Case author Danna Calder, MMSc, PA-C presents a case of a 34-year-old male with severe, recalcitrant psoriasis achieving remarkable improvement after decades of treatment challenges.

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A Remarkable Result after a Lifetime of Disappointment in the Treatment of Severe, Recalcitrant Psoriasis 

Case author Mark Lebwohl, MD, presents a case of a 86-year-old male with a progressively enlarging erythematous nodular mass with overlying telangiectases. 

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Successful Management of Basal Cell Carcinoma in a Challenging Location with a Multimodal Approach

Case author Brad Glick, DO, MPH, FAAD, presents the case of a 57-year-old female with worsening plaque psoriasis of the elbow who experienced limited responses to multiple therapies.

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Tapinarof 1% Cream Effectively Clears Plaques of the Boney Prominences

Ron Vender, MD, FRCPC, presents the case of a 31-year-old male with an 8-year history of severe psoriasis who was frustrated with the lack of effective treatment options.

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Rapid and sustained clearance of severe psoriasis with dual inhibition of IL-17A and IL-17F

Case authors Mavra Masood, MD, Jennifer Creasor, BSN, and Iltefat Hamzavi, MD, present a case of a 74-year-old female with persistent generalized vitiligo on the face and body. 

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A Case of Nonsegmental Vitiligo on the Face and Hands Treated With Combination Topical JAK Inhibitor and Phototherapy

Mark Lebwohl, MD, presents a case of a 48-year-old female with a 10-year history of psoriasis who was successfully treated with an IL-17 inhibitor after inadequate response to both phototherapy and a TNF blocker.

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Rapid Clearance of Recalcitrant Psoriasis With an IL-17 Inhibitor

Case author Stephen W. Lewellis, MD, PhD, FAAD, presents a case of a 38-year-old female with loss of pigmentation on her forehead, cheeks, and eyelids who did not respond to prior treatment with a topical corticosteroid or calcineurin inhibitor.

Successful Treatment of Nonsegmental Periorbital Vitiligo

Case authors Danny Zakria, MD, MBA, Ryan Rivera-Oyola, MD, and Darrell Rigel, MD, MS, present a case of a 58-year-old male with a history of sun exposure and a skin lesion showing signs of malignancy. 

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Accurately Assessing Prognosis for High-Risk Squamous Cell Carcinoma

Case author Boni Elewski, MD and moderator Danny Zakria, MD, MBA, present a case of a 60-year old female who was airlifted in the middle-of-the-night with a rare dermatologic emergency.

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A Life-Saving Treatment in a 60-year Old Patient With Rapid Eruption of Pustules

Case authors Lisa C. Lopez-Sanglay, APRN, FNP-BC and James Q. Del Rosso, DO, FAAD, FAOCD present a case of a 15-year-old male with a flare of atopic dermatitis primarily affecting his hands and feet and a severely pruritic rash.

Del Rosso Case Study - Atopic Dermatitis on Hands and Feet

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Effective Primary Management of an Exacerbation of Atopic Dermatitis Using a Non-Steroidal Topical Therapy

National Healthy Skin Month: Managing Adolescent and Young Adult Patients 

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, Dr Nicholas Brownstone shares his expertise on managing patients in the adolescent and young adult demographic—a pivotal stage where dermatologists must consider not only physical health but also mental well-being.&nbsp;Understanding the adolescent perspective&nbsp;Dr Brownstone highlights that skin changes throughout life, as do our psychology and worldview. These shifts are particularly pronounced during adolescence, a time when many patients first develop social anxieties tied to their appearance.&nbsp;At this stage, patients are still forming their sense of identity, and even minor skin issues can feel monumental. Dermatologists must recognize the unique emotional weight that acne carries for this group and avoid dismissing their concerns—a practice Dr Brownstone refers to as “empathetic failure.”&nbsp;The psychological impact of acne&nbsp;According to Dr Brownstone, adolescence is often the life stage where acne has the greatest psychological impact. He emphasizes that even a single pimple can feel like “the end of the world” for these patients. This perspective supports the importance of taking their concerns seriously and tailoring treatment approaches to meet their emotional as well as physical needs.&nbsp;Pearls for treating acne in adolescents&nbsp;Dr Brownstone advises dermatologists to approach acne treatment in adolescents differently than in pediatric or adult patients. Key considerations include:&nbsp;<ul><li>Empathy first: Understanding the adolescent perspective and avoiding dismissive responses that could alienate patients&nbsp;</li><li>Individualized treatment: Acknowledging that not all acne cases are equal and adjusting treatment plans accordingly&nbsp;</li><li>Aggressive treatment when needed: Dr Brownstone suggests that even one pimple may justify aggressive treatment options, including isotretinoin, if the acne is perceived as life-ruining by the patient.&nbsp;</li></ul>Key takeaways for dermatologists&nbsp;As dermatologists, it’s crucial to consider both the physical and emotional impacts of acne on adolescent patients. Dr Brownstone encourages his colleagues to view this demographic through a compassionate lens, understanding their unique challenges and tailoring care to meet their needs effectively.&nbsp;By fostering empathy and delivering personalized care, dermatologists can make a profound difference in the lives of their adolescent patients, helping them navigate this critical stage with confidence and better skin health.

Psoriasis and IL-17 Inhibitors: Balancing Efficacy and Safety with Ixekizumab 

In this episode of Topical Conversations, Brad Glick, DO, and Jason Hawkes, MD, discuss the use of IL-17 inhibitors in managing psoriasis and psoriatic arthritis, with a focus on ixekizumab. Their conversation highlights the immunologic basis of IL-17, the safety and efficacy of ixekizumab, and its role in addressing the complex interplay of skin and joint symptoms in psoriatic disease.&nbsp;The role of IL-17 in psoriasis&nbsp;They begin by explaining that IL-17 plays a dual role in skin health. It provides natural protection against infections like candidiasis; however, excessive levels of IL-17 can drive keratinocyte hyperproliferation, leading to the scaling and plaque formation characteristic of psoriasis.&nbsp;Ixekizumab, by targeting IL-17A, helps normalize keratinocyte activity and significantly improves psoriasis symptoms. This mechanism of action also explains why some patients develop candidiasis during treatment, as blocking IL-17 reduces natural defenses against infections like candidiasis.&nbsp;Managing safety concerns&nbsp;While ixekizumab does not cause inflammatory bowel disease (IBD), it can exacerbate symptoms in patients with preexisting IBD. For patients who present with both psoriasis and IBD, clinicians need to carefully weigh the benefits of improved skin symptoms against the potential for worsening gastrointestinal issues. Monitoring and patient education are essential to ensure that risks are understood and managed effectively.&nbsp;Candidiasis, a known side effect of IL-17 inhibition, also requires consideration. By understanding the underlying immunologic mechanisms, dermatologists can counsel patients appropriately and address concerns about this potential complication.&nbsp;Efficacy of ixekizumab in psoriasis&nbsp;Clinical trials, including the UNCOVER studies, have demonstrated ixekizumab’s high efficacy in psoriasis treatment. The trials revealed significant rates of disease clearance, with about half of patients achieving PASI 100. These outcomes represent a substantial improvement over earlier treatments like methotrexate and TNF inhibitors.&nbsp;However, patient characteristics such as body weight can influence outcomes. For patients with higher body weights, efficacy may decrease, potentially due to the pro-inflammatory effects of adipose tissue. These findings highlight the importance of tailoring treatment approaches to individual patient profiles.&nbsp;Ixekizumab and psoriatic arthritis&nbsp;Psoriatic arthritis (PsA), a common comorbidity of psoriasis, remains challenging to treat. While ixekizumab and other IL-17 inhibitors have shown moderate efficacy in managing joint symptoms, they are highly effective for skin improvement. Dermatologists must set realistic expectations with patients, explaining that while dramatic skin improvements are likely, joint symptoms may respond more slowly or to a lesser degree.&nbsp;Exploring future approaches&nbsp;Emerging research is investigating the potential synergy of IL-17 inhibitors with GLP-1 receptor agonists. This approach aims to address systemic inflammation associated with obesity, which is linked to higher risks of diabetes, cardiovascular disease, and poorer psoriasis outcomes. By targeting both psoriasis and metabolic health, this strategy could offer comprehensive benefits, though further studies are needed to clarify its impact.&nbsp;Key takeaways for dermatologists&nbsp;Ixekizumab represents a significant advancement in psoriasis treatment, due to its high efficacy and targeted action. While considerations such as candidiasis risk and IBD management are important, this IL-17 inhibitor remains a strong option for dermatologists, with its potential for future innovations further underscoring its value in advancing patient care.

National Healthy Skin Month: Supporting Healthy Skin in Babies 

For National Healthy Skin Month, we’re spotlighting skin health practices across all stages of life. In this segment, pediatric dermatologist Dr Lisa Swanson shares her expert insights on caring for the skin of dermatology’s youngest patients—babies. Highlighting the unique needs of infant skin, she offers guidance for parents on how to promote healthy skin from birth, including tips for potentially lowering the risk of atopic dermatitis (AD).&nbsp;Baby skin: unique needs and moisturization benefits&nbsp;Newborn skin has distinct qualities compared to other age groups. Notably, it experiences a higher rate of transepidermal water loss, leaving it vulnerable to dryness and potential skin barrier issues. This increased water loss is thought to be a factor in the later development of atopic dermatitis. "Some studies suggest that the amount of transepidermal water loss in early life may be key in determining which kids develop eczema down the road," Dr Swanson explains.&nbsp;To support skin barrier health, moisturizing a baby’s skin with sensitive skin products early on has been associated with potential benefits, including a reduced risk of AD. Although study results have been mixed—some showing improvement in eczema rates through early moisturization and others showing minimal effect—Dr Swanson notes that she sees no downside to regularly moisturizing baby skin.&nbsp;Encouraging moisturization for infants and toddlers&nbsp;When advising parents, Dr Swanson emphasizes the value of gentle, daily moisturization using high-quality, sensitive skin products. For families of newborns and expectant parents, she provides recommendations for gentle products and accessible, good-quality moisturizers. “I encourage families with a newborn baby to go ahead and moisturize,” she says, noting that applying gentle products poses no risk and could potentially reduce a child’s chances of developing AD.&nbsp;For parents with older children who already show signs of AD, Dr Swanson makes a point to highlight the importance of early skin care for any future children.&nbsp;Shifting skin care recommendations in nurseries and NICUs&nbsp;Many nurseries and NICUs still advise against using products on newborn skin. Dr Swanson hopes to shift these guidelines to encourage regular moisturization for babies as a preventive strategy. Some of the studies exploring moisturization for AD prevention included accessible products, such as Vaseline, and demonstrated a reduction in eczema risk when used consistently during infancy. Dr Swanson’s advice to parents is straightforward: “If we moisturize a baby and turns out it's not a miracle to preventing atopic dermatitis, we've still done no harm.”&nbsp;Key takeaways for dermatologists&nbsp;Dr Swanson encourages dermatologists to discuss the importance of moisturizing with expectant parents and families of newborns. As dermatologists, supporting early skin health practices can have a lasting impact on the patient’s skin health across their lifespan.

Rash Decisions - Dermatology Case Studies