Derms and Conditions

In this “Teabag” episode of Tea with Dr. D, host James Q. Del Rosso, DO, tackles questions submitted by dermatology clinicians across the country, offering evidence-based insights across several challenging clinical topics. Dr Del Rosso begins with hidradenitis suppurativa (HS), highlighting the importance of recognizing comorbidities and lifestyle factors that contribute to disease onset and progression, including smoking and elevated body mass index. He advises a phased management approach: prioritizing symptom control and patient comfort before introducing discussions about weight loss or smoking cessation. Depression, diabetes, metabolic syndrome, and cardiovascular disease are also important comorbidities to address over time. On initiating biologic therapy for HS, he explains the 3 pathologic phases, inflammatory, destructive, and burnout, and emphasizes that biologics such as adalimumab, secukinumab, or bimekizumab should be started early, in the inflammatory phase, to prevent irreversible scarring and sinus tract formation. He also shares procedural pearls, including the use of high-dose intralesional triamcinolone, incision and drainage, and deroofing for focal or persistent lesions. The discussion then shifts to photodynamic therapy (PDT) for nonmelanoma skin cancers. Referencing a study by Schlesinger et al, Dr Del Rosso reviews the efficacy of red-light PDT with 10% aminolevulinic acid gel for superficial BCC, highlighting improved clearance rates and favorable cosmetic outcomes over vehicle. Finally, Dr Del Rosso reviews new insights into topical nonsteroidal options for lichen planus, including off-label use of roflumilast and ruxolitinib creams. Both agents, with mechanisms targeting PDE4 and JAK pathways, respectively, have demonstrated reductions in inflammation and pruritus in some reports. Tune in for a concise, high-yield discussion featuring Dr Del Rosso’s practical guidance and clinical pearls for today’s dermatology practice.

In this episode of Tea with Dr D, host James Q. Del Rosso, DO, is joined by Christopher Bunick, MD, PhD, and later Lisa Swanson, MD, for a deep look at phosphodiesterase-4 (PDE4) inhibition in dermatology, with a special focus on topical roflumilast. Dr Bunick opens with a primer on the science of PDE4, an enzyme that degrades cyclic AMP (cAMP), an intracellular messenger that regulates anti-inflammatory pathways. In conditions such as atopic dermatitis (AD) and psoriasis, overactive PDE4 leads to reduced cAMP and amplified inflammation. By “gumming up” PDE4, roflumilast restores a more balanced, anti-inflammatory state. He explains why PDE4 inhibition is relevant across multiple inflammatory pathways, including Th1, Th2, and Th17, and why roflumilast has demonstrated stronger efficacy than earlier inhibitors like crisaborole. Molecularly, roflumilast mimics cyclic AMP’s binding to PDE4 across 3 key sites, producing far tighter binding than apremilast and crisaborole, which translates to superior clinical potency. Dr Bunick illustrates this with a case of palmoplantar pustular psoriasis that cleared dramatically within 8 weeks on topical roflumilast after multiple biologic and corticosteroid failures, highlighting its durability and barrier-restoring properties. He and Dr Del Rosso contrast this with the limitations of chronic steroid use, noting that roflumilast supports long-term control without barrier compromise. The discussion also touches on vitiligo, where Dr Bunick shares an early case of repigmentation following roflumilast treatment, suggesting possible cAMP-mediated stimulation of melanogenesis. They highlight the molecule’s innovative aqueous-based formulation, optimized for skin-compatible pH and excellent tolerability. In Part 2, Dr Swanson joins to discuss pediatric use. She reviews the 0.15% cream for AD in patients ≥6 years and the 0.05% cream for ages 2–5, both once-daily, steroid-free options that minimize burning and stinging compared with earlier PDE4 inhibitors. They review clinical data that demonstrate rapid itch relief, strong efficacy across IGA and EASI end points, and sustained control with twice-weekly maintenance. Tune in to hear how PDE4 inhibition, and particularly topical roflumilast, is redefining nonsteroidal therapy across age groups and disease states in dermatology.

In this special Derms and Conditions episode recorded live at Fall Clinical 2025, host James Q. Del Rosso, DO, is joined by April Armstrong, MD, MPH, and David Cohen, MD, to share highlights and clinical takeaways from this year’s meeting. Dr Armstrong kicks off with updates in hidradenitis suppurativa (HS), noting the field’s rapid progress with 3 FDA-approved therapies (adalimumab, secukinumab, and bimekizumab), emerging 3-year data for bimekizumab, and exciting new agents such as oral povorcitinib and topical ruxolitinib. She shares learnings on the importance of proactive flare management plans and setting realistic patient expectations, particularly regarding scarring and lymphedema. Dr Cohen and Dr Del Rosso echo the importance of reengaging patients with longstanding HS and highlight the promise of JAK inhibition in this complex disease. The discussion shifts to chronic spontaneous urticaria (CSU), where Dr Cohen spotlights remibrutinib, a twice-daily oral Bruton kinase inhibitor delivering rapid results sometimes within 1 to 2 weeks and potentially enabling dermatologists to manage CSU more directly. Dr Armstrong adds that dupilumab now offers another trusted option for CSU, with a head-to-head trial versus remibrutinib on the horizon. For chronic hand eczema (CHE), they discuss the paradigm-shifting approval of delgocitinib cream, a topical pan-JAK inhibitor effective across CHE subtypes and free of boxed warnings. They note strong data for pain and itch reduction and its potential to mitigate chronic steroid reliance. The episode closes with emerging oral psoriasis therapies, including 5-year deucravacitinib safety data and radiographic progression inhibition shown with guselkumab. Looking ahead, they predict major advances by 2026 in TYK2 inhibitors, OX40-targeted therapies, and personalized molecular profiling for atopic dermatitis. Tune in to the full episode for expert perspectives straight from the Fall Clinical stage!

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes David Osborne, PhD, a formulation expert behind several dermatologic topicals, to explore what drives topical performance, using dapsone and roflumilast as case studies. They begin by challenging long-held vehicle dogma rooted in mid-20th-century corticosteroid training: the idea that ointments always outperform creams or lotions. They note that with newer solubilizers, stabilizers, and vehicles, those rules don’t consistently hold for products approved in the modern era. They next revisit propylene glycol (PG) as a classic double-edged tool: its ability to dissolve more drug helped create “super-potent” corticosteroid lotions, yet higher PG levels can irritate skin, induce contact allergy, and compromise barrier function. However, they clarify that small amounts may serve as a humectant and offer antimicrobial benefits. They then discuss topical roflumilast’s development to illustrate modern formulation problem-solving: the roflumilast molecule is difficult to dissolve in water and tends to precipitate when water is present. The formulation approach minimized supersaturation (allowing a small solid fraction), leveraged a high purity grade of diethylene glycol monoethyl ether (DEGEE), known under the commercial name Transcutol, to hold the active ingredient drug (roflumilast) in solution in the presence of water, and delivered a highly moisturizing, propylene glycol-free and ethanol-free cream. Use of a unique emulsification approach ensured physical stability even at elevated temperatures while avoiding lipid extraction and additional barrier damage. For topical dapsone, Osborne incorporated pharmaceutical-grade Transcutol (free of ethylene-glycol contaminants) to partition the drug, slow release, and reduce systemic exposure. He emphasizes “topical product metamorphosis”: as water evaporates on skin, the local Transcutol concentration rises, dissolving residual crystals and enhancing delivery, the opposite of older vehicles that left behind residual visible crystals and under-delivered active. They close by looking ahead towards preservative minimalism, microbiome-aware vehicles, and designing drugs intrinsically optimized for cutaneous delivery so the base can remain as inert as possible. Tune in to the full episode to hear the formulation backstories behind roflumilast and dapsone, why PG can both enhance delivery and damage skin barrier integrity and function, how Transcutol and robust emulsifiers can solve solubility and stability hurdles, and pearls you can use tomorrow when selecting vehicles and counseling on tolerability.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with E. James Song, MD, for a discussion on phototherapy and its place in modern dermatology. While phototherapy has long been a safe and effective treatment for various skin disorders, its use has declined due to limited access, inconsistent residency training, and clinician concerns about dosing. They review why these barriers are more logistical than clinical and how newer technologies are making treatment more accessible than ever. They begin by highlighting one of the most significant advances in phototherapy: home-based narrowband UVB devices. These units feature guided dosing modes that adjust treatments based on patient feedback, minimizing risks and removing guesswork. They review real-world evidence from the LITE study, which demonstrated home-based therapy to be at least as effective as in-office treatment, with strong adherence, particularly among patients of color, while maintaining a favorable safety profile. Dr Song then reviews appropriate patient selection, contraindications, and practical steps for prescribing at-home devices, from enrollment forms to choosing unit sizes for full-body or targeted treatment. He also shares pearls on using phototherapy as an adjunct in conditions like psoriasis with psoriatic arthritis, and highlights approved indications that extend beyond psoriasis, including atopic dermatitis, vitiligo, and cutaneous T-cell lymphoma. The conversation concludes with a look at broader implications: phototherapy’s favorable cost-effectiveness compared to biologics, evidence of improvements in systemic inflammatory markers, and emerging research suggesting potential benefits in autoimmune conditions outside dermatology. Tune in to the full episode for practical guidance on this mainstay of dermatologic practice and a renewed perspective on integrating phototherapy into modern care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Natasha Mesinkovska, MD, associate professor of Dermatology at UC Irvine, to discuss the multifaceted challenges of alopecia areata (AA), an autoimmune condition with complex comorbidities and broad psychosocial implications. The conversation begins with the stigma of hair loss and the importance of addressing the patient’s emotional well-being. Dr Mesinkovska highlights her approach: asking simple but direct questions about how patients are coping and connecting them with mental health resources when needed. Comorbidities and workup are also addressed, with Dr Mesinkovska sharing her pragmatic approach to labs: thyroid-stimulating hormone test as a baseline, selective additional testing for patients with indicators of comorbidities, and requesting consultation with endocrinology when indicated. Prognosis is also discussed, with childhood onset and family history noted as adverse factors. They next explore treatment expectations, beginning with the typical timeline of response seen with oral JAK inhibitors and the importance of allowing several months for optimal hair regrowth. Many patients, once regrowth occurs, ask when they can stop therapy in hopes that results will persist without ongoing treatment; this is an important moment to counsel patients on the chronic nature of AA and emphasize that discontinuing therapy often leads to renewed hair loss. Continuing oral JAK inhibitor therapy offers the greatest likelihood of maintaining regrowth over time. They review clinical data on the durability of response of the JAK inhibitors for AA, which has shown that relapse of hair loss is common once treatment is discontinued. For those who elect to stop therapy, it is essential to emphasize the need to resume treatment promptly at the first signs of relapse, under supervision of their dermatologist. Ongoing clinical and laboratory monitoring is also highlighted as critical to ensure long-term safety. Dr Mesinkovska then discusses differential diagnoses for AA, covering lichen planopilaris, trichotillomania, and other mimickers, with biopsy reserved for challenging cases. She next reviews the 3 approved JAK inhibitors for AA, baricitinib, ritlecitinib, and deuruxolitinib, highlighting differences in efficacy, dosing, speed of response, and the role of CYP2C9 testing specific to deuruxolitinib. Clinical study data are used to outline the features that distinguish deuruxolitinib, the newest oral JAK inhibitor, from the other agents. These include a potentially faster onset of hair regrowth, enhanced efficacy with twice-daily dosing, and the ability to identify individuals who metabolize the drug more slowly through CYP2C9 testing. Tune in to the full episode to hear how dermatologists can assess comorbidities, select systemic therapies, manage patient expectations, and support the psychosocial needs of those with AA to achieve more comprehensive care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Patti Farris, MD, associate clinical professor of dermatology at Tulane University, for a timely conversation on photoprotection and sunscreen. As new concerns surface among patients, they provide an up-to-date perspective on UV exposure, formulation science, and patient counseling. Dr Farris explains the critical role of UVA radiation, which penetrates deeper into the dermis than UVB and is a major driver of photoaging and skin cancer risk. Unlike UVB, UVA is harder to block because many chemical filters only partially cover this spectrum. She also reviews the controversies surrounding oxybenzone, discussing both endocrine disruption concerns and its debated link to coral reef bleaching, emphasizing the gap between laboratory studies and real-world relevance. The discussion then turns to mineral sunscreens, which have gained popularity amid growing social media skepticism about chemical filters. While they provide strong UVA protection, cosmetic acceptability remains a significant challenge, especially for patients with skin of color due to the persistent issue of white cast. Newer innovations, including the addition of antioxidants, further expand protection by addressing visible light–induced damage. They highlight one example of an advanced formulation that pairs mineral filters with vitamin E to boost UVA defense and improve tolerability across all Fitzpatrick skin types. Finally, they reflect on generational differences in patient counseling. While older patients may prioritize cancer prevention, younger patients often respond more to messaging about photoaging and skin preservation, making it vital to tailor communication strategies. Tune in to the full episode to hear Dr Farris and Dr Del Rosso explore how dermatologists can navigate evolving sunscreen science, address patient concerns with confidence, and make practical recommendations that resonate across age groups and skin types.

In this new installment of Tea with Dr D, host James Q. Del Rosso, DO, is joined by Karan Lal, DO, to examine 3 complex cases where clinical reasoning required moving beyond conventional pathways. This episode features visually impactful case images that bring the discussion to life. The first case centers on an elderly patient on PD-L1 immunotherapy who developed erosive plaques on the head and neck. Dr Lal reviews the diagnostic challenges of atypical presentations, the limitations of standard treatments, and his decision to carefully introduce a JAK inhibitor with oncology support, illustrating the importance of balancing risks and benefits in drug-induced BP. Next, they consider a young adult male with diffuse hair loss. A biopsy confirmed androgenetic alopecia without inflammation, prompting Dr Lal to initiate low-dose oral minoxidil with finasteride. He details why combination therapy can be advantageous in younger patients, the need for counseling about shedding phases and time to response, and how to interpret prostate screening in those taking finasteride. The final case highlights a dramatic case of rhinophyma presenting as fibrotic nodules without classic inflammatory features of rosacea. Dr Lal explains his staged management of surgical debulking followed by laser resurfacing, along with the role of isotretinoin for long-term maintenance. For patients unable to pursue surgical options, he shares alternative approaches such as combining isotretinoin with neuromodulators to shrink tissue and improve appearance. Tune in to the full episode to see striking clinical images, learn how expert dermatologists navigate diagnostic uncertainty, and gain insight into creative, patient-centered strategies for challenging presentations.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Dallas/Fort Worth–based dermatologist Todd Plott, MD, for an in-depth discussion on the first extended-release formulation of minocycline approved for rosacea. The conversation begins with a historical look at tetracyclines, tracing back to tetracycline in 1953, doxycycline in 1968, and minocycline in 1971. While traditionally used as broad-spectrum antibiotics, these agents have shown efficacy in rosacea primarily due to their anti-inflammatory activity rather than antimicrobial effects. They review head-to-head clinical data showing that extended-release minocycline, commercially available as Emrosi, significantly reduced inflammatory lesions and improved Investigator Global Assessment scores in patients with moderate-to-severe rosacea, outperforming both modified-release doxycycline and placebo. The trial population averaged 25 papules per patient, demonstrating the robust improvement required for trial success. A key point of discussion is minocycline’s narrow therapeutic window. While higher doses have raised concerns about adverse effects such as hyperpigmentation and lupus-like drug reactions, pharmacokinetic data show that extended-release dosing achieves lower systemic exposure with fewer safety issues compared to immediate-release formulations. Dr Plott contextualizes this by noting that dermatology indications require far lower doses than in infectious disease, which helps explain the rationale for the extended-release formulation in rosacea. Tune in to the full episode to learn more about how extended-release minocycline and anti-inflammatory dosing fit into current rosacea treatment options, what the latest evidence shows about its efficacy and safety, and how clinicians can gain refreshed perspectives on this long-standing therapy.

Index of Suspicion is the Friend of the Clinician: Great Cases from the Northeast In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Erik Domingues, MD, a dermatologist in Fall River, MA, to review 3 cases where cutaneous presentations led to unexpected findings or required creative treatment approaches. The first case involves a 74-year-old man with diffuse granuloma annulare (GA). Although biopsy confirmed GA, the widespread involvement raised concern for an underlying condition. When standard therapy failed, Dr Domingues noted a cervical mass that proved to be an aggressive parotid carcinoma, detected earlier than it might have been without the skin eruption. The case highlights the need for thorough physical exams and clinical judgment when faced with atypical presentations. They next consider a 34-year-old woman presenting with severe alopecia areata (AA). While her main concern was hair loss, Dr Domingues also observed long-standing facial vitiligo. She was started on ritlecitinib, approved for AA and under study for vitiligo, leading to complete scalp regrowth and substantial repigmentation of her vitiligo. The case highlights how treatment can address both immediate concerns and chronic disease burden, while also reminding clinicians that many patients remain unaware of newer therapeutic options. The episode closes with a personal case: Dr Domingues’s 5-year-old son, who experienced a severe atopic dermatitis flare that stopped responding to crisaborole. Roflumilast 0.3% cream, approved for atopic dermatitis in patients 6 years and older at a lower concentration, was trialed off-label, producing rapid clearance and ongoing control with seasonal use. This case demonstrates how careful clinical judgment can guide effective off-label treatment. Tune in to the full episode for practical pearls and real-world examples of clinical reasoning, autoimmune overlap, and innovative strategies for chronic skin disease.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes April Armstrong, MD, MPH, Professor and Chief of Dermatology at UCLA, to discuss chronic hand eczema (CHE) and the introduction of the first FDA-approved treatment developed specifically for this condition. The conversation begins with a review of CHE as a distinct clinical entity, highlighting its subtypes: irritant contact dermatitis, allergic contact dermatitis, atopic hand eczema, and the less common protein contact dermatitis. They highlight occupational exposures and daily “wet work” that increase risk, while Dr Del Rosso notes the challenge of overlapping subtypes in real-world patients. Practical considerations, such as glove selection and improving patient adherence, are also addressed. The discussion then turns to delgocitinib cream, the newly approved topical pan–JAK inhibitor for moderate-to-severe CHE. Dr Armstrong explains its mechanism of action, which targets the JAK-STAT pathway across multiple immune processes involved in different CHE subtypes. They note the significance of its approval without a boxed warning, contrasting it with other topical JAK inhibitors and providing context on evolving perspectives on JAK inhibitor safety. Clinical trial findings are discussed in detail, including meaningful improvements in itch, pain, and quality of life, along with the durability of response over time. Importantly, efficacy was observed across CHE subtypes, reflecting the drug’s utility across real-world patient heterogeneity. Adverse events were minimal, with no systemic safety signals observed. Tune in to the full episode to hear Dr Armstrong and Dr Del Rosso highlight the key factors of diagnosing and treating CHE, the clinical impact of delgocitinib, and how dermatologists are now better positioned to treat this commonly encountered yet difficult to manage condition.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Andy Blauvelt, MD, to explore the mechanism, efficacy, and safety of deucravacitinib, the first FDA-approved tyrosine kinase 2 (TYK2) inhibitor for psoriasis. Dr Blauvelt begins by explaining how TYK2 inhibition differs from traditional JAK inhibition by targeting a more selective signaling pathway downstream of cytokine receptors. Unlike JAK1, JAK2, or JAK3, TYK2 is involved in a narrower range of cytokines, which may explain its distinct safety profile. Dr Del Rosso and Dr Blauvelt also clarify why deucravacitinib lacks the boxed warning seen with other oral JAK inhibitors. With allosteric binding at the TYK2 pseudokinase domain, deucravacitinib avoids cross-inhibition of other JAKs, making it more selective and potentially safer. Long-term data now supports this distinction: 5-year safety results show no increased risk of major adverse cardiac events, malignancy, or serious infections, with only a small, manageable signal for herpesvirus infections. The conversation turns to efficacy, which appears sustained over 5 years without antibody development, a potential advantage over biologics. Dr Blauvelt emphasizes its utility in high-impact areas such as the scalp, palms, soles, genitalia, and nails, and encourages systemic therapy even in patients with limited body surface area involvement when quality of life is severely affected. Tune in to the full episode to learn how deucravacitinib fits into the current psoriasis treatment algorithm, what sets TYK2 inhibition apart from other oral options, and how real-world data is shaping clinical confidence in this novel therapy.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes David Altman, MD, dermatologist at Midwest Center of Dermatology in Warren, MI, to review recent case studies that highlight unexpected presentations, treatment responses, and immune system interplay in dermatology. The first case focuses on a 34-year-old patient with severe, recalcitrant Hailey-Hailey disease. After multiple failed therapies, including antibiotics, corticosteroids, apremilast, and low-dose naltrexone, she achieved near-complete clearance within 12 weeks on dupilumab. Drs Altman and Del Rosso share their thoughts on why a drug targeting type 2 inflammation might be effective in a condition traditionally considered structural, drawing parallels to reports in Darier disease. Next, the conversation shifts to an unusual immune response observed in a patient with well-controlled psoriasis on IL-17 inhibitors who developed widespread atopic dermatitis. Dr Altman describes this as a “cytokine shift,” where suppression of IL-17 may upregulate IL-4 pathways, mirroring the reverse effect sometimes seen with IL-4 inhibition. While uncommon, such effects are now recognized in prescribing information, and the patient improved after transitioning to a broader-acting JAK inhibitor (upadacitinib). In the final case, a patient with Crohn’s disease developed rapidly progressing alopecia areata while on infliximab. Switching to tofacitinib improved hair growth but worsened gastrointestinal symptoms. Following colectomy, both the Crohn’s disease and alopecia resolved, highlighting the role of systemic inflammation in driving skin disease. Tune in to the full episode to hear more about these unique cases, the underlying immunologic mechanisms, and how lessons from complex cases can inform everyday dermatologic practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, speaks with Heather Woolery-Lloyd, MD, dermatologist and director of the Skin of Color division at the University of Miami, about the shifting dynamics of skin care among younger generations and how dermatologists can meet this growing demand for evidence-based “prejuvenation” strategies. The discussion begins with reflections on how skin care priorities have shifted from basic sun protection and moisturization to a more proactive, appearance-driven approach, especially among Gen Z. While this interest is largely aesthetic, Drs Del Rosso and Woolery-Lloyd point out that it also brings health benefits, offering dermatologists a unique opportunity to guide patients toward sound practices for photoprotection and skin longevity. They also explore the influence of social media on how young people consume skin care information. Dr Woolery-Lloyd shares findings from her research showing that most viral skin care content is not produced by medical professionals, increasing the risk of misinformation, but also noting that many young people are increasingly capable of distinguishing influencer marketing from expert guidance. They further discuss how younger patients are seeking neuromodulators and fillers as preventive strategies. Dr Del Rosso highlights the biological rationale behind these concerns, including early collagen loss and environmental skin damage. They conclude with a review of emerging ingredients like acetyl dipeptide-31 amide and bakuchiol, which offer dermal benefits with minimal irritation, potentially impacting how dermatologists counsel younger patients who are hesitant to use traditional retinoids. Tune in to the full episode to hear how dermatologists can thoughtfully engage with this prevention-minded population by acknowledging their concerns, correcting misinformation, and recommending science-backed products that promote both skin health and confidence.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Jason Hawkes, MD, Chief Scientific Officer at Oregon Medical Research Center, to explore the role of dupilumab in chronic spontaneous urticaria (CSU), a condition historically managed outside dermatology. They begin with the immunologic underpinnings of CSU, explaining the role of IL-4 and IL-13 in driving mast cell activation and the role of IL-31 in itch. Since dupilumab blocks these key cytokines, it can disrupt the disease process at multiple levels, from antibody formation to immune cell recruitment. They discuss the growing comfort among dermatologists in treating CSU now that a familiar and accessible agent like dupilumab is available, especially when compared to omalizumab, which has been limited by concerns over anaphylaxis and practice logistics. They next address real-world considerations, including the time dupilumab takes to work, the use of short-term corticosteroids, and the need for personalized treatment approaches. They caution against over-reliance on corticosteroids and discuss alternative bridging therapies like cyclosporine or methotrexate for severe cases. The episode also covers dosing nuances, patient selection, how to distinguish CSU from other urticaria types, and the importance of setting expectations. Dr Hawkes shares his experience with long-term efficacy, noting minimal loss of response among his patients. Listen to this episode for more clinical insights on dupilumab as a key treatment in managing chronic spontaneous urticaria, including considerations around patient selection, duration of therapy, and long-term disease control.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Diego Ruiz DaSilva, MD, dermatologist at Forefront Dermatology and assistant professor at Eastern Virginia Medical School. Together, they discuss Dr DaSilva’s recent publications and his journey in building a collaborative research career focused on real-world clinical insights. To begin, Dr DaSilva shares the inspiration behind his recent publication that evaluated oral JAK inhibitors in elderly patients with moderate to severe atopic dermatitis. Motivated by the positive feedback from older patients and the perception that JAKs are underutilized due to safety concerns, he conducted a multicenter retrospective study that found strong efficacy and a reassuring safety profile in patients aged 65 to 96. Next, the discussion turns to nemolizumab, an IL-31 receptor antagonist recently approved for prurigo nodularis and atopic dermatitis. Dr DaSilva highlights a patient case that prompted a broader series: a patient with cancer experiencing recalcitrant itch who saw complete resolution within days of starting nemolizumab. Across 10 cases, 8 showed a rapid and marked itch response, with no adverse events or ocular surface issues. Finally, they review a case report on palmoplantar psoriasis treated with topical roflumilast 0.3% cream. Used initially as a bridge to systemic therapy, the patient achieved unexpectedly robust results with the topical alone, avoiding the need for a biologic. Dr DaSilva notes the importance of keeping nonsteroidal topicals in mind, especially for steroid-sparing strategies. Tune in to the full episode for more real-world data and case-based insights to help manage complex dermatologic conditions.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Cheri Frey, MD, residency program director and director of cosmetic dermatology at Howard University, to discuss the clinical nuances of facial hyperpigmentation, with a special focus on melasma and the emerging role of Thiamidol. Dr Frey begins by breaking down how she categorizes facial hyperpigmentation that isn't tied to a structural lesion. She explains how the distribution, hue, and depth of pigment—epidermal, dermal, or mixed—guide diagnosis and treatment. They revisit traditional therapies like hydroquinone and oral tranexamic acid, highlighting their ongoing roles in management, while noting concerns around cytotoxicity, ochronosis, and overuse. The conversation then turns to Thiamidol, a novel topical agent recently introduced in the US as a potent and selective human tyrosinase inhibitor, unlike many legacy agents developed using mushroom tyrosinase models. Dr Frey shares data showing the superiority of Thiamidol over 2% hydroquinone and comparable efficacy to 4%, with excellent tolerability and quality-of-life benefits. Clinical applications span melasma, acne-induced postinflammatory hyperpigmentation, solar lentigines, and laser-associated hyperpigmentation. Dr Frey also discusses an exciting new study where Thiamidol replaced hydroquinone in triple-combination creams, yielding similar efficacy with improved tolerability, offering new options for patients seeking long-term, safer treatments. Tune in to the full episode to hear how Dr Frey approaches hyperpigmentation with precision and pragmatism, and how Thiamidol may be poised to reshape the treatment landscape.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by a world expert in pigmentation, Seemal R. Desai, MD, founder of Innovative Dermatology in Dallas, Texas, for a timely, clinically focused discussion on vitiligo. Dr Desai begins by outlining how to identify unstable vitiligo at the first visit, a crucial step that guides treatment decisions. He describes hallmark features of instability, including trichrome lesions, confetti-like depigmentation, inflammatory borders, pruritus, and signs of Koebnerization—and emphasizes that even one unstable lesion should prompt systemic stabilization. Vitiligo flares can occur unpredictably, even in previously stable patients. The conversation also explores common comorbidities, including autoimmune thyroid disease, diabetes mellitus, and alopecia areata. Dr Desai shares his standard lab workup at the initial visit, which includes thyroid-stimulating hormone, free thyroxine, thyroid peroxidase antibody, and vitamin D. They discuss when to repeat testing and how to interpret elevated thyroid antibody titers in asymptomatic patients. The pair also touches on psychosocial impact, especially among children and adolescents, and strategies to create space for emotional check-ins during clinical visits. In the second half of the episode, Dr Desai shares practical insights on using topical ruxolitinib cream 1.5% for nonsegmental vitiligo. Dr Del Rosso and Dr Desai discuss treatment duration, counseling around delayed response, and why BID application is critical for success. They also address combining ruxolitinib with phototherapy, tailoring treatment based on location and follicular density, and how to support patients who may feel discouraged by early speckled repigmentation. Boxed warning concerns are also reviewed, with a focus on safety and real-world reassurance for patients using topical formulations. Dr Desai closes with an essential message: patients with vitiligo deserve more than a one-line treatment plan. Hope, education, and long-term partnership are key—and new therapeutic options are on the horizon.

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.