PANP360 Hub

Your One-Stop Shop for DermatologyEducation

Welcome to the PANP360 Hub, space designed for PAs and NPs to connect, learn from one another, and bring the best of dermatology education into everyday practice.

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The PANP360 Hub is designed for PAs and NPs to connect, learn from one another, and bring the best of dermatology education into everyday practice on-demand, 24/7. With expert-led experiences, in-person conferences, live virtual discussions, and always-on resources, PANP360 gives us the tools and community to sharpen our skills, strengthen our expertise, and grow as leaders.

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PA/NP EMERGE

PA/NP EMERGE

EMERGE is an educational platform for advancing the careers of dermatology PAs & NPs that features engaging video and written content on today's most important topics in dermatology presented by top dermatology key opinion leaders.

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What are the three stages of Mycosis Fungoides?

Medically Reviewed by Nick Brownstone, MD Mycosis fungoides (MF) is the most common subtype of cutaneous T-cell lymphoma (CTCL) with a higher incidence in males than females. It is also more commonly found in African Americans than Caucasians. The average age of onset is about 50 – 55 years old and tends to have a more indolent nature. The exact etiology of MF is unknown, however, it is thought that ultraviolet radiation, environmental exposures, and infection can play a role. The three stages of MF are patch, plaque, and tumor. Beginning first with the patch stage, individuals will present with thin plaques, sometimes erythematous, with an overlying fine scale. It is said to resemble cigarette-paper. Commonly affected areas are those not often exposed to sunlight. Next, the plaque stage. In this stage, patients will develop erythematous to brown plaques that are often pruritic. The shape of these plaques can vary from oval to serpiginous. Lastly is the tumor stage. Tumors can vary in size, being anywhere from 1cm or greater, and present as violaceous to erythematous tumors. These tumors can also develop ulcerations or necrosis. Similar to the other stages, pruritus continues to affect patients. Important to note is the difference between MF and Sezary syndrome. Sezary syndrome consists of the following: erythroderma, lymphadenopathy, and the presence of Sezary cells within the skin, lymph nodes, and bloodstream. A Sezary cell is a cancerous, abnormally shaped, fast-growing T cell that can be found within the skin, blood, and lymph nodes. Sezary syndrome is often more aggressive and tends to affect adults between 60-65 years of age. Fortunately, Sezary syndrome is less common, accounting for 2% of the population with CTCL versus approximately 39% of individuals with CTCL having MF. References: Cutaneous T Cell Lymphoma. VisualDx. (n.d.). https://www.visualdx.com/visualdx/diagnosis/?moduleId=101&diagnosisId=51907&age=4#Look_For  Jonak, C., Guenova, E., Tittes, J., & Brunner, P. (2021). Mycosis fungoides and Sézary syndrome. Journal Der Deutschen Dermatologischen Gesellschaft.  Miyashiro, D., & Sanches, J. A. (2023). Mycosis fungoides and Sézary Syndrome: Clinical presentation, diagnosis, staging, and Therapeutic Management. Frontiers in Oncology, 13. https://doi.org/10.3389/fonc.2023.1141108  NCI Dictionary of Cancer terms. Comprehensive Cancer Information – NCI. (n.d.). https://www.cancer.gov/publications/dictionaries/cancer-terms/def/sezary-cell  Premalignant and malignant nonmelanoma skin cancer. CTCL. (n.d.). In Habif’s Clinical Dermatology (p. Chapter 21). essay.

Should we push our isotretinoin patients to a higher cumulative dose closer to 220mg?

Medically Reviewed by Nick Brownstone, MD Isotretinoin is the most effective treatment for severe nodulocystic acne vulgaris, and it is the only treatment option for acne that offers the potential for remission or permanent cure. I am quick to offer it to my patients when I see scarring. But the current literature is divided on the ideal dosing of isotretinoin to optimize treatment response. Many studies support a cumulative dose of 120 to 150mg/kg to decrease the risk of relapse and retrial. But could pushing patients closer to 220mg/kg further reduce the number of patients who have to undergo a second course down the road? In a prospective, unblinded, observational study, 180 patients with severe, unresponsive, nodulocystic acne received isotretinoin until 1 month after new lesions stopped developing. Mean age of participants was 19.3 years and 51.9% were female; 74.1% were white and 25.9% were defined as non-white. After treatment ended, patients were divided into a high cumulative dose group (≥220 mg/kg) and a low cumulative dose group (< 220mg/kg). Patients were monitored for 12 months after their last day of isotretinoin because previous studies have found that 80-90% of patients experienced relapse (defined as the need for prescription acne medication) within 12 to 24 months after finishing a course of isotretinoin. At 12-month follow up in the study above, the relapse rate was 47.4% in the lower-dose treatment group (<220mg/kg) compared with just 26.9% in the ≥220mg/kg group. Laboratory abnormalities (which included liver enzymes, cholesterol and triglycerides) during the treatment period were uncommon and not significantly different between the 2 dosing groups. Retinoid dermatitis was significantly more common in the high-dose treatment group (53.8 vs 31.6%), however. I personally now will push many of my severe acne patients to a cumulative dosage of 180mg/kg-220mg/kg before completing isotretinoin treatment. I also treat one month past the patient’s last pimple even if they’ve already hit their target cumulative dosage. I find in these patients that if their acne does come back after their isotretinoin course is finished, it’s usually mild and I’m able to manage it with a prescription tretinoin cream for maintenance. I always warn patients at the start of isotretinoin treatment, however, that they may need to undergo a second course down the road so they are aware of the risk that their acne may return. References: Blasiak R, Burkhart, C. High-Dose Isotretinoin Treatment and the Rate of Retrial, Relapse, and Adverse Effects in Patients with Acne Vulgaris. JAMA Dermatol. 2013; 149; (12):1392-1398. Doi:10.1001/jamadermatol.2013.6746 Coloe J, Du H, Morrell DS. Could higher doses of isotretinoin reduce the frequency of treatment failure in patients with acne? J Am Acad Dermatol. 2011;65(2):422-423

LEAP: Learning and Engagement to Accelerate Proficiency

LEAP: Learning and Engagement to Accelerate Proficiency

LEAP is the ultimate educational resource and certificate program designed exclusively for dermatology, offering a comprehensive review of complex inflammatory diseases and significant dermatologic procedures with detailed presentations by leading experts.

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Cynthia

Cynthia Trickett, PA-C, MPAS

Physician Assistant 
Forefront Dermatology 
Dallas, TX

Foday

Foday Koroma, FNP-BC, MSN, C-PAM3

Speaker, Advisor, PAMS Steerco, Mount Sinai Department of Dermatology

Curtis

Curtis Chen, PA-C

Metro Dermatology 
Bronx, NY

Nina

Nina Copeland, APRN, FNP-C, CANS

Nurse Practitioner 
Johnson Dermatology 
Fort Smith, AR

Nasslynne

Nasslynne Lenz, APRN, AGPCNP-BC

Vivida Dermatology 
Las Vegas, NV

Rachel

Rachel Printy, PA-C

Physician Assistant 
Advanced Dermatology and Cosmetic Surgery 
Tampa, FL

Kimberly

Kimberly Baker, MSN, FNP-C

Nurse Practitioner, Henry Ford Hospital

Amy

Amy Bayon, MSPA, PA-C

Physician Assistant, Academic Alliance in Dermatology

Robert

Robert Casquejo, PA-C

Founding Member
Skin and Cancer Center of Scottsdale

Omar

Omar Daabies, PA⁠-⁠C

Physician Assistant, Advanced Dermatology and Cosmetic Surgery

Douglas

Douglas DiRuggiero, DMSc, PA-C

Physician Assistant, Skin Cancer & Cosmetic Dermatology Centers

Bari

Bari Genoa, PA-C, MPAS

Physician Assistant, Infinity Dermatology Group

Sydney

Sydney Givens, PA-C

Physician Assistant, Wiregrass Dermatology
Founder, Skincare by Syndney

Adam

Adam Hetz, MPAS, PA-C

Physician Assistant, Pinnacle Dermatology

Iris

Iris Looi, PA-C, MMSc

Physician Assistant, Russak Dermatology Clinic

Victoria

Victoria Maloney, MPAS, PA-C

Physician Assistant, Medical College of Wisconsin

Andrew

Andrew Mastro, MS, PA-C

Physician Assistant, Illinois Dermatology Institute
Vice President, Illinois Society of Dermatology Physician Assistants (ISDPA)

Shanna

Shanna Miranti, MPAS, PA-C

Physician Assistant, Riverchase Dermatology

Alissa

Alissa Morrone, PA-C

Physician Assistant, GlamDerm

Leigh

Leigh Pansch, MSN, FNP-BC, DCNP

Nurse Practitioner, DOCS Dermatology
Co-chair, American Academy of Nurse Practitioner Dermatology Specialty Practice Group

Tanya

Tanya Patron, PA-C

Founder, Selfie Aesthetic
Owner, Aesthetically Speaking LLC

Jamie

Jamie Restivo, MPAS, PA-C

Physician Associate, Crumay Parnes Associates
President, Pennsylvania Dermatology Physician Assistants

Matthew

Matthew Reynolds, PA-C

Physician Assistant, Arkansas Dermatology
Founder & Clinical Trials Investigator, Arkansas Research Trials

Christopher

Christopher Roberts, MPAS, PA-C

Physician Assistant, Pariser Dermatology
Assistant Professor, Eastern Virginia Medical School, School of Health Professions

Gary

Gary Rubin, PA-C

Co-Owner and Physician Assistant, Primp Medi Spa

Najat

Najat Watch, PA-C

Physician Assistant, Henry Ford Health