This past week I attended the 2018 Winter Dermatology Conference in Maui, and it was such a great experience, filled with tons of dermatology pearls! I competed as part of the Rising Derm Stars research competition, in which 20 residents from around the country were invited to give presentations on their research. Aside from giving me an opportunity to share my research, the program also paired me up with a mentor, Dr. Shane Chapman (Chair of Dermatology at Dartmouth), who met with me and my co-mentee and gave us great life and career advice. As many of you may have seen on my instagram stories, I learned so much pearls that I’m going to start using right away in clinic. I wanted to summarize some of these points for you here; to see my commentary and explanations, check out my IG story highlight under “Maui Derm.”
Pearls about Allergic Contact Dermatitis
- If you have a patient with recalcitrant cheilitis, not improving with topical steroids and antifungals, think about allergic contact dermatitis! Maybe they are having an allergic reaction to a product they are still using. Think: lip balms, toothpastes, nail polishes, and cosmetics
- Great toothpastes to try for sensitive individuals: Cleure, VMV, Jack & Jill flavor free pastes
- For kids: Tom’s toddler propylene glycol-free toothpaste
- For people with allergies to orange, red, and blue dye: use white cotton or silk clothing only and see if that improves the rashes
- Benzoyl peroxide wash DOES NOT WORK WELL because you’re immediately washing it off! The product needs short contact on the skin; put on 5 minutes prior to shower and then wash off.
New antibiotic coming out: Sarecycline (less photosensitivity and GI upset!)
Isotretinoin: check lipid panel and hepatic panels at week 8 and if normal, no more checks. If abnormal, keep checking.
Triglycerides: what makes us nervous? High = 200 – 499 mg/dL; very high = > 500 (risk for pancreatitis).
Acute pancreatitis associated with TG > 1000 mg/dL; to reduce risk, you should reduce Isotretinoin to below 500 mg/dL. Drug holiday if > 500 mg/dL.
- Stelara is now approved for kids/teens; if their weight is < 60 kg, they get adult dosing. If less than that, then they get dosed at 0.75 mg/kg
- Humira: now approved for nail psoriasis
- Certolizumab: TNF alpha blocker; soon to be approved for skin
Superficial peeling agents (salicylic acid and glycolic acid) can work well
Discontinue topical retinoids 1 week prior to an in-office chemical peel, and make sure patients are not doing anything abrasive at home either, like using a Clarisonic brush prior to the peel
- L-carnitine 1000 to 1500 mg nightly can help to reduce the side effect of muscle cramping in patients on Vismodegib
- Serlopitant: new medication coming out for ITCHING! *this can’t come out soon enough; I have so many itchy patients!*
- First time I heard about eryfotona actinica, a sunscreen containing photolyase (DNA repair enzyme) in liposomes
- Tranexamic acid for melasma: dosing is at 250 mg twice a day, but carefully screen patients because of increased risk of blood clots
- As an alternative to Efudex alone, use Efuex plus Dovonex twice a day for 4 days to treat actinic keratoses (I’ve done this! Works a lot faster than Efudex alone). If you’re interested in this, the original paper is here
- Main conclusion: “Four-day application of calcipotriol plus 5-FU versus Vaseline plus 5-FU led to an 87.8% versus 26.3% mean reduction in the number of actinic keratoses in participants (P < 0.0001).”