large_hotel.jpg

medium_hotel.jpg

small_hotel.jpg

thumbnail_hotel.jpg

hotel.jpg

2024 Winter Clinical Dermatology Conference - Miami

large_WCM + PAMS_Fountainebleau Miami Beach_dusk.jpg

medium_WCM + PAMS_Fountainebleau Miami Beach_dusk.jpg

small_WCM + PAMS_Fountainebleau Miami Beach_dusk.jpg

thumbnail_WCM + PAMS_Fountainebleau Miami Beach_dusk.jpg

WCM + PAMS_Fountainebleau Miami Beach_dusk.jpg

2024 Patient Access Management Summit - Miami

AI may be less accurate than clinicians in usage for management decisions

AI Accurate in Diagnosing Suspicious Skin Lesions

Clinically meaningful responses seen for patients who did not achieve coprimary end point in the ECZTRA 1 and 2 trials

How Beneficial Is Tralokinumab for Patients With Atopic Dermatitis?

Incidence rates in patients with skin of color are about 10 percent of that seen for non-Hispanic Whites

Is the Incidence of Keratinocyte Carcinoma Lower for Patients of Color?

Attributable burdens were 18,960 deaths and 0.5 million disability-adjusted life years, which almost doubled from 2000 to 2019

Occupational Exposure to Solar UVR Linked to Nonmelanoma Skin Cancer

Preoperative staging with cross-sectional imaging does not influence management in localized Merkel cell carcinoma

Does Preop Staging With Imaging Impact Management of Merkel Cell Carcinoma?

More rapid onset of improvement, comparable efficacy, and good tolerability seen for M-PDT versus low-dose isotretinoin

Can Modified Photodynamic Therapy Offer Rapid Improvement of Acne?

Guidelines include strong recommendations for monoclonal antibodies and JAK inhibitors

Recommendations Developed for Atopic Dermatitis Therapies

Incorporation of religion into cultural humility training recommended, as well as dermatology education at community events

How Can Dermatology Care Be Improved for Muslim Patients?

Mohs micrographic surgery was only done on 32.3 percent of the keratinocyte carcinomas that qualified based on AUC score

Can Mohs Appropriate Use Criteria Score Help Determine Keratinocyte Carcinoma Treatment?

However, differences between acupuncture and sham acupuncture, wait-list control did not meet threshold for minimal clinically important difference

Acupuncture Offers Some Benefit in Chronic Spontaneous Urticaria

Approaching the Conversation

Join Mark Lebwohl, MD, as he provides an introduction and overview of the REMS Program for patients undergoing treatment for moderate-to-severe plaque psoriasis. Dr. Lebwohl discusses the background and rationale of the REMS Program, the program requirements, and how he counsels his patients on utilizing the program to help ensure their well-being.

Psoriasis mechanism of disease: Insights on treatment options

In this installment of Discourses in Dermatology, Dr Jason Hawkes, a medical dermatologist in the greater Sacramento area, sits down with Dr George Han, associate professor and director of clinical trials in the department of Dermatology at the Donald and Barbara Zucker School of Medicine at Hofstra Northwell, to discuss insights on treatment options for psoriasis.Biologics vs historic systemic immunosuppressantsDr Hawkes begins the discussion by asking Dr Han to highlight the primary role of biologics and their advantages compared to systemic immunosuppressants that have been used historically.Dr Han remarks that our understanding of the immunology of psoriasis has grown significantly over time, and in some cases after medications have been developed. It was initially believed that IL-12 was more important than IL-23 in psoriasis while it was later demonstrated that the inverse is true, with some animal studies showing IL-12 inhibition may actually negatively impact psoriasis treatment.He continues to comment on the ability of biologics to specifically target individual cytokines and antibodies very precisely in the body compared with the ability of small molecules, which target a few amino acid sequence differences among different receptors and cannot be as selective. Patients are often uncomfortable with biologics, wondering why they must inject themselves when they can take a pill that would be much less invasive. He explains that with small molecules, sacrifices must be made because more of the immune system is being blocked; there are more risks to inhibiting a large amount of things as opposed to specifically blocking a cytokine that’s involved in the pathogenesis of psoriasis with a targeted medication.Dr Han links this idea to TNF alpha inhibitors, which have been in use for almost 20 years. TNF alpha is a cytokine involved in a broad array of immune-mediated diseases; as a result, some of these medications have many indications as they’re ubiquitous across a large number of disease states. However, they block more of the immune system, thus leading to more contraindications. He compares this with the newer classes of biologics now available for psoriasis, which target cytokines like IL-23 and IL-17 that are specific to psoriasis.&nbsp;He goes on to explain how he counsels patients who are fearful about negative effects of biologics. He advises them that there are individuals who are born genetically without IL-17 who lead normal lives and may simply be more prone to minor fungal infections, which he finds helps his patients contextualize the effects of taking a biologic.Key points<ul><li>Biologics can target individual cytokines and antibodies precisely in the body</li><li>Small molecules cannot be as selective, thus leading to increased risk as a result of hampered immune systems</li><li>Contextualizing the effects of taking a biologic may help patients who are concerned about taking these medications</li></ul>Addressing safety concerns around biologicsDr Hawkes responds to Dr Han’s commentary by reiterating that historical agents used in psoriasis were broad-acting immunosuppressants that worked because they hampered most of the immune system. While they are effective in controlling psoriasis, they come at the cost of collateral damage to the patient.He believes this has created a paradox when it comes to payers that push strongly to use these broad-acting medications. This tendency communicates indirectly to patients and providers that the newer targeted agents may not be as safe as the older oral medications, and he sees hesitancy to use the newer agents because they’re not traditional but rather are unique molecules created in a lab. He asks Dr Han how he addresses this attitude when it comes to the safety of biologics.Dr Han confirms that there is a lot of apprehension surrounding biologics, which he posits may come from poorly designed or older studies. However, most of these medications, while newer, now have 3- to 5-year data available. They’re also evolutions of older medicines, which means they’re often more narrowly focused. He adds that IL-12 and IL-23 inhibition emerged in 2009, so there is actually a long track record of targeting these mechanisms.He recounts recently seeing a patient on etanercept and methotrexate prescribed by their rheumatologist and notes that rheumatologists are often very comfortable with methotrexate. However, he explains that the risk of liver damage and liver fibrosis from methotrexate is different for patients with rheumatoid arthritis than it is for patients with psoriasis. He recounts a study that demonstrated the highest risk was seen in patients with psoriasis, followed by those with psoriatic arthritis, and lastly, those with rheumatoid arthritis.He feels this demonstrates the importance of communicating with patients that we don’t need to rely on these medications when we have better, more targeted tools available. However, he acknowledges that when it comes to medical economics, there are often different pressures at play.Key points<ul><li>A push from payers to prescribe broad-acting medications may lead to hesitancy in using newer biologic agents</li><li>Most biologics now have 3- to 5-year safety data available&nbsp;</li><li>Biologics are evolutions of older medicines, which means they’re often more narrowly focused</li><li>Proper counseling of patients is important when it comes to explaining the benefits of biologics</li></ul>Weighing the benefits of targeted therapiesDr Hawkes continues the conversation by asking Dr Han if there are clinical scenarios in which these narrowly targeted medications may be problematic when compared to using medications with a broader impact and what may drive him to select a broader-acting biologic over a highly selective one.Dr Han highlights the sequential development from TNF alpha to IL-17 A and IL-23 inhibitors, noting the increasing effectiveness observed on the skin. Despite achieving high levels of clearance, he emphasizes that no medication is 100% effective all the time, leaving room for improvement in efficacy.The conversation then shifts to the importance of treating patients to target, aiming for maximum clearance with biologics. Dr Han acknowledges the need for enhancement in efficacy and considers the trade-offs in targeting specific conditions. For instance, IL-23 inhibitors may be effective for psoriasis but might not be the optimal choice for psoriatic arthritis, which is better addressed by TNF alpha and IL-17 inhibitors according to guidelines.He then delves into the challenges in rheumatology, particularly in assessing joint conditions. Unlike the straightforward evaluation of skin psoriasis with PASI scores, assessing the joints is more complex, and the differentiation between medications becomes more challenging.&nbsp;He recalls case reports when ustekinumab came out that showed patients exhibiting unmasking of psoriatic arthritis. He posits what was likely happening was that patients on TNF alpha inhibitors were getting good control of their psoriatic arthritis, but not their skin. When they switched medications, their skin may have improved, but at the cost of pulling efficacy from the joint. He remarks that a clinical scenario like that may drive towards one treatment versus another.Dr Han goes on to discuss the IL-17 family and considerations about different isoforms, emphasizing the significance of a holistic approach now that we can differentiate and target different aspects of IL-17. He concludes by expressing interest in how these developments will impact clinical practice.To close the discussion, Dr Hawkes reflects on the implications of a skin bias that emerges as a result of skin being accessible. He acknowledges the challenge of making assumptions and extrapolations about joint health based solely on skin findings. He comments that that the immune environment in joints might differ, requiring a broader suppression of the immune system for patients with psoriatic arthritis.He concludes by remarking on the need to learn more about the nuances of psoriatic disease and assess selective therapies to balance the benefits and disadvantages of being too broad or too narrow in treatment approaches.Key points<ul><li>Some clinical scenarios may benefit from the use of a broader-acting biologic over a highly selective one</li><li>Patients with psoriatic arthritis may require a more nuanced approach to treatment selection</li></ul>

What are some of the biggest challenges in treating molluscum contagiosum?

Navigating Patient Conversations

Watch as Tina Bhutani, MD, explains how she discusses an important topic with her patients being treated for moderate-to-severe plaque psoriasis who participate in the REMS program. Dr. Bhutani describes how she structures the patient conversation about the program, the importance of discussing the mental health comorbidities of psoriasis, and how she advises patients on what to do if they notice changes in mood or symptoms of depression. She also describes the simple process of navigating and submitting the REMS program forms.

In Episode 64 of Derms and Conditions, our host, Dr James Q. Del Rosso, sits down with Dr Shane Chapman, Chairman of the Department of Dermatology at Dartmouth Hitchcock Medical Center, to discuss nonsurgical approaches to treating nonmelanoma skin cancer.

Shane Chapman, MD

dermsquared-derms-conditions-podcast-thumbs.png

Derms and Conditions Podcast

Beyond the Knife: Practical Nonsurgical Options for Skin Cancer

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.

Adam Friedman, MD

What is Dr Adam Friedman Up To Now?

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.&nbsp; &nbsp;

Gary Goldenberg, MD

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

Join leading dermatology experts as they review the Risk Evaluation and Mitigation Strategy (REMS) program for plaque psoriasis!

The REMS Process for Psoriasis

Mark Lebwohl - An Introduction to the REMS Program for Psoriasis and Beginning the Patient Conversation

Join the leading experts as they go in-depth on some of the most important topics in dermatology. In this special feature, they give their invaluable insights into the mechanism of disease of psoriasis.

Discourses in Dermatology: New episode!

Listen to our experts on the go

Compelling clinical cases

Check out our new series: Discourses in Dermatology

Discourses in Dermatology: New expert series on psoriasis

Registration Open for Fall Clinical '24!

The leading platform for dermatology professionals to elevate patient care

Hear what the experts are saying

Latest Expert Videos