Keep these tips and pearls from dermatology experts in mind for your next appointment.
Tip 1: Avoiding Inadvertent Spock and Cruella Brows
When you treat the glabellar complex with botulinum toxin, some of the product diffuses up and relaxes the inferomedial part of the frontalis (note that the anatomy of the frontalis is highly variable, so this effect varies quite a lot from person to person). When the medial part of the frontalis is relaxed, the brain notices and increases the resting muscle tone in the lateral frontalis (ie, recruits the lateral frontalis) to compensate for the reduced resting tone in the medial frontalis, effectively raising the lateral eyebrows to a variable extent, depending on frontalis anatomy, laxity of lateral frontalis skin, etc.
This raise can be augmented by treatment of the depressors of the lateral eyebrows with 2 to 5 U of onobotulinumtoxinA to avoid developing a Spock (if unilateral raise) or a Cruella (if the tails of both brows are excessively raised).
Dr Kevin C. Smith
Niagara Falls, Ontario, Canada
Tip 2: Treating Erythrodermic Psoriasis Quickly
Erythrodermic psoriasis is a rare but life-threatening condition. After infection has been ruled out, therapy needs to be started urgently. I would recommend either brodalumab or risankizumab as they are the fastest acting subcutaneous biologics. If the patient is unable to obtain these due to access issues, then infliximab 5 mg/kg can be administered. Lastly, if the patient is unable to obtain any of these biologics, then cyclosporine at 5 mg/kg should be given in divided dosing two or three times a day. The label for cyclosporine says to start at 2.5 mg/kg/day, but that generally is too little as a starting dose in my opinion.
Dr Jashin J. Wu
Los Angeles, CA
Tip 3: Keeping Track of Back Nevi in Patients
Take a photo of the back with your camera and put it into your electronic medical record system. You can use it for comparison at follow-up visits to find any new or changing moles. It may not be as good as a professional photo, but it’s better than no photo. You can also take a photo of the back (or any area you want the patient to watch) with patients’ cell phones so they can monitor the area for any changes at home.
Dr Jennifer Stein
New York City, NY
Tip 4: “MacGyver” Maneuver for Comedone Extraction
If you are in a setting where no comedone extractor is available (as happens for me in free clinics I volunteer in), a syringe (without the needle) can work as a makeshift comedone extractor. It even collects the contents inside when applied.
Dr Jules Lipoff
Philadelphia, PA
