Derms and Conditions

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.