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Derms and Conditions

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Now in Season 3, Derms and Conditions is a podcast from the team that brings you the Fall Clinical and Winter Clinical Dermatology Conferences. Each episode, you'll hear from leading Dermatologists in the US as they talk about Dermatology's hottest and most relevant topics and conditions. Dermatologists all face a barrage of new information virtually every day that is difficult to keep up with and digest. In this podcast, you'll hear about clinical practice tips and treatment pearls that you can implement on a daily basis in your busy practice. Subscribe to Derms and Conditions today to stay in-the-know with the country's leading experts. Thanks for listening!

Location:

United States

Description:

Now in Season 3, Derms and Conditions is a podcast from the team that brings you the Fall Clinical and Winter Clinical Dermatology Conferences. Each episode, you'll hear from leading Dermatologists in the US as they talk about Dermatology's hottest and most relevant topics and conditions. Dermatologists all face a barrage of new information virtually every day that is difficult to keep up with and digest. In this podcast, you'll hear about clinical practice tips and treatment pearls that you can implement on a daily basis in your busy practice. Subscribe to Derms and Conditions today to stay in-the-know with the country's leading experts. Thanks for listening!

Language:

English


Episodes
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Outside the Box: The Power of Combining Art and Science

4/11/2024
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!

Duration:00:19:56

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Comprehensive Management of Hidradenitis Suppurativa: Expert Insights From Dr Jennifer Hsiao

3/28/2024
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.

Duration:00:26:55

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Part 2: Special Edition on Recent Reports of Benzene Found in Benzoyl Peroxide Products

3/21/2024
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.

Duration:00:33:23

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Part 1: Special Edition on Recent Reports of Benzene Found in Benzoyl Peroxide Products

3/21/2024
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.

Duration:00:22:56

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Prescribed Success: Navigating Buy-and-Bill Strategies in Dermatology Practice

3/14/2024
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.

Duration:00:32:10

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Highlights of Winter Clinical Miami 2024

2/29/2024
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.

Duration:00:20:25

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Tapping Into Tapinarof: An In-Depth Look at the Novel Treatment for Psoriasis with Dr April Armstrong

2/22/2024
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.

Duration:00:28:47

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Highlights of Winter Clinical Hawaii 2024

1/25/2024
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.

Duration:00:16:59

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A Deep Dive Into IL-17 Inhibition and Bimekizumab for Psoriasis: Straight Talk with Dr Andy Blauvelt

1/4/2024
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.

Duration:00:35:10

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Final Thoughts from 2023: Highlights from Podcasts Past…

12/28/2023
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.

Duration:00:30:52

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Untangling the Questions and Challenges in Patients with Hair Loss: Part 2

12/21/2023
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!

Duration:00:26:19

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Untangling the Questions and Challenges in Patients with Hair Loss: Part 1

12/14/2023
In episode 66 of Derms and Conditions, our host, Dr James Q. Del Rosso, sits down with Dr Jeff Donovan, a board-certified dermatologist who practices in Whistler, Canada, with his dermatology clinic dedicated only to management of hair disorders. In part one of this series, they discuss how to approach patients with alopecia areata. Dr Donovan starts by discussing conditions that can mimic alopecia areata and when a biopsy may be needed to confirm the diagnosis, prompting him to share his suggestions on biopsy caliber, appropriate sites for biopsy, and utilizing the right pathologist to review the sample. Next, the pair discusses topical treatments for patchy alopecia areata, including topical clobetasol and topical minoxidil, and the important role of intralesional corticosteroid injections. They then discuss available study data and experience with the use of oral baricitinib (a JAK inhibitor) and oral ritlecitinib (a JAK-3 and TEC kinase inhibitor) in patients with severe alopecia areata. Specific recommendations were reviewed including important efficacy and safety findings, clinical and laboratory monitoring, and certain limitations with currently available studies. Both look forward to promising developments that are anticipated with longer-term data for both baricitinib and ritlecitinib. They conclude by discussing the use of minoxidil in alopecia areata, including anecdotal evidence. Dr Donovan notes that more studies examining the effects of minoxidil in alopecia areata are needed. Tune in to the episode to find out more from a dermatologist who treats patients with hair disorders throughout his entire workday whenever he is in clinic!

Duration:00:25:45

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Does Bimekizumab Raise the Bar of Success for Moderate-to-Severe Plaque Psoriasis? Perspectives from Dr. Ted Rosen

12/7/2023
In episode 65 of Derms and Conditions, our host, James Q Del Rosso, DO, chats with Ted Rosen, MD, Professor of Dermatology at Baylor College of Medicine and Chief of Dermatology Service at Michael E. DeBakey Veterans Affairs Medical Center, to discuss new developments in psoriasis treatment. They begin by discussing the current psoriasis treatment landscape and the perception that with effective biologics now on the market, there are no longer any unmet needs in psoriasis treatment. They reflect on the importance of having a variety of treatment options with differing mechanisms of action, which can address variability in patient response. They highlight the novel mechanism of action of bimekizumab, which provides dual inhibition of both IL-17A and IL-17F. The pair then discuss the relationship between IL-17s and candidiasis, noting that while there is a broad spectrum of risk, it is usually minimal and manageable, typically presenting as oral thrush rather than serious systemic infections. Dr Rosen discusses how he counsels his patients about the increased risk of candidiasis when on an IL-17A-F blocker and the importance of balancing risk with the potential benefits. They also delve into the data on bimekizumab, highlighting the favorable PASI 75 results seen at 4 weeks and how it compared to adalimumab, ustekinumab, and secukinumab in pivotal studies. Dr Rosen also discusses how the patient conversation can differ when counseling a patient on an IL-23 blocker compared to a drug with a simplified dosing regimen with an early onset of action. The pair concludes by discussing the dosing regimen for bimekizumab, noting that it’s possible to reduce injection frequency after the initial 16 weeks of treatment and still sustain the same level of efficacy. They also discuss evidence that may suggest adjustments to the bimekizumab dosing regimen may lower the risk of candidiasis. Tune in to this episode to learn more about bimekizumab and its impact on the psoriasis treatment landscape!

Duration:00:22:42

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Beyond the Knife: Practical Nonsurgical Options for Skin Cancer

11/21/2023
In Episode 64 of Derms and Conditions, our host, Dr James Q. Del Rosso sits down with Dr Shane Chapman, Chair of the Department of Dermatology at Dartmouth Hitchcock Medical Center, to discuss nonsurgical approaches to treating nonmelanoma skin cancer. Dr. Chapman begins by discussing topical treatment options for nonmelanoma skin cancer for patients who are not candidates for surgery. He comments on the use of intralesional chemotherapy for keratoacanthomas or squamous cell carcinomas in poorly healing areas or when multiple lesions are present, compares the benefits of 5-fluorouracil and intralesional methotrexate, and explains the benefits of using oral acitretin with intralesional therapy. The pair then discuss intralesional methotrexate in more detail, explaining how methotrexate and 5-fluorouracil can be interchanged or used in combination with PDT to treat keratoacanthomas/squamous cell carcinomas. They also discuss how to approach a case of a patient with a nodular basal cell carcinoma on her nasal tip who refuses treatment with surgery or radiation. Next, they discuss treatment of broader skin lesions, such as superficial or multifocal basal cell carcinomas and detail imiquimod, 5-fluorouracil, and both red and blue light PDT as potential treatment options. To conclude, they discuss how to manage brisk imiquimod responses and the impact on treatment duration. Tune into this episode to hear the full details and learn more!

Duration:00:25:26

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What is Dr Adam Friedman Up To Now?

11/9/2023
In Episode 63 of Derms and Conditions, our host, James Q. Del Rosso, DO, sits down with Adam Friedman, MD, to discuss some important topics in dermatology, including a comprehensive resource for portraying skin conditions and his research findings relating to sensitive skin. Dr Friedman begins by describing his atlas project, created to address a gap in dermatology in the limited way textbooks and atlases portray skin conditions. The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas is a comprehensive resource that depicts dermatologic conditions across the full spectrum of skin tones to help dermatology professionals visualize the nuances in skin conditions. Next, Dr Friedman discusses his research on sensitive skin and how he puts his findings into practice with his patients. He details his global study that looked in-depth at sensitive skin and what factors trigger and exacerbate it, highlighting the importance of dermatologists having tools to assess the condition and provide management strategies. The pair also touch on guiding patients on the use of products for sensitive skin and utilizing samples. They conclude by discussing the importance of early intervention to prevent disease progression and the benefits of initiating more advanced therapies in earlier disease. Tune into this episode to hear more about what’s on Dr Adam Friedman’s mind!

Duration:00:25:29

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Live From Las Vegas! Greatest Hits from Fall Clinical Dermatology 2023

10/26/2023
In this episode of Derms and Conditions, Dr. Jim Del Rosso and Dr. Gary Goldenberg discuss some of the highlights from the meeting. These include recent FDA approvals such as bimekizumab for psoriasis and the triple topical combination for acne vulgaris, the newer nonsteroidal topical agents, tapinarof and roflumilast, and their relevant clinical use, the significance of narrow-spectrum oral antibiotic therapy with sarecycline as compared to other oral tetracycline with regard to antibiotic resistance, and physical devices such as laser systems used to treat acne vulgaris.

Duration:00:21:17

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Once Is Not Enough: Round 2 on Therapeutic Insights

10/5/2023
In episode 61 of Derms and Conditions, our host, James Q. Del Rosso, DO, presents a self-made episode where he clarifies key points on many therapies relevant to every-day clinical practice. First, he discusses topical alpha-agonist therapy for persistent facial erythema (PFE) of rosacea. Long-term data shows that daily use of either topical oxymetazoline or brimonidine appears to “reset” (lower) the baseline level of PFE in patients with rosacea. Next, he talks about sub-antibiotic dosing of doxycycline and how its anti-inflammatory properties, including support of the dermal matrix, can be used for the treatment of rosacea. He notes that studies have demonstrated reduced antibiotic selection pressure with decreased emergence of antibiotic-resistant bacterial strains with this therapeutic approach. Additionally, monotherapy with sub-antibiotic dose doxycycline used as maintenance treatment has been shown to be effective in reducing relapse of papulopustular rosacea (PPR), an approach that is appealing to those patients who do not prefer or are not compliant with topical therapy. Dr. Del Rosso then mentions sarecycline, a narrow-spectrum tetracycline FDA-approved for the treatment of acne in patients > 9years of age, which has also been shown in a large pilot study to be effective for PPR. Microbiological data demonstrates that the narrow antibiotic spectrum of sarecycline spares activity against many strains of bacteria, especially gram-negative organisms that inhabit the GI tract. He then transitions to hidradenitis suppurativa (HS) and the welcome emergence of IL-17 inhibitors for HS, which are very effective based on study results to date. Dr. Del Rosso stresses the importance of early consideration of biologic therapies (such as anti-IL agents) for HS as this disease progresses below the skin surface with eventual development of sinus tracts and scarring. If we wait until we “see” these consequences, it is too late as they have already occurred. FDA approvals and published guidelines typically depend on visibly seeing the clinical manifestation before a specific therapy is recommended, which is not early enough in many cases. He finishes with a discussion on dupilumab for the treatment of atopic dermatitis, which is often remarkably effective, but at times may be limited by partial efficacy or side effects such as conjunctivitis and facial erythema. Dr. Del Rosso discusses practical use of JAK inhibitors, such as abrocitinib and upadacitinib for AD in dupilumab “non-responders”, and also case reports with tralokinumab, a monoclonal antibody targeting IL-13. Tune in to this episode to learn more!

Duration:00:22:58

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A Closer Look at How to Address Skin Care With Your Patients

9/21/2023
In episode 60 of Derms and Conditions, our host, James Q. Del Rosso, DO, sits down with Cheri Frye, MD, the residency program director of dermatology at Howard University. The 2 discuss how to address skin care with patients and key products that should be incorporated into a skin care routine for specific skin types and populations. Dr Del Rosso begins by asking Dr Frye about her approach to advising the general patient on their skin care. She notes that interest in skin care has grown tremendously, and dermatologists are rightfully being increasingly viewed as the foremost skin care experts. She recommends that dermatologists embrace and directly incorporate skin care into management recommendations for patients and should also consider offering products to patients directly in the office for efficiency and convenience. She also stresses the importance of validating the patient’s concerns by confirming that their dermatologist is the appropriate person to consult. Next, Dr Del Rosso delves deeper into Dr Frye’s more specific recommendations for skin care. She notes that while it is difficult to generalize, data supports typical concerns that are more prevalent in certain populations, such as hyperpigmentation with darker skin tones. She recommends incorporating toners with salicylic acid and glycolic acid into acne treatment routines to tackle pigmentation. Additionally, she acknowledges that patients reluctant to discontinue using an unessential type of skin care product that may not be optimal for their skin should instead be switched to a better alternative to maintain the patient-physician relationship. They then switch topics to discuss skin care tips for dry skin. Dr Frye mentions that African American patients should use moisturizers rich in ceramides, as their skin is likely to be more deficient in this lipid based on current evidence. She emphasizes the need for open discussion and education about these skin care trends with patients. Dr Del Rosso finishes by asking about some common helpful ingredients. Dr Frye notes that ascorbic acid has beneficial antioxidant properties. She also favors niacinamide 3-5% for its antioxidant activity and recommends having glycolic acid in moisturizers specifically for concerns with dyschromia. Tune in to this episode to learn more!

Duration:00:23:49

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Improving Our Understanding of How Drugs Work: Clarifying Questions with Monoclonal Antibodies and JAK Inhibitors.

9/7/2023
In Episode 59 of Derms and Conditions, our host, James Q. Del Rosso, DO, continues his conversation with Christopher Bunick, MD, PhD, an associate professor of dermatology at Yale University School of Medicine who performs specialized research on novel treatments and therapies. After discussing sarecycline for acne in part 1, the two switch gears to monoclonal antibodies. Dr Bunick begins by discussing dupilumab, an IL-4 and IL-13 blocker with significant clinical efficacy and a favorable safety profile in treating atopic dermatitis (AD). He states that in a network meta-analysis, upadacitinib and abrocitinib were shown to be more effective at treating AD than dupilumab, but dupilumab was shown to be more efficacious than tralokinumab and lebrikizumab. He and Dr Del Rosso agree that despite being part of a similar class, each IL-13 blocker should be applied and understood individually. They note several cases where patients who responded poorly to dupilumab had a beneficial response to tralokinumab, despite having similar mechanisms of action. Next, they discuss IL-13 signaling, which is increased and more persistent in tissues compared to other cytokines. However, Dr Bunick explains that IL-4 has more potent signaling, so IL-13 isn’t necessarily more clinically relevant. He notes that more research is required to further understand the structure-function mechanisms of cytokines in the cell. He then mentions the non-canonical receptor, aka the “decoy receptor”, for IL-13, which could also explain a difference in drugs within the same class. Dr Del Rosso concludes that switching from one IL-13 blocker to another in a patient who was initially unresponsive to treatment may be more favorable than escalating to an alternative class of medication. Dr Del Rosso then discusses Dr Bunick’s recent publication that compared the adverse effects of common immunosuppressive drugs to those of upadacitinib and abrocitinib in the treatment of AD. While the study population that used the common immunosuppressives did have comorbidities outside of AD, Dr Bunick notes that the risk of adverse events still exists for those treatments in AD and is not present only in JAK inhibitors. Dr Del Rosso states that many risk factors can contribute to adverse events, and not all responsibility should be shifted to JAK inhibitors. Tune in to this episode to learn the complete details about monoclonal antibodies and JAK inhibitors!

Duration:00:25:04

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Removing the Confusion Surrounding Some Commonly Used Therapies

8/24/2023
In episode 58 of Derms and Conditions, our host, Dr James Q. Del Rosso, presents a self-made episode where he discusses some clarifications regarding commonly misunderstood therapies in dermatology. Dr Del Rosso begins by discussing the use of benzoyl peroxide (BPO) for papulopustular rosacea and notes that many providers are hesitant to use this treatment given the perceived irritant effects. He notes that the microencapsulated BPO 5% cream (FDA approved EPSOLAY®), specifically formulated to allow for the slow release of the drug in the skin, is the only formulation proven to be efficacious, safe, and tolerable in rosacea. He summarizes a 12-week study of patients with moderate to severe papulopustular rosacea in which 25% of patients were clear or almost clear at 4 weeks with total inflammation reduced by 70% at 12 weeks. In addition, he notes that the tolerability was favorable with no differences noted between the active and vehicle groups. Next, Dr Del Rosso discusses clascoterone 1% cream, FDA approved for twice daily use for acne in patients aged 12 years and older with no limitations on duration of use. He explains findings from a recently published study that show even with the maximum use of clascoterone, 4 to 6 times greater than the normal 1-gram dose, there were no clinically significant hyperkalemia readings, adverse events, or EKG changes in any participant in the control or experimental groups. Given its topical use, negligible systemic absorption especially when used as recommended, and the findings of this study, Dr Del Rosso agrees that clinicians should be reassured about the lack of risk of hyperkalemia with clascoterone use. Lastly, Dr Del Rosso switches focus to Janus kinase (JAK) inhibitors and biologics. He discusses where the boxed warnings for JAK inhibitors originated and why they are not as concerning overall with oral JAK inhibitors used for dermatologic indications in younger populations who exhibit fewer comorbidities and/or concomitant therapies. In addition, he notes that the risk of several side effects of special interest, such as lymphopenia, malignancy, and thromboembolic events are quite low. He also emphasizes that not all monoclonal antibodies with similar modes of action exhibit the same pharmacologic and therapeutic profiles. In a selected case where a patient with AD has an inadequate response or adverse event such as persistent conjunctivitis caused by dupilumab (which inhibits IL-13 and IL-4), case reports have shown that changing to another monoclonal antibody that inhibits IL-13 (ie, tralokinumab) can exhibit relevant efficacy without associated conjunctivitis. Ultimately, it is good for clinicians to have options and as much data as possible to differentiate their use. He concludes that although certain drugs are part of the same category or class, they all have differences in pharmacokinetics, and the benefits and differences of each drug must be understood to optimize treatment selection for individual patients. Tune in to this episode to learn all the valuable clinical pearls surrounding many commonly confused therapies!

Duration:00:23:03