Dermatology Weekly

The COVID-19 pandemic has presented unique challenges for medical students applying to residency programs. In this episode, Candrice R. Heath, MD (@DrCandriceHeath), talks to Virginia Alvarado Jones, MD, MS (@GinaAlvaJones), and medical student Victoria Humphrey (@VictoriaSHumphrey) about their experience navigating the dermatology residency Match process during this application cycle. They provide tips and takeaways for the next group of applicants, including how to adapt to the virtual interview process and connect with mentors and fellow residents without regular in-person contact. Dr. Heath also talks to residency program director Ilana Rosman, MD (@ilanarosman), about how the past year has opened the door for much needed changes in the residency application process (begins at 28:50). “We had two pandemics this year, right? We have COVID, and we have racial injustice. And I think that's not new. That's obviously not new at all. But I think it really has come to the forefront. And I think those two things together have made all of us much more cognizant of how we go about the process of residency selection and application making sure that we can make it equitable, inclusive, and sustainable moving forward,” Dr. Rosman says. They also discuss a holistic approach to reviewing residency applicants and virtual mentorships. *  *  * Host: Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Virginia Alvarado Jones, MD, MS (California Pacific Medical Center, San Francisco; University of Illinois at Chicago); Victoria Humphrey (University of Pittsburgh); Ilana Rosman, MD (Washington University, St. Louis) Disclosures: Dr. Heath, Dr. Jones, and Dr. Rosman, as well as Ms. Humphrey, report no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Ethnic minorities and patients living in socioeconomically disadvantaged areas are disproportionately impacted by a growing national shortage of dermatologists. In this resident takeover, Sophie A. Greenberg, MD (Twitter: @sophiegreenberg; Instagram: @sophiegreenbergmd), talks to Soraya Azzawi, MD, about how dermatology residency can serve as an opportunity to address barriers to equitable care in these populations and enact change within the specialty: “There is a stark regional misdistribution of the dermatologic workforce, with specialists tending to concentrate in the urban areas, and more rural areas are largely underserved. And as we progress through residency and start thinking about the overall trajectory of our career, it's going to be important to consider how the imbalance of the dermatologic workforce will shape where we choose to practice and how that choice impacts vulnerable communities with the greatest unmet needs,” Dr. Azzawi explains. They discuss various systemic factors that limit care in vulnerable communities and highlight ways that dermatology residents can work to better understand and meet the needs of underserved patient populations. Article: https://www.mdedge.com/dermatology/article/238575/diversity-medicine/empowering-residents-address-socioeconomic-disparities Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT107003043_e.PDF *  *  * Host: Sophie A. Greenberg, MD (Columbia University Medical Center, New York) Guest: Soraya Azzawi, MD (University of Miami/Jackson Memorial Hospital) Disclosures: Dr. Greenberg and Dr. Azzawi report no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

This week, Amber Atwater, MD, the immediate past president of the American Contact Dermatitis Society, reviews some highlights from the meeting, which was held in March. Dr. Atwater, associate professor of dermatology at Duke University, Durham, N.C., discusses the 2021 “Contact Allergen of the Year,” a chemical that has been linked to reactions associated with shin pads and is an emerging allergen that was the topic of a recent report in Dermatitis. Joining Dr. Atwater, Raina Bembry, MD, a dermatitis fellow at Duke University, provides the results of a study of shoe allergens she presented at the meeting. which found that about 20% of shoe allergens are not detected with the current screening series. Dr. Atwater and Dr. Bembry are first and second authors of this paper, respectively; other authors are members of the North American Contact Dermatitis Group. Dr. Atwater also reviews the results of a study on the potential role of expanded series patch testing in residual facial dermatitis in patients treated with dupilumab (which received the Gold Alexander A. Fisher Resident Award at the meeting), a study on patterns of contact allergy in Black and White patients in Philadelphia over 10 years (which received the Silver Fisher Resident Award), a study of contact dermatitis information on different social media sites, and results of NACDG patch test results from 2017 to 2018. Dr. Atwater disclosed receiving the Pfizer Independent Grant for Learning & Change and consulting for Henke. Dr. Bembry had no disclosures. References: https://www.mdedge.com/dermatology/article/237677/contact-dermatitis/contact-allergen-year-found-foam-shin-guards-footwear https://www.mdedge.com/dermatology/article/237834/contact-dermatitis/check-all-components-cases-suspected-shoe-allergy https://www.mdedge.com/dermatology/article/237899/contact-dermatitis/contact-dermatitis-content-varies-among-social-media *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com

Recent studies have highlighted poor representation of darker skin types in dermatology textbooks and online resources. Vincent A. DeLeo, MD, talks to Jules B. Lipoff, MD (@juleslipoff), about the general paucity of images of skin of color in learning resources as well as an overrepresentation of darker skin types in material about sexually transmitted infections. “We should be teaching our students and our residents. It shouldn’t be just a skin of color lecture. Skin of color should be through every lecture. We should be showing how everything presents in every skin type,” Dr. Lipoff notes. They also discuss the flaws in the Fitzpatrick skin type system. Article: https://www.mdedge.com/dermatology/article/236888/diversity-medicine/distribution-skin-type-diversity-photographs-aad Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT107003157.PDF *  *  * Host: Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guest: Jules B. Lipoff, MD (department of dermatology, University of Pennsylvania, Philadelphia) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Lipoff reports no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com

In 2019, the two CPT codes for skin biopsies were replaced with sex new codes that specify biopsy technique and associated procedural complexity. Vincent A. DeLeo, MD, talks to medical student Sheena Desai and Rebecca I. Hartman, MD, MPH, about this CPT change and its effect on the frequency of shave versus punch biopsies in both private and academic practices. “The average dermatologist needs to be cognizant of the fact that changing reimbursements may hypothetically influence [the] provider’s decision on what biopsy type to perform,” Ms. Desai notes. They also explain how this data can be extrapolated at a national scale. Article: https://www.mdedge.com/dermatology/article/236840/practice-management/comparison-shave-and-punch-biopsy-utilization-among Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT107003151.PDF *  *  * Host: Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: Sheena Desai, BS (department of dermatology, Brigham and Women’s Hospital, Harvard Medical School, both in Boston); Rebecca I. Hartman, MD, MPH (department of dermatology, Brigham and Women’s Hospital, Harvard Medical School, and the department of dermatology, Jamaica Plain (Mass.) Veterans Affairs Medical Center) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Ms. Schwartzberg and Dr. Hartman report no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com

COVID-19 affects multiple organ systems, and skin manifestations are prevalent. Dr. Vincent DeLeo talks to medical student Lauren Schwartzberg and Ann Lin, DO, about both common and rare cutaneous presentations of COVID-19. “I think it’s important to look at the unexplained rashes a little differently now than ever before the COVID era ... a thorough history of COVID-19 exposures and perhaps even COVID-19 testing should be considered,” Ms. Schwartzberg notes. They also discuss differences in presentation seen in adult and pediatric patients. Article: https://www.mdedge.com/dermatology/article/235467/infectious-diseases/cutaneous-manifestations-covid-19 Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT107002090.PDF *  *  * Host: Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: Lauren Schwartzberg, OMS-IV (New York Institute of Technology College of Osteopathic Medicine, Old Westbury); Ann Lin, DO (department of dermatology, St. John’s Episcopal Hospital, Far Rockaway, N.Y.) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Ms. Schwartzberg and Dr. Lin report no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com

Recent surveys show that dermatologic examinations tend to neglect the genital area. In this resident takeover, Sophie A. Greenberg, MD (@sophiegreenberg), talks to Margaret Maria Cocks, MD, PhD (@Margaret_Cocks), about the lack of focus on the genital area in the total-body skin examination (TBSE), especially in female patients, and the paucity of training on genital examinations in residency. “While [melanoma] is rare, a lot of the time when genital melanomas are identified, they’re often found later and more aggressive stages ... partially that might be because this area is not routinely examined by any care provider,” Dr. Cocks notes. They also discuss practical tips for including the genital area in the TBSE while focusing on patient comfort as well as diseases that may be overlooked by omitting the genitals in a TBSE. Article: https://www.mdedge.com/dermatology/article/236692/practice-management/genital-examination-dermatologic-practice?channel=28253 Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT107002029_e.pdf *  *  * Host: Sophie A. Greenberg, MD (department of dermatology, Columbia University Medical Center, New York) Guests: Margaret Maria Cocks, MD, PhD (department of dermatology, University of Utah, Salt Lake City) Disclosures: Dr. Greenberg and Dr. Cocks report no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dr. Murad Alam, professor of dermatology and chief of cutaneous and aesthetic surgery in the department of dermatology at Northwestern University, Chicago, discusses recently released evidence-based recommendations on preventing and treating adverse events from injectable fillers. A recent paper outlines recommendations from an American Society for Dermatologic Surgery (ASDS) multidisciplinary task force. The paper was published in the February issue of Dermatologic Surgery (Dermatol Surg. 2021 Feb 1;47(2):214-26). Dr. Alam also provides an overview of a new patient safety database – the Cutaneous Procedures Adverse Events Reporting (CAPER) system -- a collaboration between Northwestern’s department of dermatology and the ASDS Association (ASDSA). Dr. Alam is a past ASDS president and current chair of the ASDSA’s Federal Affairs Work Group. He had no disclosures. References: ASDS issues first filler safety recommendations Dermatologic surgeons debut adverse event reporting database                                            * * *        You can find more of our podcasts at: http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Medical professionals play an important role in educating the public about COVID-19 vaccination. In this episode, Dr. Candrice Heath (@DrCandriceHeath) talks to A. Shadi Kourosh, MD, MPH (@AskDermMD), and Maritza I. Perez, MD, about the impact of the COVID-19 vaccine on dermatology practices. Dr. Kourosh explains how dermatologists can counsel patients on timing of cosmetic procedures such as fillers in relationship to vaccination. They also discuss skin reactions. “I think a take-home message is that there are a variety of different [skin] reactions but that we know what they are and that they’re manageable. So the most important thing is that everyone go ahead and get vaccinated – that we as a medical community need to send our patients a message that these reactions are not in any way an obstacle to vaccination,” Dr. Kourosh advises. Dr. Kourosh and Dr. Perez also discuss how in-office procedures have changed as more patients and physicians are vaccinated. *  *  * Host: Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: A. Shadi Kourosh, MD, MPH (Harvard Medical School, Boston; Massachusetts General Hospital, Boston); Maritza I. Perez, MD (University of Connecticut, Farmington; Icahn School of Medicine at Mount Sinai, New York) Disclosures: Dr. Heath reports no conflict of interest. Dr. Karoush reports no conflict of interest. Dr. Perez reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Before the COVID-19 pandemic, telemedicine largely was underutilized in dermatology. Vincent A. DeLeo, MD, talks to George Han, MD, PhD, about the progression of the reimbursement process and the roadblocks encountered with the expansion of telemedicine. “To me, telemedicine really represents the opportunity to make a dent in access to care ... expanding our access to care, especially in underserved areas in places where a lot of people have barriers, people of lower socioeconomic status, skin of color ... there’s a lot of populations out there where we’re just not able to get the level of coverage and access to dermatologic care that we want,” Dr. Han notes. They also discuss the emergence of direct-to-consumer telemedicine services and how dermatology practices can compete. Article: https://www.mdedge.com/dermatology/article/235459/infectious-diseases/reimbursement-teledermatology-during-covid-19-public Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT107002061.PDF *  *  * Host: Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guest: George Han, MD, PhD (Icahn School of Medicine at Mount Sinai, New York) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Han reports no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com

To truly increase diversity in dermatology, students of color need to be encouraged that dermatology is achievable. In this resident takeover, Sophie A. Greenberg, MD (@sophiegreenberg), talks to Nicole A. Negbenebor, MD (Instagram: @naijalatte), about her personal experience navigating dermatology residency as an applicant of color. “Dermatology is such a wonderful field and I feel that it has had the ability to impact so many different people, different socioeconomic statuses, different backgrounds, but unfortunately the workforce does not reflect the population sometimes that they’re serving,” Dr. Negbenebor notes. They also discuss the importance of mentorship and networking opportunities, and Dr. Negbenebor offers advice on the dermatology residency application process. Article: https://www.mdedge.com/dermatology/article/235130/diversity-medicine/advice-applying-dermatology-applicant-color-keep-going?channel=64 Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT107001015_e.PDF *  *  * Host: Sophie A. Greenberg, MD (department of dermatology, Columbia University Medical Center, New York) Guests: Nicole A. Negbenebor, MD (department of dermatology, Brown University, Providence, R.I.) Disclosures: Dr. Greenberg and Dr. Negbenebor report no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Lorenzo Norris, MD, host of MDedge Psychcast, talks with Scott A. Norton, MD, MPH, MSc, and John Koo, MD, about delusions of infestation, weighing in on the diagnosis and management of patients with this challenging disorder, and more. Dr. Norton is a dermatologist and preventive medicine specialist at the Uniformed Services University of the Health Sciences in Bethesda, Md. Dr. Koo is professor of dermatology at the University of California, San Francisco, and is a dermatologist and board-certified psychiatrist. Dr. Norton and Dr. Koo had no relevant disclosures.  Reference Delusional infestation surges during COVID-19 pandemic     

Mobile applications are useful to educate medical students and trainees; however, there is no objective method to assess their quality. Vincent A. DeLeo, MD, talks to Babar Rao, MD, about determining the usefulness and credibility of dermatology educational apps including factors such as affordability, accuracy, and ease of use. “I think we will be dependent on digital learning, so the only way to really move forward is to get involved. ... I think we have to get involved and make sure that what is available on these digital educational portals is also as relevant or as accurate as our printed material,” Dr. Rao notes. They also discuss the shortcomings found in such apps, such as conflicts of interest and glitches in software performance. Article: https://www.mdedge.com/dermatology/article/233009/aesthetic-dermatology/mobile-apps-professional-dermatology-education Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106006321.PDF *  *  * Host: Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guest: Babar Rao, MD (Center for Dermatology, Robert Wood Johnson Medical School, New Brunswick, N.J., and the department of dermatology, Weill Cornell Medicine, New York) Disclosures: Dr. DeLeo is a consultant for Estée Lauder.  Dr. Rao reports no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com

Access to dermatologic care in rural areas is a growing problem. Dr. Vincent DeLeo talks to Robert T. Brodell, MD; Cindy Firkins Smith, MD; and medical student Alexandra Streifel about the influence of rural clinical experiences during residency, which may increase the likelihood of trainees establishing a practice in these isolated areas. “Rural areas are tremendously underserved. [Patients] are waiting months to get appointments. And so if we can increase the number of rural dermatologists, it’s primarily good for patients,” Dr. Smith notes. They also discuss telemedicine and its role in rural dermatologic care. Article: https://www.mdedge.com/dermatology/article/234121/health-policy/rural-residency-curricula-potential-target-improved-access Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT107001054.PDF *  *  * Hosts: Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: Robert T. Brodell, MD (department of dermatology, University of Mississippi Medical Center, Jackson); Cindy Firkins Smith, MD (Carris Health, Willmar, Minn.); Alexandra Streifel, BA (University of North Dakota, Grand Forks) Disclosures: Dr. DeLeo is a consultant for Estée Lauder.  Dr. Brodell, Dr. Smith, and Ms. Streifel report no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com

In the news: Dermatologist survey spotlights psoriasis care deficiencies in reproductive-age women Expert panel addresses gaps in acne guidelines                                         * * * There is strong evidence for a relationship between diet and various skin conditions. In this resident takeover, Daniel R. Mazori, MD, talks to Sophie A. Greenberg, MD (@sophiegreenberg), about the role of diet in acne, psoriasis, and atopic dermatitis. Because patients and parents of pediatric patients often inquire about diet in relationship to atopic dermatitis, Dr. Greenberg offers a closer analysis of the data on this association. “A small minority of patients can experience flares of their atopic dermatitis due to food allergies. And this is usually non–IgE-mediated allergen exposure. ... But I do think it’s important to know that it’s really a small minority that their skin disease flares in relationship to their diet, so I usually counsel patients that it’s unlikely to be related to diet and I think it’s important to be prudent in considering who you refer to an allergist to have a work-up for food allergies.” Article: https://www.mdedge.com/dermatology/article/233485/atopic-dermatitis/diet-and-skin-primer?channel=64 Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106005031_e.PDF *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guest: Sophie A. Greenberg, MD (department of dermatology, Columbia University Medical Center, New York) Disclosures: Dr. Mazori and Dr. Greenberg report no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

In the news: Pityriasis rosea carries few risks for pregnant women Adjuvant nivolumab plus ipilimumab shows strong results in resected stage IV melanoma *  *  * Because psoriasis and atopic dermatitis (AD) can greatly affect quality of life in pediatric patients, the development of treatments with low-side effect profiles and less laboratory monitoring is essential. Vincent A. DeLeo, MD, talks to Amy S. Paller, MD, and Jennifer B. Scott, MD, about biologics approved for psoriasis and AD in the pediatric population. “Progressively, we’ve seen the newer biologics being more and more effective in both adults and in children, so we’re able to take some of the more effective ones and apply them to our children and adolescents with psoriasis ... We keep raising the bar in children as well as adults,” Dr. Paller reflects. They also discuss the advantages and pitfalls of biologics versus traditional systemic treatments as well as therapies on the horizon. Article: https://www.mdedge.com/dermatology/article/231217/atopic-dermatitis/biologics-pediatric-psoriasis-and-atopic-dermatitis Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106005224.PDF *  *  * Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: Amy S. Paller, MD (department of dermatology and the department of pediatrics, Northwestern University, Chicago) and Jennifer B. Scott, MD (department of dermatology, Northwestern University) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Paller has been an investigator and/or consultant for numerous companies. Dr. Scott reports no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

In the news: Baseline body surface area may drive optimal baricitinib responses Avoiding atopic dermatitis triggers easier said than done                                   * * * * * * * * *  Psoriasis patients often have additional comorbidities that put them at higher risk for developing COVID-19. In this episode, Candrice R. Heath, MD (@DrCandriceHeath), talks to Mark G. Lebwohl, MD, about the benefits of continuing biologic therapies for psoriasis during the COVID-19 pandemic. They discuss findings from registry data in Italy and New York City and how the data have impacted the latest guidelines for treatment. “The [National Psoriasis Foundation COVID-19 Task Force] has come out with a recommendation that strongly encourages patients on biologics to take [the COVID-19] vaccination and to not interrupt your biologic therapy,” Dr. Lebwohl explains. They also discuss how dermatologists can counsel patients about the safety of biologics so they feel comfortable continuing treatment during the pandemic. *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Mark G. Lebwohl, MD (Icahn School of Medicine at Mount Sinai, New York) Disclosures: Dr. Heath reports no conflict of interest. Dr. Lebwohl is an employee of Mount Sinai and has received research funds and consulted with numerous pharmaceutical companies. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology News: Swedish registry study finds atopic dermatitis significantly associated with autoimmune diseases Guidance issued on COVID vaccine use in patients with dermal fillers                                               *  *  *   Dermatologic adverse events can present differently in patients with skin of color (SOC) than in White patients. In this episode, Candrice R. Heath, MD (@DrCandriceHeath), talks to Sarah J. Noor, MD, and medical student Dulce Barrios about how skin toxicities from systemic cancer therapies and radiation treatment manifest in SOC patients, particularly in the form of pigmentary changes. “We really need to understand the pathogenesis or etiology of this discoloration, because I think when this is the initial presenting feature, it’s possible … even though it looks more just like hyperpigmentation on the skin, that there is some underlying inflammatory process going on,” Dr. Noor explains. They also discuss barriers that limit participation of SOC patients in oncology clinical trials. Dr. Noor and Ms. Barrios’s poster from the Skin of Color Society (@SkinOfColor) Scientific Symposium won the Best Oral Presentation Advancing Skin of Color Dermatology “Facing the Future Award.” *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Sarah J. Noor, MD (Memorial Sloan Kettering Cancer Center, New York); Dulce Barrios, MS (State University of New York, Syracuse) Disclosures: Dr. Heath reports no conflict of interest. Dr. Noor participated in an advisory board for Kyowa Kirin. Ms. Barrios reports no conflict of interest. Show notes by: Allegra Sparta, Alicia Sonners *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

This year's top peer-to-peer interviews focus on diversity in residency training, the response to COVID-19 in academic dermatology, and tips for preparing for virtual residency interviews.  1. Diversity in residency training  2. Academic dermatology's response to COVID-19    3. Preparing for virtual residency interviews  Email Dermatology Weekly at podcasts@mdedge.com  

Dermatology News: Beware a pair of dermatologic emergencies in children: https://bit.ly/37mGA2d Preadolescent acne: Management from birth requires increasing vigilance: https://bit.ly/34mCWn0   *  *  *   Managing vitiligo can be difficult for both patients and physicians. In this episode, guest host Seemal R. Desai, MD, (@SeemalRDesaiMD) talks to Pearl E. Grimes, MD, about how to better classify vitiligo disease status and parameters that impact treatment choice. “There are some aspects of classification that are really key from a therapeutic as well as a prognostic perspective. The things that I look at on a day-to-day basis when I workup any new patient [include asking], what type of vitiligo do you have? Is it nonsegmental or is it segmental? Is the patient stable or are they progressive? And then I look at the severity of disease,” Dr. Grimes explains. They discuss the importance of stabilizing vitiligo, particularly on the face, and highlight the psychosocial impact of the disease. Dr. Grimes also highlights the role of supplements and antioxidants such as vitamin D in vitiligo treatment. *  *  * Hosts: Seemal R. Desai, MD (Innovative Dermatology, Dallas, and the University of Texas Southwestern Medical Center, Dallas) Guests: Pearl E. Grimes, MD (Vitiligo & Pigmentation Institute of Southern California, Los Angeles) Disclosures: Dr. Desai reports no conflict of interest. Dr. Grimes has conducted clinical research and/or served as a consultant for Clinuvel Pharmaceuticals, Dermaforce, Johnson & Johnson, Incyte, LaserOptek, L’Oréal, Pfizer, Procter & Gamble, and VT Technologies. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology News: International expert group agrees on redefining psoriasis severity https://bit.ly/3a6a7PJ ‘Impressive’ results with neoadjuvant T-VEC in advanced melanoma: https://bit.ly/39UEwA3 CDC shortens COVID-19 quarantine time to 10 or 7 days, with conditions: https://bit.ly/3qGIGSn *  *  * Procedural interventions in pediatric patients require special tools. Vincent A. DeLeo, MD, talks to Craig N. Burkhart, MD, MS, MPH, about dermatologic procedures in children, such as laser treatment of birthmarks or excisional mole removal. When considering general anesthesia use in children, Dr. Burkhart reflects that, “if [the patient is] a child that sits for a vaccination without a problem, they’re definitely ready to have minor surgery awake. If ... you have to pull them out from behind the bed, they’re definitely a child that is not ready.” They also discuss the importance of informed consent in teenaged patients. Article: https://www.mdedge.com/dermatology/article/231231/pediatrics/pediatric-procedural-dermatology Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106005253.PDF *  *  * Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guest: Craig N. Burkhart, MD, MS, MPH (department of dermatology, University of North Carolina at Chapel Hill, and Burkhart Pediatric & Adolescent Dermatology, Cary, N.C.) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Burkhart reports no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com

Dermatology News: Expanded indications likely for apremilast: https://bit.ly/3lx1zTZ Neoadjuvant immunotherapy combo produces high response rate in melanoma: https://bit.ly/33Dx0Wr Blood glucose on admission predicts COVID-19 severity in all: https://bit.ly/39yJjXS *  *  * Advances in noninvasive skin imaging present new opportunities for inclusion and equitable treatment of patients with skin of color. In this episode, Candrice R. Heath, MD (@DrCandriceHeath), talks to Josèe Smith and Steven Daveluy, MD, about the use of optical coherence tomography (OCT) to establish a baseline for all skin types can improve how dermatologists process pathology in the skin. They review various factors that influence OCT results and how results differ based on Fitzpatrick skin type, age, and level of sun exposure. They also highlight the benefits of noninvasive imaging versus biopsy in clinical practice. “[Even] though skin cancer is less common in skin of color, we know that melanoma and other types of skin cancer are usually diagnosed at later stages and more complicated stages, and so having earlier ways of detecting skin cancer in skin of color I think is really important for the future,” Ms. Smith explains. Ms. Smith and Dr. Daveluy’s poster from the Skin of Color Society (@SkinOfColor) Scientific Symposium won the Crowd Favorite award. *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia, Pennsylvania) Guests: Josèe Smith, BS (Wayne State University, Detroit); Steven Daveluy, MD (Wayne State University and Wayne County Medical Society of Southeast Michigan, Detroit) Disclosures: Dr. Heath, Ms. Smith, and Dr. Daveluy report no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm  

Dermatology News: Merino wool clothing improves atopic dermatitis, studies find: https://bit.ly/3fFHQQI Tildrakizumab for psoriasis shows durable efficacy over 5 years: https://bit.ly/3l1Z0c9 AMA takes on vaccine misinformation, physician vaccines, racism: https://bit.ly/33ee0O2 *  *  * Nail unit squamous cell carcinoma (SCC) is difficult to diagnose or suspect clinically because of its tendency to present as nonspecific nail plate changes. The tumors usually are painless and asymptomatic, leading to a delay in diagnosis. In this resident takeover, Daniel R. Mazori, MD, talks to Mohammed Dany, MD, PhD, about nail unit SCC and the importance of early diagnosis to avoid local destruction and bone invasion. “Usually, any subungual lesion in an immunosuppressed individual, especially if it is chronic and nonhealing, would prompt a biopsy,” Dr. Dany explains. They also discuss other risk factors and potential causes for nail unit SCC, with a particular focus on human papillomavirus infection, as well as treatment options including surgery. Article: https://www.mdedge.com/dermatology/article/231900/hair-nails/nail-unit-squamous-cell-carcinoma-updates-diagnosis-surgical?channel=64 Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106005011_e.PDF *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guests: Mohammed Dany, MD, PhD (Department of Dermatology, University of Pennsylvania, Philadelphia) Disclosures: Dr. Mazori and Dr. Dany report no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology News: Low threshold to biopsy atypical lesions may ID vulvar melanoma early, experts say https://www.mdedge.com/dermatology/article/231855/gynecologic-cancer/low-threshold-biopsy-atypical-lesions-may-id-vulvar Chronic inflammatory diseases vary widely in CHD risk https://www.mdedge.com/dermatology/article/231815/cad-atherosclerosis/chronic-inflammatory-diseases-vary-widely-chd-risk ‘Hospital at home’ increases COVID capacity in large study https://www.mdedge.com/dermatology/article/232113/coronavirus-updates/hospital-home-increases-covid-capacity-large-study   The COVID-19 pandemic has brought many longstanding health disparities to the forefront, particularly within the field of dermatology. In this episode, Candrice R. Heath, MD (@DrCandriceHeath) talks to Susan C. Taylor, MD, and Lynn McKinley-Grant, MD, about the impact dermatologists can have in reducing health care barriers among skin of color populations. They emphasize the importance of race-concordant visits and reflect on ways to foster diversity, equity, and inclusion in the dermatology workforce, beginning at the training and residency levels. “[We know] that minority dermatologists serve in underserved communities, that they accept public insurance or no insurance at all. They care for patients with particularly poor health status and are really committed to caring for patients of their own race. So it behooves all of us to examine ... how we can make a change and increase racial ethnic diversity within the specialty of dermatology,” Dr. Taylor explains. They also highlight how organizations such as the American Academy of Dermatology and the Skin of Color Society, among others, are working to institute meaningful change within the specialty. *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Susan C. Taylor, MD (University of Pennsylvania, Philadelphia); Lynn McKinley-Grant, MD (Howard University, Washington) Disclosures: Dr. Heath reports no conflict of interest. Dr. Taylor is vice president of the AAD. Dr. McKinley-Grant is president of the Skin of Color Society. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology News: Who’s at risk for depression on isotretinoin?: https://bit.ly/32AioXp Topical tapinarof effective in pivotal psoriasis trials: https://bit.ly/3pma0o0 Methotrexate users need tuberculosis tests in high-TB areas: https://bit.ly/3f0DcMV *  *  * Keeping up with the literature on atopic dermatitis (AD) is a challenge, with eight new articles posted on PubMed a day in 2020. Vincent A. DeLeo, MD, talks to Lawrence F. Eichenfield, MD, about quality of life in pediatric AD patients and how the condition affects parents/guardians, particularly in the form of sleep disturbances. Dr. Eichenfield also discusses studies that explore the impact of bathing frequency on the severity of AD as well as notable treatment advances in topical and systemic therapies in recent years. Reflecting on future research, Dr. Eichenfield posited if “recognizing significant disease early and instituting our more aggressive therapies early, will that change the development of comorbidities and will that burn out the disease more quickly or get sustained remission or cure as compared to just waiting?” Article: https://bit.ly/3f0DrHP Downloadable PDF: https://bit.ly/3lzuUy1 *  *  * Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guest: Lawrence F. Eichenfield, MD (division of pediatric dermatology, departments of dermatology and pediatrics, University of California, San Diego, and Rady Children’s Hospital, San Diego) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Eichenfield is an investigator for AbbVie, LEO Pharma, Pfizer, Regeneron, and Sanofi Genzyme. He also is a consultant for Almirall, Dermavant Sciences, Dermira, DS Biopharma, Eli Lilly, Forte Biopharma; Galderma Laboratories, Incyte, LEO Pharma, Novartis, Ortho Dermatologics, Otsuka Pharmaceutical, Pfizer, Regeneron Pharmaceuticals, and Sanofi Genzyme. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com

Dermatology News: No lab monitoring needed in adolescents on dupilumab: https://bit.ly/34YAqV0 Birch bark derivative gel found effective for EB, in phase 3 study: https://bit.ly/385LFge Skin symptoms common in COVID-19 ‘long-haulers: https://bit.ly/385LFge *   *   * Peer-to-peer Underrepresented minority (URM) students often lack the resources needed to successfully navigate careers in medicine. In this episode, Candrice Heath, MD, (@DrCandriceHeath) talks to Alfredo Siller, MD, and Amit Pandya, MD, about the influence of social and cultural capital on a URM applicant’s competitiveness for dermatology residency programs. They discuss factors that impede diversification during the residency selection process and suggest potential solutions to promote equity among dermatology program applicants. “It is important when looking at residency candidates to value factors such as cultural competence, language skills, distance traveled, grit, having overcome adversity, and also look at the applicant and say: ‘Is this individual more likely to go work in an underserved community?’ Because that’s where our patients need us,” Dr. Siller explains. Dr. Siller’s poster from the Skin of Color Society (@SkinOfColor) Scientific Symposium won Best Poster for Advancing Skin of Color Dermatology "Facing the Future Award." *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Alfredo Siller Jr, MD (Center for Clinical Studies, Webster, Texas); Amit G. Pandya, MD (University of Texas Southwestern Medical Center, Dallas; Palo Alto Foundation Medical Group, Mountain View, Calif.) Disclosures: Dr. Heath reports no conflict of interest. Dr. Siller reports no conflict of interest. Dr. Pandya is a consultant for Arcutis Biotherapeutics, AVITA Medical, Chromaderm, the Immune Tolerance Network, Incyte, Pfizer, Viela Bio, and Villaris Therapeutics. He also is an investigator for Aclaris Therapeutics, the Immune Tolerance Network, Incyte, and Pfizer. He also has stock options in Clarify Medical and Tara Medical Enterprise. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology news: Data on potential risks of COVID-19 in psoriasis patients limited, but reassuring: https://bit.ly/3jwNc0Q Red hair in women linked to elevated CRP levels in Nurses’ Health Study: https://bit.ly/2HyJRSb Rinse and repeat? Mouthwash might mitigate COVID-19 spread: https://bit.ly/2HKjF6w *  *  *   Dermatologists must feel comfortable and confident in diagnosing skin conditions in patients with skin of color, which begins during residency. In this resident takeover, Daniel R. Mazori, MD, and Nadine Shabeeb, MD, MPH, discuss how images of skin of color are greatly underrepresented in dermatology education resources, specifically textbooks and online resources. “We really rely on our textbooks for images and photographs of disease entities that we may not see that often clinically, and so if all of our patients are not represented in our resources and if we’re not seeing those patients in clinic, we’re really not ever going to be able to accurately learn and diagnose certain skin diseases,” Dr. Shabeeb explains. She also talks about her efforts to improve and strengthen the skin of color curriculum and provide antiracism resources within her residency program. Article: https://bit.ly/3kvBTHo PDF: https://bit.ly/35CfF0a *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guests: Nadine Shabeeb, MD, MPH (University of Wisconsin–Madison) Disclosures: Dr. Mazori and Dr. Shabeeb report no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology News: Non-Whites remain sorely underrepresented in phase 3 psoriasis trials (https://bit.ly/3jmv2ia) Women make progress in pediatric dermatology leadership (https://bit.ly/35nNdir) Survey: Doctors lonely, burned out in COVID-19 (https://bit.ly/3dKwhXg)   *  *  * Psoriasis patients who are pregnant or those seeking a medication-free treatment may benefit from phototherapy. Vincent A. DeLeo, MD, talks to George Han, MD, PhD, and Jashin J. Wu, MD, about the joint guidelines from the American Academy of Dermatology and National Psoriasis Foundation for psoriasis treatment with phototherapy. They provide tips for getting patients started on phototherapy and discuss different devices for at-home or in-office use. While discussing avoidance of treatment pitfalls, Dr. Han notes that “documentation really is key when you’re doing phototherapy, and that’s one of the nice things about some of the newer phototherapy units. They’ll actually be linked up to a computer control that automatically keeps the treatment record.” Article: https://www.mdedge.com/dermatology/article/226940/psoriasis/translating-2019-aad-npf-guidelines-care-management-psoriasis Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106002082.pdf *  *  * Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: George Han, MD, PhD (Icahn School of Medicine at Mount Sinai, New York); Jashin J. Wu, MD (Dermatology Research and Education Foundation, Irvine, Calif.) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Han and Dr. Wu report conflicts of interest with numerous sources in industry. Show notes: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com

In this week’s podcast, Dermatology News columnist Leslie S. Baumann, MD, interviews James J. Leyden, MD, emeritus professor of dermatology at the University of Pennsylvania, Philadelphia, about his significant ​research contributions in the field of dermatology, including finding the cure for diaper rash and the development of retinoids for acne and photoaging. Dr. Leyden also recounts his experience working with Albert Kligman, MD, at the University of Pennsylvania and how they changed the way the world treats acne with lots of contemplation, observation, perseverance, and a little luck. *  *  * 1. The interesting history of dermatologist-developed skin care  (https://www.mdedge.com/dermatology/article/227534/aesthetic-dermatology/interesting-history-dermatologist-developed-skin?channel=27928) 2. More on the history of dermatologists and skin care (https://www.mdedge.com/dermatology/article/229052/aesthetic-dermatology/more-history-dermatologists-and-skin-care) *  *  * Hosts: Nick Andrews; Leslie S. Baumann, MD (Skin Type Solutions, Miami) Guest: James J. Leyden, MD (University of Pennsylvania, Philadelphia) Disclosures: Dr. Baumann is CEO of Skin Type Solutions. Dr. Leyden did not report any conflicts of interest. Show notes: Elizabeth Mechcatie *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology News: Shingrix effective in older adults with preexisting immune-mediated disorders (https://bit.ly/2GrMy7z) New treatment options show promise for centrifugal cicatricial alopecia (https://bit.ly/36Dq2TL) Children's share of new COVID-19 cases is on the rise (https://bit.ly/34CNEoM) *  *  *       Managing a private medical practice has changed drastically in 2020. In this episode, Candrice Heath, MD (@DrCandriceHeath), talks to Caroline Robinson, MD (on Instagram @crobinsonmd; on Twitter @crobinsonmd1), about her experience opening a new dermatology practice during the COVID-19 pandemic. They discuss important safety measures when establishing the office work flow, including offering virtual visits, streamlining patient intake procedures, cleaning examination rooms, and hiring new employees. They also discuss the role of social media in building a successful dermatology practice. “When you think about where people are looking for doctors now ... they’re turning to social more than ever. ... I would say that [half] of the patients that we’ve seen have been either from social media in some way, shape, or form, and then [half] have found me from my previous work within the city,” Dr. Robinson explains. *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Caroline Robinson, MD (Tone Dermatology, Chicago) Disclosures: Dr. Heath reports no conflict of interest. Dr. Robinson is the CEO/Founder of Tone Dermatology. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology News: Review finds evidence for beta-blockers for some rosacea symptoms (https://bit.ly/3kX91rB) Source:  https://bit.ly/2HKWJUX 2019 review: https://bit.ly/36jWvOL Conservative parameters key to maximizing cosmetic laser results in skin of color (https://bit.ly/33dIhNn) Source: https://bit.ly/3jiLcd8 J&J’s one-shot COVID-19 vaccine advances to phase 3 testing (https://bit.ly/33e07Qs) *  *  * Dermatology residents are utilizing apps for up-to-date and accurate information. Vincent A. DeLeo, MD, talks to Orit Markowitz, MD, and medical student Cynthia Chan about the regulation of mobile medical apps, with an emphasis on the three apps most frequently used by residents. “I do think that while we have to be hesitant in incorporating these technologies, I also think that the silver lining is that it’s going to help us also come up with better ways to standardize our education,” Dr. Markowitz reflects. Dr. Markowitz and Ms. Chan also discuss how residents and clinicians can be more diligent about the apps they’re using to get health information. Article: https://www.mdedge.com/dermatology/article/226938/health-policy/applying-knowledge-evidence-and-regulation-mobile-apps Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/issues/articles/ct106002076.pdf *  *  * Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guests: Orit Markowitz, MD (department of dermatology, Mount Sinai Health System, New York; department of dermatology, State University of New York, Brooklyn; and the department of dermatology, New York Harbor Healthcare System); Cynthia X. Chan, BS (Geisel School of Medicine at Dartmouth, Hanover, N.H.) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Markowitz and Ms. Chan report no conflict of interest. Show notes: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Episode 82 Dermatology News: Biologics for psoriasis may also reduce coronary plaque (https://bit.ly/3ckjVEK) Journal article: https://bit.ly/3mRW2JE Three-step approach may help relieve one of the itchiest vulvar conditions (https://bit.ly/33TeGI3) Many Americans still concerned about access to health care (https://bit.ly/33TeGI3) Survey: https://bit.ly/3kO0DdF *  *  * Dermatology residents identify studying as one of the main culprits leading to burnout during residency. In this resident takeover, Daniel R. Mazori, MD, talks to Sophie A. Greenberg, MD, (@sophiegreenberg) about the firehose of information that dermatology residents encounter and how to optimize the use of the sources available for studying, particularly during COVID-19 from greater access to webinars and other online conferences. “Especially at the beginning [of residency], it’s easy to feel like there’s too much to learn. ... I would also anticipate some trial and error throughout residency so don’t let this get you frustrated. Some struggle is necessary in order to find your groove,” Dr. Greenberg explains. They also discuss how studying changes over the course of residency, from building the foundation of knowledge in the first year to deepening and consolidating the information in later years in preparation for the board examination. Article: https://www.mdedge.com/dermatology/article/228544/practice-management/studying-dermatology-residency?channel=64 Downloadable PDF: https://cdn.mdedge.com/files/s3fs-public/CT106002023_e.pdf *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guests: Sophie A. Greenberg, MD (department of dermatology, Columbia University Medical Center, New York) Disclosures: Dr. Mazori and Dr. Greenberg report no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

As lockdown restrictions are lifted, many dermatologists are resuming elective cosmetic procedures. Candrice Heath, MD, (@DrCandriceHeath) talks to Anthony M. Rossi, MD, (@DrAnthonyRossi) about the procedures patients are seeking while they have downtime as well as how physicians can safely treat these patients and conduct follow-up. They also discuss the prevalence of mask acne, known as “maskne,” during the pandemic. “We’re starting to put people on these acne regimens again. ... People who haven’t dealt with acne in a while or really never had it, we have to be putting them on a retinoid, a good skin regimen, because of all the irritation [and] the occlusion—[maskne] is real,” Dr. Rossi explains. This week in dermatology news: No one-size-fits-all approach to tissue-tightening devices (https://bit.ly/32AsJmA) New billing code for added COVID practice expense (https://bit.ly/3cb6oz9) AMA COVID-19 Billing PDF: https://bit.ly/32yaIVX Physician income drops, burnout spikes globally in pandemic (https://bit.ly/3c2HAsY) Medscape Survey: https://wb.md/3klThhu *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Anthony M. Rossi, MD (Memorial Sloan Kettering Cancer Center and Weill Cornell Medicine, New York) Disclosures: Dr. Heath and Dr. Rossi report no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts       Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology Weekly News: Fatal pediatric melanomas diverse in presentation Novel smart needle system designed to reduce the risk of filler complications COVID Update: First randomized trial reassures on ace inhibitors and ARBs for COVID patients  *  *  * The National Resident Matching Program reported that U.S .medical school seniors who matched into dermatology applied to a median of 90 programs and attended nine interviews last year, which is disadvantageous for applicants of lower socioeconomic backgrounds. Vincent DeLeo, MD, talks to Shari Lipner, MD, PhD about the interview process during COVID-19. “It’s important to try to level the playing field in this difficult time. ... While it may be possible to do live interviews in the same fashion with people from our home institutions, it really wouldn’t be fair to do that in light of the fact that many of these candidates are going to have to do the interviews virtually.” Dr. Lipner also discusses dermatology rotations for medical students and tips for applicants. Article: https://bit.ly/3k5DHGL *  *  * Hosts: Nick Andrews, Vincent A. DeLeo, MD (University of Southern California, Los Angeles) Guest: Shari R. Lipner, MD, PhD (department of dermatology, Weill Cornell Medicine, New York) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Lipner reports no conflict of interest. Show notes by: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Episode 79, the top resident takeovers of 2020 (so far). We count down the top downloaded resident interviews of Dermatology Weekly in 2020. So far this year, a variety of topics affecting residents have been covered—from the impact of training during COVID-19 to the use of low-dose naltrexone to over-the-counter (OTC) topicals in dermatology and Muir-Torre syndrome. Dermatology residency during a pandemic, Episode 73: Dr. Candrice Heath talked to three dermatology residents—Dr. Brittany Oliver (on Instagram: @dr.dermatic), Dr. Sophie Greenberg (@sophiegreenberg), and Dr. Julie Croley (@DrSkinandSmiles)—about their experiences navigating through dermatology residency during the COVID-19 pandemic. They shared their perspectives from different areas of the country on how the current health crisis has impacted their training and responsibilities. Low-dose naltrexone, Episode 52: Dr. Daniel Mazori talked to Dr. Nadine Shabeeb about the benefits of off-label low-dose naltrexone (LDN) for the treatment of inflammatory skin conditions. Dr. Shabeeb provided a practical perspective on prescribing LDN in the dermatology setting and discussed how to counsel patients about potential side effects, including concerns about its abuse potential. OTC topicals, Episode 65: Dr. Daniel Mazori talked to Dr. Sophie Greenberg about selection of OTC topicals to avoid potential adverse effects. They discussed how the Food and Drug Administration categorizes and regulates OTC products as well as resources to learn more about common ingredients in OTC topicals. Muir-Torre syndrome (MTS), Episode 61: Dr. Daniel Mazori talked to Dr. Mohammed Dany about the pathogenesis of MTS and its associated malignancies. They also reviewed diagnostic clues and tools for dermatologists when treating patients with solitary sebaceous tumors. Host: Nick Andrews Dr. Croley, Dr. Dany, Dr. Greenberg, Dr. Heath, Dr. Mazori, Dr. Oliver, and Dr. Shabeeb report no conflicts of interest. Show notes by: Melissa Sears, Alicia Sonners You can find more of our podcasts at http://www.mdedge.com/podcasts       Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology is an academically rigorous specialty, which is a major source of stress for many residents. Daniel Mazori, MD, talks to Nadine Shabeeb, MD, MPH about dermatology resident wellness and burnout. They discuss stressors for burnout in dermatology residents. “I do think that on a day-to-day basis the major stressor for me in residency is probably related to the amount of studying that we need to do,” Dr. Shabeeb reports. They also provide strategies for improving resident wellness by addressing the four areas of well-being. Article: https://bit.ly/2FMEGNf Downloadable PDF: https://bit.ly/2QaXkAj This week in dermatology news: Novel oral drug improves sunlight tolerance in patients with erythropoietic protoporphyra: https://bit.ly/34AeUWM Large study finds no link between TCI use, skin cancer in patients with AD:  https://bit.ly/3locNuS Hong Kong man gets COVID-19 twice: https://bit.ly/3hvMzEt *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York Downstate Medical Center, Brooklyn) Guests: Nadine Shabeeb, MD, MPH (University of Wisconsin Hospital and Clinics, Madison) Disclosures: Dr. Mazori and Dr. Shabeeb report no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

This week in Dermatology News: Persistent hair loss after radiation improved with minoxidil: https://bit.ly/2FFY1zx Telemedicine checklist may smooth visits with older patients: https://bit.ly/3aLVsav FDA authorizes COVID-19 saliva test: https://bit.ly/34g7pUw Dermatologists write more antibiotic prescriptions per individual clinician than other physicians, mostly to treat acne and rosacea. Dr. Vincent DeLeo talks to Dr. James Del Rosso about antibiotic use in dermatology. “Antibiotics are part of our armamentarium; they’re very important. … Primarily we’re using [antibiotics] for these inflammatory dermatoses that are not infections, and we’re prescribing them for a longer period of time,” Dr. Del Rosso explains. Dr. Del Rosso outlines acne therapies commonly associated with resistance and discusses when to use antibiotics for acne. Article: https://bit.ly/2Eb7Hl9 Downloadable PDF: https://bit.ly/2Yg4ibw *  *  * Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: James Q. Del Rosso, DO (JDR Dermatology Research/Thomas Dermatology, Las Vegas and Henderson, Nev.) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Del Rosso has served as an advisor, consultant, and speaker for Almirall, Bausch Health (Ortho Dermatologics), EPI Health, Foamix (Menlo Therapeutics), Galderma Laboratories, and Mayne Pharma. He also has served as a research investigator for Almirall, Bausch Health (Ortho Dermatologics), Foamix (Menlo Therapeutics), and Galderma Laboratories. Show notes: Allegra Sparta, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

COVID-19 has had profound effects on the financial stability of academic institutions, resident training, and patient care. Candrice Heath, MD (@DrCandriceHeath) talks to Erin Boh, MD, and Dirk Elston, MD, about emergency response plans in the academic setting as well as how institutions have been using teledermatology and managing resident education. “Our institution is doing quite well because we’ve actually jumped headlong and feetfirst into COVID research. . . . Our research dollars have increased double percentwise because of that," Dr. Boh said. *  *  * This week in dermatology news: Cutaneous clues linked to COVID-19 coagulation risk: https://bit.ly/31Ik4Ne Research letter: https://bit.ly/3kCnWIn Skin manifestations of COVID-19: https://bit.ly/2XUonnL Study highlights potential advantages of tape strips over biopsy: https://bit.ly/33TTZxi Original source: https://bit.ly/30R4WOm Botulinum toxin associated with antidepressant effects across indications, injection sites: https://bit.ly/2XVMd2m Original source: https://go.nature.com/3kGM38y *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Erin Boh, MD, PhD (Tulane University, New Orleans); Dirk M. Elston, MD (Medical University of South Carolina, Charleston) Disclosures: Dr. Heath, Dr. Boh, and Dr. Elston report no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts       Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm  

Military dermatologists play a unique role in managing acne because they need to consider the medical readiness of servicemembers during treatment. Dr. Justin Bandino, president of the Association of Military Dermatologists, talks to Dr. Catherine Brahe and Dr. Kristopher Peters about avoiding antibiotics or systemic drugs that can limit a servicemember’s operational duty status, which can be applied to civilian health care to help slow the spread of antibiotic resistance. They highlight uses of pulsed-dye laser therapy. “I would hope that many of us in the military setting could take advantage of our ability to use this variety of lasers and treatment modalities so we can contribute to the literature and make them a little more mainstream, and then maybe in the future some of them can be covered by insurance and can be used a little more frequently,” Dr. Peters explains. Article: https://bit.ly/31gQ62GDownloadable PDF: https://bit.ly/39WcZwp *  *  * This week in dermatology news: New psoriasis guidelines focus on topical and alternative treatments, and severity measures: https://bit.ly/2DlBwyYJournal Article: https://bit.ly/39YsvYs Medical Student in the UK creates handbook of clinical signs on darker skin: https://bit.ly/31lBqPJ Biologics may delay psoriatic arthritis: https://bit.ly/2XxrEJc *  *  * Hosts: Nick Andrews, Justin P. Bandino, MD (San Antonio Uniformed Services Health Education Consortium, Tex.) Guests: Catherine Brahe, MD (Naval Medical Center, Portsmouth, Va., and 3rd Battalion 6th Marines, Camp Lejeune, N.C.); Kristopher Peters, DO (Madigan Army Medical Center, Tacoma, Wash.) Disclosures: Dr. Bandino, Dr. Brahe, and Dr. Peters report no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts       Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Unlike most other cutaneous neoplasms, extramammary Paget disease (EMPD) manifests as a chronic erythematous patch. In this resident takeover, Dr. Daniel Mazori talks to Dr. Mohammed Dany about the diagnosis of primary vs secondary EMPD and the importance of screening patients for metastasis or other underlying malignancies. They also discuss the pathogenesis of EMPD and highlight future treatment targets. “The best studies that show potential are the studies focusing on PD-1 [programmed cell death receptor 1] pathway, or the checkpoint pathway. I think there is a lot of potential with immunotherapy for EMPD,” Dr. Dany explains. *  *  * This week in dermatology news: * Americans getting more sunburns (https://bit.ly/33iNOD1) * Nine states have no board-certified pediatric dermatologist, analysis reveals (https://bit.ly/3faY5Do)  * Is the presence of enanthem a clue for COVID-19? (https://bit.ly/39F2bSV)  (JAMA Research Letter: https://bit.ly/3hNZnpK) *  *  * Things you will learn in this episode: * Extramammary Paget disease characteristically presents as an erythematous patch in sites with abundant apocrine glands, such as the vulvar, scrotal, or perianal skin. “Usually the typical story would be, this is a rash that has been treated as eczema for many years but it just doesn’t go away, and it is only until the dermatologist gets a biopsy that the diagnosis of [EMPD] is made,” Dr. Dany explains. * Classic biopsy findings include pagetoid spread through the epidermis with larger cells that have blue cytoplasm, dysmorphia, and nuclear atypia. It may appear similar to other pagetoid entities such as melanoma, intraepidermal sebaceous carcinoma, or squamous cell carcinoma in situ. * Primary and secondary EMPD present in clinically and prognostically different ways, but it is difficult to discern the 2 entities based on histology. * Extramammary Paget disease requires long-term follow-up to monitor for disease recurrence or further development of malignancies. “Every patient newly diagnosed with EMPD deserves a full workup for malignancy screening,” Dr. Dany explains. * There currently is no formal staging system or treatment guidelines for EMPD. “Wide local excision has been the default in the past, but recurrence rates were very high,” Dr. Dany notes. * More research is needed to understand the pathogenesis of EMPD, but data have shown that the PD-1/PD-L1 pathway may play an important role in future therapies. * Intralesional immunotherapies can be effective in treating EMPD in sensitive areas of the body. *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (Brigham and Women’s Hospital, Boston) Guests: Mohammed Dany, MD, PhD (University of Pennsylvania, Philadelphia) Disclosures: Dr. Mazori reports no conflict of interest. Dr. Dany reports no conflict of interest. Show notes: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

To celebrate the 50th anniversary of Dermatology News, we are looking back at how the field has changed since that first issue in January 1970. The focus in episode 73 is infectious disease. There’s a lot to be grateful for but there are also challenges like antibiotic resistance that weren’t on the radar of dermatologists decades ago. In this episode, Nick Andrews welcomes Theodore Rosen, MD, to discuss the past, future, and current state of ID Dermatology. You can read more about the past 50 years of ID by clicking this link: https://bit.ly/3hri3v2 You can learn more about Dr. Rosen by clicking this link: https://bit.ly/2CtdmSU *  *  * What will your dermatology residency look like in the midst of coronavirus disease 2019 (COVID-19)? In this episode, guest host Dr. Candrice Heath talks to Drs. Brittany Oliver (@dr.dermatic), Sophie Greenberg (@sophiegreenbergmd), and Julie Croley (@DrSkinandSmiles) about their experiences navigating through dermatology residency during the COVID-19 pandemic. They share their perspectives from different areas of the country on how the current health crisis has impacted their training and responsibilities. They also provide tips for incoming dermatology residents on how to adapt their expectations to the post-COVID environment. “It was so rewarding and I was really anxious to get in and help, hearing about all the stories about exhausted physicians and patients who needed care, so I really felt called to be in the center of it and I’m really happy I could give back in that way,” Dr. Greenberg said of working with COVID-19 patients in New York City. Key takeaways from this episode: Drs. Oliver, Greenberg, and Croley describe how their roles and duties as dermatology residents have changed as their institutions have prepared for surges of COVID-19 patients. They discuss the impact of the lockdown and shifting priorities within their hospitals on their learning structure and educational opportunities, including lectures and dermatopathology training. “Our didactics were converted to Zoom once the lockdown began. . . . Some attendings volunteered to give us extra lectures because our clinics were not operating in the normal way. It helped compensate to make sure we’re getting enough education and training,” Dr. Greenberg says. Teledermatology services have been crucial to continuing patient care during the pandemic. Drs. Oliver, Greenberg, and Croley talk about the challenges and benefits of using telemedicine both now and in the future. “I am glad to be getting the exposure now so that I can use the experience on a few different platforms, and then wherever I land for my first job, I can hopefully adapt quickly to whatever it is they’re using,” Dr. Oliver says. They offer advice for new dermatology residents who are coming into a residency experience that looks different now than what they expected because of COVID-19. “Everything’s changing on a day-to-day basis: the COVID situation’s changing, the rules and policies are changing in our hospital, what was protocol yesterday might not be protocol today. . . . I think just having patience, being adaptable, and just realizing that hey, everybody is going through the exact same thing . . . is really the best advice I would have for people,” Dr. Croley emphasizes. They reflect on medical knowledge and skills they otherwise would not have learned without their experience as dermatology residents during the COVID-19 pandemic. Residency typically is a time to get to bond with co-residents and lean on family and friends for support through stressful times. Drs. Oliver, Greenberg, and Croley discuss ways they have been staying connected with people during the lockdown and while social distancing. *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia, Penn.) Guests: Brittany Oliver, MD (Hospital of the University of Pennsylvania, Philadelphia); Sophie A. Greenberg, MD (Columbia University Medical Center, New York, NY); Julie Ann Amthor Croley, MD (The University of Texas Medical Branch at Galveston) Disclosures: Drs. Heath, Oliver, Greenberg, and Croley report no conflicts of interest. Show notes: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Dermatology residents must be knowledgeable about dermatologic conditions presenting in patients of various ethnic backgrounds. Dr. Vincent DeLeo talks to Drs. Abigail Cline, Susan Taylor, and Amy McMichael about improving and expanding multiethnic training in dermatology residency. “Now that I’m in residency, it has become very clear how different presentations in skin of color can be, and I can really see the importance of proper training in a racially diverse population,” says Dr. Cline. They discuss ways to ensure that dermatology trainees get adequate exposure to conditions affecting ethnic skin and highlight the role of the Skin of Color Society in reducing racial disparities within the specialty. *  *  * This week in Dermatology News: 1. Topical PDE-4 inhibitor for psoriasis effective in phase 2b trial Original story: https://bit.ly/38YtdV3 2. Subcutaneous nemolizumab eases itching for atopic dermatitis Original story: https://bit.ly/3j3U3jp NEJM article: https://bit.ly/32icCdG 3. About 1/3 of older Americans receive shingles vaccine Original story: https://bit.ly/2Cyz9rY CDC report: https://bit.ly/2WmhOJK  *  *  * Key takeaways from this episode: There is a lack of minority representation in dermatology educational materials such as textbook photographs, which often are heavily skewed toward lighter skin types. Results from a recent survey revealed that dermatology residents in the Midwest and Northwest were not seeing a diverse patient population: “[Residents] in the Northeast, Southeast, and Southwest tended to see more diverse patients, and so they didn’t feel the need for continued lectures or skin of color clinics, but the respondents within the Midwest and the Northwest really wanted to see these patients and really wanted to see what these dermatoses look like in skin of color,” Dr. Cline explains.  To ensure dermatology trainees get adequate exposure to diverse populations, home programs can allow residents to travel and rotate to other programs where they can get firsthand experience diagnosing skin of color patients. The Skin of Color Society aims to reduce racial disparities in dermatology through a variety of programs, including its annual scientific symposium, mentorship program, and research grants. Skin of color centers throughout the United States allow dermatology residents to rotate through and work with large numbers of skin of color patients. “[They also provide] an opportunity for trainees to see patients who are very satisfied with race-concordant visits—that is, the patient and the provider are of the same racial group—so they can observe what goes into making that type of interaction very successful and rewarding for the patient,” says Dr. Taylor. Practicing dermatologists can make a positive impact by mentoring high school, college, or medical students who do not have social capital as well as contributing a gift to societies with mentorship programs that provide opportunities for residents. Dermatologists can create diversity within their own practices to improve patient access to care. “You can be great at what you do, you can be a fantastic dermatologist but still not be culturally competent, so looking at what that really means—how to understand populations that are different from you culturally, how to look at perhaps having individuals in your practice that can make those patients more comfortable . . . whether they may be your nurses or your intake people . . . just sort of looking around and seeing how you can diversify your own space so that when others come they feel like you know what you’re talking about, and I think that’s really the goal overall,” explains Dr. McMichael.    Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guests: Abigail Cline, MD, PhD (New York Medical Center, New York, and Wake Forest School of Medicine, Winston-Salem, North Carolina); Susan C. Taylor, MD (University of Pennsylvania Perelman School of Medicine, Philadelphia); Amy J. McMichael, MD (Wake Forest Baptist Medical Center, Winston-Salem, North Carolina)  Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Drs. Cline, Taylor, and McMichael report no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Nutrient deficiencies present clinically in the skin, hair, and nails. Dr. Vincent DeLeo talks to Dr. Bridget Shields about the dermatologist’s role in managing nutritional dermatoses in hospitalized patients. “As dermatologists, we’re trained to recognize subtle detail, and we may be the first or really the only physicians to pick up on the seemingly minor cutaneous manifestations of underlying nutritional disease,” Dr. Shields explains. She highlights key nutrient deficiencies and risk factors that dermatologists may routinely encounter. *  *  * This week in Dermatology News: Lifestyle changes may explain skin lesions in pandemic era patients Study highlights benefits of integrating dermatology into oncology centers Republican or Democrat, Americans vote for face masks *  *  * Key takeaways from this episode: Undernutrition in hospitalized patients is relatively common but often goes unrecognized because it may develop slowly over months to years. “Early identification and treatment of nutritional deficiencies can drastically improve patient morbidity and mortality and decrease systemwide health care costs,” Dr. Shields explains. It can be easier for dermatologists to diagnose and screen for nutrient deficiencies if they are able to identify at-risk patients. “Some really common medical conditions serve as risk factors that I think we routinely overlook as providers,” Dr. Shields notes. Dietary habits can predispose patients to nutrient deficiencies and therefore should be included as part of the patient’s history. The oral mucosa can provide important insight into a patient’s underlying metabolic and overall systemic health. Hospitalized patients often take in less calorically than they do at baseline. “I think working with a nutritionist can be really important to ensure a patient has appropriate macro- and micronutrient composition of any supplementation provided,” notes Dr. Shields. In most cases, treating the underlying nutrient deficiency will simultaneously treat the associated cutaneous manifestations. Skin-directed topical therapies can be useful in the right context but should not be used alone without the associated nutrient supplementation. More research is needed on how nutritional manipulation may impact the skin and serve as an adjunct to therapy with more traditional medication regimens.   Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Bridget E. Shields, MD (University of Pennsylvania Perelman School of Medicine, Philadelphia) Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Dr. Shields reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm  

This week in Dermatology News:  Skin patterns of COVID-19 vary widely First validated classification criteria for discord lupus erythematosus unveiled Phase 3 COVID-19 vaccine trials launching in July Dr. Vincent DeLeo counts down the top downloaded peer-to-peer interviews of Dermatology Weekly in 2020. So far this year, Dr. DeLeo and his colleagues have covered a diverse group of topics impacting the way dermatologists practice medicine, particularly during the COVID-19 pandemic—from the continued use of biologics in psoriasis patients to adopting teledermatology to recommending hair products for African American women. Teledermatology, Episode 63: Dr. Candrice Heath talked to Dr. George Han about how dermatologists can adapt their clinical practice to conduct quality teledermatology visits with their patients. They discussed potential use cases for teledermatology during the current health crisis and beyond as well as how to address technological barriers to care. Hair care products for African American women, Episode 60: Hair salon closures during the coronavirus pandemic have left women of African descent to care for their own hair at home. Dr. Lynn McKinley-Grant and Dr. Susan Taylor talked about hair care products these patients can use so that dermatologists can help African American women take care of their hair and manage dermatologic conditions. Biologics during the COVID-19 pandemic, Episode 57: Patients with severe psoriasis may be at higher risk for infection because of increased inflammation in the body. Dr. Lawrence Green discussed how to counsel patients who are taking biologics to control their psoriasis during the COVID-19 pandemic. *  *  * Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Compounding medications allows physicians to customize formulations for individual patients. In this resident takeover, Daniel R. Mazori, MD, talks to Nadine Shabeeb, MD, MPH, about compounding topicals in dermatology. They discuss clinical scenarios in which these treatments may be warranted as well as potential drug combinations. “What’s cool about compounding for [conditions such as acne, rosacea, and hyperpigmentation] is that there are oftentimes multiple etiologies that lead to patients developing those conditions, and with compounding you can mix multiple things together to target some of those different factors,” Dr. Shabeeb says. They also discuss potential disadvantages and regulations for compounded medications. *  *  * This week in Dermatology News: Pilot study shows apremilast effective for severe recurrent canker sores For urban-based African Americans, proximity to a dermatologist varies by ZIP code Vulvar melanoma is increasing in older women *  *  * Key takeaways from this episode: Compounding is a way of mixing or combining different medications and formulations that are not commonly available at most pharmacies. Advantages of topical compounded medications include simplifying treatment regimens, prescribing treatments for rare conditions that are not commonly available, bypassing potential insurance issues, and creating topical versions of oral medications. Safety and efficacy data for compounded medications are lacking. “This is usually because of the unique nature of what’s being compounded, because multiple different things are oftentimes combined together, so there’s no published data about how safe and also how efficacious these are compared to just one single formulation being used,” Dr. Shabeeb explains. Compounded medications are not covered by insurance, and out-of-pocket cost may be prohibitive for some patients. “That being said, it may be lower than the cost of a branded medication that’s not covered by insurance, but it may be more than a generic medication that is covered by insurance,” Dr. Shabeeb says. Compounding pharmacies follow safety standards set by the U.S. Pharmacopeia, and the U.S. Food and Drug Administration prohibits physicians from prescribing compounded medicines that are approved, adulterated, or misbranded drugs. “Compounded medications can’t mimic a branded medication. It has to be either a unique formulation, or combination, or strength,” Dr. Shabeeb explains. Compounding pharmacists can be a great resource for dermatologists in terms of combining appropriate treatments for patients. Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York Downstate Medical Center, Brooklyn) Guests: Nadine Shabeeb, MD, MPH (University of Wisconsin Hospital and Clinics, Madison) Disclosures: Dr. Mazori reports no conflict of interest. Dr. Shabeeb reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Photodynamic therapy (PDT) has become a preferred treatment of field cancerization. Dr. Vincent DeLeo talks to Dr. Martin Miller about results from a split-sided study evaluating the efficacy of CO2 laser ablative fractional resurfacing pretreatment followed by conventional PDT for treatment of actinic keratoses (AKs). They discuss the clinical benefits of PDT for treatment of AKs as well as future directions for this combination therapy for nonmelanoma skin cancers. *  *  * We also bring you the latest in dermatology news and research: High-fat, high-sugar diet may promote adult acne It's official: COVID-19 was bad for health care business If you reopen it, will they come? *  *  * Key takeaways from this episode: Photodynamic therapy (PDT) provides consistent predictable results and healing periods without variations in response seen with topical therapies. In a split-sided study, pretreatment with CO2 laser ablative fractional resurfacing in combination with conventional PDT showed increased efficacy of AK clearance vs. conventional PDT alone. This combination therapy showed clearance of superficial basal cell carcinoma, but nodular basal cell carcinoma and squamous cell carcinoma in situ persisted at 6 months. Side effects of treatment included hypopigmentation in face and scalp areas on the laser-treated side. Future directions for treatment may include aminolevulinic acid gel 10% with standard PDT as well as combination with a red-light source to achieve deeper penetration into the skin. Hosts: Nick Andrews, Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Martin B. Miller, MD (University of California, San Francisco) Disclosures: Dr. DeLeo is a consultant for Estée Lauder. Dr. Miller received grant support and study drug from DUSA Pharmaceuticals Inc. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Full-body skin examinations (FBSEs) are routine in dermatology practice but can create anxiety for some patients. Dr. Vincent DeLeo talks to Dr. Atieh Jibbe about reducing patient anxiety caused by FBSEs based on results from a patient questionnaire. They discuss factors that may contribute to patient anxiety and common body areas that patients prefer to exclude from FBSEs. They also provide tips for residents in training. “If you walk a patient through the exam as you’re doing it, it makes them feel a little bit more in control of the situation rather than just unexpectedly revealing certain parts of their body,” Dr. Jibbe explains. *  *  * We also bring you the latest in dermatology news and research: Biologics may carry melanoma risk for patients with immune-mediated inflammatory disease Atopic dermatitis in adults, children linked to neuropsychiatric disorders Should healthcare workers wear masks at home? *  *  * Key takeaways from this episode: Patients may have differences in comfort level during FBSEs, based on factors such as religious practices, the sex of the clinician, or concerns about undressing and/or wearing a gown. It is important to recognize and discuss potential concerns with patients before starting the exam. “Oftentimes, I think the lack of acknowledgment of [a patient’s] anxiety or the lack of acknowledgment of the fact that we are doing a sensitive exam can make people feel more uncomfortable,” Dr. Jibbe explained. Results from a pre-encounter patient questionnaire indicated there was a female predominance in exclusion of certain body parts examined and preference for being asked what areas they wanted examined. “Also we found that more females [reported] a [positive] change in their anxiety level after the postexamination survey,” Dr. Jibbe noted. When asked which areas to exclude from FBSEs, the genitals were most commonly excluded among both men and women. Other areas included the buttocks, breast/chest, legs, feet, and abdomen. It is important for clinicians to identify themselves as soon as they walk into the examination room to reduce patient anxiety. “Patients are more apt to be more comfortable if they know who you are, your name, what your role is in the health care profession, and what you’re doing for them,” Dr. Jibbe advises. Begin the exam by asking the patient to point out the areas or lesions he/she is worried about: “That immediately gives you a segue to go start an exam, and I feel that a patient would be more comfortable if they’re indicating on their body what they want you to start looking at, and then you can transition to the full-body skin exam from there,” Dr. Jibbe says. *  *  * Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: Atieh Jibbe, MD (University of Kansas Medical Center, Kansas City) Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Dr. Jibbe reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Physicians face unique challenges with regard to mental health but often are resistant to seeking professional treatment. In this special crossover episode, Guest Host Dr. Candrice Heath (@drcandriceheath) talks with Dr. Lorenzo Norris from the MDedge podcast Psychcast and psychiatrist Dr. Nicole Washington (@drnicolepsych) about common stressors and mental health conditions they encounter when treating the physician population. They discuss how dermatologists can evaluate and protect their mental health, particularly during the coronavirus disease 2019 (COVID-19) pandemic. “We will have to show ourselves some grace and realize that there are going to be some days where we don’t do as well as we think we should do, because we all have very high expectations for ourselves,” Dr. Washington advises. *  *  * We also bring you the latest in dermatology news and research: Authors of picosecond laser review predict more widespread use of the technology California wildfires caused uptick in clinical visits for atopic dermatitis COVID-19 update: distancing works, N95 respirators work better *  *  * Key takeaways from this episode: Common mental health disorders in physicians include anxiety spectrum disorder, depression, and substance use. Burnout and demoralization often present as precursors to these syndromes. Physicians have a higher suicide rate than do the general population, with an estimated 300-400 physicians dying by suicide each year. “If there are that many who actually complete, how many more are there who walk around with the thoughts daily who don’t complete? How many are there who we don’t include in the numbers that we have as far as the anxiety and depression and substance abuse because that relies on either them admitting to it or seeking treatment for it? The numbers I think are much larger,” Dr. Washington says. Economic uncertainty and financial stress brought on by fewer patient visits has created new anxiety for dermatologists that was not there before the COVID-19 pandemic. Some physicians feel guilty that they are not on the front lines of the COVID-19 pandemic. “They are feeling as if they’re watching their peers jump in and be in the game ... and they’re kind of just sitting on the bench. I’ve had multiple physicians talk about the guilt that they feel or feeling as if they aren’t doing enough and really being harder on themselves about their lack of action on the front lines, and that is affecting their mental health,” Dr. Washington observes. The amount of work physicians have taken on to keep outpatient care afloat during the pandemic can become a source of stress. “Many of my colleagues, even though they’re not necessarily seeing COVID patients, their workloads have increased tremendously ... it’s like the volume has gone down, but the stress of everything -- and meetings and constant information and education -- has gone up. So I kind of like to think sometimes COVID is everywhere and it just kind of depends on in what shape or form you have to deal with it,” Dr. Norris points out. The biggest thing dermatologists can do to protect their mental health is to be honest about their feelings and be willing to reach out and get professional assistance. Because dermatology often is perceived as the “happiest” specialty among medical professionals, dermatologists may not be pursuing treatment for their mental health because they feel bad about saying they are having a hard time. “Don’t let your circumstances or what you think people see as your circumstances stop you from reaching out,” Dr. Washington advises. *  *  * Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guests: Lorenzo Norris, MD (George Washington University, Washington); Nicole Washington, DO, MPH (Elocin Psychiatric Services) Disclosures: Dr. Heath reports no conflict of interest. Dr. Norris reports no conflict of interest. Dr. Washington reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

Patients may be relying more on over-the-counter (OTC) skin care products during the current health crisis due to limited access to dermatologists. In this resident takeover, Dr. Daniel Mazori talks to Dr. Sophie Greenberg about selection of OTC topicals to avoid potential adverse effects. “I started looking into regulation and safety data and realized there’s a gap in formal treating on this topic, so I wanted to provide a guide to residents so they can be adequately informed,” Dr. Greenberg explains. They discuss how the Food and Drug Administration categorizes and regulates OTC products as well as resources to learn more about common ingredients in OTC topicals.  *  *  * We also bring you the latest in dermatology news and research: New rosacea clinical management guidelines focus on symptomology Dermatologists saw small income drop before pandemic Remdesivir shortens COVID-19 time to recover in published study Things you will learn in this episode: Choosing the wrong OTC products can cause or exacerbate skin conditions, such as allergic contact dermatitis, eczema, and acne, or even result in systemic toxicity. The FDA categories for OTC products that are most relevant to dermatology include drugs (both prescription and nonprescription medications), cosmetics, soaps, and dietary supplements. Each category has its own unique set of regulations. Drugs include topical steroids, antibiotic ointments, acne treatments, antifungals, and sunscreens. “Most of these products were previously available by prescription only but became available over-the-counter after sufficient postmarketing safety information,” says Dr. Greenberg. Regulations for chemical sunscreens currently are in flux in light of data that demonstrate serum levels above the FDA limit for drugs that are exempt from further testing for carcinogenicity. The FDA prohibits use of 11 categories of ingredients in all cosmetics but does not require approval, testing, or disclosure of safety data prior to products going to market. “A lot of patients and lay public have expressed concerns over the safety of over-the-counter [cosmetics], especially since regulation varies across the world,” Dr. Greenberg notes. It is important to be vigilant and educate patients about imported cosmetics containing ingredients such as clobetasol that can be harmful if used incorrectly. “When we prescribe [products containing these ingredients], we have a chance to counsel patients on how to properly use [them], but the fact that people can purchase them over-the-counter is very scary,” Dr. Greenberg says. Soap is categorized independently by its ingredients and its intended purpose to be used as a cleansing agent. The FDA evaluates safety and labeling of dietary supplements before marketing but does not directly test these products. “Clinicians can refer patients to third-party agencies that verify ingredients and test for contaminants. ... since there have been reports of supplements not containing the ingredients that they said they contain or containing toxins or potential allergens,” Dr. Greenberg explains. The Environmental Working Group’s Healthy Living app allows users to scan a product’s barcode to see all of its ingredients and safety rating. Clinicians can scan pharmacy aisles to familiarize themselves with available OTC products and also try products on themselves to better understand and address patient concerns. “You can get samples at conferences or purchase different products each time you restock your own supply,” Dr. Greenberg recommends. *  *  * Hosts: Nick Andrews; Daniel R. Mazori, MD (State University of New York, Brooklyn) Guests: Sophie A. Greenberg, MD (Columbia University Medical Center, New York) Disclosures: Dr. Mazori reports no conflicts of interest. Dr. Greenberg reports no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

In the news portion of episode 64, Nick Andrews welcome Dr. Amy Paller, MD, to discuss the different dermatologic manifestations of COVID-19 especially as it pertains to pediatric patients. *  *  * Grand Rounds are not only a teaching opportunity but also a vital patient care activity. Dr. Vincent DeLeo talks to Dr. William Huang about results of a study that surveyed how patients perceive clinical case-viewing sessions in dermatology. “I think we can easily lose track of [the patient’s experience] because it is something very routine for us as an activity that we have participated in as medical students, as residents, and as faculty, but for the invited patient this is something strange, like something they saw on a medical television drama,” Dr. Huang explains. They discuss how patients felt before vs after participating in Grand Rounds as well as patients’ suggestions for how to improve the process. *  *  * Things you will learn in this episode: The goal of Grand Rounds is to get clinical opinions from a number of different physicians at the same time to achieve better outcomes in patients with conditions that are difficult to diagnose or treat.  Patients were surveyed before and immediately after participating in clinical case-viewing sessions to assess their feelings and attitudes regarding this activity. “We could not find where this had been looked at before in our specialty,” Dr. Huang explains. Patients generally felt that participating in clinical case-viewing sessions met their expectations and was a beneficial experience. “They were also very likely to participate again, which demonstrates that they had a good experience overall,” Dr. Huang says. Anxiety went down after participating in Grand Rounds vs before, but patients’ feelings of being a science experience or guinea pig went up after the session was over. It is important to recognize that patients generally are not familiar with the process of Grand Rounds and may not know what to expect or how it benefits them. “Communicate to the patient before they are scheduled what the session will actually entail from start to finish to follow-up,” Dr. Huang recommends. *  *  * Hosts: Nick Andrews; Vincent A. DeLeo, MD (Keck School of Medicine of the University of Southern California, Los Angeles) Guest: William W. Huang, MD, MPH (Wake Forest School of Medicine, Winston-Salem, N.C.) Disclosures: Dr. DeLeo is a consultant for Esteé Lauder. Dr. Huang reports no conflict of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

How is dermatology handling this change in practice toward telehealth? Guest host Dr. Candrice Heath talks with Dr. George Han about how dermatologists can adapt their clinical practice to conduct quality teledermatology visits with their patients. “Last year ... I think overall in the health system we probably had about 2,000-3,000 telehealth visits ... by the end of March [this year], I think the numbers I saw [were] around 30,000, so it’s absolutely just kind of been a huge change in the way we practice medicine,” Dr. Han explained. They discuss potential use cases for teledermatology during the current health crisis and beyond as well as how to address technological barriers to care. *  *  *   We also bring you the latest in dermatology news and research: 1. Novel inflammatory syndrome in children possibly linked to COVID-19 2. Case reports illustrate heterogeneity of skin manifestations in COVID patients 3. COVID-19 Dermatology Registry   *  *  * Things you will learn in this episode: Despite recent HIPAA relaxations, dermatologists still should be aware of privacy and security issues when conducting telehealth visits with patients. Existing resources -- such as noninvasive tests that can be self-administered by patients -- may be useful for concerning lesions that are difficult to diagnose during video visits. “There’s this genomic test for melanoma. ... I hadn’t used it very much before the COVID pandemic because we could biopsy patients in the office. ... But now that the whole paradigm has changed, I’ve actually used it more than I ever did before,” Dr. Han explained. Common conditions such as psoriasis, acne, and eczema are relatively easy to triage via telemedicine. “We’re going to have to do a lot more experimentation, certainly, if there’s a lesion that’s scaly and erythematous. ... But I think as long as you’re up front with the patients, they understand it, too,” Dr. Han said. In most cases, total-body skin examinations and evaluation of pigmented or potentially cancerous lesions still warrant an in-person visit. Biologics often can be started in patients with psoriasis or atopic dermatitis without first seeing them in person. “If it’s a pretty clear case of psoriasis, I would say that your treatment options are not limited by the fact that we’re handling over telemedicine, and I think that’s really nice for our patients. There are a number of treatments out there that you don’t need laboratory screening for, so those are helpful to have on hand,” Dr. Han said. For older patients who may not have the necessary technology skills or devices to participate in video consultations, the Centers for Medicare & Medicaid Services recently issued a guidance that telephone visits will now be paid at the level of an established visit (levels 2–4). “The recognition is there that we’re still doing important work for our patients and you don’t necessarily need that video signal to be able to do this, and we certainly don’t want to create any artificial barriers to access to care,” Dr. Han said. Prior to COVID-19, telehealth services use was low because patients did not think of it as a legitimate option, but the marketplace will demand these services moving forward now that they are seeing the benefits. “I think it’s important as we go ahead in the next phase ... we use the lessons we’ve learned during this pandemic of just large numbers of people utilizing teledermatology services to help map out what makes sense for our specialty ... as well as technical requirements that we should be asking of our vendors providing these services,” Dr. Han advised. Beyond the parameters of the COVID-19 pandemic, teledermatology also provides access to care for patients in parts of the country with limited access to dermatologists, such as in rural areas. Dermatologists can use telehealth services for short hands-off visits, such as to counsel patients, check in before titrating doses, or follow-up after a cosmetic procedure. “Those are situations where you actually might improve your show rate by offering telemedicine services,” Dr. Han noted. A tip sheet is available online that provides information to help dermatologists adopt telehealth in their practice. It describes what you need, how to select a software platform, and how to monitor workflow.  Patients should be asked to provide high-quality photographs before the visit via a HIPAA-secured chat or email. “We always recommend that you get a HIPAA-secured email server account if you can if you’re asking for patients to send in photos, because what happens is that once they send those photos to you, you are responsible for the safety and security of that photo,” Dr. Han explains.  Set expectations for patients up front and be realistic about what you think is reasonable for implementing telehealth services in your practice. “If you’re not comfortable seeing concerning lesions, suspicious moles, those things, you should make it very clear to your schedulers that patients should be told that if it is one of those problems, they cannot be seen by this methodology,” Dr. Han recommended. *  *  *   Hosts: Nick Andrews; Candrice R. Heath, MD (Temple University Hospital, Philadelphia) Guest: George Z. Han, MD, PhD (Icahn School of Medicine, New York) Disclosures: Dr. Heath and Dr. Han report no conflicts of interest. Show notes by: Alicia Sonners, Melissa Sears *  *  * You can find more of our podcasts at http://www.mdedge.com/podcasts      Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm