Magan Medical Clinic, Dermatology
We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:
Note: Cosmetic treatments are not performed in Dermatology but instead by Maganís Medical Aesthetics Laser Center.
If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.
We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.
Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).
For appointments, please call (626) 331-6411. We look forward to serving you!
"Whatís New in..."
A monthly column by Dr. Chiang
What's New in Sarcoid
Sarcoid is a disease in which the body becomes inflamed, resulting in damage especially to the lungs and lymph nodes. This also results in scar-like rashes on the skin. A manifestation that traditionally hasnít been taught or appreciated is that there is also commonly (~40% of patients) nerve damage as well, resulting in pain and uncomfortable sensations. These symptoms are commonly mistaken for fibromyalgia syndrome.
Unfortunately, a recent study reports that mainstay treatments (corticosteroids, methotrexate) are not very effective in treating the nerve damage. This is partly because nerves are known to heal much more slowly than other parts of the body (they regenerate only 1 inch/month after injury). Thus, once any nerve is damaged by the disease, it may take years of remission before it can be healed. A limited 3 person case series did report that a treatment called intravenous immunoglobulin may be helpful. However, at approximately $40,000 (I could only find a published 2006 cost of $25,000 but anecdotally costs seem to have roughly doubled in the past 10 years) for 3 months of medication for what has been reported as permanent treatment with no end, the hassle for the patient of visiting an infusion center every 2-3 weeks, the risks of immunosuppression, and the unlikelihood of insurance covering indefinite $160,000/yr experimental therapy, it is not currently a practical option.
While I hope more practical treatments may be available in the future, the main takeaway for me is for the numerous patients I see in clinic with itching, esp. when out of proportion to the rash (ie, very itchy patient with clinically mild or no rash), it is not simply a skin disease. There is also likely a common endpoint of nerve damage. The causes likely vary (sun damage which has been theorized to damage superficial nerves, age-related degeneration, diabetes, hypertension, poor circulation, damage from scratching, scar tissue, etc) and it is often impossible to find the exact cause. Even though there are treatments to attempt, patients and doctors are often frustrated that there is no one medication that is guaranteed to work. Step therapy is usually needed (ie, start with relatively safe medication and potentially work up to stronger medications with more side effects if first-line treatment fails).
If you have unusual lesions on your skin, please make an appointment for dermatology consultation at (626) 331-6411 to discuss your options.
Charles Chiang, MD, FAAD
- Jancin B. Small fiber neuropathy common, vexing in sarcoidosis. Dermatology News 2016
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