Internal Medicine

Dermatology   

Questions discussed in this category



Do you reserve biologics for more systemic involvement? When do you initiate biologics such as secukinumab? 

What changes do you make to your treatment approach to adapt to this altered disease state?

How do you balance concern for causing skin hypopigmentation with many of the traditional treatment modalities we have?

Are you aware of any data regarding relative risk of molluscum contagiosum infection in reference to DMARDs/biologics?

SLE manifestations include arthralgias and cytopenias which are stable. Previously did well on methotrexate, but developed GI side effects. HCQ is on ...

Given that Accutane can affect calcium homeostasis, would you recommend continuing Accutane or are additional steps or workup warranted?

Would you view this as a sign that disease is not adequately controlled despite labs and imaging suggesting no active vasculitis? 

What specific settings and devices do you prefer to use? 

Do you have a preference for biologics or phosphodiesterase inhibitors? 

The patient has ongoing inflammatory arthritis despite methotrexate, apremilast, and jak inhibitor trials.

What treatment regimen have you found most effective? Do you recommend any lifestyle changes or prescribe oral azoles? Any experience with topical r...

Do you start/trial them on another biologic or just rely on topical therapies?

Female in her early 40s with chronic spontaneous urticaria occurring consistently only at night for the past 4 years. Lesions develop only at night wh...

 What treatment do you initiate before you have a clear diagnosis?

Drug elimination is often helpful, but some triggers are not easy to identify because they are found in food items.

When do you switch to steroid-sparing medications? What steroid-sparing therapies do you prefer?

Do you empirically treat itchy patients -with a non specific rash- for scabies without obvious clinical findings for scabies? 

Do you use combination therapies such as betamethasone and calcipotriene foam?

Given the side effect profile and risk of relapse off oral TXA therapy, do you prefer pulse dosing (i.e. 3 months on, 3 months off) or continuous ther...

Do you first try adding topicals or UV? At what point do you decide to switch biologics and at that point do you try to class switch to a different MO...

In which situations or patient populations do you find this useful? How is it sterilized?

What side effects do you highlight in conversation with them? How do you approach toxicity monitoring?

Mother's insurance plan has a high deductible and phototherapy is inconvenient (family lives 50 minutes away). 

For instance - any tips regarding coordination of care/transportation, associated lymphedema management, wound care, and pain control would be welcome...

I have an elderly patient with a history of biopsy-proven psoriasis on IL-17 biologic therapy. She has developed an intense itch without a primary ras...

Do you order blood work to evaluate for underlying dyslipidemia or other metabolic diseases?

Have you had success with deroofing or surgical excision? Is ILK the best option?

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?

Have you recommended supplementing less common supplements such as zinc or selenium?

Do your recommendations differ depending on the fragrance category (i.e fragrance mix I, II or balsam of Peru)?

This question is part of a collaboration with RheumMadness and is in reference to Pathogenic ANCA (RAVE Trial).

Are you less likely to prescribe it for patients with dyslipidemia or autoimmune disease?

(Refractory to mycophenolate, azathioprine, and methotrexate. UpToDate suggests thalidomide or IVIG with mixed efficacy, while there are some case rep...

And if so, what is your approach to the diagnosis?

Do you recommend any dietary changes or supplements? Do you modify your recommendations if the patient is breast feeding?

Do you typically order a systemic workup? And, after topical corticosteroids, what other treatment options do you prefer?

Do you do blood work? Or do you rely on review of systems?

Are dilute bleach baths enough? Should they use any topical therapies? Is there a need for Staph decolonization with something like mupirocin?

Do you typically start the patient on hydroxychloroquine?  What work-up do you perform?

Are there ways to overcome barriers in insurance coverage of this combination of treatments?

Several speakers at ACR 2021 commented on the important role of drug levels in the management of these patients and cautioned against adding medicatio...

What labs do you order? How often do you order labs?  Have you ever needed to discontinue isotretinoin due to lab abnormalities?

Are there cases where food or environmental allergies significantly worsen eczema in children?

Does your treatment management differs for oral erosive lichen planus? How would you approach patients with active malignancy on chemo and radiation?

If so, where can patients find it? And besides topical clindamycin, what other topicals do you find helpful for individual lesions?

The symptoms can be really miserable.I try to control it with antihistamines (don't find these helpful in most cases) and topical steroids, but that d...

Do you refer them to Ophthalmology? Have you had to switch patients off of Dupixent due to their ocular side effects?

Should one restart lamotrigine or look for an alternative? If no other alternative available, is slow titration vs regular titration preferred?

Are there any medications that surgeons like discontinued before their procedure?

Do you recommend any changes to their personal hygiene practices? or changes to their environment?

What recommendations do you provide if there is concern that the patient is beginning to flare? Have you prescribed any of the new JAK inhibitors?

Does your evaluation hinge on nonresolution with warming? How extensive is your workup?

In your experience, do specific patient features predict a better response?

Other than inflammatory markers and following symptoms/exam, do you need any other specific monitoring for progression to systemic disease? 

Would you switch to itraconazole or perform fungal cultures? When would you consider repeating the course of treatment? 

Do you obtain vascular imaging routinely in these cases, and if so, do you use cross-sectional or invasive angiography?

In other words, do we think of TNFi induced lupus and TNFi induced psoriasis as a drug effect or a class effect? 

E.g., MPO vs PR3, newly diagnosed vs relapsed, renal involvement. Acknowledge that the ADVOCATE study was not powered to detect these differences, but...

What if the patient has MGUS? Do patients with type 1 cryoglobulins need a bone marrow biopsy as part of the work up?

If so, are there specific patient populations for which you would use this metric?

This question is part of a collaboration with RheumMadness and is specifically in reference to: ADIRA Diet


Papers discussed in this category


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The New England journal of medicine, 2010-07-15

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J Am Acad Dermatol, 2016 Feb 03

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Rheumatology (Oxford),

Journal of psoriasis and psoriatic arthritis, 2019-04

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Ann Rheum Dis, 2011 Nov 29

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Am J Respir Crit Care Med,

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JAMA Dermatol,

Mod Rheumatol, 2020 Sep 17

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Clin Exp Rheumatol, 2012 Oct 17

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Am J Clin Dermatol,

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International journal of clinical rheumatology, 2010

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The Journal of rheumatology, 2015-11

Ophthalmology, 2016-06

Lupus science & medicine, 2017

Journal of immunology research, 2017

Lupus science & medicine, 2018

Arthritis care & research, 2019-07

Clin Pharmacol Ther, 2018 Jun

Lupus Sci Med, 2016

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ACR Open Rheumatol, 2020 Oct 12

Arthritis Rheumatol, 2021 May 02

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Arthritis Rheum,

Lupus,

Arthritis Rheumatol, 2020 Jan 07

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J Am Acad Dermatol,

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Dermatology,

Best practice & research. Clinical rheumatology, 2013-06

Dermatol Ther, 2016 Apr 12

JAMA Dermatol,

J Dermatol,

J Am Acad Dermatol, 2021 Jul 02

Ann Plast Surg,

Journal of psychiatric practice, 2018-11

Journal of the American Academy of Dermatology, 2019-05

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J Am Acad Dermatol, 2021 Apr 18

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Antimicrob Agents Chemother, 2008 Nov 17

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Rheumatology (Oxford),

Am J Clin Dermatol,

JAMA Dermatol, 2022 Mar 01

Am J Clin Dermatol,

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Int J Radiat Oncol Biol Phys,

Eur J Dermatol,

Arthritis Res Ther, 2021 Sep 04

Journal of the American Academy of Dermatology, 2011-05

Lupus, 2016 May 27

Clin Exp Rheumatol, 2013 Aug 02

J Rheumatol, 2022 Aug 01

Dermatol Ther, 2014 Aug 12

Medicine (Baltimore), 2019 Dec

J Clin Invest, 2013 Nov 15

Clinical pharmacokinetics, 2018-12

Frontiers in immunology, 2018

Clinical immunology (Orlando, Fla.), 2020 Jul 15

The Pediatric infectious disease journal, 2018 Oct

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The Journal of rheumatology, 2012-01

JAAD Case Rep, 2019 Oct 10

Arthritis Care Res (Hoboken), 2022 Aug 04

JAMA dermatology, 2018-10-01

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Archives of dermatology, 2002 Sep

JAMA dermatology, 2018-12-01

J Cutan Aesthet Surg, 2019 Apr-Jun

JAMA Dermatol, 2022 Aug 01

Proceedings of the National Academy of Sciences of the United States of America, 2010 Apr 19

Dermatol Ther, 2021 May

Current rheumatology reviews, 2019

Am J Clin Dermatol, 2022 Jun 23

Ann Afr Med, 2020 Jul-Sep

Arch Dermatol, 2006 Mar

Clin Rev Allergy Immunol, 2010 Apr

Lupus, 2020 Mar 19

N Engl J Med, 2022 Oct 06

Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG, 2023 Feb 11

Clinical rheumatology, 1988 Sep

Journal of the American Academy of Dermatology, 1987 Apr

Journal of the American Academy of Dermatology, 2020 May 19

Science advances, 2024 Jul 03

Annals of the rheumatic diseases, 2023 May 29

Clinical and experimental dermatology, 2021 Mar 09

JAAD case reports, 2019 Mar 01

Dermatologic therapy, 2020 May 03

The Journal of allergy and clinical immunology, 2012 Feb 14

Lupus, 2019-05

Journal of the American Academy of Dermatology, 2020 Apr 28

The British journal of dermatology, 2003 Jul

Journal of the American Academy of Dermatology, 2020-01

Journal of the American Academy of Dermatology, 2020 Apr 26

Journal of drugs in dermatology : JDD, 2023 Oct 01

Journal of the American Academy of Dermatology, 2003-04

Annals of the rheumatic diseases, 2024 Mar 18

Ann Rheum Dis, 2020 Dec 17

Journal of the American Academy of Dermatology, 2023 Dec 07

JAMA dermatology, 2020 May 01

Photodermatology, photoimmunology & photomedicine, 2023 Dec 07

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Allergy, 2021 Oct 20

Allergy, asthma & immunology research, 2020 Sep

The journal of allergy and clinical immunology. In practice, 2018 Jul-Aug

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American journal of clinical dermatology, 2022 Sep 15

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Transplant international : official journal of the European Society for Organ Transplantation, 2019 Oct 07

The British journal of dermatology, 2020 Apr 13

Arthritis care & research, 2016 Jan

Lupus, 2014 Feb 06

Annals of the rheumatic diseases, 2023 Oct 12

Journal of the American Academy of Dermatology, 2015 Jan 30

Journal of the European Academy of Dermatology and Venereology : JEADV, 2016 Dec 20

American journal of clinical dermatology, 2020 Aug

Arthritis care & research, 2023 Nov 28

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The journal of allergy and clinical immunology. In practice, 2021 Mar

The journal of allergy and clinical immunology. In practice, 2021 Apr 20

The journal of allergy and clinical immunology. In practice, 2020 Mar 13

The journal of allergy and clinical immunology. In practice, 2024 Feb

N Engl J Med,

Autoimmunity reviews, 2023 Dec 20

Antibiotics (Basel, Switzerland), 2023 May 29

Clinical kidney journal, 2016 Nov 10

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Lancet Gastroenterol Hepatol, 2023 Feb 01