-light or red-light photodynamic therapy (PDT) in treating AKs or NMSCs?
Need to say what you are treating.
Are there certain patient characteristics that drive you to recommend intralesional 5-FU or MTX for a large SCC on the back?
Intralesional 5-FU or MTX can be an option for a large SCC on the back if the patient is not a good surgical candidate due to advanced elderly age, significant co-morbidities, or for those who decline surgery. These treatments can also be used neoadjuvantly to shrink large tumors and potentially red...
How should the use of the DecisionDx-Melanoma test be integrated into clinical practice to potentially avoid sentinel lymph node biopsy?
At this time, DecisionDx should be used as an extra piece of molecular information, not for clinical decision-making. The study done on DecisionDx was mainly retrospective, not prospective, so it has limited value in guiding patient care at this time. I would base your decision on SLBx on the curren...
What recommendations do you provide to patients on isotretinoin about timing of tattoos?
No specific recommendations due to the absence of robust data
What questions are important to ask before performing PDL laser?
Before performing PDL treatment, the patient should be asked if they‘ve had previous laser treatment and if they have had any adverse effects. They should be asked if they are on retinoids, topical acne preparations, or any skin irritants, as these should be discontinued for a couple of weeks post-t...