The conversation centers on the regulatory and practical differences between 503A and 503B compounding pharmacies, with particular attention to 503A facilities, where customized medications are prepared based on individual prescriptions. They outline key concerns with this model, including variability in formulation, lack of standardized testing, and limited oversight compared with FDA-approved therapies. Unlike commercially developed medications, compounded products are not required to undergo stability testing, penetration studies, or clinical trials, raising questions about consistency, efficacy, and safety.

A recurring theme is the challenge of knowing exactly what patients receive. Without controls on formulation integrity or bioavailability, clinicians may encounter variability not only between pharmacies, but even between batches from the same source, highlighting how this uncertainty can complicate treatment decisions.

The episode also contrasts compounded therapies with FDA-approved options, using topical clascoterone as an example of a rigorously tested, standardized formulation. While both speakers acknowledge that compounding has a role, particularly in addressing unmet or niche patient needs, they note that its use today has expanded beyond its original intent.

Tune in to the episode to hear how clinicians can approach compounded therapies with greater scrutiny, balance their use against standardized treatments, and make more informed decisions in everyday dermatology practice.

The conversation opens with a shift many dermatologists are seeing in practice: patients arriving more informed and more influenced by social media, asking detailed questions about ingredients, formulations, and skin care routines. This evolving dynamic requires clinicians to not only select effective therapies but also contextualize an expanding array of over-the-counter and adjunctive options.

Dr Woolery-Lloyd and Dr Del Rosso revisit foundational therapies such as benzoyl peroxide, addressing concerns around benzene and reinforcing its continued role as a reliable, effective agent. They emphasize the importance of formulation and tolerability, noting that lower concentrations (around 4% or less) can offer similar efficacy with reduced irritation when well-formulated.

A central theme is the growing importance of the skin barrier and microbiome in acne management. The speakers highlight how barrier-supportive skin care, including moisturizers and adjunctive products, can improve both tolerability and clinical outcomes. They underscore that regimen success often depends on the full system of care, not just prescription therapies.

The discussion also explores newer over-the-counter formulations, including polyhydroxy acids for gentle exfoliation, multifunctional moisturizers targeting post-inflammatory hyperpigmentation, and emerging adjuncts like hypochlorous acid sprays (particularly useful for truncal acne).

Throughout, the episode reinforces a practical message: effective acne management today requires thoughtful integration of prescription therapies, formulation science, and patient-centered skin care guidance.

Tune in to the episode to hear how clinicians are navigating increasingly informed patients, optimizing tolerability without sacrificing efficacy, and building acne regimens that account for both therapeutic impact and real-world adherence.

They begin by reflecting on how patient expectations and therapeutic options have shifted over the past decade. Dr Baldwin highlights improvements in topical formulations that have enhanced both efficacy and tolerability, allowing many patients with mild to moderate and even some severe acne to be managed with topicals alone. This shift has also reduced reliance on prolonged oral antibiotic use.

They next address practical considerations, including access and adherence. Dr Baldwin discusses the role of specialty pharmacies in helping ensure patients receive prescribed therapies without substitution and the importance of providing specific skin care recommendations to minimize irritation and improve outcomes.

A key focus of the conversation is topical clascoterone, a first-in-class androgen receptor inhibitor that targets the androgen-sebum pathway and reduces sebum production progressively over time. They emphasize the benefit of initiating it early and setting appropriate expectations with patients, as its therapeutic effects build over 2 to 3+ months. Both clinicians advocate pairing clascoterone from the outset with a combination of topical agents that addresses other pathophysiologic cascades in acne to provide early visible improvement while supporting longer-term disease control. Other agents, such as benzoyl peroxide, topical retinoids, and clindamycin, are available in combination topical formulations to allow for ease of use, including a triple-combination topical gel.   

They also discuss strategies for simplifying complex regimens, especially for younger patients, and review admixture data supporting compatibility between clascoterone and other topical agents.

Tune in to the episode for practical pearls on designing combination topical regimens, setting realistic expectations with patients, and applying these strategies to optimize acne management.

Disclaimer: This podcast is not intended to provide diagnosis, treatment, or medical advice. Content provided in this podcast is for educational purposes only. Please consult with a physician regarding any health-related diagnosis or treatment.

They begin by discussing the importance of early recognition, particularly for scarring forms such as discoid lupus erythematosus, where permanent damage often drives diagnosis rather than earlier inflammatory changes. To help clinicians recognize disease activity sooner, Dr Merola shares a practical mnemonic (PASTE) highlighting features including follicular plugging, atrophy, scarring, telangiectasia, and erythema.

They next discuss the clinical nuances of subacute cutaneous lupus erythematosus, including the need to evaluate for drug-induced disease. Medications such as hydrochlorothiazide and over-the-counter proton pump inhibitors may act as triggers and require careful medication history review.

They next review current and emerging treatment strategies. While first-line therapy remains centered on antimalarials such as hydroxychloroquine, attention is increasingly turning toward targeted therapies approved for other immune-mediated diseases. For example, anifrolumab, which inhibits type I interferon signaling and is approved for systemic lupus, has demonstrated activity in cutaneous lupus and is being evaluated in dedicated trials. Similarly, the TYK2 inhibitor deucravacitinib, approved for psoriasis and psoriatic arthritis, has shown signals of efficacy for lupus-associated skin disease in early studies.

They then discuss investigational therapies being developed specifically for lupus pathways. Among these is litifilimab, a monoclonal antibody targeting plasmacytoid dendritic cells to reduce type I interferon signaling. With fast-track designation and emerging clinical data, litifilimab highlights ongoing efforts to develop therapies directed at key immunologic drivers of both cutaneous and systemic lupus.

Tune in to the full episode to hear diagnostic pearls for recognizing CLE earlier, strategies for identifying drug-induced disease, and perspectives on emerging therapies under investigation for cutaneous lupus.

Dr Tarbox reflects on the vision she brought to her role as department chair and the principles that guide her approach to residency education. Central to that philosophy is cultivating enthusiastic, lifelong learners. While a strong grounding in foundational dermatology, including historical therapies, is essential, she emphasizes that residents must also be fluent in emerging therapies and evolving evidence. She highlights the value of conferences, podcasts, and other modern educational resources that help clinicians remain current while connecting learning to real-world practice.

The conversation also explores the growing influence of artificial intelligence (AI) in medicine. Dr Tarbox notes that AI tools are becoming increasingly accessible and may support educational development and information gathering. However, she cautions that technology should complement, not replace, clinical judgment. Both clinicians agree that medical students and residents must learn to critically evaluate AI-generated content, verify references, and take responsibility for the work they sign their names to. She shares practical strategies for mentoring trainees in this area, including careful citation review and clear expectations around responsible AI use.

Finally, she reflects on the leadership lessons she has learned since becoming chair, including the importance of communication, collaborative decision-making, and balancing ambitious ideas with institutional realities.

Tune into the episode to hear Dr Tarbox share insights on dermatology leadership, residency education, responsible use of emerging technologies, and the behind-the-scenes decisions that shape the training of future dermatologists.

They begin with Seiter sharing his approach to reviewing new literature, encouraging clinicians to look beyond mainstream dermatology journals to cross-disciplinary publications to help reshape long-held assumptions. Using lichen planus as an example, he revisits the entrenched association between diffuse lichen planus and hepatitis C. While many clinicians routinely test for hepatitis C in these patients, new data suggest the association is uncommon. More compelling, however, is the emerging link between persistent, widespread lichen planus and underlying malignancy. Seiter outlines how he thoughtfully screens for red flags and gaps in preventive care without alarming patients prematurely, reinforcing the importance of looking beyond a single lab test.

The conversation then shifts to acanthosis nigricans, where traditional teaching centers on hyperglycemia and diabetes risk. Seiter explains why acanthosis nigricans is more accurately viewed as a marker of hyperinsulinemia rather than elevated A1c. He discusses incorporating HOMA-IR calculations to identify early insulin resistance, particularly in adolescents whose A1C may remain normal for years. Both clinicians stress that a “normal” A1C should not prematurely reassure patients when cutaneous markers signal metabolic risk.

Additional topics include reconsidering intralesional triamcinolone as the default therapy for keloids, with discussion of emerging data on intralesional insulin as a potentially lower–adverse event alternative, and a pragmatic conversation about JAK inhibitor safety. Comparing adverse event data across agents, they emphasize individualized risk assessment, careful monitoring, and shared decision-making over reflexive fear of boxed warnings.

Tune into the episode to explore how questioning assumptions, broadening your literature review, and contextualizing risk can sharpen your clinical reasoning and elevate patient care in everyday dermatology practice.

They begin with Dr Swanson highlighting an important clinical reality: acne is presenting at increasingly younger ages, prompting earlier conversations about skin care routines and long-term strategies. At the same time, dermatologists now have several truly novel topical options, an uncommon development in acne therapeutics over the past decade.

Using a typical adolescent patient as a reference point, she then outlines the range of options she reviews in clinic: foundational topical regimens (retinoids, benzoyl peroxide combinations, clascoterone, topical minocycline foam, or fixed triple combinations), selective short courses of oral antibiotics, consideration of oral probiotics based on emerging data, and hormonal approaches in appropriate female patients. She emphasizes tailoring mechanisms when combining therapies; for example, pairing hormonal therapy with a topical that offers a complementary pathway.

Dr Del Rosso revisits the 4 pillars of acne pathophysiology, highlighting androgen-driven sebum production as an upstream contributor. This leads to a focused discussion on clascoterone as the first topical androgen receptor inhibitor and how targeting sebum early may alter lesion development. Both clinicians stress that clascoterone is best viewed as foundational rather than adjunctive therapy, emphasizing the importance of setting realistic expectations on time to peak efficacy.

The conversation also covers tolerability, barrier considerations, twice-daily adherence, and admixture data with common topical agents. Clinical pearls include setting early follow-ups to reinforce adherence, aligning office staff messaging, and using shared decision-making to balance patient priorities like oil control and pore appearance with mechanistic treatment goals.

Tune in to the episode to hear real strategies for initiating acne therapy with intention, integrating newer topicals early, and guiding patients toward regimens that are both physiologically sound and sustainable in everyday practice.

The discussion opens with Dr Daveluy’s work in an oncodermatology clinic and the critical role dermatologists play in managing cutaneous side effects from cancer therapies. He explains that while oncologists may be inclined to pause or discontinue cancer treatment in the face of severe skin reactions, dermatologists are uniquely positioned to identify, manage, and mitigate these effects, often allowing patients to remain on life-saving therapy and achieve better oncologic outcomes.

The conversation then shifts to teledermatology, highlighting the Veterans Affairs health system’s leadership in expanding access, particularly for rural patients. Dr Daveluy describes his team-based model in which dermatoscopy is standardized across sites, allowing frontline clinicians to submit high-quality images for rapid dermatologic input.

Clinical pearls follow, including management of epidermal growth factor receptor-inhibitor eruptions with tetracyclines and selective use of agents such as isotretinoin or dapsone to keep patients on cancer therapy. Importantly, brisk skin reactions may correlate with positive tumor response, reinforcing the goal of treating through, rather than stopping, therapy.

The episode concludes with an exploration of integrative dermatology. Dr Daveluy advocates for consideration of evidence-based supplements, thoughtful discussion of diet and stress, and careful counseling rather than dismissing patient interest. Case examples illustrate both benefit and harm, underscoring the importance of third-party testing and drug–supplement awareness. A final reflection on mind-body medicine through practices like “laughter yoga” highlights tools that can help patients reframe flares and improve quality of life, even when disease activity is beyond their control.

Tune in to the episode to hear expert insights on managing cancer-therapy–related skin reactions, expanding access through teledermatology, and thoughtfully integrating complementary approaches into everyday dermatology practice.

They begin with Dr Ferris describing the motivations that led her to consider a leadership role, sharing the self-reflective questions that guided her thinking, including how to continue growing professionally, how care delivery can be improved, and where she could make the greatest long-term impact.

The conversation then turns to stepping into the chair role itself. Dr Ferris introduces the idea of a “listening tour,” and the value of meeting with faculty and staff early, understanding what matters most to them, and easing fears that change will disrupt what they value in their work. She stresses that a department’s success depends on shared ownership, not top-down decision-making.

They next discuss building productive relationships beyond the academic setting, particularly with community dermatologists. Dr Ferris describes her department’s noncompetitive approach, focusing on clinical excellence, referral partnerships, and aligning care so patients are matched with the right expertise.

A key portion of the discussion centers on working effectively with advanced practice providers (APPs). Dr Ferris outlines her department’s physician-to-APP model, highlighting mentorship, collaboration, and thoughtful delegation to ensure high-quality care.

The episode concludes with Dr Ferris sharing her goals for the future, including reducing silos, strengthening integration between clinical care and research, expanding translational efforts, and improving access for underserved and rural populations through tools like e-consults. She emphasizes the importance of engaging faculty, residents, and learners in shaping a shared vision and turning ideas into action.

Tune in to the episode to hear practical leadership insights, real-world lessons on collaboration, and thoughtful perspectives on guiding a dermatology department through growth and change.

The conversation begins with mast cell biology, including their origin in the bone marrow, tissue-specific phenotypes, and roles beyond classic allergic disease. Dr Madigan explains how mast cells contribute to immune defense and wound healing, with Dr Del Rosso noting how infrequently they are discussed in routine dermatology training despite their relevance across multiple conditions.

They then explore mastocytosis across the age spectrum, contrasting pediatric presentations (many of which remit by adolescence) with adult-onset disease, where cutaneous findings often signal systemic involvement. Dr Madigan reviews current National Comprehensive Cancer Network guidance, emphasizing that most adults presenting with cutaneous mastocytosis will have some degree of systemic disease and may warrant more detailed testing for accurate staging, prognostic differentiation, and management choices. The discussion highlights the heterogeneity of systemic mastocytosis, from indolent forms to advanced disease with organ involvement or associated hematologic neoplasms.

The episode also covers practical diagnostic and workup considerations, including laboratory evaluation, KIT mutation testing, and biopsy considerations. Dr Madigan stresses the importance of experienced dermatopathology interpretation and thoughtful site selection to optimize diagnostic yield.

Treatment strategies are discussed through a pragmatic lens, ranging from symptom-directed therapies to cytoreductive and targeted tyrosine kinase inhibitors, with an emphasis on individualized care based on disease subtype, symptomatology, and prognosis. The episode closes with resources to help dermatologists navigate diagnostic assistance and treatments via specialty centers and clinical trials.

Listen to the episode to deepen your understanding of mast cell disease, sharpen your diagnostic approach, and gain practical guidance on evaluation, staging, and management strategies, both for real-world practice and for determining when referral to specialized care is warranted.

The conversation begins with the role of formulation and vehicle design, addressing a common concern in acne management: barrier disruption and application-site irritation. Unlike retinoids or benzoyl peroxide, clascoterone is an androgen receptor inhibitor formulated in a vehicle shown to sustain and slightly increase moisture content in the skin, supporting  barrier function while remaining compatible with other topical acne therapies. Data evaluating transepidermal water loss and corneometry demonstrate that the finished, marketed formulation sustains skin moisturization, reinforcing its barrier-friendly profile.

The discussion then turns to real-world use, where clascoterone is frequently combined with other topical agents. An admixture stability study examined whether clascoterone degrades, or causes degradation of, commonly used acne treatments such as benzoyl peroxide, clindamycin, adapalene, and retinoids. Using chromatographic and mass spectrometric analysis, the study confirmed that clascoterone remains stable and compatible when layered with these agents.

Finally, Dr Draelos reviews clinical data demonstrating progressive sebum reduction in patients with mild to moderate acne, measured using standardized sebumeter technology. Sebum levels decreased beginning around 12 weeks and continued to decline through 52 weeks, paralleling reductions in acne lesions, oily appearance, and visible pore size. Together, these findings clarify how clascoterone works at the target organ level and why its clinical benefits extend over time.

Tune in to the episode to hear how these studies answer key mechanistic and practical questions about clascoterone, and how its barrier-friendly formulation, combination compatibility, and sustained sebum reduction may inform everyday acne management in clinical practice.

The episode opens with a challenging pustular eruption in a 30-year-old male initially labeled as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Through a stepwise reassessment, the discussion walks through acute generalized exanthematous pustulosis versus generalized pustular psoriasis, highlighting latency periods, biopsy limitations, recurrence patterns, and the clinical clues that ultimately prompted a shift in diagnosis and management. The case also surfaces practical access barriers, including insurance denial of spesolimab due to tuberculosis testing requirements, and explores how evolving guidance contrasts with current labeling realities.

Subsequent cases broaden the scope to mucocutaneous eruptions, clarifying distinctions among erythema multiforme, Mycoplasma-induced rash and mucositis/reactive infectious mucocutaneous eruption, and SJS/TEN. A key takeaway discussed is the importance of prioritizing drug causality when classic triggers and timelines are present, even in the setting of concurrent infection, to avoid potentially catastrophic outcomes.

The final case focuses on neonatal lupus and explores how recognizing characteristic cutaneous findings can lead to appropriate evaluation for systemic involvement and timely referral, even when skin disease itself is self-limited.

Tune into the episode to follow expert clinicians as they reason through diagnostic uncertainty, rethink initial assumptions, and highlight the small diagnostic details that can meaningfully change disease management.

Dr Del Rosso opens by highlighting the launch of Tea with Dr. D, a sister vodcast that brings expert discussions to video, incorporating slides and procedural footage. He spotlights an episode with HS expert Lauren Lam, MD, who walks through comprehensive hidradenitis suppurativa management from patient check-in through long-term care. He also reviews Spilling the Tea with Dr. D, a hybrid audio-video mailbag format that addresses listener-submitted clinical questions.

He then revisits key moments from the core Derms and Conditions series, beginning with Michael Payette, DO, who discussed building a dedicated HS clinic, collaborating with nondermatology providers, and his early adoption of GLP-1 agents for inflammatory disease management. Additional highlights include an episode with E. James Song, MD, on modern nb-UVB phototherapy units and practical guidance for safe implementation, as well as a unique discussion with Clay Cockerell, MD, JD, on estate planning considerations for physicians.

Vitiligo emerged as a recurring focus in 2025, with expert insights from Seemal Desai, MD, and Pearl Grimes, MD, covering disease assessment, treatment timelines, topical ruxolitinib, oral therapies, phototherapy, and running a dedicated vitiligo center.

Dr Del Rosso also revisits episodes on extended-release minocycline for rosacea, oral JAK inhibitors in older adults, challenging case-based discussions, evolving approaches to photoprotection and skin care counseling, and emerging therapies across alopecia areata, hyperhidrosis, tyrosine kinase 2 inhibition in psoriasis, and chronic hand eczema, including a recent FDA approval.

Tune in to the full episode for a look back at a year of clinically relevant education aimed at supporting dermatologists in everyday practice.

The conversation begins with an overview of platelet-rich plasma (PRP), including its evolution in the US and the growing body of evidence supporting its role in androgenetic alopecia, telogen effluvium, alopecia areata, and scarring alopecia. Dr Goldenberg outlines PRP as a regenerative therapy rather than a hair-specific treatment, describing how growth factors help stimulate dormant follicles and prolong the anagen phase. He reviews the preparation process, ideal candidates, contraindications, and why early intervention yields the best outcomes. Procedural videos throughout the episode illustrate PRP techniques, from multi-needle mesotherapy devices to targeted injections with a 30-gauge needle, and demonstrate approaches to analgesia and treatment tailoring by pattern of loss.

The discussion extends to the role of exosomes in regenerative dermatology. Dr Goldenberg explains their mechanism, the distinction between human- and plant-derived products, and his rationale for combining exosomes with PRP when feasible. Additional videos highlight injection and microneedling-based delivery methods, offering insight into how these modalities complement each other in alopecia.

Tune in to the full episode for expert guidance

They begin with a discussion on setting patient expectations around treatment duration. With vitiligo therapies requiring long-term commitment, Dr Grimes explains that it is a chronic disease requiring ongoing management, whether using older therapies or newer JAK inhibitors. By establishing realistic expectations early, patients are less likely to abandon therapy prematurely when repigmentation is not yet visible.

They also address common misconceptions around skin type. While vitiligo is more noticeable in darker skin, its prevalence is similar across all skin tones. In her clinical experience and in ruxolitinib trials and emerging oral JAK data, Dr Grimes has observed meaningful repigmentation across phototypes, with no major response differences that would warrant altering expectations for lighter-skinned patients.

They next discuss practical therapeutic considerations, including typical timelines for assessing response and the role of regimen adjustments during the first year.  When using ruxolitinib, she considers disease extent, anatomic site, and expected repigmentation patterns, noting that the face and neck tend to respond best, with the hands remaining challenging.

She also reviews her approach to initial workup, including autoimmune screening, particularly for thyroid disease, as well as her use of supplements to mitigate oxidative stress pathways implicated in melanocyte destruction.

Tune in to the full episode to hear Dr Grimes share additional clinical pearls, discuss combination strategies, and offer guidance on setting patients up for long-term success in vitiligo management.

Dr Del Rosso begins with hidradenitis suppurativa (HS), highlighting the importance of recognizing comorbidities and lifestyle factors that contribute to disease onset and progression, including smoking and elevated body mass index. He advises a phased management approach: prioritizing symptom control and patient comfort before introducing discussions about weight loss or smoking cessation. Depression, diabetes, metabolic syndrome, and cardiovascular disease are also important comorbidities to address over time.

On initiating biologic therapy for HS, he explains the 3 pathologic phases, inflammatory, destructive, and burnout, and emphasizes that biologics such as adalimumab, secukinumab, or bimekizumab should be started early, in the inflammatory phase, to prevent irreversible scarring and sinus tract formation. He also shares procedural pearls, including the use of high-dose intralesional triamcinolone, incision and drainage, and deroofing for focal or persistent lesions.

The discussion then shifts to photodynamic therapy (PDT) for nonmelanoma skin cancers. Referencing a study by Schlesinger et al, Dr Del Rosso reviews the efficacy of red-light PDT with 10% aminolevulinic acid gel for superficial BCC, highlighting improved clearance rates and favorable cosmetic outcomes over vehicle.

Finally, Dr Del Rosso reviews new insights into topical nonsteroidal options for lichen planus, including off-label use of roflumilast and ruxolitinib creams. Both agents, with mechanisms targeting PDE4 and JAK pathways, respectively, have demonstrated reductions in inflammation and pruritus in some reports.

Tune in for a concise, high-yield discussion featuring Dr Del Rosso’s practical guidance and clinical pearls for today’s dermatology practice.

Dr Bunick opens with a primer on the science of PDE4, an enzyme that degrades cyclic AMP (cAMP), an intracellular messenger that regulates anti-inflammatory pathways. In conditions such as atopic dermatitis (AD) and psoriasis, overactive PDE4 leads to reduced cAMP and amplified inflammation. By “gumming up” PDE4, roflumilast restores a more balanced, anti-inflammatory state. 

He explains why PDE4 inhibition is relevant across multiple inflammatory pathways, including Th1, Th2, and Th17, and why roflumilast has demonstrated stronger efficacy than earlier inhibitors like crisaborole. Molecularly, roflumilast mimics cyclic AMP’s binding to PDE4 across 3 key sites, producing far tighter binding than apremilast and crisaborole, which translates to superior clinical potency. 

Dr Bunick illustrates this with a case of palmoplantar pustular psoriasis that cleared dramatically within 8 weeks on topical roflumilast after multiple biologic and corticosteroid failures, highlighting its durability and barrier-restoring properties. He and Dr Del Rosso contrast this with the limitations of chronic steroid use, noting that roflumilast supports long-term control without barrier compromise. 

The discussion also touches on vitiligo, where Dr Bunick shares an early case of repigmentation following roflumilast treatment, suggesting possible cAMP-mediated stimulation of melanogenesis. They highlight the molecule’s innovative aqueous-based formulation, optimized for skin-compatible pH and excellent tolerability. 

In Part 2, Dr Swanson joins to discuss pediatric use. She reviews the 0.15% cream for AD in patients ≥6 years and the 0.05% cream for ages 2–5, both once-daily, steroid-free options that minimize burning and stinging compared with earlier PDE4 inhibitors. They review clinical data that demonstrate rapid itch relief, strong efficacy across IGA and EASI end points, and sustained control with twice-weekly maintenance. 

Tune in to hear how PDE4 inhibition, and particularly topical roflumilast, is redefining nonsteroidal therapy across age groups and disease states in dermatology. 

Dr Armstrong kicks off with updates in hidradenitis suppurativa (HS), noting the field’s rapid progress with 3 FDA-approved therapies (adalimumab, secukinumab, and bimekizumab), emerging 3-year data for bimekizumab, and exciting new agents such as oral povorcitinib and topical ruxolitinib. She shares learnings on the importance of proactive flare management plans and setting realistic patient expectations, particularly regarding scarring and lymphedema. Dr Cohen and Dr Del Rosso echo the importance of reengaging patients with longstanding HS and highlight the promise of JAK inhibition in this complex disease.

The discussion shifts to chronic spontaneous urticaria (CSU), where Dr Cohen spotlights remibrutinib, a twice-daily oral Bruton kinase inhibitor delivering rapid results sometimes within 1 to 2 weeks and potentially enabling dermatologists to manage CSU more directly. Dr Armstrong adds that dupilumab now offers another trusted option for CSU, with a head-to-head trial versus remibrutinib on the horizon.

For chronic hand eczema (CHE), they discuss the paradigm-shifting approval of delgocitinib cream, a topical pan-JAK inhibitor effective across CHE subtypes and free of boxed warnings. They note strong data for pain and itch reduction and its potential to mitigate chronic steroid reliance.

The episode closes with emerging oral psoriasis therapies, including 5-year deucravacitinib safety data and radiographic progression inhibition shown with guselkumab. Looking ahead, they predict major advances by 2026 in TYK2 inhibitors, OX40-targeted therapies, and personalized molecular profiling for atopic dermatitis.

Tune in to the full episode for expert perspectives straight from the Fall Clinical stage!

They begin by challenging long-held vehicle dogma rooted in mid-20th-century corticosteroid training: the idea that ointments always outperform creams or lotions. They note that with newer solubilizers, stabilizers, and vehicles, those rules don’t consistently hold for products approved in the modern era.

They next revisit propylene glycol (PG) as a classic double-edged tool: its ability to dissolve more drug helped create “super-potent” corticosteroid lotions, yet higher PG levels can irritate skin, induce contact allergy, and compromise barrier function. However, they clarify that small amounts may serve as a humectant and offer antimicrobial benefits.

They then discuss topical roflumilast’s development to illustrate modern formulation problem-solving: the roflumilast molecule is difficult to dissolve in water and tends to precipitate when water is present. The formulation approach minimized supersaturation (allowing a small solid fraction), leveraged a high purity grade of diethylene glycol monoethyl ether (DEGEE), known under the commercial name Transcutol, to hold the active ingredient drug (roflumilast) in solution in the presence of water, and delivered a highly moisturizing, propylene glycol-free and ethanol-free cream. Use of a unique emulsification approach ensured physical stability even at elevated temperatures while avoiding lipid extraction and additional barrier damage.

For topical dapsone, Osborne incorporated pharmaceutical-grade Transcutol (free of ethylene-glycol contaminants) to partition the drug, slow release, and reduce systemic exposure. He emphasizes “topical product metamorphosis”: as water evaporates on skin, the local Transcutol concentration rises, dissolving residual crystals and enhancing delivery, the opposite of older vehicles that left behind residual visible crystals and under-delivered active.

They close by looking ahead towards preservative minimalism, microbiome-aware vehicles, and designing drugs intrinsically optimized for cutaneous delivery so the base can remain as inert as possible.

Tune in to the full episode to hear the formulation backstories behind roflumilast and dapsone, why PG can both enhance delivery and damage skin barrier integrity and function, how Transcutol and robust emulsifiers can solve solubility and stability hurdles, and pearls you can use tomorrow when selecting vehicles and counseling on tolerability.

They begin by highlighting one of the most significant advances in phototherapy: home-based narrowband UVB devices. These units feature guided dosing modes that adjust treatments based on patient feedback, minimizing risks and removing guesswork. They review real-world evidence from the LITE study, which demonstrated home-based therapy to be at least as effective as in-office treatment, with strong adherence, particularly among patients of color, while maintaining a favorable safety profile.

Dr Song then reviews appropriate patient selection, contraindications, and practical steps for prescribing at-home devices, from enrollment forms to choosing unit sizes for full-body or targeted treatment. He also shares pearls on using phototherapy as an adjunct in conditions like psoriasis with psoriatic arthritis, and highlights approved indications that extend beyond psoriasis, including atopic dermatitis, vitiligo, and cutaneous T-cell lymphoma.

The conversation concludes with a look at broader implications: phototherapy’s favorable cost-effectiveness compared to biologics, evidence of improvements in systemic inflammatory markers, and emerging research suggesting potential benefits in autoimmune conditions outside dermatology.

Tune in to the full episode for practical guidance on this mainstay of dermatologic practice and a renewed perspective on integrating phototherapy into modern care.

The conversation begins with the stigma of hair loss and the importance of addressing the patient’s emotional well-being. Dr Mesinkovska highlights her approach: asking simple but direct questions about how patients are coping and connecting them with mental health resources when needed.

Comorbidities and workup are also addressed, with Dr Mesinkovska sharing her pragmatic approach to labs: thyroid-stimulating hormone test as a baseline, selective additional testing for patients with indicators of comorbidities, and requesting consultation with endocrinology when indicated. Prognosis is also discussed, with childhood onset and family history noted as adverse factors.

They next explore treatment expectations, beginning with the typical timeline of response seen with oral JAK inhibitors and the importance of allowing several months for optimal hair regrowth. Many patients, once regrowth occurs, ask when they can stop therapy in hopes that results will persist without ongoing treatment; this is an important moment to counsel patients on the chronic nature of AA and emphasize that discontinuing therapy often leads to renewed hair loss. Continuing oral JAK inhibitor therapy offers the greatest likelihood of maintaining regrowth over time. 

They review clinical data on the durability of response of the JAK inhibitors for AA, which has shown that relapse of hair loss is common once treatment is discontinued. For those who elect to stop therapy, it is essential to emphasize the need to resume treatment promptly at the first signs of relapse, under supervision of their dermatologist. Ongoing clinical and laboratory monitoring is also highlighted as critical to ensure long-term safety.

Dr Mesinkovska then discusses differential diagnoses for AA, covering lichen planopilaris, trichotillomania, and other mimickers, with biopsy reserved for challenging cases.

She next reviews the 3 approved JAK inhibitors for AA, baricitinib, ritlecitinib, and deuruxolitinib, highlighting differences in efficacy, dosing, speed of response, and the role of CYP2C9 testing specific to deuruxolitinib. Clinical study data are used to outline the features that distinguish deuruxolitinib, the newest oral JAK inhibitor, from the other agents. These include a potentially faster onset of hair regrowth, enhanced efficacy with twice-daily dosing, and the ability to identify individuals who metabolize the drug more slowly through CYP2C9 testing.

Tune in to the full episode to hear how dermatologists can assess comorbidities, select systemic therapies, manage patient expectations, and support the psychosocial needs of those with AA to achieve more comprehensive care.

Dr Farris explains the critical role of UVA radiation, which penetrates deeper into the dermis than UVB and is a major driver of photoaging and skin cancer risk. Unlike UVB, UVA is harder to block because many chemical filters only partially cover this spectrum. She also reviews the controversies surrounding oxybenzone, discussing both endocrine disruption concerns and its debated link to coral reef bleaching, emphasizing the gap between laboratory studies and real-world relevance.

The discussion then turns to mineral sunscreens, which have gained popularity amid growing social media skepticism about chemical filters. While they provide strong UVA protection, cosmetic acceptability remains a significant challenge, especially for patients with skin of color due to the persistent issue of white cast. Newer innovations, including the addition of antioxidants, further expand protection by addressing visible light–induced damage. They highlight one example of an advanced formulation that pairs mineral filters with vitamin E to boost UVA defense and improve tolerability across all Fitzpatrick skin types.

Finally, they reflect on generational differences in patient counseling. While older patients may prioritize cancer prevention, younger patients often respond more to messaging about photoaging and skin preservation, making it vital to tailor communication strategies.

Tune in to the full episode to hear Dr Farris and Dr Del Rosso explore how dermatologists can navigate evolving sunscreen science, address patient concerns with confidence, and make practical recommendations that resonate across age groups and skin types.

The first case centers on an elderly patient on PD-L1 immunotherapy who developed erosive plaques on the head and neck. Dr Lal reviews the diagnostic challenges of atypical presentations, the limitations of standard treatments, and his decision to carefully introduce a JAK inhibitor with oncology support, illustrating the importance of balancing risks and benefits in drug-induced BP.

Next, they consider a young adult male with diffuse hair loss. A biopsy confirmed androgenetic alopecia without inflammation, prompting Dr Lal to initiate low-dose oral minoxidil with finasteride. He details why combination therapy can be advantageous in younger patients, the need for counseling about shedding phases and time to response, and how to interpret prostate screening in those taking finasteride.

The final case highlights a dramatic case of rhinophyma presenting as fibrotic nodules without classic inflammatory features of rosacea. Dr Lal explains his staged management of surgical debulking followed by laser resurfacing, along with the role of isotretinoin for long-term maintenance. For patients unable to pursue surgical options, he shares alternative approaches such as combining isotretinoin with neuromodulators to shrink tissue and improve appearance.

Tune in to the full episode to see striking clinical images, learn how expert dermatologists navigate diagnostic uncertainty, and gain insight into creative, patient-centered strategies for challenging presentations.

The conversation begins with a historical look at tetracyclines, tracing back to tetracycline in 1953, doxycycline in 1968, and minocycline in 1971. While traditionally used as broad-spectrum antibiotics, these agents have shown efficacy in rosacea primarily due to their anti-inflammatory activity rather than antimicrobial effects.

They review head-to-head clinical data showing that extended-release minocycline, commercially available as Emrosi, significantly reduced inflammatory lesions and improved Investigator Global Assessment scores in patients with moderate-to-severe rosacea, outperforming both modified-release doxycycline and placebo. The trial population averaged 25 papules per patient, demonstrating the robust improvement required for trial success.

A key point of discussion is minocycline’s narrow therapeutic window. While higher doses have raised concerns about adverse effects such as hyperpigmentation and lupus-like drug reactions, pharmacokinetic data show that extended-release dosing achieves lower systemic exposure with fewer safety issues compared to immediate-release formulations. Dr Plott contextualizes this by noting that dermatology indications require far lower doses than in infectious disease, which helps explain the rationale for the extended-release formulation in rosacea.

Tune in to the full episode to learn more about how extended-release minocycline and anti-inflammatory dosing fit into current rosacea treatment options, what the latest evidence shows about its efficacy and safety, and how clinicians can gain refreshed perspectives on this long-standing therapy.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Erik Domingues, MD, a dermatologist in Fall River, MA, to review 3 cases where cutaneous presentations led to unexpected findings or required creative treatment approaches.

The first case involves a 74-year-old man with diffuse granuloma annulare (GA). Although biopsy confirmed GA, the widespread involvement raised concern for an underlying condition. When standard therapy failed, Dr Domingues noted a cervical mass that proved to be an aggressive parotid carcinoma, detected earlier than it might have been without the skin eruption. The case highlights the need for thorough physical exams and clinical judgment when faced with atypical presentations.

They next consider a 34-year-old woman presenting with severe alopecia areata (AA). While her main concern was hair loss, Dr Domingues also observed long-standing facial vitiligo. She was started on ritlecitinib, approved for AA and under study for vitiligo, leading to complete scalp regrowth and substantial repigmentation of her vitiligo. The case highlights how treatment can address both immediate concerns and chronic disease burden, while also reminding clinicians that many patients remain unaware of newer therapeutic options.

The episode closes with a personal case: Dr Domingues’s 5-year-old son, who experienced a severe atopic dermatitis flare that stopped responding to crisaborole. Roflumilast 0.3% cream, approved for atopic dermatitis in patients 6 years and older at a lower concentration, was trialed off-label, producing rapid clearance and ongoing control with seasonal use. This case demonstrates how careful clinical judgment can guide effective off-label treatment.

Tune in to the full episode for practical pearls and real-world examples of clinical reasoning, autoimmune overlap, and innovative strategies for chronic skin disease.

The conversation begins with a review of CHE as a distinct clinical entity, highlighting its subtypes: irritant contact dermatitis, allergic contact dermatitis, atopic hand eczema, and the less common protein contact dermatitis. They highlight occupational exposures and daily “wet work” that increase risk, while Dr Del Rosso notes the challenge of overlapping subtypes in real-world patients. Practical considerations, such as glove selection and improving patient adherence, are also addressed.

The discussion then turns to delgocitinib cream, the newly approved topical pan–JAK inhibitor for moderate-to-severe CHE. Dr Armstrong explains its mechanism of action, which targets the JAK-STAT pathway across multiple immune processes involved in different CHE subtypes. They note the significance of its approval without a boxed warning, contrasting it with other topical JAK inhibitors and providing context on evolving perspectives on JAK inhibitor safety.

Clinical trial findings are discussed in detail, including meaningful improvements in itch, pain, and quality of life, along with the durability of response over time. Importantly, efficacy was observed across CHE subtypes, reflecting the drug’s utility across real-world patient heterogeneity. Adverse events were minimal, with no systemic safety signals observed.

Tune in to the full episode to hear Dr Armstrong and Dr Del Rosso highlight the key factors of diagnosing and treating CHE, the clinical impact of delgocitinib, and how dermatologists are now better positioned to treat this commonly encountered yet difficult to manage condition.

Dr Blauvelt begins by explaining how TYK2 inhibition differs from traditional JAK inhibition by targeting a more selective signaling pathway downstream of cytokine receptors. Unlike JAK1, JAK2, or JAK3, TYK2 is involved in a narrower range of cytokines, which may explain its distinct safety profile.

Dr Del Rosso and Dr Blauvelt also clarify why deucravacitinib lacks the boxed warning seen with other oral JAK inhibitors. With allosteric binding at the TYK2 pseudokinase domain, deucravacitinib avoids cross-inhibition of other JAKs, making it more selective and potentially safer. Long-term data now supports this distinction: 5-year safety results show no increased risk of major adverse cardiac events, malignancy, or serious infections, with only a small, manageable signal for herpesvirus infections.

The conversation turns to efficacy, which appears sustained over 5 years without antibody development, a potential advantage over biologics. Dr Blauvelt emphasizes its utility in high-impact areas such as the scalp, palms, soles, genitalia, and nails, and encourages systemic therapy even in patients with limited body surface area involvement when quality of life is severely affected.

Tune in to the full episode to learn how deucravacitinib fits into the current psoriasis treatment algorithm, what sets TYK2 inhibition apart from other oral options, and how real-world data is shaping clinical confidence in this novel therapy.

The first case focuses on a 34-year-old patient with severe, recalcitrant Hailey-Hailey disease. After multiple failed therapies, including antibiotics, corticosteroids, apremilast, and low-dose naltrexone, she achieved near-complete clearance within 12 weeks on dupilumab. Drs Altman and Del Rosso share their thoughts on why a drug targeting type 2 inflammation might be effective in a condition traditionally considered structural, drawing parallels to reports in Darier disease.

Next, the conversation shifts to an unusual immune response observed in a patient with well-controlled psoriasis on IL-17 inhibitors who developed widespread atopic dermatitis. Dr Altman describes this as a “cytokine shift,” where suppression of IL-17 may upregulate IL-4 pathways, mirroring the reverse effect sometimes seen with IL-4 inhibition. While uncommon, such effects are now recognized in prescribing information, and the patient improved after transitioning to a broader-acting JAK inhibitor (upadacitinib).

In the final case, a patient with Crohn’s disease developed rapidly progressing alopecia areata while on infliximab. Switching to tofacitinib improved hair growth but worsened gastrointestinal symptoms. Following colectomy, both the Crohn’s disease and alopecia resolved, highlighting the role of systemic inflammation in driving skin disease.

Tune in to the full episode to hear more about these unique cases, the underlying immunologic mechanisms, and how lessons from complex cases can inform everyday dermatologic practice.

The discussion begins with reflections on how skin care priorities have shifted from basic sun protection and moisturization to a more proactive, appearance-driven approach, especially among Gen Z. While this interest is largely aesthetic, Drs Del Rosso and Woolery-Lloyd point out that it also brings health benefits, offering dermatologists a unique opportunity to guide patients toward sound practices for photoprotection and skin longevity.

They also explore the influence of social media on how young people consume skin care information. Dr Woolery-Lloyd shares findings from her research showing that most viral skin care content is not produced by medical professionals, increasing the risk of misinformation, but also noting that many young people are increasingly capable of distinguishing influencer marketing from expert guidance.

They further discuss how younger patients are seeking neuromodulators and fillers as preventive strategies. Dr Del Rosso highlights the biological rationale behind these concerns, including early collagen loss and environmental skin damage.

They conclude with a review of emerging ingredients like acetyl dipeptide-31 amide and bakuchiol, which offer dermal benefits with minimal irritation, potentially impacting how dermatologists counsel younger patients who are hesitant to use traditional retinoids.

Tune in to the full episode to hear how dermatologists can thoughtfully engage with this prevention-minded population by acknowledging their concerns, correcting misinformation, and recommending science-backed products that promote both skin health and confidence.

They begin with the immunologic underpinnings of CSU, explaining the role of IL-4 and IL-13 in driving mast cell activation and the role of IL-31 in itch. Since dupilumab blocks these key cytokines, it can disrupt the disease process at multiple levels, from antibody formation to immune cell recruitment.

They discuss the growing comfort among dermatologists in treating CSU now that a familiar and accessible agent like dupilumab is available, especially when compared to omalizumab, which has been limited by concerns over anaphylaxis and practice logistics.

They next address real-world considerations, including the time dupilumab takes to work, the use of short-term corticosteroids, and the need for personalized treatment approaches. They caution against over-reliance on corticosteroids and discuss alternative bridging therapies like cyclosporine or methotrexate for severe cases.

The episode also covers dosing nuances, patient selection, how to distinguish CSU from other urticaria types, and the importance of setting expectations. Dr Hawkes shares his experience with long-term efficacy, noting minimal loss of response among his patients.

Listen to this episode for more clinical insights on dupilumab as a key treatment in managing chronic spontaneous urticaria, including considerations around patient selection, duration of therapy, and long-term disease control.

 To begin, Dr DaSilva shares the inspiration behind his recent publication that evaluated oral JAK inhibitors in elderly patients with moderate to severe atopic dermatitis. Motivated by the positive feedback from older patients and the perception that JAKs are underutilized due to safety concerns, he conducted a multicenter retrospective study that found strong efficacy and a reassuring safety profile in patients aged 65 to 96.

Next, the discussion turns to nemolizumab, an IL-31 receptor antagonist recently approved for prurigo nodularis and atopic dermatitis. Dr DaSilva highlights a patient case that prompted a broader series: a patient with cancer experiencing recalcitrant itch who saw complete resolution within days of starting nemolizumab. Across 10 cases, 8 showed a rapid and marked itch response, with no adverse events or ocular surface issues.

Finally, they review a case report on palmoplantar psoriasis treated with topical roflumilast 0.3% cream. Used initially as a bridge to systemic therapy, the patient achieved unexpectedly robust results with the topical alone, avoiding the need for a biologic. Dr DaSilva notes the importance of keeping nonsteroidal topicals in mind, especially for steroid-sparing strategies.

Tune in to the full episode for more real-world data and case-based insights to help manage complex dermatologic conditions.

 Dr Frey begins by breaking down how she categorizes facial hyperpigmentation that isn't tied to a structural lesion. She explains how the distribution, hue, and depth of pigment—epidermal, dermal, or mixed—guide diagnosis and treatment. They revisit traditional therapies like hydroquinone and oral tranexamic acid, highlighting their ongoing roles in management, while noting concerns around cytotoxicity, ochronosis, and overuse.

 The conversation then turns to Thiamidol, a novel topical agent recently introduced in the US as a potent and selective human tyrosinase inhibitor, unlike many legacy agents developed using mushroom tyrosinase models. Dr Frey shares data showing the superiority of Thiamidol over 2% hydroquinone and comparable efficacy to 4%, with excellent tolerability and quality-of-life benefits. Clinical applications span melasma, acne-induced postinflammatory hyperpigmentation, solar lentigines, and laser-associated hyperpigmentation.

 Dr Frey also discusses an exciting new study where Thiamidol replaced hydroquinone in triple-combination creams, yielding similar efficacy with improved tolerability, offering new options for patients seeking long-term, safer treatments.

 Tune in to the full episode to hear how Dr Frey approaches hyperpigmentation with precision and pragmatism, and how Thiamidol may be poised to reshape the treatment landscape.

Dr Desai begins by outlining how to identify unstable vitiligo at the first visit, a crucial step that guides treatment decisions. He describes hallmark features of instability, including trichrome lesions, confetti-like depigmentation, inflammatory borders, pruritus, and signs of Koebnerization—and emphasizes that even one unstable lesion should prompt systemic stabilization. Vitiligo flares can occur unpredictably, even in previously stable patients.

The conversation also explores common comorbidities, including autoimmune thyroid disease, diabetes mellitus, and alopecia areata. Dr Desai shares his standard lab workup at the initial visit, which includes thyroid-stimulating hormone, free thyroxine, thyroid peroxidase antibody, and vitamin D. They discuss when to repeat testing and how to interpret elevated thyroid antibody titers in asymptomatic patients. The pair also touches on psychosocial impact, especially among children and adolescents, and strategies to create space for emotional check-ins during clinical visits.

In the second half of the episode, Dr Desai shares practical insights on using topical ruxolitinib cream 1.5% for nonsegmental vitiligo. Dr Del Rosso and Dr Desai discuss treatment duration, counseling around delayed response, and why BID application is critical for success. They also address combining ruxolitinib with phototherapy, tailoring treatment based on location and follicular density, and how to support patients who may feel discouraged by early speckled repigmentation. Boxed warning concerns are also reviewed, with a focus on safety and real-world reassurance for patients using topical formulations.

Dr Desai closes with an essential message: patients with vitiligo deserve more than a one-line treatment plan. Hope, education, and long-term partnership are key—and new therapeutic options are on the horizon.

Dr Del Rosso begins by tackling common challenges with oral apremilast for psoriasis, sharing strategies to manage gastrointestinal side effects and improve patient adherence. He provides tips on starter packs, meal timing, and even reducing caffeine intake to minimize nausea and cramping during therapy initiation. 

Next, he discusses the evaluation of alopecia areata severity and how to determine eligibility for oral Janus kinase (JAK) inhibitors, including baricitinib (Olumiant) and ritlecitinib (Litfulo). Dr Del Rosso outlines a practical approach to scalp assessment using SALT scores, explains how psychosocial impact and eyebrow/eyelash loss can upgrade severity, and reviews important safety considerations for JAK inhibitor therapy. He also previews a recently FDA-approved third option: deuruxolitinib (Leqselvi).  

Finally, Dr Del Rosso covers the newly FDA-approved modified-release oral minocycline 40 mg capsule formulation (Emrosi) for rosacea, highlighting its anti-inflammatory benefits and superior efficacy compared with subantimicrobial-dose doxycycline in a head-to-head controlled-study evaluation. He explains its mechanism of action, favorable safety profile, and how it fits into the modern rosacea treatment landscape. 

Tune in for a fast-paced roundup of pearls, pitfalls, and pro tips that can make all the difference in your day-to-day dermatology practice. 

The conversation begins with a discussion of therapeutic decision-making for new patients with moderate to severe atopic dermatitis. Dr Hebert emphasizes the importance of listening closely to both the child and their caregivers to identify emotional barriers, needle phobia, steroid concerns, and gaps in previous care. She explains why patient-centered care requires flexible strategies, and how once-daily, steroid-free topical agents are often more acceptable to families than systemic options or injectable biologics. 

Dr Del Rosso and Dr Hebert focus on topical tapinarof, an aryl hydrocarbon receptor agonist approved for atopic dermatitis down to 2 years of age. Dr Hebert walks through the advantages of its once-daily use, its natural compound origin, and favorable safety profile, particularly for young children and anxious parents. She shares several compelling cases, including a 3-year-old with 85% body surface area involvement who responded dramatically in a clinical trial, and a 7-year-old girl with longstanding disease and prior cyclosporine exposure who found relief with tapinarof. 

Together, the clinicians explore practical pearls for real-world use, including how to apply the cream properly, whether to moisturize before or after, how to avoid waste, and when to reintroduce the medication after a flare. Dr Hebert highlights that many of her patients, and their families, experience life-changing improvements in sleep, school participation, and self-esteem, underscoring the broader impact of effective topical treatment. 

The episode closes with a reminder that personalized care, consistent moisturization, and confidence in the safety of non-steroidal options like tapinarof can help families navigate treatment with less stress—and better results. 

Dr Lim provides an update on comprehensive photoprotection that includes ultraviolet radiation coverage, recognizes the growing role of visible light protection, and incorporates ingredients with antioxidant activity. He also explains where mineral sunscreens can be particularly helpful in clinical practice. 

A major part of the discussion highlights the progression of science supporting DNA repair through the use of liposomes containing photolyases. These enzymes have been shown to repair cyclobutane pyrimidine dimers—mutagenic DNA lesions induced by UVA and UVB exposure. Incorporating photolyases into sunscreen formulations has been associated with reduced actinic keratosis formation and enhanced skin protection. 

Dr Del Rosso shares his insights on ISDIN's Eryfotona Actinica and Eryfotona Ageless, two mineral sunscreens that include photolyase-containing liposomes, also known as DNA Repairsomes®, to enhance natural DNA repair processes. Each product contains additional active ingredients offering distinct benefits for specific patient needs. Dr Del Rosso and Dr Lim discuss how these formulations fit into both preventive and reparative strategies, particularly for patients with a history of actinic damage or elevated risk for nonmelanoma skin cancers. The conversation then covers the value of broad-spectrum protection, lightweight formulations, and patient education to encourage consistent use. Dr Lim offers practical pearls on counseling patients, improving sunscreen adherence, and integrating these strategies into everyday dermatologic care. 

They also touch on the importance of photoprotection in skin of color, emphasizing the need for inclusive clinical research and personalized recommendations. Dr Lim reinforces the importance of year-round sun protection, even for individuals who perceive themselves to be at lower risk. 

The episode wraps up with forward-looking insights into the future of photoprotection, including emerging technologies and formulation innovations that may reshape dermatologic sun care. From thoughtful commentary to evidence-based guidance, tune in for the latest in photoprotection—just in time for summer. 

Dr Lam emphasizes the importance of both medical and surgical interventions in order to provide comprehensive management of this multifaceted disease state. She shares her step-by-step approach for identifying which lesions are best suited for deroofing, breaking down key considerations like Hurley staging, scarring assessment, and palpation for sinus tracts. From assessing lesions that have resisted biologic therapy to recognizing when a seemingly mild case may actually benefit from surgical intervention, she explains how deroofing fits seamlessly into a well-rounded HS treatment plan, often working in tandem with biologic agents to address stubborn or recurrent lesions without disrupting systemic control. 

The conversation then turns to technique. Dr Lam outlines her preferred tools, all which are easily accessible in dermatology practices, and explains how she navigates physically challenging areas like the axilla and groin. The pair emphasize the importance of patient education; Dr Del Rosso raises questions about preventing complications such as biofilm formation and hypergranulation, while Dr Lam addresses these issues and shares her strategies for effective wound management. 

Together, they reflect on how deroofing can markedly improve comfort and quality of life for HS patients, particularly those who have struggled with focal areas of chronic drainage and recurrent abscesses despite optimized medical therapy. Dr Lam’s enthusiasm for the procedure is readily apparent and contagious, and her practical advice makes the incorporation of deroofing into the management plan feel readily achievable, even for dermatology clinicians who are new to surgical HS management. 

Dr Lam shares how she built an efficient, trust-centered model of care at her Calgary clinic, from using intake tools and patient education videos to identifying comorbidities and staging severity. She walks through her approach to treatment selection—focusing on what brings the most value in that moment—and discusses when and how she incorporates patient education, intralesional corticosteroids, biologic therapy, deroofing, laser hair removal, and other approaches into her care strategy.

Whether you see HS regularly or only occasionally, this conversation offers practical strategies, clinical nuances, and a fresh perspective on improving care for this complex condition.

Dr Del Rosso kicks things off with the ever-popular question: Do I really need to monitor blood potassium in healthy patients on spironolactone for acne? He breaks down current guideline perspectives, red flags for high-risk populations, and his own reasoning for when and why he orders labs.

Next, he walks through the expanding world of topical nonsteroidal agents for atopic dermatitis, including:

 Ruxolitinib 1.5% cream (Opzelura) – FDA-approved for mild to moderate AD in patients ≥12 years old and also for vitiligo; Dr Del Rosso discusses addresses black box warnings, despite low systemic absorption in most real-world scenarios.

 Roflumilast 0.15% cream (Zoryve) – Approved down to 6 years of age, well-tolerated with itch reduction data to back it.

 Tapinarof 1% cream (VTAMA) – Approved down to 2 years of age and used effectively in moderate-to-severe disease with favorable skin tolerability.

He explains why these newer agents may be preferred over topical corticosteroids for sensitive areas like the face. In response to questions about actinic keratoses, Dr Del Rosso dives into tirbanibulin 1% ointment (Klisyri), a microtubule inhibitor used once daily for five days. While FDA-approved for face and scalp field treatment up to 100 cm², he shares how he’s successfully using it off-label for forearms and hands, sometimes in combination with cryotherapy.

The episode closes with a discussion of oral antibiotic safety in acne, including:

 Why TMP-SMX (trimethoprim-sulfamethoxazole) works—but must be used selectively due to rare but serious adverse events (TEN, pulmonary toxicity)

 Why azithromycin is not optimal for acne and only used selectively.

 And why mandatory lab monitoring for oral tetracyclines like doxycycline or minocycline isn’t recommended routinely—but clinical vigilance is.

With insights on everything from lab work to lid margins, this is one episode you’ll want to bookmark, replay, and pass along to your dermatology colleagues.

They explore why chronic hand eczema isn’t a single disease but a spectrum of overlapping etiologies—ranging from atopic dermatitis and irritant or allergic contact dermatitis to more elusive triggers. Dr Stein Gold shares practical strategies for teasing out potential causes, discusses some potential limitations of patch testing, and highlights the importance of patient history and thorough skin assessment.

The conversation also covers current treatment approaches, from topical corticosteroids to systemic therapies, and introduces delgocitinib cream, a pan-JAK inhibitor under FDA review, as a unique and valuable nonsteroidal option. Drs Stein Gold and Del Rosso explain how its broad immunomodulatory action may help address the condition’s diverse inflammatory pathways while remaining well tolerated, even on fissured skin.

Whether you're managing stubborn cases or looking for updates on investigational therapies, this episode offers practice-ready recommendations for clinicians and a reminder not to overlook the emotional toll of hand eczema on patients’ daily lives.

They kick off with a practical discussion on older systemic options like methotrexate and

cyclosporine, including when these tried-and-true agents still have a place in modern practice.

From there, Dr Armstrong walks through the evolving role of apremilast, particularly in hard-to-

treat variants like palmoplantar pustulosis and in patients with milder disease who prefer oral

options. The pair then take listeners through the clinical data behind deucravacitinib, a selective

TYK2 inhibitor, highlighting its strong efficacy, minimal lab monitoring, and newly released five-

year safety results.

The conversation also covers real-world patient selection, payer considerations, and how

clinicians can use guidelines to support access to newer therapies. Whether you’re looking to

refine your psoriasis treatment strategy or better counsel patients on long-term safety, this

episode delivers practical pearls you can use in clinic tomorrow.

dermatology to something equally important but rarely discussed—legal and financial planning.

He’s joined by his longtime friend and dermatopathologist, Dr Clay Cockerell, who also happens

to be a licensed attorney with a passion for educating physicians about estate planning.

Dr Cockerell breaks down the fundamentals of trusts, wills, and malpractice insurance in plain

language, highlighting why every physician should care about these topics. Listeners will learn

the key differences between revocable and irrevocable trusts, how to protect assets from

creditors, and why picking the right trustee is critical.

They also dive into the historical roots of trusts (spoiler: think the Crusades), fiduciary responsibilities, and how physicians can control the distribution of assets during and after their lifetimes.

The conversation also covers non-compete clauses, contract negotiations, and the importance

of tail coverage in malpractice policies. Dr Cockerell shares real-world advice from his own

experience and emphasizes why physicians—especially new grads—should never sign contracts without legal review.

Packed with practical insights, humor, and a few personal anecdotes, this episode offers a

must-hear legal primer for dermatology professionals at any career stage.

longtime friend and pediatric dermatology expert, Dr Lisa Swanson. Together, they

explore the rapidly evolving treatment landscape for pediatric atopic dermatitis, with a

focus on newly approved non-steroidal topical therapies.

Dr Swanson shares her insights on tapinarof 1% cream, now FDA-approved for patients

as young as two years old, and topical roflumilast 0.15% cream, approved down to age

six. The duo discusses how aryl hydrocarbon receptor (AhR) agonism makes tapinarof

effective in both atopic dermatitis and psoriasis, likening its action to a “SNOO” that

adjusts to soothe inflammation.

They also dive into data from the ADORING 1 and ADORING 2 phase 3 trials,

highlighting tapinarof’s rapid reduction in itch and its positive impact on sleep—critical

outcomes for both children and their parents. Dr Swanson offers real-world anecdotes

about the sleep-depriving toll of pediatric eczema and how effective therapies can

restore rest for the entire family.

The conversation touches on skin of color considerations, including how atopic

dermatitis may present differently and why diverse representation in clinical trials is

essential. Dr Swanson underscores the importance of tactile assessments and shares

practical pearls for evaluating eczema severity across skin types.

Finally, they explore safety and tolerability, emphasizing tapinarof’s low risk of systemic

absorption, even in young children prone to thumb-sucking or hand-to-mouth behavior.

Tune in for clinical pearls, new treatment insights, and a few laughs between two

dermatology BFFs.

Winter Clinical Dermatology Conference – Miami® with a deep dive into some of the standout

posters presented at the meeting.

Dr Del Rosso begins the review with new insights on topical clascoterone 1% cream and its

impact on the skin barrier, tolerability, and sebum reduction. He explores recent studies

showing that clascoterone does not compromise the permeability barrier or increase

transepidermal water loss—key considerations for its use alongside other acne treatments like

benzoyl peroxide and topical retinoids.

The analysis shifts to a comparative study on a triple combination acne therapy featuring

clindamycin 1.2%, adapalene 0.15%, and benzoyl peroxide 3.1%, which demonstrated superior

efficacy over dual-combination formulations. Dr Del Rosso breaks down early activity data,

inflammatory and non-inflammatory lesion reductions, and how polymeric emulsion

technology enhances both efficacy and tolerability.

He also highlights new data on topical ruflomilast for atopic dermatitis in younger patients

(ages 2-5) and explores the recent FDA approval of tapinarof 1% cream for atopic dermatitis

down to age two. Posters on itch and sleep improvements in pediatric patients, as well as

efficacy in skin of color, provide valuable clinical insights.

Tune in for this rapid-fire breakdown of key posters, packed with data-driven takeaways to

enhance your dermatology practice.

The discussion kicks off with chronic hand eczema, a condition that can be difficult to diagnose and treat due to its multiple causes. Dr Cohen highlights emerging data on new treatment options, including dupilumab, topical JAK inhibitors like ruxolitinib, and upcoming therapies like delgocitinib. They explore whether these newer therapies could be effective across different causes of hand eczema, even when an allergen isn’t clearly identified.

Dr Armstrong then shifts the conversation to the next frontier in psoriasis treatment, including new oral therapies that are pushing efficacy to higher levels. They discuss IL-23 receptor antagonists, IL-17 inhibitors, and TNF inhibitors in development, as well as 5-year safety and efficacy data for deucravacitinib, which shows no long-term need for routine monitoring.

The group also tackles the evolving treatment landscape for hidradenitis suppurativa (HS), where combination therapy is emerging as a key strategy. Dr Armstrong shares insights into guidance from the HS Foundation and the potential of pairing JAK inhibitors with IL-17 or TNF inhibitors for refractory cases.

They wrap up with practical pearls from the conference, including extended terbinafine treatment durations for fungal infections, pediatric biologic use around live vaccines, and the latest treatment options for molluscum contagiosum.

Tune in to this information-packed episode for expert insights and clinical updates straight from Winter Clinical 2025!

Dr Green highlights that an estimated 16 million people in the US experience clinical hyperhidrosis, with axillary hyperhidrosis being the most frequently reported. However, a significant challenge is patient reluctance to discuss symptoms, often due to embarrassment or frustration with ineffective or irritating treatments. Dr Green suggests raising awareness through social media, office signage, and intake forms to help identify more patients needing care. The discussion then shifts to treatment options, including botulinum toxin, devices such as the Brella SweatControl Patch and the energy-based miraDry, and pharmacologic therapies.  They explore anticholinergic treatments in depth, explaining how sofpironium bromide gel differs from traditional glycopyrrolate wipes. While glycopyrrolate wipes can be messy, highly saturated, and prone to causing systemic absorption from contact with the hands, sofpironium bromide gel is applied via an applicator in a metered dose, reducing unintended exposure and improving application precision. Unlike glycopyrrolate, which affects muscarinic M1 receptors found throughout the body, sofpironium targets muscarinic M3 receptors, which are more specific to sweat glands, reducing the likelihood of systemic side effects. They next review clinical trial methodologies for hyperhidrosis, including the Hyperhidrosis Disease Severity Measure and gravimetric sweat production assessments, noting that they favor patient-reported outcomes over objective sweat measurements, as perceived symptom relief is the most important assessment for this condition. Tune in to the full episode to hear expert insights on identifying and treating hyperhidrosis with new and emerging therapies that improve both efficacy and the patient experience.

They begin with Dr Vender sharing his 90/70/40 rule, a numeric approach to evaluating biologic efficacy in psoriasis. He explains that across biologic agents, PASI75 responses typically reach 90%, PASI90 responses reach 70%, and PASI100 responses about 40%, providing a useful benchmark for evaluating treatment success. With many biologics showing similar efficacy and strong safety profiles, this method can help guide selection.

They also discuss how comorbidities impact biologic choices, with Dr Vender noting he avoids TNF inhibitors in patients with multiple sclerosis, latent tuberculosis, malignancy, or hepatitis, though they remain a preferred option for women of childbearing potential. He advises caution when using IL-17 inhibitors in patients with a history of inflammatory bowel disease. While tuberculosis screening remains routine, he questions its necessity for anti-IL-17 and IL-23 inhibitors, given their lack of association with latent TB reactivation.

The discussion then moves to chronic hand dermatitis, with Dr Vender stressing thorough history-taking, including identifying occupational exposures, and diagnostic testing, including patch testing and scrapings. He highlights alitretinoin, an oral retinoid specifically approved for chronic hand dermatitis, as an effective and well-tolerated treatment option.

They conclude with a discussion on protective measures for chronic hand dermatitis, including hypoallergenic gloves, cotton liners, and emollient barrier creams.

Tune in to the full episode to hear expert insights on optimizing psoriasis treatment and managing chronic hand dermatitis in clinical practice.

Dr Portela shares how he unintentionally became an influencer, initially using social media to market his new practice without a budget. His following grew as he provided accurate, engaging, and evidence-based dermatologic education, evolving into a broader platform for both patients and clinicians.

They discuss combatting misinformation, as much of the skin care advice online comes from nonmedical sources. Dr Portela emphasizes that his goal is to provide science-backed, accessible information, mirroring the guidance he offers in the clinic. He recommends the AAD website, DermNet, and YouTube’s certified health professionals as trusted resources and uses AI tools like ChatGPT to simplify patient education, though he stresses the importance of reviewing content for accuracy before sharing.

They also address legal considerations, with Dr Portela advising dermatologists to avoid direct medical advice online and instead keep recommendations general and educational. He cautions that malpractice policies typically do not cover social media activity, making it crucial to understand liability risks.

Finally, they discuss brand partnerships, with Dr Portela emphasizing authenticity and trust. He only endorses products he has personally used and recommended in practice, ensuring his audience receives honest, unbiased information.

Tune in to the full episode for insights on navigating social media responsibly, protecting credibility, and effectively leveraging online platforms for dermatologic education.

They begin by discussing the importance of outreach and education to raise awareness of HS among non-dermatology health care providers, such as OB-GYNs and urgent care practitioners, highlighting how early referral and intervention can prevent long-term complications such as scarring and sinus tract formation.

They then explore the role of GLP-1 therapies and biologics in HS treatment. Dr Payette shares his multimodal approach, explaining how GLP-1s address an underlying cause of inflammation while biologics target active inflammation. He outlines practical tips for managing insurance approvals and counseling patients on the benefits and potential side effects of these therapies.

The episode also covers strategies for discussing lifestyle changes, such as weight loss and smoking cessation, while being sensitive to patient challenges. Dr Payette notes that combining weight reduction with biologics can often yield good outcomes, helping patients achieve better disease control and remission.

Tune in to the full episode to learn how a systematic, patient-centered approach to HS management can improve outcomes for this challenging condition.

The conversation addresses a crucial yet often unclear topic for dermatologists: balancing safety and efficacy when managing AD in patients during pregnancy and lactation. Dr Shahriari emphasizes the importance of addressing uncontrolled inflammation, which can have potential consequences for both the mother and baby, such as premature birth and maternal sleep disruption. She shares insights into the physiological changes during pregnancy, including the shift from a Th1 to a Th2 immune state, and how this can impact conditions like AD and psoriasis.

The discussion highlights the limited data available for systemic treatments in this population, as pregnant women are excluded from clinical trials. Despite this, therapies like dupilumab and cyclosporine are discussed for their safety profiles, with dupilumab often considered when patients need effective control with minimal risk. Dr Shahriari also addresses strategies to involve partners in treatment decisions, ensuring patients feel supported and informed.

Drs Del Rosso and Shahriari emphasize the importance of open communication with patients, managing risk tolerance, and understanding the nuances of systemic treatment in pregnancy and lactation. Dr Shahriari shares real-world cases, including the use of dupilumab in a pregnant patient with severe AD and counseling a patient with psoriasis who unintentionally administered a biologic injection during the first trimester.

Tune in to the full episode for practical guidance on navigating these complex cases and balancing patient care with available evidence. This episode is a must-listen for dermatologists managing pregnant or breastfeeding patients with inflammatory skin conditions.

Dr Del Rosso revisits key insights from some of the most impactful episodes on this 100th Episode of Derms and Conditions Podcasts:

• Episode 91 with Dr Joel Gelfand explored psoriasis comorbidities and the importance of connecting with patients on both physical and mental health. Dr Gelfand emphasized the need for dermatologists to assess cardiovascular risks and encourage patients to engage with their broader medical team.
• Episode 89 with Dr Jessica Kaffenberger took a deep dive into hidradenitis suppurativa, including strategies to address disease chronicity, tackle psychosocial aspects, weight and smoking challenges tactfully, initiating biologic agents early to halt disease progression before permanent sequelae markedly increase and specific tips for using intralesional corticosteroids and infliximab infusion for severe cases.
• Episode 96 with Dr David Cotter explored the art and science of patch testing, especially for patients with atopic dermatitis who may have concurrent allergic contact dermatitis. Dr Cotter shared practical advice on tailoring patch testing and considerations regarding ongoing medications used to treat atopic dermatitis.
• Episode 90 with Dr Jason Hawkes took a closer look at TYK2 inhibition with deucravacitinib, highlighting its novel allosteric mechanism, its more selective pathway inhibition, and 4-year safety and efficacy data.
• Episode 97 with Dr Tina Bhutani provided insights on newer nonsteroidal topicals like roflumilast and tapinarof, including tips for integrating these agents with corticosteroids and using them under occlusion for thicker lesions.

With so many exceptional episodes in 2024 and exciting plans ahead, listeners can look forward to even more cutting-edge insights in 2025. Don’t miss any of these conversations—catch up anytime at dermsquared.com/podcasts/derms-and-conditions

They begin by highlighting how treatment selection often depends more on disease location and patient impact than on body surface area alone and discuss the importance of addressing comorbidities, such as metabolic syndrome or inflammatory bowel disease, when determining the best therapy for each patient.

Dr Glick then shares anecdotal examples to illustrate the value of deucravacitinib, including its success in treating an elderly patient with longstanding psoriasis and a younger patient with psoriasis and psoriatic arthritis. Efficacy in difficult-to-treat sites such as the scalp is also important to note.

They then address the importance of collaboration with primary care physicians to address underlying cardiovascular and metabolic risks while encouraging patients to adopt healthy lifestyle changes like smoking cessation and exercise.

They conclude by highlighting the importance of long-term data, citing deucravacitinib’s 4-year efficacy and safety results, and anticipate the arrival of new oral therapies that will further expand treatment choices and improve patient outcomes.

Tune in to the full episode for deeper insights into the challenges and opportunities in systemic therapy selection for psoriasis, including strategies for navigating the expanding treatment landscape, tips for addressing comorbidities, and pearls for integrating therapies like deucravacitinib into practice with a patient-centered approach.

They begin by discussing the importance of considering patient-specific factors, such as contraindications, access, and age, when selecting among the 3 currently available biologics for AD: dupilumab, tralokinumab, and lebrikizumab. While these therapies share many similarities, nuanced differences—such as dupilumab’s approval for younger patients and asthma comorbidity, or lebrikizumab’s sustained efficacy after discontinuation—can guide treatment decisions.

They also discuss adverse events, including conjunctivitis and dupilumab-associated facial erythema, highlighting strategies for managing these issues. Dr Song notes that switching within the IL-13 pathway can often resolve conjunctivitis and speculates on the possible mechanisms behind facial redness.

They then explore one critical insight: the potential for patients to fail one biologic and still respond to another within the same class. While complete nonresponders may benefit from switching to a different class, such as JAK inhibitors, partial responders often do well with another IL-13 inhibitor.

Tune in to the full episode to explore more insights on optimizing AD management, including how to navigate biologic options, manage adverse events, and approach challenging cases while embracing new therapies and tailoring care to each patient’s unique needs.

They begin by highlighting the role of topical corticosteroids as a cornerstone of psoriasis management. Dr Bhutani explains that she often uses high-potency options like clobetasol for thick plaques and milder steroids like hydrocortisone for sensitive areas. She shares a practical approach: using steroids for acute flares and transitioning to nonsteroidals, such as tapinarof or roflumilast, for maintenance. This approach emphasizes the versatility of topical treatments, allowing dermatologists to tailor treatments, enhance efficacy, and simplify regimens to improve adherence.

They then discuss the unique mechanisms of newer nonsteroidals, particularly tapinarof as an aryl hydrocarbon receptor agonist. This mechanism reduces inflammation through key psoriasis pathways and may even affect memory T cells, contributing to tapinarof’s potential remittive effect.

For challenging areas, Dr Bhutani offers pearls such as occlusion to boost penetration and creative strategies to address palmoplantar psoriasis. She also introduces an effective maintenance strategy, advising patients to scale back topicals to twice a week during remission to reduce side effects while sustaining symptom control.

Tune in to the full episode for actionable insights for dermatologists navigating the balance between traditional and innovative topical therapies in managing psoriasis.

They begin with Dr Cotter highlighting the importance of a holistic approach when evaluating patients with AD and ACD. A thorough history and physical examination, combined with a detailed understanding of allergen exposure, are essential for tailoring patch testing to the patient’s specific needs. He notes that AD and ACD frequently coexist, and identifying an allergen component is particularly valuable in cases of treatment-resistant AD or when new patterns, such as hand or facial dermatitis, emerge.

For patients already on systemic therapies like biologics and JAK inhibitors, interpreting patch test results requires careful consideration. While biologics may control aspects of ACD, breakthrough dermatitis often signals clinically relevant allergens. Patch testing can be performed without discontinuing current biologic or JAK inhibitor therapy, though a washout period and repeat testing may sometimes be needed.

Dr Cotter shares that patch testing can significantly improve outcomes, especially for patients who prefer allergen avoidance over additional systemic therapies. Tools like allergen-detection apps can empower patients to avoid triggers in their daily lives. When avoidance is not feasible, oral JAK inhibitors approved for AD can also help manage both AD and ACD symptoms in many cases.

Tune in to the full episode to explore the value of patch testing in modern dermatology and get actionable strategies to improve care for patients with complex dermatitis cases.

The discussion opens with a look at the current "embarrassment of riches" in AD treatments. Dermatologists now have multiple biologic options to choose from, each with distinct features. Dr Lio highlights lebrikizumab's flexible dosing, which can shift to once monthly after the initial treatment period, potentially offering patients a more manageable treatment routine. They also explore key differences among IL-13 inhibitors, such as lebrikizumab’s unique binding characteristics that may influence the overall balance of IL-13 in the body. Dr Lio also notes the possibility of achieving relative remission for certain patients on lebrikizumab, as suggested by a long-term extension study where some patients maintained improvement even after stopping the drug.

They also cover the safety and tolerability aspects of AD therapies, including conjunctivitis, arthropathy, and erythematous reactions sometimes seen with these drugs. Dr Lio shares insights on managing these side effects, emphasizing that despite similar mechanisms of action, switching between IL-13 inhibitors may alleviate adverse reactions for certain patients.

Tune in to the full episode for expert insights on differentiating and integrating the latest therapies for AD, strategies for engaging patients in their treatment plans, and valuable guidance on navigating today’s expanding therapeutic landscape.

They begin by noting that past limitations left clinicians with few FDA-approved treatment options for younger patients, often relying on off-label therapies without robust pediatric data. However, legislative changes and incentives, such as patent extensions for drugs studied in pediatric populations, have encouraged pharmaceutical companies to invest in pediatric trials, enabling dermatologists to gain access to more targeted therapies for children.

Despite this progress, enrolling young children in clinical trials remains challenging, partly due to concerns from parents about potential risks. Dr Hebert shares her approach to easing these concerns, often by conducting trials with adult and adolescent populations first so parents have a better understanding of a therapy's safety profile.

Drs Hebert and Del Rosso then address the logistical aspects of pediatric trials, from initial phone screenings to addressing parents’ concerns about risk-benefit profiles, placebo arms, and the long-term safety of therapies. Dr Hebert underscores the need to accommodate the unique schedules and needs of young patients, such as adjusting appointments to fit around school hours.

She also shares tips for administering injections to children, including using ice packs, straightforward explanations, and comforting strategies to make the experience as positive as possible.

Throughout the conversation, Dr Hebert emphasizes the trust placed in dermatologists by parents and highlights the importance of respectful, compassionate communication, which ultimately strengthens the therapeutic alliance.

Tune in to the full episode to learn more about pediatric clinical trials, hear insights on patient and parent communication, and get valuable guidance for dermatologists aiming to expand their expertise in pediatric patient care.

The discussion kicks off with psoriasis, where exciting progress in oral TYK2, IL-23, and IL-17A inhibitors is providing potential for effective, safe options for moderate-to-severe cases. For atopic dermatitis, they review the recent approval of lebrikizumab and the real-world efficacy of tralokinumab for head and neck involvement. They also spotlight OX40/OX40 ligand inhibitors—amlitelimab and rocatinlimab—as promising long-acting treatments currently in development.

In prurigo nodularis, the newly approved nemolizumab, an IL-31 inhibitor, offers antifibrotic benefits and has notably not shown evidence of conjunctivitis risk seen with other biologics. For vitiligo, BET inhibitors are creating new opportunities by targeting epigenomics, and several JAK inhibitors are pending phase 3 data. For hidradenitis suppurativa, focus has shifted from TNF inhibitors to IL-17 inhibitors like secukinumab, with bimekizumab and oral JAK inhibitors, including povarcitinib, in late-stage development.

They round out the episode with chronic hand eczema, where topical ruxolitinib and delgocitinib—a pan-JAK inhibitor recently approved in Europe—show encouraging results.

Tune in to the full episode for a full recap of these developments and other breakthroughs from the Fall Clinical Dermatology 2024 Meeting!

They begin by explaining the drug's flexibility, with an initial loading dose followed by maintenance dosing that can be extended to once a month for patients who achieve a satisfactory response after 16 weeks. Dr Shahriari emphasizes that determining an adequate response involves more than skin clearance; persistent symptoms like itchiness can indicate the need to continue more frequent dosing.

They then discuss how many patients maintained their treatment response even after tapering dosing, with some experiencing benefits through week 52, suggesting a durable effect even when the treatment was paused.

When discussing real-world use, Dr Shahriari notes lebrikizumab’s convenience for both patients and providers, as it does not require baseline or ongoing lab monitoring and has no drug-drug interactions. Addressing safety, Dr. Shahriari notes that while common side effects like conjunctivitis and injection site reactions were observed, the drug was generally well-tolerated without any major safety concerns.

They conclude by reflecting on the heterogeneity of AD, noting that patients may respond differently to medications even within the same class and that it’s important to have multiple options to personalize treatment for each patient.

Tune in to the full episode to hear more about lebrikizumab’s clinical performance and the growing toolbox for AD management that is allowing dermatologists to offer safer, more targeted treatments that greatly improve patients' quality of life.

Dr Gelfand reflects on his early observations of patients with psoriasis and their potential internal health issues, noting how in the past, psoriasis was primarily seen as just a skin condition. However, research and a pivotal article on inflammatory pathways in atherosclerosis led to improved understanding that psoriasis is linked to cardiovascular disease.

Dr Gelfand then discusses the groundbreaking use of electronic medical records to track patients with psoriasis over time, revealing higher incidences of cardiovascular events and mortality. This research highlighted that people with moderate to severe psoriasis have a reduced life expectancy by about 5 years, underscoring the need for dermatologists to address comorbidities in their patients.

The conversation then explores practical advice for clinicians, focusing on the role of dermatologists in identifying cardiovascular and diabetes risks in patients with psoriasis. Dr Gelfand suggests a simple yet effective approach: educate patients about their increased health risks, perform basic screenings like cholesterol and blood pressure checks, and collaborate with primary care physicians or cardiologists when needed. By fostering multidisciplinary care, dermatologists can play a crucial role in preventing life-threatening conditions in their patients.

Tune in to the full episode for guidance on addressing the broader health risks associated with psoriasis and the practical steps dermatologists can take to help reduce these risks. From screening for cardiovascular disease to forming strong collaborations with other health care providers, this episode offers valuable insights for improving patient outcomes.

They begin by discussing the JAK-STAT pathway, with Dr Hawkes noting that while the science behind it was well known, TYK2's role in psoriasis took time to fully understand. TYK2 regulates key cytokines like IL-12, IL-23, and type 1 interferons, which are critical in psoriasis and psoriatic arthritis. Its more focused role within the immune response reduces the risk of systemic side effects compared to broader-acting JAK inhibitors.

They also explore deucravacitinib’s selectivity, which targets the pseudokinase domain of TYK2, offering greater precision compared to inhibitors that target the ATP-binding domain shared by other JAKs. This selectivity results in deucravacitinib’s cleaner safety profile, reflected in the lack of a boxed warning and minimal monitoring requirements.

Finally, they review long-term data, noting deucravacitinib's superior efficacy to apremilast and a stable safety profile over four years. While some safety signals, like herpetic infections, slightly increased over time, most adverse events were stable or decreased. They conclude by discussing the importance of personalized treatment decisions, emphasizing deucravacitinib’s advantages for patients who prefer oral medications and want to avoid injections.

Tune in to the full episode for a comprehensive discussion on the clinical relevance of TYK2 inhibitors and the role of deucravacitinib in the psoriasis treatment landscape.

The discussion begins with a reflection on traditional therapies used for HS, such as antibiotics and intralesional injections, and how they were often insufficient in managing the condition. Dr Kaffenberger emphasizes the importance of being proactive with treatment, especially with the use of biologics earlier in the course of the disease, even for patients with moderate HS.

They also address the limitations of the Hurley staging system for HS, which, as a system based on visible disease severity, often delays biologic treatment until irreversible damage has occurred. Dr Kaffenberger calls for earlier use of biologics to prevent chronic sequelae. She also highlights the difficulty of obtaining insurance approval for biologics at early stages of the disease and recommends using templates from the HS Foundation to support prior authorizations.

Dr Kaffenberger then stresses the importance of early diagnosis, noting that HS is often misdiagnosed as sporadically occurring abscesses or cysts. She encourages health care providers to look for early signs like double-headed comedones and recommends laser hair removal as an early intervention strategy.

Addressing the psychological burden of HS, they highlight the high rates of anxiety, depression, and suicidal ideation among patients. Dr Kaffenberger advises dermatologists to build rapport, connect patients with mental health resources, and consider the impact of weight loss and smoking cessation in managing HS, while approaching conversations nonjudgmentally.

Tune in to the full episode for a comprehensive look at HS management and how dermatologists can improve outcomes for their patients.

They begin by explaining that while monoclonal antibodies like dupilumab and tralokinumab have been effective for many patients, JAK inhibitors can offer a powerful alternative for those seeking better control of their symptoms. They emphasize the importance of regularly assessing patient satisfaction with their treatment and exploring whether a switch to a JAK inhibitor might be beneficial.

Dr Lebwohl then refers to treat-to-target principles recently established by a consensus conference, where EASI 75 is a moderate goal and EASI 90 is optimal. JAK inhibitors, he suggests, are more likely to help patients reach these higher targets, especially when symptoms persist despite achieving EASI 75.

They continue to discuss data demonstrating that upadacitinib significantly improves outcomes, with 40.8% of patients achieving EASI 90 compared to 22.5% with dupilumab. Additionally, upadacitinib-treated patients are more likely to report minimal impact on their quality of life as measured by the Dermatology Life Quality Index.

Finally, Dr Lebwohl stresses the importance of discussing the risks associated with JAK inhibitors, including boxed warnings, in a clear and contextualized manner to help patients make informed decisions.

Tune in to the full episode to gain a deeper understanding of the nuances of JAK inhibitors in AD treatment, including practical tips for patient management, insights into the latest clinical data, and optimizing patient care.

They begin by discussing the role of newer nonsteroidal options for psoriasis like roflumilast and tapinarof, highlighting their benefits in contrast to corticosteroids, which, despite their effectiveness, can carry significant adverse effects. Dr Noor describes how he incorporates these treatments into his practice, starting with topical steroids in some cases and transitioning to nonsteroidal options as needed. Dr Noor’s approach allows for flexible treatment plans tailored to each patient’s response.

Dr Noor goes on to note that his experience with tapinarof aligns with emerging clinical data, showing effectiveness in challenging areas like the scalp with minimal adverse effects. He highlights that while contact dermatitis was observed in trials, it is rare in his practice, and proper patient education helps mitigate risks.

They then discuss the remittive effect that some patients achieve with tapinarof, thanks to its mechanism of action as an aryl hydrocarbon receptor agonist. This contrasts with corticosteroids, which are often seen as temporary solutions. He encourages health care providers to take the time to engage thoughtfully with patients, recognizing their investment in their care and the value of personalized attention and education.

Tune in to this episode for valuable insights on optimizing psoriasis treatment and improving patient care through effective use of nonsteroidal therapies and enhanced communication strategies.

Dr Rodriguez emphasizes that we're moving into an era where personalized patient evaluations are playing a greater role in disease management, not to replace the judgment of the clinician, but to assist the clinician during the process of treatment selection. The Mind.Px patch, which is currently available for use, is designed to predict a patient's response to anti-TNF, anti-IL 17, or anti-IL 23 agents, and epitomizes this shift towards precision medicine. He explains how the patch enables dermatologists to customize psoriasis treatments based on molecular signatures, with evidence supporting improved overall patient outcomes as compared to clinical judgment alone.

He shares his real-world experience of integrating the Mind.Px patch into clinical practice, highlighting its simplicity and the minimal learning curve required for its use. He points out that the real challenge lies in integrating the patch into a busy dermatology practice, ensuring timely results, and coordinating subsequent treatment.

Dr Del Rosso then poses various clinical scenarios to Dr Rodriguez, exploring the practicality of the patch. They acknowledge that data shows better response rates and faster achievement of PASI75 among physicians using the patch.

When selecting the test site, Dr Rodriguez advises choosing an early erythematous plaque, noting that the procedure is painless and well-received by patients who appreciate the use of both for cutting-edge diagnostic technology and treatments. He emphasizes the importance of clear communication with patients about the patch’s benefits and logistics, as it requires a few weeks to get results.

They also cover the practical aspects of obtaining and using the patch, including insurance coverage and patient assistance programs to manage costs.

Tune in to learn how the Mind.Px dermal patch is guiding the future of personalized psoriasis treatment and how you can incorporate this innovative tool into your practice for better clinical outcomes

They begin by providing an overview of glucagon-like peptide-1 (GLP-1) agents and their mechanisms of action. These drugs, which include terzepitide (marketed as Mounjaro and Zepbound) and semaglutide (available as Ozempic and Wegovy), are GLP-1 receptor agonists that enhance insulin secretion, reduce appetite, and promote weight loss.

Dr Allred then shares his personal experience, noting that patients on GLP-1 therapy, prescribed by their primary care physicians, showed remarkable improvements in their hidradenitis suppurativa (HS) symptoms. Observing these benefits, he began prescribing GLP-1 agents himself. Although randomized controlled trials directly linking GLP-1 agents to HS improvement are lacking, clinical observations align with the understanding that obesity-related systemic inflammation impacts dermatologic conditions like HS and psoriasis.

The conversation then shifts to discussing weight management with patients. They stress the importance of empathy and understanding, particularly for patients with HS who may find exercise counterproductive due to flare-ups. By explaining that reducing systemic inflammation through weight loss can significantly improve HS symptoms, they find patients more receptive to GLP-1 therapy.

Finally, they cover the practical aspects of integrating GLP-1 prescribing into dermatologic practice. Drs Allred and Cameron advise on patient assessment, including checking BMI and potential contraindications like a history of thyroid cancer. They highlight the importance of monitoring basic labs, such as glucose, hemoglobin A1c, and lipid profiles, to track the therapy’s impact and support insurance approvals.

Tune in to learn how dermatologists can leverage GLP-1 agents to improve patient outcomes by addressing the inflammatory underpinnings of conditions like HS and enhancing overall quality of life.

They begin with rosacea, with Dr Del Rosso explaining the historical perspective and highlighting a landmark article that classified the condition into subtypes. This classification system, although useful, has led to some confusion over the years. He discusses the condition’s complexity and the need to reconsider the traditional subtypes. He stresses the importance of evaluating patients individually, considering the phenotype presented during consultations, and understanding the interplay between erythema, papules, and pustules.

The conversation then shifts to hidradenitis suppurativa (HS) and other disease states, with Dr Del Rosso emphasizing the need for therapies to evolve alongside our understanding of the disease. He points out that package inserts often lag behind current clinical practices, and highlighting the disconnect between FDA-approved prescribing information and real-world application and experience, encourages dermatologists to stay informed about the latest pathophysiological insights and therapeutic options.

Advocating for a personalized approach to dermatologic care, they discuss recognizing that therapies within the same class can behave differently across various disease states and patient populations. They emphasize the value of real-world studies in capturing the practical application of treatments, contrasting with the controlled settings of phase 3 clinical trials.

As the episode draws to a close, Drs Dunn and Del Rosso reflect on the dynamic nature of dermatologic practice, encouraging listeners to stay informed and adaptable. They highlight the importance of reassessing traditional approaches considering evolving evidence. This episode offers a comprehensive overview of the current landscape of dermatologic therapies, providing listeners with actionable insights and a deeper understanding of how to navigate the complexities of modern dermatologic practice.

They begin by discussing some common pitfalls that can lead to missed diagnoses. Dr Cockerell emphasizes the importance of proper biopsy techniques, noting issues such as inadequate superficial biopsies that miss diagnostic areas and improper punch biopsies that fail to assess critical features. He also addresses insufficient preset menu options in EMR systems that lack necessary detail, advocating for including clinical photographs with unusual skin biopsies to improve diagnostic accuracy.

They then expand on the topic of the underutilization of EMR systems to send clinical photographs to dermatopathology labs, urging more offices to adopt this practice to provide valuable context for difficult cases.

Dr Cockerell then shares his journey of continuous learning, having pursued multiple MBAs and a law degree. He emphasizes the value of business and legal knowledge in medical practice, noting that his MBA education helped him with personal finance, hiring, leadership, and people skills, while his law degree provided valuable insights into understanding legal documents and advocating for his rights.

Dr Del Rosso and Dr Cockerell then speculate on the increasing rates of burnout among dermatologists and emphasize the importance of hobbies and interests outside of medicine, with both agreeing that diversifying one's interests is crucial to maintaining passion and satisfaction in one's career.

Tune in to the full episode for more valuable insights into improving dermatology practices, the importance of continuous learning, and strategies for maintaining work-life balance to prevent burnout.

They begin by highlighting the importance of setting patient expectations early and communicating that initial treatment plans are not binding and can be adjusted based on patient feedback and treatment efficacy.

They explore the challenges of getting systemic treatments approved for conditions affecting areas like the scalp, hands, feet, or nails, which may not respond well to topicals but often require step therapy before systemic agents are approved.

Sharing strategies for streamlining the approval and appeals process, Dr Song explains the value of referencing expert panel guidance to support treatment plans and how using prepopulated templates from organizations like the HS Foundation can streamline approvals and strengthen appeals for off-label usage of drugs like infliximab.

Both doctors stress the importance of thorough documentation, highlighting the need for effective note-taking that includes the key phrases payers look for to reduce denial rates. Dr Song notes the significance of understanding the requirements of major payers and maintaining a log of these requirements to stay current.

The episode also covers the concept of bridge programs, which, while beneficial on paper, can be labor-intensive to maintain. Dr Song advises using them judiciously, opting for reasonable alternatives when possible, so long as it does not compromise patient care.

Tune in to the full episode for a detailed look at the ins and outs of clinical decision-making, medication approval, and the importance of clear communication and conscientious documentation in dermatologic practice.

They begin by discussing the significance of patient history, emphasizing the importance of context clues like family history, seasonal variations in symptoms, and quality of life impacts in forming a comprehensive understanding of the individual.

They also address navigating the challenges of gathering family histories, noting that despite challenges in obtaining accurate details, it's crucial to maintain a broad perspective while making diagnoses, focusing on key features while not losing sight of supportive aspects.

Next, they highlight diagnostic challenges, emphasizing the need to consider atypical presentations and always keep a range of differentials in mind. Dr Golant discusses using therapeutics as both a treatment and diagnostic tool, with an emphasis on reassessment if treatment expectations are not met. Trigger factors are also explored, with both doctors sharing anecdotes that illustrate the impact of environmental triggers on symptoms.

The pair also discusses their differing approaches to making skin care recommendations to their patients, highlighting that this varies among practitioners with some providing liberal suggestions and others providing more specific guidance.

They then move on to discuss how they select treatments for their patients, noting that the integration of topical therapy is patient-dependent, with newer agents gaining traction due to improved tolerability. Systemic therapies, including monoclonal antibodies and JAK inhibitors, offer promising options, with treatment selection tailored to individual patient factors.

Looking ahead, they note that advancements in monoclonal antibodies and targeted therapies hold promise for improving AD management. They conclude their discussion by highlighting evolving guidelines and a shift away from corticosteroids towards more targeted therapies, signaling progress in the field.

Tune in to the full episode to hear more about using guidelines to inform a holistic approach to the management of atopic dermatitis!

They begin with an overview of the OX40/OX40 ligand pathway, a key regulatory mechanism believed to govern type 2 inflammation at its source. The OX40/OX40 ligand serves as a crucial costimulatory molecule, facilitating communication between immune cells. This interaction, occurring upstream in the inflammatory cascade, has become the focus of therapeutic interventions aimed at modulating AD.

They also highlight the impact of the heterogeneity of AD, characterized by various cytokine profiles and immune responses, emphasizing the significance of targeting the OX40/OX40 ligand pathway. By intervening at this early stage, it becomes possible to personalize treatment strategies and address the diverse manifestations of the disease.

They then discuss the potential of OX40/OX40 ligand modulation to influence immune memory, leading to sustained responses even after treatment cessation. Clinical data suggest the possibility of extended remission periods, enabling a shift towards disease modification rather than symptom control alone.

Looking ahead, the pair discusses how the integration of OX40/OX40 ligand-targeted therapies with existing treatments could yield synergistic effects, expanding treatment options for not only AD but also related inflammatory conditions.

Tune in to the full episode to learn more about this novel target and how it may revolutionize the management of a spectrum of immune-mediated diseases.

This episode is supported by Sanofi. The content included in this episode is independently developed by the Derms and Conditions team and their guest speakers, and reflects their own views and opinions.

The discussion begins with the host addressing concerns regarding the "authenticity" of AI and how Dr Kamangar developed a strong interest in AI, stemming from her engineering background and interest in health technology, particularly in the development of language-learning models. She explains the significance of ChatGPT opening the door publicly for AI, followed by specialized models revolutionizing AI accuracy. They then discuss the vetting process for AI accuracy, addressing both anticipated and logical errors and the more subtle errors seen in field-specific results. Dr Kamangar emphasizes the importance of using specialized AI models for dermatology to ensure the most precise results.

The discussion with both Dr Kamangar and Dr Armstrong also touches on the ethical considerations surrounding AI use in medical writing, highlighting the necessity of disclosing AI involvement to uphold integrity in academic publishing. Exploring the use of AI in electronic medical records (EMRs), Dr Kamangar and Armstrong underscore the importance of maintaining HIPAA compliance and the need for human oversight when integrating AI into EMRs and publications. They note that when implemented effectively, AI use in EMRs has the potential to reduce human errors, and with both medical record documentation and publication writing, has the potential to alleviate burnout.

The conversation then shifts to the role of residents in integrating AI tools into their practice, with Dr Armstrong noting that residents are often early adopters of new technologies. They also emphasize the importance of physician involvement in the early development of dermatology-specific AI solutions, which is essential for shaping tools that address real-world challenges in dermatologic practice.

Looking forward, they both anticipate continued integration of AI in dermatology practice, emphasizing the need for physicians to familiarize themselves with this technology to determine what models are dependable and ultimately to optimize patient care.

Tune into the episode to further explore the many nuanced challenges and opportunities presented by AI adoption in dermatology!

They begin by defining urticaria as a collection of conditions, explaining that this is often not well-delineated in textbooks or literature. Dr Hawkes categorizes urticaria into acute and chronic types, with chronic further divided into chronic inducible urticaria, which results from an identifiable trigger, and chronic spontaneous urticaria, which has no clear cause.

They then explore differential diagnoses for CSU, including drug-induced urticarial reactions and conditions like mastocytosis or urticarial bullous pemphigoid that require thorough consideration.

Transitioning to treatment strategies, they evaluate the use of systemic corticosteroids like prednisone for short-term relief in patients with CSU, taking into account reservations about long-term efficacy and potential side effects. Antihistamines are also highlighted for their rapid action, with Dr Hawkes encouraging prompt dosage adjustments if initial doses are ineffective.

The conversation shifts to omalizumab, an injectable anti-IgE monoclonal antibody that has waned in popularity among dermatologists due to practical limitations and concerns over anaphylaxis risk. However, it is highlighted as a very effective treatment option for many patients with CSU, as it is amenable to office administration with low rates of anaphylaxis in real-world practice and has a broad consensus for use in guidelines.

They conclude by touching on newer therapies in development that target alternative mechanisms, such as BTK and SYK inhibitors, which will broaden the therapeutic alternatives for patients with CSU.

Tune into the full episode to gain a deeper understanding of CSU and glean invaluable insights into the nuances of this multifaceted condition.

The conversation begins with a focus on a novel combination treatment for a challenging disease state: vitiligo. Dr Issa explores the potential of combining topical ruxolitinib with microneedling to promote repigmentation. He explains the rationale behind this approach, citing the proinflammatory cytokine milieu induced by microneedling, which can promote melanogenesis and repigmentation. He shares a successful case study involving a pediatric patient with segmental vitiligo who, after failing multiple other therapies, achieved significant repigmentation after undergoing this combined treatment.

The discussion then shifts to Dr Issa's experiences with observing responses in untreated areas of inflammatory disease after treating a specific area. They consider the possible mechanisms of action behind this phenomenon and discuss the case of pediatric patient with severe atopic dermatitis who saw improvement in untreated areas after applying tapinarof to symptomatic areas, suggesting a possibly systemic anti-inflammatory effect mediated by regulatory T cells.

Their discussion concludes by addressing the critical unmet need in the supply chain for epinephrine and the impact on clinical practice where lidocaine with ephinephrine is necessary for local anesthetic use. They discuss midodrine, an alpha-1-specific agonist, as an alternative to epinephrine, with findings indicating that midodrine allows for the reduction of epinephrine needed in lidocaine combinations and the significant effects observed at lower dilutions.

Tune in to the full episode to hear more about Dr Issa’s innovative approaches, groundbreaking research, and cutting-edge strategies that address critical needs in dermatology!

They begin by exploring the diagnostic hurdles associated with HS, with Dr Hsiao sharing insights to help clinicians navigate through potential misdiagnoses. She emphasizes the importance of recognizing subtle indicators of the disease and thinking outside the box when it comes to the location of lesions, as they may present in atypical areas. She also highlights the significance of recurrent history, which can serve as a diagnostic hallmark.

Next, the pair discusses comorbidities associated with HS, with Dr Hsiao detailing the importance of inquiring about patients' primary care arrangements. She notes that while dermatologists may not directly manage these comorbidities, they can play a vital role in identifying and initiating the necessary steps toward management.

The discussion then moves to the significant psychological impact of HS, emphasizing the necessity of open dialogue with patients about the psychological toll of HS and the benefits of seeking mental health support. Screening tools like the PHQ-2 can aid in identifying patients at risk and initiating necessary interventions.

They next address the limitations of current clinical guidelines for HS and the need for a paradigm shift towards intervening earlier in the disease process to prevent irreversible tissue damage.

The discussion concludes with the presentation of a clinical scenario describing a patient transitioning from oral antibiotics to a biologic, with Dr Hsiao outlining her suggested approach for such a patient.

In Part 1, Dr Del Rosso interviews David Light, cofounder and president of Valisure, an independent quality assurance company that aims to address a critical gap in the health care supply chain. Dr Del Rosso and Mr Light delve into the details regarding how a product review gets initiated, the financial source of such reviews, and the important differences between Valisure’s work and that of Good Manufacturing Practice (GMP) testing facilities. Finally, they address the impact that manufacturing issues have on the increasing incidences of drug shortages in the United States.

In Part 2, Dr Del Rosso continues his conversation with David Light to discuss stability testing—what it is, why it’s important, and how Valisure undertook stability testing on products containing benzoyl peroxide. Mr Light details the rationale for conducting accelerated stability testing at elevated temperatures to evaluate the safety of the products across their entire lifecycles. Dr Bunick also joins the conversation to comment on the misperceptions about FDA-allowable limits of benzene in consumer products and the urgent need for change in how products are evaluated and formulated to ensure patient safety first and foremost. Lastly, Dr Del Rosso and Dr Bunick discuss how dermatologists should counsel patients in the short term on minimizing the risk of benzene exposure while we await further testing, external validation, and regulatory guidance.

In Part 1, Dr Del Rosso interviews David Light, cofounder and president of Valisure, an independent quality assurance company that aims to address a critical gap in the health care supply chain. Dr Del Rosso and Mr Light delve into the details regarding how a product review gets initiated, the financial source of such reviews, and the important differences between Valisure’s work and that of Good Manufacturing Practice (GMP) testing facilities. Finally, they address the impact that manufacturing issues have on the increasing incidences of drug shortages in the United States.

In Part 2, Dr Del Rosso continues his conversation with David Light to discuss stability testing—what it is, why it’s important, and how Valisure undertook stability testing on products containing benzoyl peroxide. Mr Light details the rationale for conducting accelerated stability testing at elevated temperatures to evaluate the safety of the products across their entire lifecycles. Dr Bunick also joins the conversation to comment on the misperceptions about FDA-allowable limits of benzene in consumer products and the urgent need for change in how products are evaluated and formulated to ensure patient safety first and foremost. Lastly, Dr Del Rosso and Dr Bunick discuss how dermatologists should counsel patients in the short term on minimizing the risk of benzene exposure while we await further testing, external validation, and regulatory guidance.

Dr Rubin shares some of the challenges he has faced and explains the value of buy-and-bill for dermatologists, particularly in complex cases where medications may not be easily accessible through traditional pharmacies. They cover suitable medications, such as biologics for psoriasis, cutaneous T-cell lymphoma, and other conditions, as well as the financial benefits, clinical advantages, and patient convenience associated with in-office administration.

The conversation dives into the practical aspects of implementing buy-and-bill. They explore the importance of understanding insurance processes, obtaining prior authorizations, and tracking patient outcomes. The pair emphasize the need to start small, gradually expanding buy-and-bill capabilities while ensuring proper documentation and reimbursement. 

Dr Rubin offers rich practical advice and reiterates the importance of mentorship and seeking assistance from experts in billing and reimbursement. He also extends an invitation for further consultation via email and expresses his willingness to support colleagues in navigating the complexities of practice management. This episode is a valuable listen for dermatologists looking to optimize their practice operations and enhance patient care through buy-and-bill.

Dr Swanson discusses the recent FDA approval of cantharidin and berdazimer gel for molluscum contagiosum and the challenges of diagnosing single lesions. She highlights the importance of providing accurate information to schools and daycares about the contagiousness of the virus and the unnecessary quarantine measures that are often enforced.

The pair share their excitement about the ability to profoundly impact patients' lives with newer therapies for chronic conditions, particularly bimekizumab, an anti-IL17A and anti-IL17F for plaque psoriasis, and oral deucravacitinib, a TYK2 inhibitor for plaque psoriasis that now has 3-year efficacy and safety data.

They also discuss the presentation of herpes labialis in adolescents, with Dr Swanson emphasizing the marked severity of the primary outbreak, the importance of counseling these patients on managing outbreaks, and making efforts to destigmatize this condition among this population.

Dr Swanson also looks forward several anticipated FDA approvals which include lebrikizumab for atopic dermatitis, both topical tapinarof and topical roflumilast also for atopic dermatitis including young children, and the approval of topical ruxolitinib extended to younger children. She also emphasizes that emerging access to acne medications in children of younger ages is important as puberty develops earlier. She discusses the effectiveness of clindamycin, benzoyl peroxide, and adapalene as a once daily combination treatment for acne and the availability of topical clascoterone, an androgen receptor inhibitor, which can be used twice daily for both adolescent girls and boys with acne.

They conclude with a discussion on the importance of character and kindness in the field of dermatology based on a presentation at the meeting by special guest speaker Lori Greiner, which Dr Swanson demonstrates through her expressed willingness to help those without access to a pediatric dermatologist and an open-door policy for clinical consultation.

They begin by discussing Dr Armstrong’s history of professional interest in psoriasis. The conversation then moves to focus solely on tapinarof, a topical cream that works by modulating the aryl hydrocarbon receptor (AhR). 

Dr Armstrong explains the unique mechanism of action of tapinarof and its effects on Th17 cytokines, antioxidant activity, and skin barrier function. She also discusses the efficacy demonstrated in clinical trials, with nearly 40% of patients achieving PASI 75 after 12 weeks, as well as the remittive effect in maintaining clear or almost clear skin. 

They address the safety profile of tapinarof, including the occurrence of folliculitis and contact irritation, and provide tips for its use in clinical practice. Dr Armstrong also emphasizes its versatility and potential as a combination therapy with systemic medications. All in all, the episode provides listeners with an expansive understanding of tapinarof as an effective and well-tolerated nonsteroidal treatment for plaque psoriasis.

They cover a diverse slate of topics, including the 2023 allergen of the year (lanolin), notable advancements in psoriasis treatment including topicals and biologics, updates on diagnostic tools for melanoma, and clinical pearls for treating actinic keratosis with combinations of cryosurgery, topical field therapy, and PDT. The group reviews guidelines for atopic dermatitis and effective therapies like omalizumab and oral antihistamines for chronic spontaneous urticaria and secukinumab for hidradenitis suppurativa, as well as the need to improve outdated clinical guidance in the US. 

Together, they examine the evolving role of artificial intelligence in dermatology and underscore the importance of practitioner well-being. From new therapies to new indications, tune in to hear a poignant analysis of key themes from the meeting this year.

The pair discusses bimekizumab’s dosing schedule, with an induction dosing period of once a month for 16 weeks followed by maintenance dosing every 8 weeks, a unique feature compared with other IL-17 blockers. Dr Blauvelt emphasizes bimekizumab's exceptional efficacy, with rapid and sustained results, reaching close to 60% of patients achieving PASI 100 after a single dose and around 70% within a year.

The discussion includes comparisons with other IL-17 blockers, addressing the drug's suitability for different patient profiles. Safety considerations, such as oral candidiasis, are explored, with Dr Blauvelt providing insights into managing these side effects. The conversation delves into additional areas of interest, such as ongoing studies for psoriatic arthritis (PsA) and hidradenitis suppurativa (HS).

Regarding safety, they touch on topics like suicidal ideation and liver enzyme elevations. Dr Blauvelt emphasizes the importance of understanding the baseline risks associated with mental health issues in patients with psoriasis. The FDA's cautious approach is acknowledged, and Dr Blauvelt provides context, comparing bimekizumab with other biologics in terms of suicidal ideation data.

In summary, Dr Blauvelt expresses enthusiasm for bimekizumab as a new and highly effective option for patients with psoriasis, citing its remarkable efficacy and potential future indications for PsA and HS. The episode concludes with a discussion on scalp psoriasis and bimekizumab's positive impact on treating this condition.

To start, the episode delves into highlights from an interview with Dr Shane Chapman, who specializes in skin cancer. Dr Chapman shares insights into nonsurgical options for treating nonmelanoma skin cancer, focusing on strategies for cases of squamous cell carcinoma and nodular basal cell carcinoma that may not be amenable to surgical treatment for a variety of reasons.

Next, Dr Del Rosso features an episode with Dr Adam Friedman, who explores the topic of sensitive skin as a standalone entity. They highlight the prevalence of sensitive skin and the need for dermatologists to acknowledge and address this poorly understood condition with an open-minded approach.

In another segment, Dr Del Rosso revisits the work of Dr Matt Zirwas, who specializes in chronic dermatitis and inflammatory skin diseases. Dr Zirwas shares valuable insights on diagnosing scabies and addresses concerns about the differentiation of cutaneous T cell lymphoma from atopic dermatitis in older patients.

Dr Del Rosso concludes with a review of a 2-part series featuring Dr Jeff Donovan, who provides comprehensive insights into alopecia areata. Dr Donovan discusses the many mimickers of alopecia areata and when and how to conduct a biopsy. He reviews treatment options for alopecia areata and discusses the efficacy of newer agents, such as JAK inhibitors, to treat severe alopecia areata. The use of dupilumab in selected cases, especially in children with both alopecia areata and atopic dermatitis, is also reviewed. Other relevant suggestions from Dr Donovan include his perspectives on both clinical and laboratory assessments, his discussion of other inflammatory hair diseases, and tips on differentiating these other hair disorders from alopecia areata along with suggestions on management approaches.

Overall, Dr Del Rosso provides a comprehensive review, sharing insights and practical tips from featured experts. It was a great year for the Derms and Conditions podcast, mostly because of those who listened in and the expert faculty who shared their expertise so openly.

In conclusion, Dr Del Rosso encourages engagement and feedback from the audience to help shape the direction of future podcast episodes.

Dr Donovan begins the discussion by addressing autoimmune thyroid disease associated with alopecia areata and the appropriate laboratory interpretation and monitoring for these patients. He discusses the comprehensive baseline laboratory tests he collects before initiating JAK inhibitor treatment as well as how he approaches laboratory monitoring during the course of therapy.

Next, the pair addresses how to tackle low laboratory values, such as vitamin D and ferritin, that are associated with more severe alopecia areata. Dr Donovan emphasizes that when treating iron deficiency, patient comfort and adherence are paramount. The pair notes that patients genuinely appreciate a thorough and concerned clinician and how important it is to set appropriate patient expectations with treatment.

They then transition to the use of dupilumab in atopic children with alopecia areata who experience hair regrowth and how to determine which patients are more likely to respond to this treatment.

Next, Dr Del Rosso describes a difficult case of lichen planopilaris, and Dr Donovan shares key clinical and dermatoscopic findings and encourages clinicians to have a low threshold for biopsy when suspecting lichen planoplilaris or another disorder other than alopecia areata, some which may cause scarring. He discusses treatment with topical corticosteroids, intralesional triamcinolone injections, doxycycline, hydroxychloroquine, methotrexate, and cyclosporine in isolation and in combinations and what would constitute an appropriate trial on these therapies.

More data are needed on the use of JAK inhibitors for causes of inflammatory alopecia other than alopecia areata.

Dr Donovan concludes by mentioning education opportunities available in hair loss and his final words of wisdom regarding alopecia.

Tune in to this episode to learn all the details from a true hair expert!

Dr Donovan starts by discussing conditions that can mimic alopecia areata and when a biopsy may be needed to confirm the diagnosis, prompting him to share his suggestions on biopsy caliber, appropriate sites for biopsy, and utilizing the right pathologist to review the sample.

Next, the pair discusses topical treatments for patchy alopecia areata, including topical clobetasol and topical minoxidil, and the important role of intralesional corticosteroid injections. They then discuss available study data and experience with the use of oral baricitinib (a JAK inhibitor) and oral ritlecitinib (a JAK-3 and TEC kinase inhibitor) in patients with severe alopecia areata. Specific recommendations were reviewed including important efficacy and safety findings, clinical and laboratory monitoring, and certain limitations with currently available studies. Both look forward to promising developments that are anticipated with longer-term data for both baricitinib and ritlecitinib.

They conclude by discussing the use of minoxidil in alopecia areata, including anecdotal evidence. Dr Donovan notes that more studies examining the effects of minoxidil in alopecia areata are needed.

Tune in to the episode to find out more from a dermatologist who treats patients with hair disorders throughout his entire workday whenever he is in clinic!

They begin by discussing the current psoriasis treatment landscape and the perception that with effective biologics now on the market, there are no longer any unmet needs in psoriasis treatment. They reflect on the importance of having a variety of treatment options with differing mechanisms of action, which can address variability in patient response. They highlight the novel mechanism of action of bimekizumab, which provides dual inhibition of both IL-17A and IL-17F.

The pair then discuss the relationship between IL-17s and candidiasis, noting that while there is a broad spectrum of risk, it is usually minimal and manageable, typically presenting as oral thrush rather than serious systemic infections. Dr Rosen discusses how he counsels his patients about the increased risk of candidiasis when on an IL-17A-F blocker and the importance of balancing risk with the potential benefits.

They also delve into the data on bimekizumab, highlighting the favorable PASI 75 results seen at 4 weeks and how it compared to adalimumab, ustekinumab, and secukinumab in pivotal studies. Dr Rosen also discusses how the patient conversation can differ when counseling a patient on an IL-23 blocker compared to a drug with a simplified dosing regimen with an early onset of action.

The pair concludes by discussing the dosing regimen for bimekizumab, noting that it’s possible to reduce injection frequency after the initial 16 weeks of treatment and still sustain the same level of efficacy.

They also discuss evidence that may suggest adjustments to the bimekizumab dosing regimen may lower the risk of candidiasis.

Tune in to this episode to learn more about bimekizumab and its impact on the psoriasis treatment landscape!

Shane Chapman, Chair of the Department of Dermatology at Dartmouth Hitchcock Medical

Center, to discuss nonsurgical approaches to treating nonmelanoma skin cancer. 

Dr. Chapman begins by discussing topical treatment options for nonmelanoma skin cancer for

patients who are not candidates for surgery. He comments on the use of intralesional

chemotherapy for keratoacanthomas or squamous cell carcinomas in poorly healing areas or

when multiple lesions are present, compares the benefits of 5-fluorouracil and intralesional

methotrexate, and explains the benefits of using oral acitretin with intralesional therapy.

The pair then discuss intralesional methotrexate in more detail, explaining how methotrexate

and 5-fluorouracil can be interchanged or used in combination with PDT to treat

keratoacanthomas/squamous cell carcinomas. They also discuss how to approach a case of a

patient with a nodular basal cell carcinoma on her nasal tip who refuses treatment with surgery

or radiation.

Next, they discuss treatment of broader skin lesions, such as superficial or multifocal basal cell

carcinomas and detail imiquimod, 5-fluorouracil, and both red and blue light PDT as potential

treatment options.

To conclude, they discuss how to manage brisk imiquimod responses and the impact on

treatment duration. Tune into this episode to hear the full details and learn more!

Dr Friedman begins by describing his atlas project, created to address a gap in dermatology in the limited way textbooks and atlases portray skin conditions. The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas is a comprehensive resource that depicts dermatologic conditions across the full spectrum of skin tones to help dermatology professionals visualize the nuances in skin conditions.

Next, Dr Friedman discusses his research on sensitive skin and how he puts his findings into practice with his patients. He details his global study that looked in-depth at sensitive skin and what factors trigger and exacerbate it, highlighting the importance of dermatologists having tools to assess the condition and provide management strategies. The pair also touch on guiding patients on the use of products for sensitive skin and utilizing samples.

They conclude by discussing the importance of early intervention to prevent disease progression and the benefits of initiating more advanced therapies in earlier disease.

Tune into this episode to hear more about what’s on Dr Adam Friedman’s mind!

practice. First, he discusses topical alpha-agonist therapy for persistent facial erythema (PFE) of rosacea. Long-term data shows that daily use of either topical oxymetazoline or

brimonidine appears to “reset” (lower) the baseline level of PFE in patients with rosacea. 

Next, he talks about sub-antibiotic dosing of doxycycline and how its anti-inflammatory properties, including support of the dermal matrix, can be used for the treatment of

rosacea. He notes that studies have demonstrated reduced antibiotic selection pressure with decreased emergence of antibiotic-resistant bacterial strains with this therapeutic

approach. Additionally, monotherapy with sub-antibiotic dose doxycycline used as maintenance treatment has been shown to be effective in reducing relapse of papulopustular rosacea (PPR), an

approach that is appealing to those patients who do not prefer or are not compliant with topical therapy. Dr. Del Rosso then mentions sarecycline, a narrow-spectrum tetracycline FDA-approved for

the treatment of acne in patients > 9years of age, which has also been shown in a large pilot study to be effective for PPR.

Microbiological data demonstrates that the narrow antibiotic spectrum of sarecycline spares activity against many strains of bacteria, especially gram-negative organisms that

inhabit the GI tract.

He then transitions to hidradenitis suppurativa (HS) and the welcome emergence of IL-17 inhibitors for HS, which are very effective based on study results to date. Dr. Del Rosso

stresses the importance of early consideration of biologic therapies (such as anti-IL agents) for HS as this disease progresses below the skin surface with eventual development of sinus

tracts and scarring. If we wait until we “see” these consequences, it is too late as they have already occurred. FDA approvals and published guidelines typically depend on visibly

seeing the clinical manifestation before a specific therapy is recommended, which is not early enough in many cases.

He finishes with a discussion on dupilumab for the treatment of atopic dermatitis, which is often remarkably effective, but at times may be limited by partial efficacy or side effects

such as conjunctivitis and facial erythema. Dr. Del Rosso discusses practical use of JAK inhibitors, such as abrocitinib and upadacitinib for AD in dupilumab “non-responders”,

and also case reports with tralokinumab, a monoclonal antibody targeting IL-13. Tune in to this episode to learn more!

Dr Del Rosso begins by asking Dr Frye about her approach to advising the general patient on their skin care. She notes that interest in skin care has grown tremendously, and dermatologists are rightfully being increasingly viewed as the foremost skin care experts. She recommends that dermatologists embrace and directly incorporate skin care into management recommendations for patients and should also consider offering products to patients directly in the office for efficiency and convenience. She also stresses the importance of validating the patient’s concerns by confirming that their dermatologist is the appropriate person to consult.

Next, Dr Del Rosso delves deeper into Dr Frye’s more specific recommendations for skin care. She notes that while it is difficult to generalize, data supports typical concerns that are more prevalent in certain populations, such as hyperpigmentation with darker skin tones. She recommends incorporating toners with salicylic acid and glycolic acid into acne treatment routines to tackle pigmentation. Additionally, she acknowledges that patients reluctant to discontinue using an unessential type of skin care product that may not be optimal for their skin should instead be switched to a better alternative to maintain the patient-physician relationship. 

They then switch topics to discuss skin care tips for dry skin. Dr Frye mentions that African American patients should use moisturizers rich in ceramides, as their skin is likely to be more deficient in this lipid based on current evidence. She emphasizes the need for open discussion and education about these skin care trends with patients. Dr Del Rosso finishes by asking about some common helpful ingredients. Dr Frye notes that ascorbic acid has beneficial antioxidant properties. She also favors niacinamide 3-5% for its antioxidant activity and recommends having glycolic acid in moisturizers specifically for concerns with dyschromia. Tune in to this episode to learn more!

Dr Bunick begins by discussing dupilumab, an IL-4 and IL-13 blocker with significant clinical efficacy and a favorable safety profile in treating atopic dermatitis (AD). He states that in a network meta-analysis, upadacitinib and abrocitinib were shown to be more effective at treating AD than dupilumab, but dupilumab was shown to be more efficacious than tralokinumab and lebrikizumab. He and Dr Del Rosso agree that despite being part of a similar class, each IL-13 blocker should be applied and understood individually. They note several cases where patients who responded poorly to dupilumab had a beneficial response to tralokinumab, despite having similar mechanisms of action.

Next, they discuss IL-13 signaling, which is increased and more persistent in tissues compared to other cytokines. However, Dr Bunick explains that IL-4 has more potent signaling, so IL-13 isn’t necessarily more clinically relevant. He notes that more research is required to further understand the structure-function mechanisms of cytokines in the cell. He then mentions the non-canonical receptor, aka the “decoy receptor”, for IL-13, which could also explain a difference in drugs within the same class. Dr Del Rosso concludes that switching from one IL-13 blocker to another in a patient who was initially unresponsive to treatment may be more favorable than escalating to an alternative class of medication.

Dr Del Rosso then discusses Dr Bunick’s recent publication that compared the adverse effects of common immunosuppressive drugs to those of upadacitinib and abrocitinib in the treatment of AD. While the study population that used the common immunosuppressives did have comorbidities outside of AD, Dr Bunick notes that the risk of adverse events still exists for those treatments in AD and is not present only in JAK inhibitors. Dr Del Rosso states that many risk factors can contribute to adverse events, and not all responsibility should be shifted to JAK inhibitors. Tune in to this episode to learn the complete details about monoclonal antibodies and JAK inhibitors!

Next, Dr Del Rosso discusses clascoterone 1% cream, FDA approved for twice daily use for acne in patients aged 12 years and older with no limitations on duration of use. He explains findings from a recently published study that show even with the maximum use of clascoterone, 4 to 6 times greater than the normal 1-gram dose, there were no clinically significant hyperkalemia readings, adverse events, or EKG changes in any participant in the control or experimental groups. Given its topical use, negligible systemic absorption especially when used as recommended, and the findings of this study, Dr Del Rosso agrees that clinicians should be reassured about the lack of risk of hyperkalemia with clascoterone use.

Lastly, Dr Del Rosso switches focus to Janus kinase (JAK) inhibitors and biologics. He discusses where the boxed warnings for JAK inhibitors originated and why they are not as concerning overall with oral JAK inhibitors used for dermatologic indications in younger populations who exhibit fewer comorbidities and/or concomitant therapies. In addition, he notes that the risk of several side effects of special interest, such as lymphopenia, malignancy, and thromboembolic events are quite low. He also emphasizes that not all monoclonal antibodies with similar modes of action exhibit the same pharmacologic and therapeutic profiles. In a selected case where a patient with AD has an inadequate response or adverse event such as persistent conjunctivitis caused by dupilumab (which inhibits IL-13 and IL-4), case reports have shown that changing to another monoclonal antibody that inhibits IL-13 (ie, tralokinumab) can exhibit relevant efficacy without associated conjunctivitis. Ultimately, it is good for clinicians to have options and as much data as possible to differentiate their use. He concludes that although certain drugs are part of the same category or class, they all have differences in pharmacokinetics, and the benefits and differences of each drug must be understood to optimize treatment selection for individual patients.

Tune in to this episode to learn all the valuable clinical pearls surrounding many commonly confused therapies!

Dr Del Rosso begins by introducing sarecycline, a major new antibiotic in dermatology, and has Dr Bunick discuss some of his research on the medication. Dr Bunick explains how the recent scientific findings on the biochemistry of sarecycline translate clinically and have allowed us to not only advance our understanding of sarecycline but also other tetracyclines, including minocycline and doxycycline. Drs Del Rosso and Bunick follow this up by agreeing on the importance of dermatologists having a strong understanding of tetracyclines given their prevalence and frequency of use in clinical practice.

Next, they switch focus to C. acnes, and Dr Bunick discusses his new findings on the ribosomal structure of C. acnes through the use of cryo-electron microscopy and how tetracyclines interact with it. Dr Bunick’s research group found that sarecycline binds C. acnes at both the 30S ribosomal subunit and a new additional ribosomal binding site, which had not previously been discovered. In addition, Dr Bunick notes how these variations in the mechanism of action can explain why tetracycline antibiotics have different properties, such as side effect profiles, despite being in the same chemical class. Drs Bunick and Del Rosso further solidify this point by explaining how similar research has established differences between PDE4 inhibitors such as roflumilast.

Finally, they discuss antibiotic resistance in acne and how clinicians can better select therapies. Dr Bunick explains that sarecycline has the lowest rate of antibiotic resistance amongst tetracyclines because it targets C. acnes through 2 ribosomal binding sites and has an mRNA interfering carbon side chain that no other tetracycline possesses. Overall, Drs Bunick and Del Rosso agree that there is substantial scientific evidence on the effectiveness of sarecycline that supports its use by clinicians. Tune in to this episode to learn more about the new developments on antibiotics being discovered at a molecular level in the treatment of acne!

They begin by recounting how teledermatology became as widespread as it is and its evolution during the COVID-19 pandemic. Even though its use has slowed down as people have returned to in-person visits, Dr Serota shares his reasons that it will remain a valuable asset to clinicians for years to come.

Next, Dr Del Rosso voices the concerns of many physicians regarding diagnostic limitations with telehealth and liability concerns if you do not do a full exam. Dr Serota points out that there has never been a successful malpractice lawsuit due to misdiagnosis in telehealth, and you can avoid problems by setting expectations and discussing limitations with the patient in advance.

Finally, Dr Serota shares his tips and pitfalls for incorporating teledermatology into your practice. Whether you want to add in a few telehealth visits to your practice or completely transition to remote work, this episode is filled with pearls to help you get started.

Dr Del Rosso begins by asking Dr Webster about any major changes to acne dogma over the last few decades. Dr Webster points out that while our knowledge is constantly evolving, our understanding of acne hasn’t changed as drastically as it has for diseases such as psoriasis. We know the 4 common pillars for acne pathophysiology, and we know the immune system is involved. The main mistake we have made is placing too much weight on newer data and ignoring older, equally robust data.

Next, they switch focus to antibiotics, and Dr Del Rosso asks about their role in acne management. Dr Webster finds topical antibiotics such as erythromycin and clindamycin ineffective as monotherapy due to drug resistance. However, benzoyl peroxide has not been shown to create resistance and therefore remains very effective. They also discuss oral antibiotics and some of the newer narrow-spectrum options like sarecycline.

Dr Del Rosso then asks Dr Webster about a hypothetical but very common case of a patient with moderate acne and how he would approach treatment. Dr Webster states that he disagrees with stepwise therapy and believes you should use your clinical experience to start with the right medication, right away. You should also identify what the patient’s goals are and recognize what they are willing to tolerate with regard to treatments. He notes that after about 4 to 6 weeks of treatment, he can tell if a therapy is having a beneficial effect or if he needs to recommend a stronger option. Finally, they discuss isotretinoin and key considerations surrounding its usage. Tune in to this episode to learn more!

Dr Del Rosso begins by asking how to learn more about the science and evidence behind specific supplements and diets. Dr Sivamani advises starting with medical literature and evaluating publications with a search of PubMed or even Google. He suggests specific integrative medicine journals such as the Journal of Integrative Medicine and the Journal of Complementary and Integrative Medicine. However, he notes that even the Journal of the American Academy of Dermatology and British Journal of Dermatology will publish on nutrition and cosmeceuticals. Regarding social media posts or blogs, Dr Sivamani advises considering the source–is it a board-certified dermatologist or a local beauty educator?

Next, Dr Sivamani discusses how to counsel patients on the evidence behind making certain holistic changes using atopic dermatitis as an example. Even for his naturopathic patients, he can obtain their consent to start a biologic or other systemic medication by discussing how to approach their symptoms from multiple facets. This can be particularly helpful for conditions such as acne where patients are often concerned with what they are eating. Tune in to this episode to learn more about integrative dermatology and how you can incorporate it into your practice.

Dr. Zirwas shares several pearls for differentiating among atopic dermatitis, psoriasis, photosensitive dermatitis, CTCL, and contact dermatitis, and describes a new method for diagnosing scabies. He also discusses when to perform a biopsy and management approaches when the biopsy does not provide a clear answer.

Dr. Zirwas then names several topical products with low allergenicity, including everything from cleansers and moisturizers to detergents and fabric softeners, that are beneficial to patients with sensitive skin. Dr. Del Rosso asks about disease-directed therapy and systemic treatment options, prompting Dr. Zirwas to dive into his medications of choice for each phenotype and patient population.

This episode is full of pearls for a variety of eczematous and inflammatory dermatoses, so tune in to learn more!

Patients often wonder if they need to use sunscreen when the UV index is low, if sunscreen is necessary for patients with darker skin tones, what the difference is between organic and inorganic sunscreens, and if sunscreen is safe for the environment. Dr. Del Rosso and Dr. Rigel answer all of these questions and many more, so tune in to this episode to learn how to counsel your patients and improve their sunscreen usage.

Dr. Zirwas begins by recounting his experiences with dermatitis unspecified, also known as non-atopic adult dermatitis, and how he became interested in treating this complex disease. Dr. Del Rosso asks how to differentiate between this disease and other similar diagnoses, prompting Dr. Zirwas to share his method for recognizing the many types of eczema and contact dermatitis.

Patients that receive this diagnosis often want to know what caused it and how it can be prevented. While the answer is not always clear, Dr. Zirwas provides his tips for counseling patients on possible triggers. This can include the food that they eat and its effect on the microbiome, as well as the many products they apply to their skin. Dr. Zirwas has plenty of suggestions for products with low allergenicity that these patients can try.

Finally, the two discuss the role nickel plays in contact dermatitis and how to differentiate between atopic dermatitis, allergic contact dermatitis, and irritant contact dermatitis. This episode is full of pearls for one of the trickiest diagnoses in dermatology, so tune in to learn more!

Dr. Blauvelt first discusses dupilumab and how this medication blazed the trail for the treatment of severe atopic dermatitis in patients with very limited options. Dr. Del Rosso clarifies the difference in mechanism of action between dupilumab and the newer drugs tralokinumab and lebrikizumab, and the two comment on how this impacts efficacy and safety. A common adverse effect seen with these drugs is eye related issues such as conjunctivitis and keratoconjunctivitis sicca, and they advise how to manage these conditions if they arise.

Next, Dr. Del Rosso switches focus to the FDA-approved oral JAK inhibitors for atopic dermatitis, abrocitinib and upadacitinib. The biggest concern with JAK inhibitors has been their safety profile and black box warnings. However, Dr. Blauvelt discusses how these black box warnings came from a trial for tofacitinib to treat rheumatoid arthritis in a patient population featuring older patients with cardiac comorbidities that were taking prednisone and methotrexate concomitantly. This episode is full of clinical pearls for using the newest and most efficacious drugs for atopic dermatitis, so tune in to learn more!

Drs. Lebwohl and Del Rosso discussed how specific cytokines can be targeted for a safer treatment of atopic dermatitis. They emphasized that the targeted therapies for atopic dermatitis do not have any boxed warnings and the treatment of cytokines, specifically interleukin-4 (IL-4) and IL-13, can significantly improve itching and dermatitis. Dr. Lebwohl discussed the inhibiting of IL-13 to make atopic dermatitis better and that blocking IL-4 and IL-13 was highly effective for treating atopic dermatitis.

In terms of utilizing less targeted therapies, Dr. Lebwohl stated that all the drugs they use work by knocking down IL-13 but with varying side effects. The use of old drugs such as methotrexate and cyclosporine has several side effects, and doctors need to be cautious about their usage.

With 11 biologic medications now available for psoriasis, Dr. Blauvelt recommends breaking them down into three categories based on mechanism: the original TNF blockers, the IL-17 blockers, and the IL-23 blockers. He suggests that dermatologists should have a go-to medication in each class and provides several tips on choosing the right class for the right patient based on efficacy, safety, and convenience.

Next, Dr. Del Rosso asks about the role these agents can play in affecting cardiovascular events for which psoriasis is a known risk factor. Dr. Blauvelt shares his favorite class of biologics for slowing down atherosclerosis, and recommends the best class for other common comorbidities, such as IBD, hepatitis or HIV infection, and cancer.

Finally, the two switch gears and discuss oral options for psoriasis and how deucravacitinib, recently approved by the FDA last September, fairs against other options. This episode is full of clinical pearls for managing your psoriasis patients with all the newest therapies, so tune in to learn more!

They begin by highlighting the landmark approval of dupilumab in 2017 and how it completely revolutionized treatment of the disease at a time when options were very limited. Now, with additional biologics and a few JAK inhibitors on the market, both discuss some tips for choosing between the drug classes based on patient characteristics. Importantly, they also discuss the black box warning for JAK inhibitors and how to counsel patients on what this means.

Next, they review some nonsteroidal topical medications including roflumilast, ruxolitinib, and tapinarof and their tolerability and efficacy. Finally, Dr. Golant provides some of her favorite clinical pearls from her years of experience treating atopic dermatitis. Tune in to hear her take on the growing options for atopic dermatitis!

Dr. Cohen takes us back to the beginning of his cosmetics journey and how he strategically chose an IPL device as his first purchase so that he could treat a variety of conditions important to his patients. He then reviews additional pearls and pitfalls as he looked to expand into other devices. These tips range from how to choose a device based on versatility and consumables, to how to counsel patients on what to expect throughout the treatment course. If you are looking to add any amount of procedural or cosmetic dermatology into your practice, you won’t want to miss this episode with a world expert in laser therapy.

The two begin by discussing the many benefits of AAD membership and what the AAD is currently doing to support its members. In an economy that has seen record levels of inflation, physicians have still had to face an 8.5% cut to Medicare reimbursements. Dr. Kaufmann explains how he is working to counteract these cuts, and how you can support this mission by reaching out to him directly to get involved or by donating to the SkinPAC. Finally, Dr. Kaufmann shares some of his favorite initiatives that he has worked on and some exciting ideas for the future. You won’t want to miss learning about his fruitful tenure as AAD president and everything he has done for the specialty.

The trio reviews important tips from a variety of topics, ranging from contact dermatitis to psoriasis. Many lectures from this meeting focused on the new biologics and JAK inhibitors available to treat inflammatory conditions such as psoriasis and atopic dermatitis. The group unpacks important considerations for each of these medications and how to effectively use them to improve patient outcomes. Finally, they discuss deucravacitinib and its unique mechanism of action of TYK2 inhibition. Tune in to hear our KOLs recap some of the best clinical pearls from the meeting!

They start with an overview of therapies with new mechanisms of action and discuss other medications that are in the pipeline. Dr. Strober then provides important tips for screening for psoriasis comorbidities. Since at least 1 in 5 patients will get significant psoriatic arthritis, and patients with moderate to severe psoriasis are at increased risk for cardiac events, Dr. Strober emphasizes that working with other specialists is critical to ensure comprehensive care.

Finally, Dr. Strober reviews the many benefits of deucravacitinib (SOTYKTU), including its once-daily oral dosing, excellent safety profile, and lack of lab monitoring. He notes that deucravacitinib is very effective, even more so than methotrexate, and comparable to cyclosporine but without all of the side effects. He discusses the unique mechanism of action of TYK2 inhibition and how this targeted action limits the drug’s side effects and allows it to avoid the black box warning that other JAK inhibitors carry. Tune in to this episode to learn more about this new drug that Dr. Strober believes will revolutionize psoriasis management. 

Host James Q. Del Rosso, DO, explains the value of occasionally going back and listening to past episodes as some "pearls" always seem to emerge that were missed during the initial listening of the podcast. Some of the greatest hits from episodes released in 2022 were highlighted. This includes perspectives on managing actinic keratoses (Dr. Mark G. Lebwohl, MD), a review of the "STOP" approach to rosacea which incorporates effective patient collaboration (Dr. Julie C. Harper, MD), ways to integrate aesthetic and cosmetic dermatology into your medical dermatology practice (Dr. Patricia K. Farris, MD), and a discussion of how tumescent anesthesia can expand the range of procedures that dermatologists can effectively and safely perform in the office (Dr. Sandra Lee, MD).

Many thanks for listening and we look forward to Season 3 in 2023.

Dr. Glick emphasizes that TNF inhibitors remain a very important part of our psoriasis therapeutic armamentarium despite newer drugs coming to the market. About 30% of psoriasis patients will get psoriatic arthritis and TNF inhibitors are very effective at treating both skin and joint disease. In addition, TNF inhibitors are used to treat inflammatory bowel disease as well and are often selected by Dr. Glick to treat psoriasis if there is a family history of IBD.

Dr. Glick provides several valuable tips on recognizing the most common signs and symptoms of psoriatic arthritis and quickly but effectively screening patients at every visit. He also discusses several common clinical scenarios and how to choose the right drug for the right patient. Finally, he provides his thoughts on biosimilars and how they stack up against their counterparts. Tune in to learn more from an accomplished psoriasis veteran!

Dermatologists are in a great position to make the initial diagnosis of this rare disease as it involves the skin in 80-90% of cases. Dr. High discusses several clinical pearls about BPDCN including how it presents, important considerations for the dermatopathologist, and the best techniques to biopsy the lesion in order to maximize diagnostic yield. Finally, he reviews the next steps in disease management once the diagnosis is made. Dermatologists can have a significant impact on patient outcomes with BPDCN by making the diagnosis early, so tune in to this episode to learn more!

Dr. Cather is an expert in psoriasis as she is currently managing over 1,700 patients on systemic therapy. She and Dr. Del Rosso discuss the exciting new Mind.Px test, a dermal biomarker patch developed by Mindera Health that can noninvasively obtain a sample of a patient’s transcriptome to help determine which biologic they will optimally respond to. Dr. Cather describes how Mind.Px can limit trial-and-error through a targeted approach. Many patients lose faith in psoriasis medications after multiple treatment failures, so data from this test can uncover which drug class, either TNF-inhibitors, IL-17 inhibitors, or IL-23 inhibitors, will work best for them. Precision medicine is a hot new topic with a lot of new information to navigate, so tune in to this episode to learn Dr. Cather’s tips on using the Mind.Px test to improve your psoriasis patients’ outcomes!

Dr. Bunick begins by sharing his unique background and how he became interested in structural biology and the way medications work at a molecular level. Once he discovered his passion for Dermatology, he turned his attention to understanding antibiotics and how resistance develops. In this episode, he reviews new data on the effects antibiotics have on our microbiome and overall health. He also discusses sarecycline and how its unique properties compared to other tetracyclines help limit resistance and adverse effects. Since Dermatologists prescribe more antibiotics than any other specialty, this is definitely an episode you won’t want to miss!

This is a very unique episode of Derms and Conditions filled with clinical pearls for four conditions! Dr. Armstrong discusses two biologics that have great data for prurigo nodularis as well as a new topical JAK inhibitor for vitiligo. Dr. Cohen highlights some advances for atopic dermatitis while revealing the highly anticipated 2023 allergen of the year. Finally, the two share their thoughts on the landmark approval of deucravacitinib for psoriasis. Don’t miss hearing our KOLs discuss its novel mechanism, efficaciousness, and safety profile so that you can confidently answer your patients’ questions about this new therapy. Tune in today!

In this episode we diverge from the usual discussion of clinical conditions and get a unique view into the Glasers’ family dynamic and the impact that dermatology has had on these brilliant women.

You won’t want to miss these important pearls that can help you navigate this complex but exciting area of therapeutics.

Next, Dr. Del Rosso asks Dr. Merola about dermatomyositis including tips on diagnosis and which laboratory tests are best to order. Finally, Dr. Merola ends the episode with a focus on psoriatic arthritis, including key diagnostic tips to help differentiate it from other arthritic disorders. 

Next, Dr. Lio discusses his use of alternative medications in dermatology and the criteria he uses for selection of these therapies. Specifically, the use of coconut oil is highlighted. Dr. Lio ends the episode by offering some tips on how to select the appropriate patient and properly counsel them on JAK Inhibitors for the treatment of Atopic Dermatitis.

Finally, don't miss the ending where we learn about Dr Lio's passion for Pizza, his crust preference, and which pizza place in the US has 'changed his life'.

He offers some available resources for dermatologists who want to become better educated in the business area. The discussion emphasizes the central importance of quality patient care in any business model of dermatological practice. Finally, Dr. Lain offers some important tips and considerations for new dermatologists who are entering into practice. 

Next, Dr. Goldenberg discusses the use of precision medicine in helping to select the correct psoriasis biologic. Dr. Goldenberg stresses that precision medicine is a useful tool in dermatology but decisions must be made in conjunction with clinical judgment. The episode ends with Dr. Del Rosso highlighting some of the advantages precision medicine may have in selecting biologic medications for psoriasis. 

While Dr. Lee embraced this opportunity, it was not without its challenges. Dr. Lee addresses how she controlled blending her media life and image with her active dermatology practice and how she dealt with certain challenges and criticisms that she faced along the way. Their discussion concludes with highlighting an important area of education in office-based surgery that Dr. Lee is passionate about: practical and effective use of tumescent anesthesia by dermatologic surgeons for large surgical excisions. 

Specifically, Dr. Kircik highlights why the vehicle matters when choosing a topical therapy and why topical therapy is still important in the current clinical landscape. Additionally, Drs. Del Rosso and Kircik discuss different formulations of topical therapies along with their advantages and disadvantages.

Dr. Brownstone spends the next part of the episode discussing his recent clinical management recommendations article on delusions of parasitosis. He offers some tips and tricks to help dermatologists manage these often difficult patients. Finally, the episode ends with Dr. Brownstone discussing some exciting new updates with the journal. This is an episode you won't want to miss!

Dr. Armstrong highlights a new cream based formulation of calcipotriene-betamethasone and two new non-steroidal topical options for the treatment of psoriasis in the pipeline. Dr. Armstrong also highlights pearls from Dr. Kirby's lecture on HS including the use of antibiotics and proper injections techniques for steroids.

The episode ends with Dr. Cohen's discussion of the allergen of the year and Dr. Armstrong's discussion on the use of oral minoxidil in the treatment of hair loss. 

Specifically, they discuss bridging a patient to dupilumab with cyclosporine, how to effectively switch between different biologic therapies for psoriasis, and how to use apremilast effectively in patients with severe psoriasis. Finally, Dr. Del Rosso asks Dr. Armstrong about best practices for vaccination in patients on oral and biologic therapies for psoriasis and atopic dermatitis. 

Drs. Del Rosso and Zirwas also discuss a new non-steroidal, topical agent for pruritus. Dr. Zirwas discusses, in detail, the hypothesized mechanism of action for this novel agent and shares his success using it in his clinic. Finally, he briefly mentions some alternative oral agents for the pruritic patient.

Next Dr. Del Rosso asks Dr. Rossi for tips on treating keratoacanthomas of the lower extremities with subcutaneous methotrexate. Finally, Dr. Rossi discusses the use of immunotherapy in treating squamous cell carcinoma.

Topics include the use of adalimumab during surgery, risk of TB reactivation, and risk of malignancy. Dr. Han ends the episode by sharing his experience with telemedicine and how dermatologists can help shape its uncertain future. 

Dr. Strober further discusses in depth how certain JAK inhibitors interact with TYK2 and what he thinks are the most important points regarding this pathway in psoriasis pathophysiology. Finally, Dr. Strober discusses in detail why allosteric binding offers improved specificity in JAK inhibition.

Dr. Moody also discusses the use of hedgehog inhibitors and the role they play in the treatment. He reviews indications, side effects, and important pearls when teaching medical students and residents about the surgical and medical treatment of basal cell carcinoma. 

Dr. Desai discusses tips and methods for using chemical peels on patients with skin of color including advantages of certain chemical compounds, the use of chemical peels with topical acne medications and how to counsel patients about expectations and downtime.

He further discusses best practices for performing a chemical peel in different Fitzpatrick skin types and which conditions respond best. The episode concludes with Dr. Desai discussing a few new updates on the treatment of Vitiligo. 

Treatment for acne scarring is also discussed and Dr. Graber shares some tips and tricks for treating sequelae of acne. Dr. Del Rosso asks Dr. Graber how she integrates physical and medical treatments for rosacea and residual erythema associated with rosacea. Finally, Dr. Graber shares an in office pearl which involves the use of a hair dryer and a pulsed dye laser.

Dr. Del Rosso and Dr. Bhatia also discuss the optimal use of photodynamic therapy for actinic keratoses, both pre-procedural and post-procedure. Finally, Dr. Del Rosso poses an intriguing question and Dr. Bhatia shares a very important clinical pearl for management of dermatological issues in the Emergency Room.

Dr. Del Rosso and Dr. Friedman discuss many diverse topics on CBD including FDA regulations, counseling patients, and clinical studies on topical CBD gel in the treatment of xerosis and atopic dermatitis. They further discuss evidence regarding the risk of oral spironolactone in breast cancer recurrence along with effective ways to manage and counsel patients who have a personal or family history of breast cancer. 

Drs. Del Rosso and Zirwas discuss the origins of latex allergies and clinical patterns to recognize in hand, scalp, and face dermatitis, as well as some of Dr. Zirwas' favorite products for sensitive skin, including gloves for patients and medical professionals, deodorants, antiperspirants, hair coloring, and soaps.

Dr. McMichael has found that dermatology is full of wonderful relationships, and that this camaraderie has been the foundation for her success in mentoring residents, students, and even patients. “If you support people, and you make them know that you are confident in their ability […] they do infinitely better.” said Dr. McMichael. “If you want to have a really invigorating career that’s rewarding, you feed [them] and they feed you.”

For more information, visit https://fallclinical.health/derms-and-conditions-podcast-episode-02

David Cohen, MD

Vice Chair for Clinical Affairs and the Charles C. And Dorothea E. Harris Professor of Dermatology

NYU Langone Health

New York, NY

James Q. Del Rosso, DO

Co-director

Adjunct Clinical Professor (Dermatology)

Touro University College of Osteopathic Medicine

Henderson, NV

For more information, visit https://fallclinical.health/derms-and-conditions-podcast-episode-01

David Cohen, MD

Vice Chair for Clinical Affairs and the Charles C. And Dorothea E. Harris Professor of Dermatology

NYU Langone Health

New York, NY

James Q. Del Rosso, DO

Co-director

Adjunct Clinical Professor (Dermatology)

Touro University College of Osteopathic Medicine

Henderson, NV

Dermatologists all face a barrage of new information virtually every day that is difficult to keep up with and digest. In this podcast, you'll hear about clinical practice tips and treatment pearls that you can implement on a daily basis in your busy practice.

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