Derms and Conditions

In this special mailbag episode of Derms and Conditions, James Q. Del Rosso, DO, takes on your questions from the field, offering expert guidance and real-world tips on some of the most common challenges in dermatology today.  Dr Del Rosso begins by tackling common challenges with oral apremilast for psoriasis, sharing strategies to manage gastrointestinal side effects and improve patient adherence. He provides tips on starter packs, meal timing, and even reducing caffeine intake to minimize nausea and cramping during therapy initiation.  Next, he discusses the evaluation of alopecia areata severity and how to determine eligibility for oral Janus kinase (JAK) inhibitors, including baricitinib (Olumiant) and ritlecitinib (Litfulo). Dr Del Rosso outlines a practical approach to scalp assessment using SALT scores, explains how psychosocial impact and eyebrow/eyelash loss can upgrade severity, and reviews important safety considerations for JAK inhibitor therapy. He also previews a recently FDA-approved third option: deuruxolitinib (Leqselvi).   Finally, Dr Del Rosso covers the newly FDA-approved modified-release oral minocycline 40 mg capsule formulation (Emrosi) for rosacea, highlighting its anti-inflammatory benefits and superior efficacy compared with subantimicrobial-dose doxycycline in a head-to-head controlled-study evaluation. He explains its mechanism of action, favorable safety profile, and how it fits into the modern rosacea treatment landscape.  Tune in for a fast-paced roundup of pearls, pitfalls, and pro tips that can make all the difference in your day-to-day dermatology practice. 

In this episode of Derms and Conditions, Dr James Q. Del Rosso is joined by Dr Adelaide Hebert, Chief of Pediatric Dermatology at McGovern School of Medicine and Children's Memorial Hermann Hospital in Houston, Texas. Back by popular demand, Dr Hebert shares her clinical experience managing pediatric atopic dermatitis—particularly in patients who are treatment resistant, injection-averse, or fearful of topical steroids.  The conversation begins with a discussion of therapeutic decision-making for new patients with moderate to severe atopic dermatitis. Dr Hebert emphasizes the importance of listening closely to both the child and their caregivers to identify emotional barriers, needle phobia, steroid concerns, and gaps in previous care. She explains why patient-centered care requires flexible strategies, and how once-daily, steroid-free topical agents are often more acceptable to families than systemic options or injectable biologics.  Dr Del Rosso and Dr Hebert focus on topical tapinarof, an aryl hydrocarbon receptor agonist approved for atopic dermatitis down to 2 years of age. Dr Hebert walks through the advantages of its once-daily use, its natural compound origin, and favorable safety profile, particularly for young children and anxious parents. She shares several compelling cases, including a 3-year-old with 85% body surface area involvement who responded dramatically in a clinical trial, and a 7-year-old girl with longstanding disease and prior cyclosporine exposure who found relief with tapinarof.  Together, the clinicians explore practical pearls for real-world use, including how to apply the cream properly, whether to moisturize before or after, how to avoid waste, and when to reintroduce the medication after a flare. Dr Hebert highlights that many of her patients, and their families, experience life-changing improvements in sleep, school participation, and self-esteem, underscoring the broader impact of effective topical treatment.  The episode closes with a reminder that personalized care, consistent moisturization, and confidence in the safety of non-steroidal options like tapinarof can help families navigate treatment with less stress—and better results. 

In this episode of Derms and Conditions, Dr James Q. Del Rosso welcomes esteemed dermatologist Dr Henry Lim from Michigan. Together, they explore the evolving science behind photoprotection, the importance of advances in sunscreen formulations and ingredients, and the clinical relevance of sunscreen formulations that both protect against and repair photodamage.  Dr Lim provides an update on comprehensive photoprotection that includes ultraviolet radiation coverage, recognizes the growing role of visible light protection, and incorporates ingredients with antioxidant activity. He also explains where mineral sunscreens can be particularly helpful in clinical practice.  A major part of the discussion highlights the progression of science supporting DNA repair through the use of liposomes containing photolyases. These enzymes have been shown to repair cyclobutane pyrimidine dimers—mutagenic DNA lesions induced by UVA and UVB exposure. Incorporating photolyases into sunscreen formulations has been associated with reduced actinic keratosis formation and enhanced skin protection.  Dr Del Rosso shares his insights on ISDIN's Eryfotona Actinica and Eryfotona Ageless, two mineral sunscreens that include photolyase-containing liposomes, also known as DNA Repairsomes®, to enhance natural DNA repair processes. Each product contains additional active ingredients offering distinct benefits for specific patient needs. Dr Del Rosso and Dr Lim discuss how these formulations fit into both preventive and reparative strategies, particularly for patients with a history of actinic damage or elevated risk for nonmelanoma skin cancers. The conversation then covers the value of broad-spectrum protection, lightweight formulations, and patient education to encourage consistent use. Dr Lim offers practical pearls on counseling patients, improving sunscreen adherence, and integrating these strategies into everyday dermatologic care.  They also touch on the importance of photoprotection in skin of color, emphasizing the need for inclusive clinical research and personalized recommendations. Dr Lim reinforces the importance of year-round sun protection, even for individuals who perceive themselves to be at lower risk.  The episode wraps up with forward-looking insights into the future of photoprotection, including emerging technologies and formulation innovations that may reshape dermatologic sun care. From thoughtful commentary to evidence-based guidance, tune in for the latest in photoprotection—just in time for summer. 

In Part Two of the Tea with Dr. D premiere, James Q. Del Rosso, DO, returns with Lauren Lam, MD, a Canadian dermatologist with a keen interest and extensive experience in managing hidradenitis suppurativa (HS). After covering overall considerations and the medical side of HS management in Part One, they shift gears to focus on important physical approaches, including one of the most effective—and often underutilized—surgical interventions: deroofing.  Dr Lam emphasizes the importance of both medical and surgical interventions in order to provide comprehensive management of this multifaceted disease state. She shares her step-by-step approach for identifying which lesions are best suited for deroofing, breaking down key considerations like Hurley staging, scarring assessment, and palpation for sinus tracts. From assessing lesions that have resisted biologic therapy to recognizing when a seemingly mild case may actually benefit from surgical intervention, she explains how deroofing fits seamlessly into a well-rounded HS treatment plan, often working in tandem with biologic agents to address stubborn or recurrent lesions without disrupting systemic control.  The conversation then turns to technique. Dr Lam outlines her preferred tools, all which are easily accessible in dermatology practices, and explains how she navigates physically challenging areas like the axilla and groin. The pair emphasize the importance of patient education; Dr Del Rosso raises questions about preventing complications such as biofilm formation and hypergranulation, while Dr Lam addresses these issues and shares her strategies for effective wound management.  Together, they reflect on how deroofing can markedly improve comfort and quality of life for HS patients, particularly those who have struggled with focal areas of chronic drainage and recurrent abscesses despite optimized medical therapy. Dr Lam's enthusiasm for the procedure is readily apparent and contagious, and her practical advice makes the incorporation of deroofing into the management plan feel readily achievable, even for dermatology clinicians who are new to surgical HS management. 

In this premiere episode of Tea with Dr D, Dr James Q Del Rosso welcomes Dr Lauren Lam, a Canadian dermatologist with special interest and strong experience in managing patients affected by hidradenitis suppurativa (HS). They engage in a thoughtful and comprehensive conversation about diagnosing and treating this common yet often elusive skin condition—especially in its early stages—which has been notoriously difficult to treat. Their discussion integrates both medical and surgical approaches to optimize outcomes. Dr Lam shares how she built an efficient, trust-centered model of care at her Calgary clinic, from using intake tools and patient education videos to identifying comorbidities and staging severity. She walks through her approach to treatment selection—focusing on what brings the most value in that moment—and discusses when and how she incorporates patient education, intralesional corticosteroids, biologic therapy, deroofing, laser hair removal, and other approaches into her care strategy. Whether you see HS regularly or only occasionally, this conversation offers practical strategies, clinical nuances, and a fresh perspective on improving care for this complex condition.

In this first mailbag edition of Derms and Conditions, Dr James Q. Del Rosso flies solo to answer your questions—submitted by clinicians across the country. From potassium monitoring to topical field therapy, it's a rapid-fire round of guidance grounded in the latest literature, clinical experience, and practical wisdom. Dr Del Rosso kicks things off with the ever-popular question: Do I really need to monitor blood potassium in healthy patients on spironolactone for acne? He breaks down current guideline perspectives, red flags for high-risk populations, and his own reasoning for when and why he orders labs. Next, he walks through the expanding world of topical nonsteroidal agents for atopic dermatitis, including:  Ruxolitinib 1.5% cream (Opzelura) – FDA-approved for mild to moderate AD in patients ≥12 years old and also for vitiligo; Dr Del Rosso discusses addresses black box warnings, despite low systemic absorption in most real-world scenarios.  Roflumilast 0.15% cream (Zoryve) – Approved down to 6 years of age, well-tolerated with itch reduction data to back it.  Tapinarof 1% cream (VTAMA) – Approved down to 2 years of age and used effectively in moderate-to-severe disease with favorable skin tolerability. He explains why these newer agents may be preferred over topical corticosteroids for sensitive areas like the face. In response to questions about actinic keratoses, Dr Del Rosso dives into tirbanibulin 1% ointment (Klisyri), a microtubule inhibitor used once daily for five days. While FDA-approved for face and scalp field treatment up to 100 cm², he shares how he's successfully using it off-label for forearms and hands, sometimes in combination with cryotherapy. The episode closes with a discussion of oral antibiotic safety in acne, including:  Why TMP-SMX (trimethoprim-sulfamethoxazole) works—but must be used selectively due to rare but serious adverse events (TEN, pulmonary toxicity)  Why azithromycin is not optimal for acne and only used selectively.  And why mandatory lab monitoring for oral tetracyclines like doxycycline or minocycline isn't recommended routinely—but clinical vigilance is. With insights on everything from lab work to lid margins, this is one episode you'll want to bookmark, replay, and pass along to your dermatology colleagues.

In this episode of Derms and Conditions, host Dr James Del Rosso speaks with Dr Linda Stein Gold, Director of Dermatology at Henry Ford Health, to unpack one of dermatology's most frustrating and multifactorial conditions: chronic hand eczema. They explore why chronic hand eczema isn't a single disease but a spectrum of overlapping etiologies—ranging from atopic dermatitis and irritant or allergic contact dermatitis to more elusive triggers. Dr Stein Gold shares practical strategies for teasing out potential causes, discusses some potential limitations of patch testing, and highlights the importance of patient history and thorough skin assessment. The conversation also covers current treatment approaches, from topical corticosteroids to systemic therapies, and introduces delgocitinib cream, a pan-JAK inhibitor under FDA review, as a unique and valuable nonsteroidal option. Drs Stein Gold and Del Rosso explain how its broad immunomodulatory action may help address the condition's diverse inflammatory pathways while remaining well tolerated, even on fissured skin. Whether you're managing stubborn cases or looking for updates on investigational therapies, this episode offers practice-ready recommendations for clinicians and a reminder not to overlook the emotional toll of hand eczema on patients' daily lives.

In this episode of Derms and Conditions, Dr James Q Del Rosso is joined by Dr April Armstrong, Chair of Dermatology at UCLA, for a thorough discussion of oral therapies for plaque psoriasis—what's new, what still works, and how to choose the right treatment for the right patient. They kick off with a practical discussion on older systemic options like methotrexate and cyclosporine, including when these tried-and-true agents still have a place in modern practice. From there, Dr Armstrong walks through the evolving role of apremilast, particularly in hard-to- treat variants like palmoplantar pustulosis and in patients with milder disease who prefer oral options. The pair then take listeners through the clinical data behind deucravacitinib, a selective TYK2 inhibitor, highlighting its strong efficacy, minimal lab monitoring, and newly released five- year safety results. The conversation also covers real-world patient selection, payer considerations, and how clinicians can use guidelines to support access to newer therapies. Whether you're looking to refine your psoriasis treatment strategy or better counsel patients on long-term safety, this episode delivers practical pearls you can use in clinic tomorrow.

In this episode of Derms and Conditions, Dr James Q. Del Rosso shifts gears from clinical dermatology to something equally important but rarely discussed—legal and financial planning. He's joined by his longtime friend and dermatopathologist, Dr Clay Cockerell, who also happens to be a licensed attorney with a passion for educating physicians about estate planning. Dr Cockerell breaks down the fundamentals of trusts, wills, and malpractice insurance in plain language, highlighting why every physician should care about these topics. Listeners will learn the key differences between revocable and irrevocable trusts, how to protect assets from creditors, and why picking the right trustee is critical. They also dive into the historical roots of trusts (spoiler: think the Crusades), fiduciary responsibilities, and how physicians can control the distribution of assets during and after their lifetimes. The conversation also covers non-compete clauses, contract negotiations, and the importance of tail coverage in malpractice policies. Dr Cockerell shares real-world advice from his own experience and emphasizes why physicians—especially new grads—should never sign contracts without legal review. Packed with practical insights, humor, and a few personal anecdotes, this episode offers a must-hear legal primer for dermatology professionals at any career stage.

In this episode of Derms and Conditions, Dr James Q. Del Rosso welcomes back his longtime friend and pediatric dermatology expert, Dr Lisa Swanson. Together, they explore the rapidly evolving treatment landscape for pediatric atopic dermatitis, with a focus on newly approved non-steroidal topical therapies. Dr Swanson shares her insights on tapinarof 1% cream, now FDA-approved for patients as young as two years old, and topical roflumilast 0.15% cream, approved down to age six. The duo discusses how aryl hydrocarbon receptor (AhR) agonism makes tapinarof effective in both atopic dermatitis and psoriasis, likening its action to a “SNOO” that adjusts to soothe inflammation. They also dive into data from the ADORING 1 and ADORING 2 phase 3 trials, highlighting tapinarof's rapid reduction in itch and its positive impact on sleep—critical outcomes for both children and their parents. Dr Swanson offers real-world anecdotes about the sleep-depriving toll of pediatric eczema and how effective therapies can restore rest for the entire family. The conversation touches on skin of color considerations, including how atopic dermatitis may present differently and why diverse representation in clinical trials is essential. Dr Swanson underscores the importance of tactile assessments and shares practical pearls for evaluating eczema severity across skin types. Finally, they explore safety and tolerability, emphasizing tapinarof's low risk of systemic absorption, even in young children prone to thumb-sucking or hand-to-mouth behavior. Tune in for clinical pearls, new treatment insights, and a few laughs between two dermatology BFFs.

In this episode of Derms and Conditions, host Dr James Q. Del Rosso returns from the 2025 Winter Clinical Dermatology Conference – Miami® with a deep dive into some of the standout posters presented at the meeting. Dr Del Rosso begins the review with new insights on topical clascoterone 1% cream and its impact on the skin barrier, tolerability, and sebum reduction. He explores recent studies showing that clascoterone does not compromise the permeability barrier or increase transepidermal water loss—key considerations for its use alongside other acne treatments like benzoyl peroxide and topical retinoids. The analysis shifts to a comparative study on a triple combination acne therapy featuring clindamycin 1.2%, adapalene 0.15%, and benzoyl peroxide 3.1%, which demonstrated superior efficacy over dual-combination formulations. Dr Del Rosso breaks down early activity data, inflammatory and non-inflammatory lesion reductions, and how polymeric emulsion technology enhances both efficacy and tolerability. He also highlights new data on topical ruflomilast for atopic dermatitis in younger patients (ages 2-5) and explores the recent FDA approval of tapinarof 1% cream for atopic dermatitis down to age two. Posters on itch and sleep improvements in pediatric patients, as well as efficacy in skin of color, provide valuable clinical insights. Tune in for this rapid-fire breakdown of key posters, packed with data-driven takeaways to enhance your dermatology practice.

In this special live episode of Derms and Conditions, recorded at the 2025 Winter Clinical Dermatology Conference - Hawaii®, host Dr James Q. Del Rosso welcomes Dr April Armstrong, chief of dermatology at UCLA, and Dr David Cohen, dermatologist at NYU Langone, to break down the key takeaways from this year's meeting.   The discussion kicks off with chronic hand eczema, a condition that can be difficult to diagnose and treat due to its multiple causes. Dr Cohen highlights emerging data on new treatment options, including dupilumab, topical JAK inhibitors like ruxolitinib, and upcoming therapies like delgocitinib. They explore whether these newer therapies could be effective across different causes of hand eczema, even when an allergen isn't clearly identified.   Dr Armstrong then shifts the conversation to the next frontier in psoriasis treatment, including new oral therapies that are pushing efficacy to higher levels. They discuss IL-23 receptor antagonists, IL-17 inhibitors, and TNF inhibitors in development, as well as 5-year safety and efficacy data for deucravacitinib, which shows no long-term need for routine monitoring. The group also tackles the evolving treatment landscape for hidradenitis suppurativa (HS), where combination therapy is emerging as a key strategy. Dr Armstrong shares insights into guidance from the HS Foundation and the potential of pairing JAK inhibitors with IL-17 or TNF inhibitors for refractory cases.   They wrap up with practical pearls from the conference, including extended terbinafine treatment durations for fungal infections, pediatric biologic use around live vaccines, and the latest treatment options for molluscum contagiosum.   Tune in to this information-packed episode for expert insights and clinical updates straight from Winter Clinical 2025!

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

In this episode of Derms and Conditions, host James Del Rosso, DO, welcomes Ron Vender, MD, Associate Clinical Professor of Dermatology at McMaster University, to discuss practical strategies for psoriasis treatment and the management of chronic hand dermatitis. They begin with Dr Vender sharing his 90/70/40 rule, a numeric approach to evaluating biologic efficacy in psoriasis. He explains that across biologic agents, PASI75 responses typically reach 90%, PASI90 responses reach 70%, and PASI100 responses about 40%, providing a useful benchmark for evaluating treatment success. With many biologics showing similar efficacy and strong safety profiles, this method can help guide selection. They also discuss how comorbidities impact biologic choices, with Dr Vender noting he avoids TNF inhibitors in patients with multiple sclerosis, latent tuberculosis, malignancy, or hepatitis, though they remain a preferred option for women of childbearing potential. He advises caution when using IL-17 inhibitors in patients with a history of inflammatory bowel disease. While tuberculosis screening remains routine, he questions its necessity for anti-IL-17 and IL-23 inhibitors, given their lack of association with latent TB reactivation. The discussion then moves to chronic hand dermatitis, with Dr Vender stressing thorough history-taking, including identifying occupational exposures, and diagnostic testing, including patch testing and scrapings. He highlights alitretinoin, an oral retinoid specifically approved for chronic hand dermatitis, as an effective and well-tolerated treatment option. They conclude with a discussion on protective measures for chronic hand dermatitis, including hypoallergenic gloves, cotton liners, and emollient barrier creams. Tune in to the full episode to hear expert insights on optimizing psoriasis treatment and managing chronic hand dermatitis in clinical practice.

In this episode of Derms and Conditions, James Del Rosso, DO, welcomes Dustin Portela, DO, a private practice dermatologist in Boise, ID, and well-known social media presence, to discuss the challenges and responsibilities of dermatologists engaging online while maintaining professional integrity. Dr Portela shares how he unintentionally became an influencer, initially using social media to market his new practice without a budget. His following grew as he provided accurate, engaging, and evidence-based dermatologic education, evolving into a broader platform for both patients and clinicians. They discuss combatting misinformation, as much of the skin care advice online comes from nonmedical sources. Dr Portela emphasizes that his goal is to provide science-backed, accessible information, mirroring the guidance he offers in the clinic. He recommends the AAD website, DermNet, and YouTube's certified health professionals as trusted resources and uses AI tools like ChatGPT to simplify patient education, though he stresses the importance of reviewing content for accuracy before sharing. They also address legal considerations, with Dr Portela advising dermatologists to avoid direct medical advice online and instead keep recommendations general and educational. He cautions that malpractice policies typically do not cover social media activity, making it crucial to understand liability risks. Finally, they discuss brand partnerships, with Dr Portela emphasizing authenticity and trust. He only endorses products he has personally used and recommended in practice, ensuring his audience receives honest, unbiased information. Tune in to the full episode for insights on navigating social media responsibly, protecting credibility, and effectively leveraging online platforms for dermatologic education.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Michael Payette, MD, a dermatologist in private practice at Central Connecticut Dermatology, to discuss practical approaches to managing hidradenitis suppurativa (HS). Dr Payette shares his experience establishing a dedicated HS clinic and provides insights into addressing diagnostic delays, patient education, and emerging treatments. They begin by discussing the importance of outreach and education to raise awareness of HS among non-dermatology health care providers, such as OB-GYNs and urgent care practitioners, highlighting how early referral and intervention can prevent long-term complications such as scarring and sinus tract formation. They then explore the role of GLP-1 therapies and biologics in HS treatment. Dr Payette shares his multimodal approach, explaining how GLP-1s address an underlying cause of inflammation while biologics target active inflammation. He outlines practical tips for managing insurance approvals and counseling patients on the benefits and potential side effects of these therapies. The episode also covers strategies for discussing lifestyle changes, such as weight loss and smoking cessation, while being sensitive to patient challenges. Dr Payette notes that combining weight reduction with biologics can often yield good outcomes, helping patients achieve better disease control and remission. Tune in to the full episode to learn how a systematic, patient-centered approach to HS management can improve outcomes for this challenging condition.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Mona Shahriari, MD, associate director of clinical trials at Central CT Dermatology and assistant clinical professor at Yale University, to discuss the challenges of treating pregnant and breastfeeding patients, particularly those with atopic dermatitis (AD). The conversation addresses a crucial yet often unclear topic for dermatologists: balancing safety and efficacy when managing AD in patients during pregnancy and lactation. Dr Shahriari emphasizes the importance of addressing uncontrolled inflammation, which can have potential consequences for both the mother and baby, such as premature birth and maternal sleep disruption. She shares insights into the physiological changes during pregnancy, including the shift from a Th1 to a Th2 immune state, and how this can impact conditions like AD and psoriasis. The discussion highlights the limited data available for systemic treatments in this population, as pregnant women are excluded from clinical trials. Despite this, therapies like dupilumab and cyclosporine are discussed for their safety profiles, with dupilumab often considered when patients need effective control with minimal risk. Dr Shahriari also addresses strategies to involve partners in treatment decisions, ensuring patients feel supported and informed. Drs Del Rosso and Shahriari emphasize the importance of open communication with patients, managing risk tolerance, and understanding the nuances of systemic treatment in pregnancy and lactation. Dr Shahriari shares real-world cases, including the use of dupilumab in a pregnant patient with severe AD and counseling a patient with psoriasis who unintentionally administered a biologic injection during the first trimester. Tune in to the full episode for practical guidance on navigating these complex cases and balancing patient care with available evidence. This episode is a must-listen for dermatologists managing pregnant or breastfeeding patients with inflammatory skin conditions.  

In this milestone 100th episode of Derms and Conditions, host James Del Rosso, DO, takes listeners on a year-in-review journey through some of the greatest highlights from 2024. This special solo episode reflects on standout conversations with leading dermatologists and previews exciting plans for 2025.   Dr Del Rosso revisits key insights from some of the most impactful episodes on this 100th Episode of Derms and Conditions Podcasts:   Episode 91 with Dr Joel Gelfand explored psoriasis comorbidities and the importance of connecting with patients on both physical and mental health. Dr Gelfand emphasized the need for dermatologists to assess cardiovascular risks and encourage patients to engage with their broader medical team. Episode 89 with Dr Jessica Kaffenberger took a deep dive into hidradenitis suppurativa, including strategies to address disease chronicity, tackle psychosocial aspects, weight and smoking challenges tactfully, initiating biologic agents early to halt disease progression before permanent sequelae markedly increase and specific tips for using intralesional corticosteroids and infliximab infusion for severe cases. Episode 96 with Dr David Cotter explored the art and science of patch testing, especially for patients with atopic dermatitis who may have concurrent allergic contact dermatitis. Dr Cotter shared practical advice on tailoring patch testing and considerations regarding ongoing medications used to treat atopic dermatitis. Episode 90 with Dr Jason Hawkes took a closer look at TYK2 inhibition with deucravacitinib, highlighting its novel allosteric mechanism, its more selective pathway inhibition, and 4-year safety and efficacy data. Episode 97 with Dr Tina Bhutani provided insights on newer nonsteroidal topicals like roflumilast and tapinarof, including tips for integrating these agents with corticosteroids and using them under occlusion for thicker lesions.   With so many exceptional episodes in 2024 and exciting plans ahead, listeners can look forward to even more cutting-edge insights in 2025. Don't miss any of these conversations—catch up anytime at dermsquared.com/podcasts/derms-and-conditions

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Brad Glick, DO, dermatologist and residency program director at Larkin Health Center in South Florida, to discuss the complexities of selecting systemic therapies for psoriasis. They share insights on navigating the abundance of treatment options, focusing on patient-centric considerations, with an emphasis on the TYK2 inhibitor deucravacitinib. They begin by highlighting how treatment selection often depends more on disease location and patient impact than on body surface area alone and discuss the importance of addressing comorbidities, such as metabolic syndrome or inflammatory bowel disease, when determining the best therapy for each patient. Dr Glick then shares anecdotal examples to illustrate the value of deucravacitinib, including its success in treating an elderly patient with longstanding psoriasis and a younger patient with psoriasis and psoriatic arthritis. Efficacy in difficult-to-treat sites such as the scalp is also important to note. They then address the importance of collaboration with primary care physicians to address underlying cardiovascular and metabolic risks while encouraging patients to adopt healthy lifestyle changes like smoking cessation and exercise. They conclude by highlighting the importance of long-term data, citing deucravacitinib's 4-year efficacy and safety results, and anticipate the arrival of new oral therapies that will further expand treatment choices and improve patient outcomes. Tune in to the full episode for deeper insights into the challenges and opportunities in systemic therapy selection for psoriasis, including strategies for navigating the expanding treatment landscape, tips for addressing comorbidities, and pearls for integrating therapies like deucravacitinib into practice with a patient-centered approach.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes E. James Song, MD, Chief Medical Officer at Frontier Dermatology, to explore the nuances of systemic therapy selection for atopic dermatitis (AD) and offer practical guidance on tailoring treatment plans to optimize outcomes for these patients. They begin by discussing the importance of considering patient-specific factors, such as contraindications, access, and age, when selecting among the 3 currently available biologics for AD: dupilumab, tralokinumab, and lebrikizumab. While these therapies share many similarities, nuanced differences—such as dupilumab's approval for younger patients and asthma comorbidity, or lebrikizumab's sustained efficacy after discontinuation—can guide treatment decisions. They also discuss adverse events, including conjunctivitis and dupilumab-associated facial erythema, highlighting strategies for managing these issues. Dr Song notes that switching within the IL-13 pathway can often resolve conjunctivitis and speculates on the possible mechanisms behind facial redness. They then explore one critical insight: the potential for patients to fail one biologic and still respond to another within the same class. While complete nonresponders may benefit from switching to a different class, such as JAK inhibitors, partial responders often do well with another IL-13 inhibitor. Tune in to the full episode to explore more insights on optimizing AD management, including how to navigate biologic options, manage adverse events, and approach challenging cases while embracing new therapies and tailoring care to each patient's unique needs.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Tina Bhutani, MD, CEO and clinical dermatologist at Synergy Dermatology in San Francisco, to explore the evolving role of topical corticosteroids in psoriasis care and their interplay with newer nonsteroidal agents. With the wide array of treatments available today, they highlight the enduring importance of topicals in dermatology practice, even as systemic therapies become increasingly effective. They begin by highlighting the role of topical corticosteroids as a cornerstone of psoriasis management. Dr Bhutani explains that she often uses high-potency options like clobetasol for thick plaques and milder steroids like hydrocortisone for sensitive areas. She shares a practical approach: using steroids for acute flares and transitioning to nonsteroidals, such as tapinarof or roflumilast, for maintenance. This approach emphasizes the versatility of topical treatments, allowing dermatologists to tailor treatments, enhance efficacy, and simplify regimens to improve adherence. They then discuss the unique mechanisms of newer nonsteroidals, particularly tapinarof as an aryl hydrocarbon receptor agonist. This mechanism reduces inflammation through key psoriasis pathways and may even affect memory T cells, contributing to tapinarof's potential remittive effect. For challenging areas, Dr Bhutani offers pearls such as occlusion to boost penetration and creative strategies to address palmoplantar psoriasis. She also introduces an effective maintenance strategy, advising patients to scale back topicals to twice a week during remission to reduce side effects while sustaining symptom control. Tune in to the full episode for actionable insights for dermatologists navigating the balance between traditional and innovative topical therapies in managing psoriasis.

In this episode of Derms and Conditions, host James Del Rosso, DO, welcomes David Cotter, MD, a dermatologist in clinical practice and assistant clinical professor at the University of Nevada Las Vegas School of Medicine, to discuss the integral role of patch testing in managing atopic dermatitis (AD) and allergic contact dermatitis (ACD), providing practical insights on incorporating patch testing into practice and differentiating between these often-overlapping conditions. They begin with Dr Cotter highlighting the importance of a holistic approach when evaluating patients with AD and ACD. A thorough history and physical examination, combined with a detailed understanding of allergen exposure, are essential for tailoring patch testing to the patient's specific needs. He notes that AD and ACD frequently coexist, and identifying an allergen component is particularly valuable in cases of treatment-resistant AD or when new patterns, such as hand or facial dermatitis, emerge. For patients already on systemic therapies like biologics and JAK inhibitors, interpreting patch test results requires careful consideration. While biologics may control aspects of ACD, breakthrough dermatitis often signals clinically relevant allergens. Patch testing can be performed without discontinuing current biologic or JAK inhibitor therapy, though a washout period and repeat testing may sometimes be needed. Dr Cotter shares that patch testing can significantly improve outcomes, especially for patients who prefer allergen avoidance over additional systemic therapies. Tools like allergen-detection apps can empower patients to avoid triggers in their daily lives. When avoidance is not feasible, oral JAK inhibitors approved for AD can also help manage both AD and ACD symptoms in many cases. Tune in to the full episode to explore the value of patch testing in modern dermatology and get actionable strategies to improve care for patients with complex dermatitis cases.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, invites Peter Lio, MD, a clinical professor of dermatology at Northwestern University, to explore the complexities of selecting therapies for atopic dermatitis (AD) with a particular focus on the newly approved IL-13 inhibitor, lebrikizumab. With a growing number of treatment options, Dr Lio and Dr Del Rosso examine how these therapies are enhancing patient management in unique ways. The discussion opens with a look at the current "embarrassment of riches" in AD treatments. Dermatologists now have multiple biologic options to choose from, each with distinct features. Dr Lio highlights lebrikizumab's flexible dosing, which can shift to once monthly after the initial treatment period, potentially offering patients a more manageable treatment routine. They also explore key differences among IL-13 inhibitors, such as lebrikizumab's unique binding characteristics that may influence the overall balance of IL-13 in the body. Dr Lio also notes the possibility of achieving relative remission for certain patients on lebrikizumab, as suggested by a long-term extension study where some patients maintained improvement even after stopping the drug. They also cover the safety and tolerability aspects of AD therapies, including conjunctivitis, arthropathy, and erythematous reactions sometimes seen with these drugs. Dr Lio shares insights on managing these side effects, emphasizing that despite similar mechanisms of action, switching between IL-13 inhibitors may alleviate adverse reactions for certain patients. Tune in to the full episode for expert insights on differentiating and integrating the latest therapies for AD, strategies for engaging patients in their treatment plans, and valuable guidance on navigating today's expanding therapeutic landscape.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Adelaide Hebert, MD, chief of pediatric dermatology at McGovern School of Medicine and Children's Memorial Hermann Hospital in Houston, to discuss the intricacies and challenges of pediatric clinical research. They begin by noting that past limitations left clinicians with few FDA-approved treatment options for younger patients, often relying on off-label therapies without robust pediatric data. However, legislative changes and incentives, such as patent extensions for drugs studied in pediatric populations, have encouraged pharmaceutical companies to invest in pediatric trials, enabling dermatologists to gain access to more targeted therapies for children. Despite this progress, enrolling young children in clinical trials remains challenging, partly due to concerns from parents about potential risks. Dr Hebert shares her approach to easing these concerns, often by conducting trials with adult and adolescent populations first so parents have a better understanding of a therapy's safety profile. Drs Hebert and Del Rosso then address the logistical aspects of pediatric trials, from initial phone screenings to addressing parents' concerns about risk-benefit profiles, placebo arms, and the long-term safety of therapies. Dr Hebert underscores the need to accommodate the unique schedules and needs of young patients, such as adjusting appointments to fit around school hours. She also shares tips for administering injections to children, including using ice packs, straightforward explanations, and comforting strategies to make the experience as positive as possible. Throughout the conversation, Dr Hebert emphasizes the trust placed in dermatologists by parents and highlights the importance of respectful, compassionate communication, which ultimately strengthens the therapeutic alliance. Tune in to the full episode to learn more about pediatric clinical trials, hear insights on patient and parent communication, and get valuable guidance for dermatologists aiming to expand their expertise in pediatric patient care.

In this special live episode of Derms and Conditions, recorded at the Fall Clinical Dermatology 2024 Meeting, host Dr James Q. Del Rosso welcomes Dr April Armstrong, chief of dermatology at UCLA, to discuss key highlights from the conference. Together, they cover the latest in psoriasis treatments, promising developments for vitiligo, advances in hidradenitis suppurativa, and much more. The discussion kicks off with psoriasis, where exciting progress in oral TYK2, IL-23, and IL-17A inhibitors is providing potential for effective, safe options for moderate-to-severe cases. For atopic dermatitis, they review the recent approval of lebrikizumab and the real-world efficacy of tralokinumab for head and neck involvement. They also spotlight OX40/OX40 ligand inhibitors—amlitelimab and rocatinlimab—as promising long-acting treatments currently in development. In prurigo nodularis, the newly approved nemolizumab, an IL-31 inhibitor, offers antifibrotic benefits and has notably not shown evidence of conjunctivitis risk seen with other biologics. For vitiligo, BET inhibitors are creating new opportunities by targeting epigenomics, and several JAK inhibitors are pending phase 3 data. For hidradenitis suppurativa, focus has shifted from TNF inhibitors to IL-17 inhibitors like secukinumab, with bimekizumab and oral JAK inhibitors, including povarcitinib, in late-stage development. They round out the episode with chronic hand eczema, where topical ruxolitinib and delgocitinib—a pan-JAK inhibitor recently approved in Europe—show encouraging results. Tune in to the full episode for a full recap of these developments and other breakthroughs from the Fall Clinical Dermatology 2024 Meeting!

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Mona Shahriari, MD, associate director of clinical trials at Central CT Dermatology and assistant clinical professor at Yale University, to discuss the recent FDA approval of lebrikizumab, approved for atopic dermatitis (AD) in patients 12 years of age and up who have failed topical treatments like corticosteroids or calcineurin inhibitors, and its potential impact on treatment strategies. They begin by explaining the drug's flexibility, with an initial loading dose followed by maintenance dosing that can be extended to once a month for patients who achieve a satisfactory response after 16 weeks. Dr Shahriari emphasizes that determining an adequate response involves more than skin clearance; persistent symptoms like itchiness can indicate the need to continue more frequent dosing. They then discuss how many patients maintained their treatment response even after tapering dosing, with some experiencing benefits through week 52, suggesting a durable effect even when the treatment was paused. When discussing real-world use, Dr Shahriari notes lebrikizumab's convenience for both patients and providers, as it does not require baseline or ongoing lab monitoring and has no drug-drug interactions. Addressing safety, Dr. Shahriari notes that while common side effects like conjunctivitis and injection site reactions were observed, the drug was generally well-tolerated without any major safety concerns. They conclude by reflecting on the heterogeneity of AD, noting that patients may respond differently to medications even within the same class and that it's important to have multiple options to personalize treatment for each patient. Tune in to the full episode to hear more about lebrikizumab's clinical performance and the growing toolbox for AD management that is allowing dermatologists to offer safer, more targeted treatments that greatly improve patients' quality of life.

In this episode of Derms and Conditions, host Dr James Q. Del Rosso welcomes Dr Joel M. Gelfand, Professor of Dermatology and Epidemiology at the University of Pennsylvania, to explore the critical issue of comorbidities in dermatology, with a focus on psoriasis, and address why dermatologists should take an active role in recognizing and addressing these risks. Dr Gelfand reflects on his early observations of patients with psoriasis and their potential internal health issues, noting how in the past, psoriasis was primarily seen as just a skin condition. However, research and a pivotal article on inflammatory pathways in atherosclerosis led to improved understanding that psoriasis is linked to cardiovascular disease. Dr Gelfand then discusses the groundbreaking use of electronic medical records to track patients with psoriasis over time, revealing higher incidences of cardiovascular events and mortality. This research highlighted that people with moderate to severe psoriasis have a reduced life expectancy by about 5 years, underscoring the need for dermatologists to address comorbidities in their patients. The conversation then explores practical advice for clinicians, focusing on the role of dermatologists in identifying cardiovascular and diabetes risks in patients with psoriasis. Dr Gelfand suggests a simple yet effective approach: educate patients about their increased health risks, perform basic screenings like cholesterol and blood pressure checks, and collaborate with primary care physicians or cardiologists when needed. By fostering multidisciplinary care, dermatologists can play a crucial role in preventing life-threatening conditions in their patients. Tune in to the full episode for guidance on addressing the broader health risks associated with psoriasis and the practical steps dermatologists can take to help reduce these risks. From screening for cardiovascular disease to forming strong collaborations with other health care providers, this episode offers valuable insights for improving patient outcomes.

In this episode of Derms and Conditions, host James Del Rosso, DO, is joined by Jason Hawkes, MD, a dermatologist and investigator at the Medical Research Center of Oregon, to discuss tyrosine kinase 2 (TYK2) inhibitors, particularly deucravacitinib, for plaque psoriasis. They explain how deucravacitinib, which targets the TYK2 pathway, differs from other JAK inhibitors by avoiding the "off-target" effects associated with JAK 1, 2, and 3 inhibitors, offering a more selective and safe treatment option. They begin by discussing the JAK-STAT pathway, with Dr Hawkes noting that while the science behind it was well known, TYK2's role in psoriasis took time to fully understand. TYK2 regulates key cytokines like IL-12, IL-23, and type 1 interferons, which are critical in psoriasis and psoriatic arthritis. Its more focused role within the immune response reduces the risk of systemic side effects compared to broader-acting JAK inhibitors. They also explore deucravacitinib's selectivity, which targets the pseudokinase domain of TYK2, offering greater precision compared to inhibitors that target the ATP-binding domain shared by other JAKs. This selectivity results in deucravacitinib's cleaner safety profile, reflected in the lack of a boxed warning and minimal monitoring requirements. Finally, they review long-term data, noting deucravacitinib's superior efficacy to apremilast and a stable safety profile over four years. While some safety signals, like herpetic infections, slightly increased over time, most adverse events were stable or decreased. They conclude by discussing the importance of personalized treatment decisions, emphasizing deucravacitinib's advantages for patients who prefer oral medications and want to avoid injections. Tune in to the full episode for a comprehensive discussion on the clinical relevance of TYK2 inhibitors and the role of deucravacitinib in the psoriasis treatment landscape.

In this episode of Derms and Conditions, host James Del Rosso sits down with Dr Jessica Kaffenberger, an associate professor in dermatology at Ohio State University in Columbus, Ohio, to discuss the latest in hidradenitis suppurativa (HS) management. From navigating treatment challenges to addressing patient concerns, Dr Kaffenberger shares valuable insights on bridging older therapies with biologics, early diagnosis, and the importance of mental health and other forms of support to reduce risk factors for progression of HS, such as smoking cessation and weight reduction.  The discussion begins with a reflection on traditional therapies used for HS, such as antibiotics and intralesional injections, and how they were often insufficient in managing the condition. Dr Kaffenberger emphasizes the importance of being proactive with treatment, especially with the use of biologics earlier in the course of the disease, even for patients with moderate HS. They also address the limitations of the Hurley staging system for HS, which, as a system based on visible disease severity, often delays biologic treatment until irreversible damage has occurred. Dr Kaffenberger calls for earlier use of biologics to prevent chronic sequelae. She also highlights the difficulty of obtaining insurance approval for biologics at early stages of the disease and recommends using templates from the HS Foundation to support prior authorizations. Dr Kaffenberger then stresses the importance of early diagnosis, noting that HS is often misdiagnosed as sporadically occurring abscesses or cysts. She encourages health care providers to look for early signs like double-headed comedones and recommends laser hair removal as an early intervention strategy. Addressing the psychological burden of HS, they highlight the high rates of anxiety, depression, and suicidal ideation among patients. Dr Kaffenberger advises dermatologists to build rapport, connect patients with mental health resources, and consider the impact of weight loss and smoking cessation in managing HS, while approaching conversations nonjudgmentally. Tune in to the full episode for a comprehensive look at HS management and how dermatologists can improve outcomes for their patients.

In this episode of Derms and Conditions, host James Del Rosso, DO, speaks with Mark Lebwohl, MD, Dean for Clinical Therapeutics at the Icahn School of Medicine at Mount Sinai, about the role of Janus kinase (JAK) inhibitors, particularly upadacitinib, in treating atopic dermatitis. They provide insights into the benefits of JAK inhibitors compared to monoclonal antibodies, patient selection, and the implications of recent clinical data. They begin by explaining that while monoclonal antibodies like dupilumab and tralokinumab have been effective for many patients, JAK inhibitors can offer a powerful alternative for those seeking better control of their symptoms. They emphasize the importance of regularly assessing patient satisfaction with their treatment and exploring whether a switch to a JAK inhibitor might be beneficial. Dr Lebwohl then refers to treat-to-target principles recently established by a consensus conference, where EASI 75 is a moderate goal and EASI 90 is optimal. JAK inhibitors, he suggests, are more likely to help patients reach these higher targets, especially when symptoms persist despite achieving EASI 75. They continue to discuss data demonstrating that upadacitinib significantly improves outcomes, with 40.8% of patients achieving EASI 90 compared to 22.5% with dupilumab. Additionally, upadacitinib-treated patients are more likely to report minimal impact on their quality of life as measured by the Dermatology Life Quality Index. Finally, Dr Lebwohl stresses the importance of discussing the risks associated with JAK inhibitors, including boxed warnings, in a clear and contextualized manner to help patients make informed decisions. Tune in to the full episode to gain a deeper understanding of the nuances of JAK inhibitors in AD treatment, including practical tips for patient management, insights into the latest clinical data, and optimizing patient care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Omar Noor, MD, co-owner of Rao Dermatology in New York, NY, who shares his expertise on integrating nonsteroidal topical therapies into psoriasis treatment. As systemic therapies continue to advance, Dr Noor emphasizes the enduring importance of topical treatments with a focus on the aryl hydrocarbon receptor agonist, tapinarof. They begin by discussing the role of newer nonsteroidal options for psoriasis like roflumilast and tapinarof, highlighting their benefits in contrast to corticosteroids, which, despite their effectiveness, can carry significant adverse effects. Dr Noor describes how he incorporates these treatments into his practice, starting with topical steroids in some cases and transitioning to nonsteroidal options as needed. Dr Noor's approach allows for flexible treatment plans tailored to each patient's response. Dr Noor goes on to note that his experience with tapinarof aligns with emerging clinical data, showing effectiveness in challenging areas like the scalp with minimal adverse effects. He highlights that while contact dermatitis was observed in trials, it is rare in his practice, and proper patient education helps mitigate risks. They then discuss the remittive effect that some patients achieve with tapinarof, thanks to its mechanism of action as an aryl hydrocarbon receptor agonist. This contrasts with corticosteroids, which are often seen as temporary solutions. He encourages health care providers to take the time to engage thoughtfully with patients, recognizing their investment in their care and the value of personalized attention and education. Tune in to this episode for valuable insights on optimizing psoriasis treatment and improving patient care through effective use of nonsteroidal therapies and enhanced communication strategies.

In this episode, our host, James Q. Del Rosso, DO, welcomes Dr Adrian Rodriguez, a dermatologist from Nashville, to discuss the exciting advancements in personalized medicine for psoriasis, particularly focusing on the practical use of a dermal biomedical patch to help clinicians optimize selection of biologics agents for patients with psoriasis.  Dr Rodriguez emphasizes that we're moving into an era where personalized patient evaluations are playing a greater role in disease management, not to replace the judgment of the clinician, but to assist the clinician during the process of treatment selection. The Mind.Px patch, which is currently available for use, is designed to predict a patient's response to anti-TNF, anti-IL 17, or anti-IL 23 agents, and epitomizes this shift towards precision medicine. He explains how the patch enables dermatologists to customize psoriasis treatments based on molecular signatures, with evidence supporting improved overall patient outcomes as compared to clinical judgment alone. He shares his real-world experience of integrating the Mind.Px patch into clinical practice, highlighting its simplicity and the minimal learning curve required for its use. He points out that the real challenge lies in integrating the patch into a busy dermatology practice, ensuring timely results, and coordinating subsequent treatment. Dr Del Rosso then poses various clinical scenarios to Dr Rodriguez, exploring the practicality of the patch. They acknowledge that data shows better response rates and faster achievement of PASI75 among physicians using the patch. When selecting the test site, Dr Rodriguez advises choosing an early erythematous plaque, noting that the procedure is painless and well-received by patients who appreciate the use of both for cutting-edge diagnostic technology and treatments. He emphasizes the importance of clear communication with patients about the patch's benefits and logistics, as it requires a few weeks to get results. They also cover the practical aspects of obtaining and using the patch, including insurance coverage and patient assistance programs to manage costs. Tune in to learn how the Mind.Px dermal patch is guiding the future of personalized psoriasis treatment and how you can incorporate this innovative tool into your practice for better clinical outcomes

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, and guests Michael Cameron, MD, and James Allred, MD, discuss the intersection of GLP-1 agents and dermatology, exploring how these drugs, initially designed for managing type 2 diabetes, are now offering promising benefits for skin conditions associated with obesity. They begin by providing an overview of glucagon-like peptide-1 (GLP-1) agents and their mechanisms of action. These drugs, which include terzepitide (marketed as Mounjaro and Zepbound) and semaglutide (available as Ozempic and Wegovy), are GLP-1 receptor agonists that enhance insulin secretion, reduce appetite, and promote weight loss. Dr Allred then shares his personal experience, noting that patients on GLP-1 therapy, prescribed by their primary care physicians, showed remarkable improvements in their hidradenitis suppurativa (HS) symptoms. Observing these benefits, he began prescribing GLP-1 agents himself. Although randomized controlled trials directly linking GLP-1 agents to HS improvement are lacking, clinical observations align with the understanding that obesity-related systemic inflammation impacts dermatologic conditions like HS and psoriasis. The conversation then shifts to discussing weight management with patients. They stress the importance of empathy and understanding, particularly for patients with HS who may find exercise counterproductive due to flare-ups. By explaining that reducing systemic inflammation through weight loss can significantly improve HS symptoms, they find patients more receptive to GLP-1 therapy. Finally, they cover the practical aspects of integrating GLP-1 prescribing into dermatologic practice. Drs Allred and Cameron advise on patient assessment, including checking BMI and potential contraindications like a history of thyroid cancer. They highlight the importance of monitoring basic labs, such as glucose, hemoglobin A1c, and lipid profiles, to track the therapy's impact and support insurance approvals. Tune in to learn how dermatologists can leverage GLP-1 agents to improve patient outcomes by addressing the inflammatory underpinnings of conditions like HS and enhancing overall quality of life.

In this special episode of Derms and Conditions, Charlie Dunn, MD, chief resident at Kansas City University, steps in as the host to interview James Del Rosso, DO, offering a fresh perspective for our listeners. Together, they explore the evolution of dermatologic therapies and the understanding of disease states, providing valuable insights for both early-career dermatologists and seasoned practitioners alike. They begin with rosacea, with Dr Del Rosso explaining the historical perspective and highlighting a landmark article that classified the condition into subtypes. This classification system, although useful, has led to some confusion over the years. He discusses the condition's complexity and the need to reconsider the traditional subtypes. He stresses the importance of evaluating patients individually, considering the phenotype presented during consultations, and understanding the interplay between erythema, papules, and pustules. The conversation then shifts to hidradenitis suppurativa (HS) and other disease states, with Dr Del Rosso emphasizing the need for therapies to evolve alongside our understanding of the disease. He points out that package inserts often lag behind current clinical practices, and highlighting the disconnect between FDA-approved prescribing information and real-world application and experience, encourages dermatologists to stay informed about the latest pathophysiological insights and therapeutic options. Advocating for a personalized approach to dermatologic care, they discuss recognizing that therapies within the same class can behave differently across various disease states and patient populations. They emphasize the value of real-world studies in capturing the practical application of treatments, contrasting with the controlled settings of phase 3 clinical trials. As the episode draws to a close, Drs Dunn and Del Rosso reflect on the dynamic nature of dermatologic practice, encouraging listeners to stay informed and adaptable. They highlight the importance of reassessing traditional approaches considering evolving evidence. This episode offers a comprehensive overview of the current landscape of dermatologic therapies, providing listeners with actionable insights and a deeper understanding of how to navigate the complexities of modern dermatologic practice.

In this episode of Derms and Conditions, host James Q Del Rosso, DO, is joined by Clay Cockerell, MD, a practicing dermatopathologist at Cockerell Dermatology in Dallas, TX, whose expertise in dermatopathology and commitment to ongoing education offer listeners practical advice on enhancing patient care and professional fulfillment. They begin by discussing some common pitfalls that can lead to missed diagnoses. Dr Cockerell emphasizes the importance of proper biopsy techniques, noting issues such as inadequate superficial biopsies that miss diagnostic areas and improper punch biopsies that fail to assess critical features. He also addresses insufficient preset menu options in EMR systems that lack necessary detail, advocating for including clinical photographs with unusual skin biopsies to improve diagnostic accuracy. They then expand on the topic of the underutilization of EMR systems to send clinical photographs to dermatopathology labs, urging more offices to adopt this practice to provide valuable context for difficult cases. Dr Cockerell then shares his journey of continuous learning, having pursued multiple MBAs and a law degree. He emphasizes the value of business and legal knowledge in medical practice, noting that his MBA education helped him with personal finance, hiring, leadership, and people skills, while his law degree provided valuable insights into understanding legal documents and advocating for his rights. Dr Del Rosso and Dr Cockerell then speculate on the increasing rates of burnout among dermatologists and emphasize the importance of hobbies and interests outside of medicine, with both agreeing that diversifying one's interests is crucial to maintaining passion and satisfaction in one's career. Tune in to the full episode for more valuable insights into improving dermatology practices, the importance of continuous learning, and strategies for maintaining work-life balance to prevent burnout.

In this episode of Derms and Conditions, host James Q Del Rosso, DO, and James Song, MD, FAAD, co-chief medical officer and director of clinical research at Frontier Dermatology in Mill Creek, WA, explore the complexities of clinical decision-making in dermatology. Dr Song shares his insights on maintaining efficiency in a busy private practice, particularly when dealing with challenging medication approvals. They begin by highlighting the importance of setting patient expectations early and communicating that initial treatment plans are not binding and can be adjusted based on patient feedback and treatment efficacy. They explore the challenges of getting systemic treatments approved for conditions affecting areas like the scalp, hands, feet, or nails, which may not respond well to topicals but often require step therapy before systemic agents are approved. Sharing strategies for streamlining the approval and appeals process, Dr Song explains the value of referencing expert panel guidance to support treatment plans and how using prepopulated templates from organizations like the HS Foundation can streamline approvals and strengthen appeals for off-label usage of drugs like infliximab. Both doctors stress the importance of thorough documentation, highlighting the need for effective note-taking that includes the key phrases payers look for to reduce denial rates. Dr Song notes the significance of understanding the requirements of major payers and maintaining a log of these requirements to stay current. The episode also covers the concept of bridge programs, which, while beneficial on paper, can be labor-intensive to maintain. Dr Song advises using them judiciously, opting for reasonable alternatives when possible, so long as it does not compromise patient care. Tune in to the full episode for a detailed look at the ins and outs of clinical decision-making, medication approval, and the importance of clear communication and conscientious documentation in dermatologic practice.

In this episode of Derms and Conditions, host James Q Del Rosso, DO, is joined by Alexandra Golant, MD, to discuss taking a holistic approach to diagnosing and managing atopic dermatitis beyond the AAD guidelines, exploring the importance of looking beyond treatment rankings and considering comprehensive patient information. They begin by discussing the significance of patient history, emphasizing the importance of context clues like family history, seasonal variations in symptoms, and quality of life impacts in forming a comprehensive understanding of the individual. They also address navigating the challenges of gathering family histories, noting that despite challenges in obtaining accurate details, it's crucial to maintain a broad perspective while making diagnoses, focusing on key features while not losing sight of supportive aspects. Next, they highlight diagnostic challenges, emphasizing the need to consider atypical presentations and always keep a range of differentials in mind. Dr Golant discusses using therapeutics as both a treatment and diagnostic tool, with an emphasis on reassessment if treatment expectations are not met. Trigger factors are also explored, with both doctors sharing anecdotes that illustrate the impact of environmental triggers on symptoms. The pair also discusses their differing approaches to making skin care recommendations to their patients, highlighting that this varies among practitioners with some providing liberal suggestions and others providing more specific guidance. They then move on to discuss how they select treatments for their patients, noting that the integration of topical therapy is patient-dependent, with newer agents gaining traction due to improved tolerability. Systemic therapies, including monoclonal antibodies and JAK inhibitors, offer promising options, with treatment selection tailored to individual patient factors. Looking ahead, they note that advancements in monoclonal antibodies and targeted therapies hold promise for improving AD management. They conclude their discussion by highlighting evolving guidelines and a shift away from corticosteroids towards more targeted therapies, signaling progress in the field. Tune in to the full episode to hear more about using guidelines to inform a holistic approach to the management of atopic dermatitis!

In this episode of Derms and Conditions, host James Q Del Rosso, DO, is joined by Shawn Kwatra, MD, to discuss an intriguing breakthrough in atopic dermatitis (AD) therapeutics: the OX40/OX40 ligand pathway. As advancements in AD treatment continue to unfold rapidly, this pathway has emerged as a novel target, presenting a promising avenue for achieving long-term relief by targeting upstream inflammatory signals. By normalizing disease processes and potentially inducing longer periods of remission, understanding this pathway may offer a paradigm shift in AD management. They begin with an overview of the OX40/OX40 ligand pathway, a key regulatory mechanism believed to govern type 2 inflammation at its source. The OX40/OX40 ligand serves as a crucial costimulatory molecule, facilitating communication between immune cells. This interaction, occurring upstream in the inflammatory cascade, has become the focus of therapeutic interventions aimed at modulating AD. They also highlight the impact of the heterogeneity of AD, characterized by various cytokine profiles and immune responses, emphasizing the significance of targeting the OX40/OX40 ligand pathway. By intervening at this early stage, it becomes possible to personalize treatment strategies and address the diverse manifestations of the disease. They then discuss the potential of OX40/OX40 ligand modulation to influence immune memory, leading to sustained responses even after treatment cessation. Clinical data suggest the possibility of extended remission periods, enabling a shift towards disease modification rather than symptom control alone. Looking ahead, the pair discusses how the integration of OX40/OX40 ligand-targeted therapies with existing treatments could yield synergistic effects, expanding treatment options for not only AD but also related inflammatory conditions. Tune in to the full episode to learn more about this novel target and how it may revolutionize the management of a spectrum of immune-mediated diseases. This episode is supported by Sanofi. The content included in this episode is independently developed by the Derms and Conditions team and their guest speakers, and reflects their own views and opinions.

In this episode of Derms and Conditions, host James Q Del Rosso, DO, interviews Faranak Kamangar, MD, and April Armstrong, MD, MPH, about the integration of artificial intelligence (AI) in dermatology. They discuss specialized dermatologic models, ethical considerations, and the crucial role of physicians in refining these technologies. The discussion begins with the host addressing concerns regarding the "authenticity" of AI and how Dr Kamangar developed a strong interest in AI, stemming from her engineering background and interest in health technology, particularly in the development of language-learning models. She explains the significance of ChatGPT opening the door publicly for AI, followed by specialized models revolutionizing AI accuracy. They then discuss the vetting process for AI accuracy, addressing both anticipated and logical errors and the more subtle errors seen in field-specific results. Dr Kamangar emphasizes the importance of using specialized AI models for dermatology to ensure the most precise results. The discussion with both Dr Kamangar and Dr Armstrong also touches on the ethical considerations surrounding AI use in medical writing, highlighting the necessity of disclosing AI involvement to uphold integrity in academic publishing. Exploring the use of AI in electronic medical records (EMRs), Dr Kamangar and Armstrong underscore the importance of maintaining HIPAA compliance and the need for human oversight when integrating AI into EMRs and publications. They note that when implemented effectively, AI use in EMRs has the potential to reduce human errors, and with both medical record documentation and publication writing, has the potential to alleviate burnout. The conversation then shifts to the role of residents in integrating AI tools into their practice, with Dr Armstrong noting that residents are often early adopters of new technologies. They also emphasize the importance of physician involvement in the early development of dermatology-specific AI solutions, which is essential for shaping tools that address real-world challenges in dermatologic practice. Looking forward, they both anticipate continued integration of AI in dermatology practice, emphasizing the need for physicians to familiarize themselves with this technology to determine what models are dependable and ultimately to optimize patient care. Tune into the episode to further explore the many nuanced challenges and opportunities presented by AI adoption in dermatology!

In this episode of Derms and Conditions, host James Q Del Rosso, DO, engages in a comprehensive discussion with Jason Hawkes, MD, MS, FAAD, a medical dermatologist in Rocklin, CA, on chronic spontaneous urticaria (CSU). They discuss CSU's position in the spectrum of urticarial conditions, explore differential diagnoses and treatment strategies, and offer a wealth of valuable insights into this complex disease. They begin by defining urticaria as a collection of conditions, explaining that this is often not well-delineated in textbooks or literature. Dr Hawkes categorizes urticaria into acute and chronic types, with chronic further divided into chronic inducible urticaria, which results from an identifiable trigger, and chronic spontaneous urticaria, which has no clear cause. They then explore differential diagnoses for CSU, including drug-induced urticarial reactions and conditions like mastocytosis or urticarial bullous pemphigoid that require thorough consideration. Transitioning to treatment strategies, they evaluate the use of systemic corticosteroids like prednisone for short-term relief in patients with CSU, taking into account reservations about long-term efficacy and potential side effects. Antihistamines are also highlighted for their rapid action, with Dr Hawkes encouraging prompt dosage adjustments if initial doses are ineffective. The conversation shifts to omalizumab, an injectable anti-IgE monoclonal antibody that has waned in popularity among dermatologists due to practical limitations and concerns over anaphylaxis risk. However, it is highlighted as a very effective treatment option for many patients with CSU, as it is amenable to office administration with low rates of anaphylaxis in real-world practice and has a broad consensus for use in guidelines. They conclude by touching on newer therapies in development that target alternative mechanisms, such as BTK and SYK inhibitors, which will broaden the therapeutic alternatives for patients with CSU. Tune into the full episode to gain a deeper understanding of CSU and glean invaluable insights into the nuances of this multifaceted condition.

In this episode of Derms and Conditions, host James Q Del Rosso, DO, interviews Naiem Issa, MD, PhD, FAAD, a dermatologist and dermatologic surgeon practicing at Forefront Dermatology in Vienna, VA, to discuss innovative approaches to treating challenging conditions. From exploring groundbreaking treatments for vitiligo to the mechanisms behind systemic responses in inflammatory diseases, this episode offers valuable insights into the intersection of art and science in dermatology. The conversation begins with a focus on a novel combination treatment for a challenging disease state: vitiligo. Dr Issa explores the potential of combining topical ruxolitinib with microneedling to promote repigmentation. He explains the rationale behind this approach, citing the proinflammatory cytokine milieu induced by microneedling, which can promote melanogenesis and repigmentation. He shares a successful case study involving a pediatric patient with segmental vitiligo who, after failing multiple other therapies, achieved significant repigmentation after undergoing this combined treatment. The discussion then shifts to Dr Issa's experiences with observing responses in untreated areas of inflammatory disease after treating a specific area. They consider the possible mechanisms of action behind this phenomenon and discuss the case of pediatric patient with severe atopic dermatitis who saw improvement in untreated areas after applying tapinarof to symptomatic areas, suggesting a possibly systemic anti-inflammatory effect mediated by regulatory T cells. Their discussion concludes by addressing the critical unmet need in the supply chain for epinephrine and the impact on clinical practice where lidocaine with ephinephrine is necessary for local anesthetic use. They discuss midodrine, an alpha-1-specific agonist, as an alternative to epinephrine, with findings indicating that midodrine allows for the reduction of epinephrine needed in lidocaine combinations and the significant effects observed at lower dilutions. Tune in to the full episode to hear more about Dr Issa's innovative approaches, groundbreaking research, and cutting-edge strategies that address critical needs in dermatology!

In this episode of Derms and Conditions, host James Q Del Rosso, DO, sits down with Jennifer Hsiao, MD, associate professor of clinical dermatology at Keck Medicine of University of Southern California, to discuss the multifaceted world of hidradenitis suppurativa (HS). From addressing diagnostic obstacles to understanding comorbidities, this episode guides clinicians through the many complexities of HS management. They begin by exploring the diagnostic hurdles associated with HS, with Dr Hsiao sharing insights to help clinicians navigate through potential misdiagnoses. She emphasizes the importance of recognizing subtle indicators of the disease and thinking outside the box when it comes to the location of lesions, as they may present in atypical areas. She also highlights the significance of recurrent history, which can serve as a diagnostic hallmark. Next, the pair discusses comorbidities associated with HS, with Dr Hsiao detailing the importance of inquiring about patients' primary care arrangements. She notes that while dermatologists may not directly manage these comorbidities, they can play a vital role in identifying and initiating the necessary steps toward management. The discussion then moves to the significant psychological impact of HS, emphasizing the necessity of open dialogue with patients about the psychological toll of HS and the benefits of seeking mental health support. Screening tools like the PHQ-2 can aid in identifying patients at risk and initiating necessary interventions. They next address the limitations of current clinical guidelines for HS and the need for a paradigm shift towards intervening earlier in the disease process to prevent irreversible tissue damage. The discussion concludes with the presentation of a clinical scenario describing a patient transitioning from oral antibiotics to a biologic, with Dr Hsiao outlining her suggested approach for such a patient.

In this 2-part special edition of Derms and Conditions, host James Q Del Rosso, DO, sits down with David Light, cofounder and president of Valisure, and Christopher Bunick, associate professor of dermatology and translational medicine at Yale University and medical and dermatologic advisor for Valisure, to shed light on Valisure's recent Citizen Petition to the US Food and Drug Administration regarding findings of high levels of benzene in benzoyl peroxide-containing products. In Part 1, Dr Del Rosso interviews David Light, cofounder and president of Valisure, an independent quality assurance company that aims to address a critical gap in the health care supply chain. Dr Del Rosso and Mr Light delve into the details regarding how a product review gets initiated, the financial source of such reviews, and the important differences between Valisure's work and that of Good Manufacturing Practice (GMP) testing facilities. Finally, they address the impact that manufacturing issues have on the increasing incidences of drug shortages in the United States. In Part 2, Dr Del Rosso continues his conversation with David Light to discuss stability testing—what it is, why it's important, and how Valisure undertook stability testing on products containing benzoyl peroxide. Mr Light details the rationale for conducting accelerated stability testing at elevated temperatures to evaluate the safety of the products across their entire lifecycles. Dr Bunick also joins the conversation to comment on the misperceptions about FDA-allowable limits of benzene in consumer products and the urgent need for change in how products are evaluated and formulated to ensure patient safety first and foremost. Lastly, Dr Del Rosso and Dr Bunick discuss how dermatologists should counsel patients in the short term on minimizing the risk of benzene exposure while we await further testing, external validation, and regulatory guidance.

In this 2-part special edition of Derms and Conditions, host James Q Del Rosso, DO, sits down with David Light, cofounder and president of Valisure, and Christopher Bunick, associate professor of dermatology and translational medicine at Yale University and medical and dermatologic advisor for Valisure, to shed light on Valisure's recent Citizen Petition to the US Food and Drug Administration regarding findings of high levels of benzene in benzoyl peroxide-containing products. In Part 1, Dr Del Rosso interviews David Light, cofounder and president of Valisure, an independent quality assurance company that aims to address a critical gap in the health care supply chain. Dr Del Rosso and Mr Light delve into the details regarding how a product review gets initiated, the financial source of such reviews, and the important differences between Valisure's work and that of Good Manufacturing Practice (GMP) testing facilities. Finally, they address the impact that manufacturing issues have on the increasing incidences of drug shortages in the United States. In Part 2, Dr Del Rosso continues his conversation with David Light to discuss stability testing—what it is, why it's important, and how Valisure undertook stability testing on products containing benzoyl peroxide. Mr Light details the rationale for conducting accelerated stability testing at elevated temperatures to evaluate the safety of the products across their entire lifecycles. Dr Bunick also joins the conversation to comment on the misperceptions about FDA-allowable limits of benzene in consumer products and the urgent need for change in how products are evaluated and formulated to ensure patient safety first and foremost. Lastly, Dr Del Rosso and Dr Bunick discuss how dermatologists should counsel patients in the short term on minimizing the risk of benzene exposure while we await further testing, external validation, and regulatory guidance.

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews Cory Rubin, MD, dermatologist and owner of the Michigan Dermatology Institute, about the business side of running a practice, with specific focus on the buy-and-bill model. Dr Rubin shares some of the challenges he has faced and explains the value of buy-and-bill for dermatologists, particularly in complex cases where medications may not be easily accessible through traditional pharmacies. They cover suitable medications, such as biologics for psoriasis, cutaneous T-cell lymphoma, and other conditions, as well as the financial benefits, clinical advantages, and patient convenience associated with in-office administration. The conversation dives into the practical aspects of implementing buy-and-bill. They explore the importance of understanding insurance processes, obtaining prior authorizations, and tracking patient outcomes. The pair emphasize the need to start small, gradually expanding buy-and-bill capabilities while ensuring proper documentation and reimbursement.  Dr Rubin offers rich practical advice and reiterates the importance of mentorship and seeking assistance from experts in billing and reimbursement. He also extends an invitation for further consultation via email and expresses his willingness to support colleagues in navigating the complexities of practice management. This episode is a valuable listen for dermatologists looking to optimize their practice operations and enhance patient care through buy-and-bill.

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews pediatric dermatologist Lisa Swanson, MD, live at Winter Clinical Miami 2024 to review conference highlights and discuss diagnosing and treating molluscum contagiosum, herpes labialis in the adolescent population, and newer and emerging therapies for chronic skin diseases like atopic dermatitis and acne. Dr Swanson discusses the recent FDA approval of cantharidin and berdazimer gel for molluscum contagiosum and the challenges of diagnosing single lesions. She highlights the importance of providing accurate information to schools and daycares about the contagiousness of the virus and the unnecessary quarantine measures that are often enforced. The pair share their excitement about the ability to profoundly impact patients' lives with newer therapies for chronic conditions, particularly bimekizumab, an anti-IL17A and anti-IL17F for plaque psoriasis, and oral deucravacitinib, a TYK2 inhibitor for plaque psoriasis that now has 3-year efficacy and safety data. They also discuss the presentation of herpes labialis in adolescents, with Dr Swanson emphasizing the marked severity of the primary outbreak, the importance of counseling these patients on managing outbreaks, and making efforts to destigmatize this condition among this population. Dr Swanson also looks forward several anticipated FDA approvals which include lebrikizumab for atopic dermatitis, both topical tapinarof and topical roflumilast also for atopic dermatitis including young children, and the approval of topical ruxolitinib extended to younger children. She also emphasizes that emerging access to acne medications in children of younger ages is important as puberty develops earlier. She discusses the effectiveness of clindamycin, benzoyl peroxide, and adapalene as a once daily combination treatment for acne and the availability of topical clascoterone, an androgen receptor inhibitor, which can be used twice daily for both adolescent girls and boys with acne. They conclude with a discussion on the importance of character and kindness in the field of dermatology based on a presentation at the meeting by special guest speaker Lori Greiner, which Dr Swanson demonstrates through her expressed willingness to help those without access to a pediatric dermatologist and an open-door policy for clinical consultation.

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, interviews April Armstrong, MD, MPH, a professor and Chief of Dermatology at UCLA, about the development of tapinarof, a novel nonsteroidal topical treatment for psoriasis.  They begin by discussing Dr Armstrong's history of professional interest in psoriasis. The conversation then moves to focus solely on tapinarof, a topical cream that works by modulating the aryl hydrocarbon receptor (AhR).  Dr Armstrong explains the unique mechanism of action of tapinarof and its effects on Th17 cytokines, antioxidant activity, and skin barrier function. She also discusses the efficacy demonstrated in clinical trials, with nearly 40% of patients achieving PASI 75 after 12 weeks, as well as the remittive effect in maintaining clear or almost clear skin.  They address the safety profile of tapinarof, including the occurrence of folliculitis and contact irritation, and provide tips for its use in clinical practice. Dr Armstrong also emphasizes its versatility and potential as a combination therapy with systemic medications. All in all, the episode provides listeners with an expansive understanding of tapinarof as an effective and well-tolerated nonsteroidal treatment for plaque psoriasis.

In this episode of Derms and Conditions, our host, James Q. Del Rosso, DO, is joined by April Armstrong, MD, MPH, and David Cohen, MD, MPH, live at Winter Clinical Hawaii 2024 to review highlights from the conference.  They cover a diverse slate of topics, including the 2023 allergen of the year (lanolin), notable advancements in psoriasis treatment including topicals and biologics, updates on diagnostic tools for melanoma, and clinical pearls for treating actinic keratosis with combinations of cryosurgery, topical field therapy, and PDT. The group reviews guidelines for atopic dermatitis and effective therapies like omalizumab and oral antihistamines for chronic spontaneous urticaria and secukinumab for hidradenitis suppurativa, as well as the need to improve outdated clinical guidance in the US.  Together, they examine the evolving role of artificial intelligence in dermatology and underscore the importance of practitioner well-being. From new therapies to new indications, tune in to hear a poignant analysis of key themes from the meeting this year.

In this episode of Derms and Conditions, Andy Blauvelt, MD, joins James Q. Del Rosso, DO, to discuss IL-17 inhibition, with a focus on bimekizumab as a treatment for psoriasis. Bimekizumab is unique for inhibiting both IL-17A and IL-17F, demonstrating higher efficacy and a favorable safety profile. Dr Blauvelt highlights the drug's mechanism of action and covers its approval process, global use, and notable data. He emphasizes its efficacy in achieving Psoriasis Area Severity Index 100 (PASI 100) clearance. The pair discusses bimekizumab's dosing schedule, with an induction dosing period of once a month for 16 weeks followed by maintenance dosing every 8 weeks, a unique feature compared with other IL-17 blockers. Dr Blauvelt emphasizes bimekizumab's exceptional efficacy, with rapid and sustained results, reaching close to 60% of patients achieving PASI 100 after a single dose and around 70% within a year. The discussion includes comparisons with other IL-17 blockers, addressing the drug's suitability for different patient profiles. Safety considerations, such as oral candidiasis, are explored, with Dr Blauvelt providing insights into managing these side effects. The conversation delves into additional areas of interest, such as ongoing studies for psoriatic arthritis (PsA) and hidradenitis suppurativa (HS). Regarding safety, they touch on topics like suicidal ideation and liver enzyme elevations. Dr Blauvelt emphasizes the importance of understanding the baseline risks associated with mental health issues in patients with psoriasis. The FDA's cautious approach is acknowledged, and Dr Blauvelt provides context, comparing bimekizumab with other biologics in terms of suicidal ideation data. In summary, Dr Blauvelt expresses enthusiasm for bimekizumab as a new and highly effective option for patients with psoriasis, citing its remarkable efficacy and potential future indications for PsA and HS. The episode concludes with a discussion on scalp psoriasis and bimekizumab's positive impact on treating this condition.

In this episode of Derms and Conditions, our host, Dr James Q. Del Rosso, reflects on the past year of podcasting, offering a rich summary of key dermatologic topics discussed throughout 2023.  To start, the episode delves into highlights from an interview with Dr Shane Chapman, who specializes in skin cancer. Dr Chapman shares insights into nonsurgical options for treating nonmelanoma skin cancer, focusing on strategies for cases of squamous cell carcinoma and nodular basal cell carcinoma that may not be amenable to surgical treatment for a variety of reasons. Next, Dr Del Rosso features an episode with Dr Adam Friedman, who explores the topic of sensitive skin as a standalone entity. They highlight the prevalence of sensitive skin and the need for dermatologists to acknowledge and address this poorly understood condition with an open-minded approach. In another segment, Dr Del Rosso revisits the work of Dr Matt Zirwas, who specializes in chronic dermatitis and inflammatory skin diseases. Dr Zirwas shares valuable insights on diagnosing scabies and addresses concerns about the differentiation of cutaneous T cell lymphoma from atopic dermatitis in older patients. Dr Del Rosso concludes with a review of a 2-part series featuring Dr Jeff Donovan, who provides comprehensive insights into alopecia areata. Dr Donovan discusses the many mimickers of alopecia areata and when and how to conduct a biopsy. He reviews treatment options for alopecia areata and discusses the efficacy of newer agents, such as JAK inhibitors, to treat severe alopecia areata. The use of dupilumab in selected cases, especially in children with both alopecia areata and atopic dermatitis, is also reviewed. Other relevant suggestions from Dr Donovan include his perspectives on both clinical and laboratory assessments, his discussion of other inflammatory hair diseases, and tips on differentiating these other hair disorders from alopecia areata along with suggestions on management approaches. Overall, Dr Del Rosso provides a comprehensive review, sharing insights and practical tips from featured experts. It was a great year for the Derms and Conditions podcast, mostly because of those who listened in and the expert faculty who shared their expertise so openly. In conclusion, Dr Del Rosso encourages engagement and feedback from the audience to help shape the direction of future podcast episodes.

In episode 67 of Derms and Conditions, our host, Dr James Q. Del Rosso, sits down again with Dr Jeff Donovan, a board-certified dermatologist who practices in Whistler, Canada, with his dermatology clinic dedicated solely to the management of hair disorders, for part two of their discussion on alopecia areata and other hair loss conditions. Dr Donovan begins the discussion by addressing autoimmune thyroid disease associated with alopecia areata and the appropriate laboratory interpretation and monitoring for these patients. He discusses the comprehensive baseline laboratory tests he collects before initiating JAK inhibitor treatment as well as how he approaches laboratory monitoring during the course of therapy. Next, the pair addresses how to tackle low laboratory values, such as vitamin D and ferritin, that are associated with more severe alopecia areata. Dr Donovan emphasizes that when treating iron deficiency, patient comfort and adherence are paramount. The pair notes that patients genuinely appreciate a thorough and concerned clinician and how important it is to set appropriate patient expectations with treatment. They then transition to the use of dupilumab in atopic children with alopecia areata who experience hair regrowth and how to determine which patients are more likely to respond to this treatment. Next, Dr Del Rosso describes a difficult case of lichen planopilaris, and Dr Donovan shares key clinical and dermatoscopic findings and encourages clinicians to have a low threshold for biopsy when suspecting lichen planoplilaris or another disorder other than alopecia areata, some which may cause scarring. He discusses treatment with topical corticosteroids, intralesional triamcinolone injections, doxycycline, hydroxychloroquine, methotrexate, and cyclosporine in isolation and in combinations and what would constitute an appropriate trial on these therapies. More data are needed on the use of JAK inhibitors for causes of inflammatory alopecia other than alopecia areata. Dr Donovan concludes by mentioning education opportunities available in hair loss and his final words of wisdom regarding alopecia. Tune in to this episode to learn all the details from a true hair expert!