The&nbsp;Derms and Conditions&nbsp;Podcast had a very&nbsp;successful year in 2022! Many discussions took place covering a wide range of topics in dermatology,&nbsp;including new published information, treatments, technologies, medications, and&nbsp;practical tips to improve the overall performance of your practice.&nbsp;Derms and Conditions&nbsp;wraps up the year by summarizing valuable insights and information for dermatology practitioners.

The&nbsp;Derms and Conditions&nbsp;Podcast had a very&nbsp;successful year in 2022! Many discussions took place covering a wide range of topics in dermatology,&nbsp;including new published information, treatments, technologies, medications, and&nbsp;practical tips to improve the overall performance of your practice.&nbsp;Derms and Conditions&nbsp;wraps up the year by summarizing valuable insights and information for dermatology practitioners.
Host James&nbsp;Q. Del Rosso, DO,&nbsp;explains the value of occasionally going back and listening to past episodes as&nbsp;some "pearls" always seem to emerge that were missed during the initial&nbsp;listening of the podcast. Some of the greatest hits from episodes released in 2022 were highlighted. This includes perspectives on managing actinic keratoses (Dr. Mark G. Lebwohl, MD), a review of the "STOP" approach to rosacea which incorporates effective patient collaboration (Dr. Julie C. Harper, MD), ways to integrate aesthetic and cosmetic dermatology into your medical dermatology practice (Dr. Patricia K. Farris, MD), and a discussion of how tumescent anesthesia can expand the range of procedures that dermatologists can effectively and safely perform in the office (Dr. Sandra Lee, MD).
&nbsp;Many thanks for listening and we look forward to Season 3 in 2023.
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Greatest Hits from Derms and Conditions 2022

In Episode 41 of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO brings back a prior podcast guest in Brad P. Glick, DO, a member of the board of directors of the AAD and National Psoriasis Foundation as well as the residency program director at Larkin Palm Springs in Miami. The two discuss psoriasis management and the utility of anti-TNF drugs.

Sponsor &nbsp;<img class="image_resized" style="width:36.87%;" src="https://d18uhdhjoz8by6.cloudfront.net/ucb_3d73c03cfa.png" alt="UCB Logo" srcset="https://d18uhdhjoz8by6.cloudfront.net/thumbnail_ucb_3d73c03cfa.png 245w," sizes="100vw" width="245px">In Episode 41 of Derms and Conditions, our host James Q. Del Rosso, DO brings back a prior podcast guest in Brad P. Glick, DO, a member of the board of directors of the AAD and National Psoriasis Foundation as well as the residency program director at Larkin Palm Springs in Miami. The two discuss psoriasis management and the utility of anti-TNF drugs. Dr. Glick emphasizes that TNF inhibitors remain a very important part of our psoriasis therapeutic armamentarium despite newer drugs coming to the market. About 30% of psoriasis patients will get psoriatic arthritis and TNF inhibitors are very effective at treating both skin and joint disease. In addition, TNF inhibitors are used to treat inflammatory bowel disease as well and are often selected by Dr. Glick to treat psoriasis if there is a family history of IBD. Dr. Glick provides several valuable tips on recognizing the most common signs and symptoms of psoriatic arthritis and quickly but effectively screening patients at every visit. He also discusses several common clinical scenarios and how to choose the right drug for the right patient. Finally, he provides his thoughts on biosimilars and how they stack up against their counterparts. Tune in to learn more from an accomplished psoriasis veteran! FINANCIAL DISCLOSURES: James Q. Del Rosso, DO CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Brad P. Glick, DO, MPH N/A

A Blast From The Past: Remembering the Importance of TNF Inhibition in Psoriatic Disease

In Episode 40 of Derms and Conditions, our host James Q. Del Rosso, DO sits down with Whitney A. High, MD, JD, a Professor of Dermatology and Pathology at the University of Colorado. The two discuss blastic plasmacytoid dendritic cell neoplasm (BPDCN), a highly aggressive and fatal malignancy that can be very challenging to diagnose.

Sponsor <img src="https://d18uhdhjoz8by6.cloudfront.net/Stemline_logo_s_7bf9f61c83.png" alt="Stemline" srcset="https://d18uhdhjoz8by6.cloudfront.net/thumbnail_Stemline_logo_s_7bf9f61c83.png 245w," sizes="100vw" width="245px">In Episode 40 of Derms and Conditions, our host James Q. Del Rosso, DO sits down with Whitney A. High, MD, JD, a Professor of Dermatology and Pathology at the University of Colorado. The two discuss blastic plasmacytoid dendritic cell neoplasm (BPDCN), a highly aggressive and fatal malignancy that can be very challenging to diagnose.Dermatologists are in a great position to make the initial diagnosis of this rare disease as it involves the skin in 80-90% of cases. Dr. High discusses several clinical pearls about BPDCN including how it presents, important considerations for the dermatopathologist, and the best techniques to biopsy the lesion in order to maximize diagnostic yield. Finally, he reviews the next steps in disease management once the diagnosis is made. Dermatologists can have a significant impact on patient outcomes with BPDCN by making the diagnosis early, so tune in to this episode to learn more! FINANCIAL DISCLOSURES: JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Whitney A. High, MD, JD No financial relationships to disclose&nbsp;

Bringing a Rare Disease to Light

In Episode 39&nbsp;of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO sits down with Jennifer Cather, MD, a dermatologist and Medical Director at Mindful Dermatology and Modern Research Associates in Dallas, Texas. She and Dr. Del Rosso discuss the exciting new Mind.Px test that can noninvasively obtain a sample of a patient’s transcriptome to help determine which biologic they will optimally respond to.

In Episode 39&nbsp;of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO sits down with Jennifer Cather, MD, a dermatologist and Medical Director at Mindful Dermatology and Modern Research Associates in Dallas, Texas, and a good friend of Dr. Del Rosso.Dr. Cather is an expert in psoriasis as she is currently managing over 1,700 patients on systemic therapy. She and Dr. Del Rosso discuss the exciting new Mind.Px test, a dermal biomarker patch developed by Mindera Health that can noninvasively obtain a sample of a patient’s transcriptome to help determine which biologic they will optimally respond to. Dr. Cather describes how Mind.Px can limit trial-and-error through a targeted approach. Many patients lose faith in psoriasis medications after multiple treatment failures, so data from this test can uncover which drug class, either TNF-inhibitors, IL-17 inhibitors, or IL-23 inhibitors, will work best for them. Precision medicine is a hot new topic with a lot of new information to navigate, so tune in to this episode to learn Dr. Cather’s tips on using the Mind.Px test to improve your psoriasis patients’ outcomes! FINANCIAL DISCLOSURES JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Jennifer Cather, MD &nbsp;CONSULTANTAbbvie, Amgen, Lilly. &nbsp;

Even The Best Can Get Better: Observations From A Seasoned Veteran of Psoriasis Treatment

In Episode 38 of Derms and Conditions, our host James Q. Del Rosso, DO sits down with Chris Bunick, MD, PhD, an Associate Professor of Dermatology at Yale University. The two discuss the important topic of antibiotic stewardship in Dermatology.

In Episode 38 of Derms and Conditions, our host James Q. Del Rosso, DO sits down with Chris Bunick, MD, PhD, an Associate Professor of Dermatology at Yale University. The two discuss the important topic of antibiotic stewardship in Dermatology.Dr. Bunick begins by sharing his unique background and how he became interested in structural biology and the way medications work at a molecular level. Once he discovered his passion for Dermatology, he turned his attention to understanding antibiotics and how resistance develops. In this episode, he reviews new data on the effects antibiotics have on our microbiome and overall health. He also discusses sarecycline and how its unique properties compared to other tetracyclines help limit resistance and adverse effects. Since Dermatologists prescribe more antibiotics than any other specialty, this is definitely an episode you won’t want to miss! FINANCIAL DISCLOSURES JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo)&nbsp; SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo)&nbsp; RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo).&nbsp; CHRIS BUNICK, MD, PhD: Chris Bunick, MD, PhD, has served as an investigator for Almirall; a consultant for AbbVie, Almirall, Arcutis, LEO Pharma, Sanofi-Regeneron, and UCB; and a speaker for and received honoraria from Allergan, Almirall, LEO Pharma, and UCB.

Can We Take The "Anti" Out of Antibiotic Use in Dermatology?

In Episode 37 of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO sits down with April W. Armstrong, MD, MPH and David E. Cohen, MD, MPH live at Fall Clinical 2022 in Las Vegas, NV to discuss highlights from the meeting.

In Episode 37 of Derms and Conditions, our host James Q. Del Rosso, DO sits down with April W. Armstrong, MD, MPH and David E. Cohen, MD, MPH live at Fall Clinical 2022 in Las Vegas, NV to discuss highlights from the meeting. This is a very unique episode of Derms and Conditions filled with clinical pearls for four conditions! Dr. Armstrong discusses two biologics that have great data for prurigo nodularis as well as a new topical JAK inhibitor for vitiligo. Dr. Cohen highlights some advances for atopic dermatitis while revealing the highly anticipated 2023 allergen of the year. Finally, the two share their thoughts on the landmark approval of deucravacitinib for psoriasis. Don’t miss hearing our KOLs discuss its novel mechanism, efficaciousness, and safety profile so that you can confidently answer your patients’ questions about this new therapy. Tune in today! <img style="height:auto;max-width:100%;" src="https://fchealth-assets.s3.amazonaws.com/episode37-DC-fc22.jpg" alt="Live Episode Recording at FC22"> FINANCIAL DISCLOSURES: JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). DAVID COHEN, MD, MPH: Consultant and Honorarium: Ferndale Laboratories, Asana Medimetriks [past] Leo UCB Novartis Dermavant FSJ FIDE. (FIDE receives industry sponsorship from AbbVie, Almirall, Amgen, Arcutis, Bausch and Lomb, Bristol-Myers Squibb, Celgene Dermavant, Dermira, Janssen, Kyowa Hakko Kirin, LEO, Lilly, Novartis, Ortho Dermatologics, Pfizer, Sanofi Genzyme, Regeneron, Sun Pharma, UCB, Valeant) Cosmetic Ingredient Review (CIR) Stock or stock options: Dermira [past], Medimetriks [past], Brickell Biotech [past], Kadmon, Evommune, Timber Board of Directors: Kadmon, Timber, Evommune, Dermira-[Past] APRIL ARMSTRONG, MD, MPH: Research investigator and/or scientific advisor to AbbVie, Almirall, Arcutis, ASLAN, BI, BMS, EPI, Incyte, Leo, UCB, Janssen, Lilly, Nimbus, Novartis, Ortho Dermatologics, Sun, Dermavant, Dermira, Sanofi, Regeneron, Pfizer, and Modmed.

Highlights of Fall Clinical 2022: The Hits Just Keep On Coming!

You're listening to the Derms and Conditions podcast. So welcome to Derms and conditions. This is a live performance of derms and conditions we have, backed by popular demand, we did this meeting in Hawaii, and it was with April Armstrong and David Cohen, and they were so well received that we brought them back again. I have a funny feeling they might be a fixture, but they're certainly back for the second year now a message from our advertiser, Bristol Myers Squib at last. So, tictic two, which is ducravacitinib, a new FDA approved treatment option. To learn more, visit www.sotictuhcp.com. That's spelled www.sotyktuhcp.com. So, April, I'm going to ask you to start off. What we do here is we look at highlights from the meeting and April and David, throughout the meeting, they listen to different presentations and write down things that they really think are important and clinically relevant to you as dermatologists. So, April, what struck your fancy? Yeah, there are several areas that really caught my attention, and one thing is we have our new approval for pariegal noduleires, for example, with dupilumab, for patients with or without atopy. So that's very important. There's also the discussion of the nemolisumab data, phase three data, which looked great for paragonodularis as well. So I think those would be wonderful options for our patients with this very difficult to treat disease. David, anything that hit you as being clinically relevant and important? Well, I want to point out, having come to this meeting almost since the beginning, I cannot remember a period of time where we've packed so much new information into so short a period of time. Right. We have new approvals for atopic dermatites. We have two jack inhibitors, we have an il 13 inhibitor, we have two new topicals in psoriasis. We got a new topical in atopic dermatites, all in the last year, and it's really amazing that we're able to cover that all here. So I think those highlights are the big ones for me. And trying to sort of drink from the fire hose of information coming in that is so entirely clinically relevant. This is not theoretical stuff. This is going live in your office on Monday. Right. What really hits me is that two disease states that I've always found to be very difficult. And almost before I walk in the room, I feel badly, because I never really thought I was going to be able to do much to help people was vitaligo. And patients that had rapidly progressive or severe alopecia because it was so difficult to get these patients better. But we now have FDA approved treatments, treatments that have established efficacy. They have their benefits versus risks and certainly don't work in everyone, but it's great to have those advances. Yeah. And Simal Desai and pearl Grimes covered it. I think they pretty much call this a historic time for vitiligo. Right. So I remember them highlighting, of course, topical ruxalitinib, which has been a major breakthrough. Twice daily, up to 10% of body surface area having real material and clinically relevant improvement, particularly on areas like head and neck, with some caution about expectations in April areas. Right. I think another thing I took home from them was don't forget about the other therapies that we've been using for a while, the topical corticosteros, the topical tacrolimus, and, of course, phototherapy, all as adjunctive now to a brand new FDA approved topical medicine. Keeping in mind how long it might take for patients to get better, this is something that's a matter of months as opposed to a matter of weeks. Exactly. Right. So, April, let's come back to you. I'm sure you saw more things that you liked in the program. Yes, I saw a lot of things that I liked in the program, I think. And, Jim, you alluded to earlier regarding hair. Right. Hair disorders in alopecia. Ariata, we really dove deeply on the use of aricitinib. Two milligram, how one starts with two milligram, then go to four milligram if necessary. But also, very importantly for those patients who may be on tofacitinib already, how do you transition them from tofacitinib to berry, which is very interesting. So perhaps for those patients who are getting results on TOfA, but to now transition to an FDA approved therapy, 1 may want to do it slowly so they don't get disappointed. Now, April, you've heard of psoriasis, right? You're familiar with psoriasis. Can you give us some information on new advances in psoriasis? Yes, very exciting new developments in psoriasis. First in the development of non steroidal medications. So we've seen the approval of topinorov, which is a non steroidal in psoriasis, as well as then following that, just a few months later, the approval also of a topical rofumalast. And what was shown is that now we have topical therapies that are non steroidal, much stronger in efficacy than the ones that we had before. Right. I feel comfortable saying that, because even though we don't have head to head data, we've observed the results with the previous treatments that were non steroidal compared to what we saw in these studies. And you feel very comfortable saying that they work faster and better than the previous ones. Well, you're right. We don't have head to heads. But what we do have with our prior therapies are clinical trials that harms with the steroid, with adjunctive therapy. And the differences between adding those non steroidals on were very marginal. These are demonstrative results compared to placebo and deltas, between placebo and active that we had not seen before with topical therapies. Both of those therapies that April mentioned really have notable efficacy once daily and in cream formats that patients could use on regular body sites. But they could put it on their face, they could put it in intriguinous areas, and it's going to work. And if any of the things that you hear about at the meeting, those are the ones that are going to be right out of the gate on Monday morning, you can go live on because of their ease of use. And if patients continue to use them, you're not concerned about how long they're using it or if they're putting it on a different area. In terms of side effects. One of the things that was interesting to me was when we think about oral Janus kinase inhibitors, right? They advances in atopic dermatitis and some other areas, alopecia areata. But one place where they've lagged behind until recently is in psoriasis, right? And some were even evaluated and were not approved for psoriasis. So it was interesting that when we saw decravacitinib get FDA approval, I think everybody was anticipating that the box warnings were going to be there, and it turned out that they're not. So what's behind that, in your mind, April, in terms of that difference? I think the difference is data. I think a decision was made that's evidence based. And what we see is that ducravacitinib has a very unique mechanism of action where it binds to the allosteric. It's an allosteric binding, so it really binds to distinct sites from where other jack inhibitors that we have may bind. And clinically, what we see is a profile, an efficacy profile that's superior to a premalass in this head to head evaluation, and also demonstrate a safety profile where we have really laboratory parameters similar to a premalass, as well as placebo. And I think this is a time, I think that's why the community is very excited. I think FDA recognized these features of the medication and being the once daily medication, an oral medication that needed no titration that patients can take with or without food. It really offers a significant new option in oral realm for our psoriasis patients and being metabolized by several different enzymes. We're not concerned about drug, drug interactions. Absolutely. I think April got exactly right and I don't think it would have been a surprise to anyone in this room or at that conference when there was welling anticipation on what the label was going to look like. Right. I mean, the jacks as a class are spectacularly efficacious, right. But they require patient selection and monitoring. And the question would be, would a tick two orally available medicine look like a jack label or not? And I think this was a perfect situation of really understanding the mechanism of the target that any company would look for and reverse engineering to specifically go after your target whilst not going after off target areas and worked. The question would be, would it deliver? And it did deliver. And we're looking at efficacies almost two x of what we were used to orally. Well, it had to go from the basic science that suggested this to turning out in the clinical studies, which is really what it did. Yeah. And I shall say I think that is a significant development for our other oral medications, such as a premalass, for example. We also saw discussion of the data in adolescent pediatric populations. And so I think that's interesting. That's great that we have more options for oral options for our younger patients as well. Well, it's nice to have different options. We know what a premolast does and what it doesn't do. And now we have another option to consider that we're learning about. And I think it's great. I think it is important to know that patients have to get a baseline tb test or it's recommended in the label they do and have periodic lipids tested, but you don't need a complete blood cell count. Every patient has to get liver enzymes or whatever. I'm going to take a break for a moment and we'll get back to our discussion. Let's pause for a message from our advertiser, Bristol Myers Squibb, who invites you to learn more about sotiktu, which is the kravacitinib, a new FDA approved treatment option, by visiting www.sotictuhcp.com. I'll spell it for you www.sotyktuhcp.com. So, David, was there anything else in the meeting? That couple of things. Number one, we've spoken about some of them, but for the first time ever, we're seeing new drugs come on the market with active comparators. We never had that before. Right. We have jack inhibitors for atopic dermatitis with a comparator to the foundational biologic therapy, dupilumab. When did we ever get that kind of information before? And I really like the format you guys put together, putting Simal Desai and Ali Galan in a boxing match, going after each other, trying to figure out which drugs should you use for atopic dermatitis, jack inhibitors or biologic drugs? Well, I'm going to tell you that was my idea, and it was supposed to be me, but I got boxed out by Simal. So what are you going to do? Well, guy's going to be president of the AAD. What are you going to do? So, April, any thoughts from you? Yes. So a few things. One is when we're looking at Hydranita Separtiva, I think the big splash there is that we have data from Sekukinumab's pivotal studies, which showed that Q two week dosing of secucunumab worked well for patients with HS. The Q four week data, they show positive results in one of the two studies. So I think that is quite notable. I also love Dr. Elusky, Bonnie Elusky's talk in terms of minoxidil, right? Oral minoxidil, that's talk of the town. And she brought her own experience where you take the 2.5 milligram oral tablet, you cut it in quarters, give it a quarter of them, which is zero point 65 to start in women, and you use half, 1.25 to start in men, and then to see how they may do with that starting dose, and then decide whether to adjust that accordingly. So, David, we're waiting bated breath to hear about the allergen of the year. I know that's why most people come to full clinical. It's probably the only reason for some of them. And I will say for the last three years prior, we had some allergens of the year that were a little difficult to digest or to immediately take into clinic. But the 2023 allergen of the year was lanolin. It's going to be lanolin. Right. And I think the only people who know that right now are the people who attended fall clinical because it just kind of broke. And so lanolin is derived from sheep. Sheep sebum. Right. And it's incredibly pervasive in personal care products. And the truth is, Lanol feels wonderful when it goes on irritated skin. It's a reason why it's been used for a really long time. The issue is, if we take a look at lanolin allergic patients, you tend to find a disproportionate number of them that have chilitis, lip dermatitis, dermatitis in their groin, in the anal area. And that's the time where the clinician takes a pause and say, we have some recalcitrant disease. It's not responding to some topical steroids. What may be fueling this, and it may be sometimes as simple as, let's pull back the lanolin product, let's continue our therapies, as we're doing before, and see if we can make some headway. So I think it was a wonderful allergen of the year and immediately actionable. What about the difference between lanolin and lanolin alcohol? Yeah, pretty much. Yeah, I know. So I think anytime you see on a package lanolin, lanolin alcohol, amercol, wool, wax, wool alcohol, you're going to have to assume that's going to be lanolin based. The question on the degree of refinement is going to be so difficult clinically that I think you're just going to wind up avoiding that one for now. Right. But this is one of those allergens where you don't need to immediately go to patch testing on it. Now, one other caveat. Sometimes lanolin on intact skin, you're checking it on the anticubital faucet and nothing's happening, and you're making an assumption they're not allergic to it. That may be a little bit of a paradox. Lanolin can take a while to come on and a while to go away, and it tends to bother irritated skin. So one of the things I noticed before we wrap up is none of the highlights that either of you mentioned came from any of my presentations. I guess I'll have to do better next year. So I want to thank both of you for helping out with this. I think it's great. Great pearls for everyone. And so we'll end with now a message from our advertiser at last. So tick two, which is ducravasitnib, now approved as a treatment option by the Food and Drug Administration. Bristolmeyersquib invites you to learn more by visiting www.sotictuhcp.com, spelled www.sotyktuhcp.com, and for all of you out there. We're going to be coming around, and maybe you'll be lucky enough to get a derms and conditions hat, which we started. And April, I know you'll sport this extremely well. It's a derms and conditions shirt. Oh, thank you very much. Why don't you stand up and sport it? David, the same for you. Thank you. And Jim, your talks are highlights. My talks are highlights. Thank you, David. You made up for it. Thank you for listening to this episode of Derms and Conditions. If you have any questions or comments, please email us at podcasts at Fred Health. And most importantly, if you like this episode, subscribe to the Derms and Conditions podcast on Apple Podcasts or wherever you get your favorite shows. Thanks for joining us.

In Episode 36 of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO sits down with Dr. Linda Stein-Gold, the Director of Dermatology Clinical Research and the Division Head of Dermatology at Henry Ford Health. The two discuss various topical treatment options in the management of psoriasis.

In Episode 36 of Derms and Conditions, our host James Q. Del Rosso, DO sits down with Dr. Linda Stein-Gold, who is the Director of Dermatology Clinical Research and the Division Head of Dermatology at Henry Ford Health. The two discuss various topical treatment options in the management of psoriasis.Dr. Stein-Gold begins by reiterating that despite the development of new systemic therapies, topical therapy remains a mainstay in psoriasis management. She discusses a new formulation of betamethasone dipropionate that uses an emollient spray to deliver the corticosteroid into the superficial aspects of the skin while limiting deeper penetration and systemic absorption. Another option to limit adverse effects is decreasing the concentration of the corticosteroid, and Dr. Stein-Gold describes a clinical trial that compared clobetasol 0.025% and 0.05% and showed that the lower concentration had similar efficacy but a much better safety profile. This episode is filled with clinical pearls for treating psoriasis and improving patient outcomes.

The Gold Standard of Topical Therapy in Psoriasis

In celebration of National Daughters Day on September 25, we have a special episode of&nbsp;Derms and Conditions! Our host James Q. Del Rosso, DO, sits down with Dee Anna Glaser, MD, and her two daughters, Katherine and Ella.

In celebration of National Daughters Day on September 25, we have a special episode of Derms and Conditions! Our host James Q. Del Rosso, DO, sits down with Dee Anna Glaser, MD, and her two daughters, Katherine and Ella. &nbsp; Many in the Dermatology community know Dr. Glaser as she is very involved at conferences and is a leader in hyperhidrosis. But many may not know that both of her daughters are also dermatologists. The three of them share their path to dermatology and how they independently discovered their passion for the field.&nbsp; &nbsp; In this episode we diverge from the usual discussion of clinical conditions and get a unique view into the Glasers&rsquo; family dynamic and the impact that dermatology has had on these brilliant women.

All in the Family: Keeping Up with the Glasers

In Episode 34, host James Q. Del Rosso, DO sits down with Joslyn Sciacca Kirby, MD, MEd, MS, to discuss Hidradenitis Suppurativa and the difficulty that they, along with many Dermatologists, face in treating it.

In Episode 34 of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO sits down with Joslyn Sciacca Kirby, MD, MEd, MS, who is an Associate Professor of Dermatology at Penn State Health. The two discuss Hidradenitis Suppurativa and the difficulty that they, along with many Dermatologists, face in treating it. They begin by pointing out all of the treatment modalities that have historically been used and how some are still effective, while others should be retired, especially when facing severe or refractory disease. Dr.&nbsp;Kirby&nbsp;then shares some of her preferred topical and systemic therapies and how to select the right drug for the right patient. Finally, she relays that there is hope for the future in treating HS, as she personally participates in clinical trials for new monoclonal antibodies that have shown promising results. You don&rsquo;t want to miss this episode filled with pearls on treating one of the most stubborn dermatologic conditions. FINANCIAL DISCLOSURES JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Joslyn R. Sciacca Kirby, MD, MEd SPEAKER AbbVie GRANTS Incyte CONSULTANT AbbVie, Bayer, ChemoCentryx, InflaRx, Janssen, Moonlake, Novartis, UCB

The Story So Far: How One Thoughtful Dermatologist Is UnFOLDing the Challenges of "HS"

In Episode 33 of&nbsp;Derms and Conditions, host James Q. Del Rosso, DO sits down with April W. Armstrong, MD, MPH, Professor of Dermatology and Associate Dean at the University of Southern California and discuss&nbsp;the different members of the JAK family and how they enhance different intracellular signals.

In Episode 33 of Derms and Conditions, our host James Q. Del Rosso, DO sits down with April W. Armstrong, MD, MPH, Professor of Dermatology and Associate Dean at the University of Southern California. The two discuss the Janus tyrosine kinase (JAK) pathway and how JAK inhibitors have become a useful tool in treating several chronic dermatologic conditions. Dr. Armstrong notes that different members of the JAK family pair in different ways and therefore enhance different intracellular signals. In fact, these pairings are why certain JAK inhibitors are used for certain disease states and subsequently lead to a variety of adverse effects. Dr. Armstrong emphasizes the importance of knowing which JAK molecule the drug acts upon and the associated side effects for clinical monitoring. She highlights that one member of the JAK family, TYK2, can have a more targeted effect based on where the molecule is inhibited and therefore lead to fewer adverse effects. She discusses an example of a common case encountered in practice and some of the relative and absolute contraindications to starting a JAK inhibitor. You won’t want to miss these important pearls that can help you navigate this complex but exciting area of therapeutics. JAMES DEL ROSSO, DO FINANCIAL DISCLOSURES: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). APRIL ARMSTRONG, MD, MPH FINANCIAL DISCLOSURES: Research investigator and/or scientific advisor to AbbVie, Almirall, Arcutis, ASLAN, BI, BMS, EPI, Incyte, Leo, UCB, Janssen, Lilly, Nimbus, Novartis, Ortho Dermatologics, Sun, Dermavant, Dermira, Sanofi, Regeneron, Pfizer, and Modmed.

Fundamentals of JAK Inhibitors and What Makes Them TYK

In Episode 32 of&nbsp;Derms and Conditions, James Q. Del Rosso, DO chats with Brad P. Glick, DO, MPH and they discuss the advantages of topical therapies and their pivotal role in managing chronic diseases, even in the setting of significant advances in targeted systemic therapy.

In Episode 32 of Derms and Conditions, our host James Q. Del Rosso, DO, chats with Brad P. Glick, DO, MPH, the residency program director at Larkin Palm Springs in Miami. Dr. Glick and Dr. Del Rosso discuss the advantages of topical therapies and their pivotal role in managing chronic diseases, even in the setting of significant advances in targeted systemic therapy. Dr. Glick emphasizes that the adjunctive use of topical and systemic therapies is key to obtaining and maintaining clearance.&nbsp; Next, they discuss the new combination of betamethasone dipropionate and calcipotriene cream and the unique formulation used to deliver the two very different medications effectively and synergistically.&nbsp; Finally, Dr. Glick weighs in on the age-old debate: New York or Chicago-style pizza? You've got to hear this! FINANCIAL DISCLOSURES: James Q. Del Rosso, DO CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Brad P. Glick, DO, MPH N/A

A Topical Makeover: Taking Something Good and Making it Even Better

In this episode of Derms &amp; Conditions, James Q. Del Rosso, DO gleans up-to-date practical information on hair loss from Natasha Mesinkovska, MD, PhD, based on her extensive clinical and research experience in&nbsp;this area of dermatology.

In this episode of Derms &amp; Conditions, James Q. Del Rosso, DO gleans up-to-date practical information on hair loss from Natasha Mesinkovska, MD, PhD, based on her extensive clinical and research experience in this area of dermatology. Several entities and challenges are discussed with tips on both diagnosis and management.&nbsp; The latter half focuses on alopecia areata, including its relationships to both atopy and autoimmune disease. The episode concludes with how Dr. Mesinkovska integrates oral JAK inhibitors into her management plan. This discussion is loaded with pearls! FINANCIAL DISCLOSURES: James Q. Del Rosso, DO CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo).

Tying Up The Loose Ends With Managing Hair Loss: Practical Advice That Will Help Right Now

In Episode 30 of Derms and Conditions, host James Q. Del Rosso, DO speaks with Joseph Merola, MD, MMSc, a board certified rheumatologist and dermatologist. They discuss the diagnosis and management of cutaneous lupus and key diagnostic tips for psoriatic arthritis.

In Episode 30 of Derms and Conditions, host James Q. Del Rosso, DO speaks with Joseph Merola, MD, MMSc, a board certified rheumatologist and dermatologist who is an Associate Professor of Dermatology at Harvard Medical School. Dr. Merola and Dr. Del Rosso first discuss the diagnosis and management of cutaneous lupus with a special focus on drug-induced lupus. Next, Dr. Del Rosso asks Dr. Merola about dermatomyositis including tips on diagnosis and which laboratory tests are best to order. Finally, Dr. Merola ends the episode with a focus on psoriatic arthritis, including key diagnostic tips to help differentiate it from other arthritic disorders. FINANCIAL DISCLOSURES: James Q. Del Rosso, DO CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Joseph F. Merola, MD, MMSc Consultant/Investigator and/or Research funding&mdash;Amgen, BMS, Avotres, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Sanofi, Regeneron, Biogen, Pfizer, Leo Pharma.

The Smartest One in the Rheum: A Conversation with Joseph Merola, MD, MMSc

In Episode 29 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with Peter Lio, MD, about useful patient questionnaires that he uses in his practice, his use of the ADCT (Atopic Dermatitis Control Tool), and other impactful clinical pearls.

In Episode 29 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with Peter Lio, MD, Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University in Chicago, IL. The episode begins with Dr. Del Rosso asking Dr. Lio about useful patient questionnaires that he uses in his practice. Dr. Lio then discusses his use of the ADCT (Atopic Dermatitis Control Tool) which helps assess the waxing/waning nature of the disease. Next, Dr. Lio discusses his use of alternative medications in dermatology and the criteria he uses for selection of these therapies. Specifically, the use of coconut oil is highlighted. Dr. Lio ends the episode by offering some tips on how to select the appropriate patient and properly counsel them on JAK Inhibitors for the treatment of Atopic Dermatitis. Finally, don't miss the ending where we learn about Dr Lio's passion for Pizza, his crust preference, and which pizza place in the US has 'changed his life'. FINANCIAL DISCLOSURES: James Q. Del Rosso, DO CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). PETER LIO, MD Speaker: Regeneron/Sanofi Genzyme, Pfizer, Eli Lilly, LEO, Galderma, and L'Oreal Advisory Board: Almirall, ASLAN Pharmaceuticals, Dermavant, Regeneron/Sanofi Genzyme, Pfizer, LEO Pharmaceuticals, AbbVie, Eli Lilly, Micreos, L'Oreal, Pierre-Fabre, Johnson &amp; Johnson, Level Ex, KPAway, Unilever, Menlo Therapeutics, Theraplex, IntraDerm, Exeltis, AOBiome, Altus Labs, Galderma, Verrica, Arbonne, Amyris, Bodewell, YobeeCare, Burt's Bees, My-Or Diagnostics, and Kimberly-Clark. Research: AOBiome, Regeneron/Sanofi Genzyme, and AbbVie Patent Holder: Theraplex AIM (Patent Pending) Stockholder: Micreos, YobeeCare, and Altus Labs, KPAway, LearnSkin

Thick or Thin? Lessons with Peter Lio on Atopic Dermatitis and Other Impactful Pearls

In Episode 28 of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO speaks with Ted Lain MD, MBA, about the business of dermatology and how dermatologists can become better educated in&nbsp;this area

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In Episode 28 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with Ted Lain MD, MBA, who is the Chief Medical Officer at Sanova Dermatology. During this episode, Dr. Lain shares how he became interested in the business of dermatology early in his career, along with his consistent dedication to being a very knowledgeable and competent dermatologist. He offers some available resources for dermatologists who want to become better educated in the business area. The discussion emphasizes the central importance of quality patient care in any business model of dermatological practice. Finally, Dr. Lain offers some important tips and considerations for new dermatologists who are entering into practice. Financial Disclosures: James Q. Del Rosso, DO CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Ted Lain, MD, MBA None.
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Knowing the Business of Dermatology Involves More Than Just Being a Good Doctor: One Dermatologist Shares His Success Story

In Episode 27 of Derms and Conditions, James Q. Del Rosso, DO speaks with Gary Goldenberg, MD about precision medicine in the field of dermatology. Dr. Goldberg discusses his use of electric impedance spectroscopy technology on his decision to biopsy pigmented skin lesions that are suspicious for melanoma.

In Episode 27 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with Gary Goldenberg, MD who is in Private Practice in New York, NY and serves as Assistant Clinical Professor of Dermatology at The Icahn School of Medicine at Mount Sinai Hospital. Dr. Del Rosso and Dr. Goldenberg spend the episode discussing precision medicine in the field of dermatology. Dr. Goldenberg discusses his use of electric impedance spectroscopy technology on his decision to biopsy pigmented skin lesions that are suspicious for melanoma. Next, Dr. Goldenberg discusses the use of precision medicine in helping to select the correct psoriasis biologic. Dr. Goldenberg stresses that precision medicine is a useful tool in dermatology but decisions must be made in conjunction with clinical judgment. The episode ends with Dr. Del Rosso highlighting some of the advantages precision medicine may have in selecting biologic medications for psoriasis.&nbsp; Financial Disclosures: James Q. Del Rosso, DO CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Gary Goldenberg, MD Consultant: AbbVie, Allergan, Amgen, ALMA, Almirall, Bayer, Castle Biosciences, Celgene, Dermira, Eclipse, Galderma, Genentech, GSK/Stiefel, Intraderm, ISDIN, Janssen, Leo, Menlo, Novartis, Pharaderm, Pfizer, Ranbaxy, Regeneron/Sanofi, Scibase, Suneva, TEVA, Valeant/Ortho Dermatologic, Verrica Speakers’ Bureau or Honoraria: AbbVie, ALMA, Bayer, Celgene, Dermira, LEO, Merz, Novartis, Pharmaderm, Pfizer, Regeneron/Sanofi Other Financial Benefit: BOD-Verrica

How Precision Medicine is Revolutionizing Dermatology

In Episode 26 of Derms and Conditions, our host James Q. Del Rosso, DO talks with board-certified dermatologist Sandra S. Lee, MD who is well known as “Dr. Pimple Popper”, a global social media and television star.

In Episode 26 of Derms and Conditions, our host James Q. Del Rosso, DO talks with board-certified dermatologist Sandra S. Lee, MD who is well known as “Dr. Pimple Popper”, a global social media and television star. Dr. Del Rosso starts by asking Dr. Lee about her family background related to dermatology. The discussion moves to later in her career when, as a practicing dermatologist, she fortuitously found her way within the world of being a "star" on social media and TV. While Dr. Lee embraced this opportunity, it was not without its challenges. Dr. Lee addresses how she controlled blending her media life and image with her active dermatology practice and how she dealt with certain challenges and criticisms that she faced along the way. Their discussion concludes with highlighting an important area of education in office-based surgery that Dr. Lee is passionate about: practical and effective use of tumescent anesthesia by dermatologic surgeons for large surgical excisions. FINANCIAL DISCLOSURES: JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). SANDRA S. LEE: N/A

Beyond the "Pimple Popper" Persona: A Closer Look at Sandra Lee, MD

In Episode 25 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with Leon H. Kircik, MD about topical therapies for psoriasis and why vehicle matters.

In Episode 25 of&nbsp;Derms and Conditions, our host James Q. Del Rosso, DO speaks with Leon H. Kircik, MD, a Clinical Professor of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City who also has a private practice in Louisville, Kentucky. Throughout the episode, Drs. Del Rosso and Kircik discuss topical therapy of psoriasis. Specifically, Dr. Kircik highlights why the vehicle matters when choosing a topical therapy and why topical therapy is still important in the current clinical landscape. Additionally, Drs. Del Rosso and Kircik discuss different formulations of topical therapies along with their advantages and disadvantages. 
Financial Disclosures:
 JAMES DEL ROSSO, DO:&nbsp;
CONSULTANT/ADVISOR&nbsp;
Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo)&nbsp;
SPEAKER BUREAU&nbsp;
Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo)&nbsp;
RESEARCH INVESTIGATOR&nbsp;
Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo).&nbsp;
 LEON KIRCIK, MD
CONSULTANT/ADVISOR&nbsp;
Abbvie, Allergan, Inc., Almirall, Amgen, Inc., Arcutis, Biogen-Idec, BMS, Celgene, Cipher, Connetics Corporation, Dermavant, Dermira, Dr. Reddy&rsquo;s Lab, Eli Lilly, Galderma, Genentech, Inc., GlaxoSmithKline, PLC, Johnson &amp; Johnson, Leo, Merck, Novartis AG, Promius, Stiefel Laboratories, Inc., Sun Pharma, Taro, UCB, Valeant Pharmaceuticals Intl.
SPEAKER BUREAU&nbsp;
Abbott Laboratories, Allergan, Inc., Almirall, Amgen, Inc., Cipher, Connetics Corporation, Dermavant, Dermira, Eli Lilly, Galderma, Genentech, Inc., GlaxoSmithKline, PLC, Johnson &amp; Johnson, Leo, PharmaDerm, Serono (Merck Serono International SA), Stiefel Laboratories, Inc., Sun Pharma, Taro, UCB, Valeant Pharmaceuticals Intl.
RESEARCH INVESTIGATOR&nbsp;
Abbvie, Allergan, Inc., Almirall, Amgen, Inc., Arcutis, BMS, Boehringer-Ingleheim, Breckinridge Pharma, Celgene, Centocor, Inc., Cellceutix, Combinatrix, Connetics Corporation, Coria, Dermavant, Dermira, Dow Pharmaceutical Sciences, Inc., Dr. Reddy&rsquo;s Lab, Eli Lilly, Galderma, Genentech, Inc., GlaxoSmithKline, PLC, Idera, Johnson &amp; Johnson, Leo, Maruho, Merck, Medicis Pharmaceutical Corp., Novartis AG, Promius, PharmaDerm, Pfizer, Stiefel Laboratories, Inc., Sun Pharma, UCB, Valeant Pharmaceuticals Intl., XenoPort.

Finding the Right Formula with Topical Corticosteroid Therapy

In Episode 24 of Derms and Conditions, our host James Q. Del Rosso, DO talks with Julie C. Harper, MD who is in private practice in Birmingham, AL and is a recent past-President of the American Acne and Rosacea Society. Dr. Del Rosso and Dr. Harper spend the episode discussing important considerations in the diagnosis and treatment of rosacea.

In Episode 24 of Derms and Conditions, our host James Q. Del Rosso, DO talks with Julie C. Harper, MD who is in private practice in Birmingham, AL and is a recent past-President of the American Acne and Rosacea Society. Dr. Del Rosso and Dr. Harper spend the episode discussing important considerations in the diagnosis and treatment of rosacea. Emphasis is placed on noting the sources of facial redness in rosacea so that treatment selection can be optimized. Dr. Harper includes practical tips for treating a rosacea patient who presents with both persistent facial erythema and papules/pustules and concludes the episodes presenting her "STOP" mnemonic when seeing a rosacea patient in the office.&nbsp; &nbsp; Financial Disclosures: JAMES DEL ROSSO, DO:&nbsp; CONSULTANT/ADVISOR&nbsp; Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo)&nbsp; SPEAKER BUREAU&nbsp; Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo)&nbsp; RESEARCH INVESTIGATOR&nbsp; Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo).&nbsp; JULIE C. HARPER, MD&nbsp; Grant/Research Support:&nbsp; Almirall&nbsp; Consultant:&nbsp; Almirall, Cutera, EPI, Galderma, LaRoche Posay, Ortho, Sun, Vyne&nbsp; Speakers&rsquo; Bureau or Honoraria:&nbsp; Almirall, EPI, Galderma, Journey, Ortho, Sun, Vyne

How Can You Stop Seeing Red When Facing Up To Rosacea?

In Episode 23 of Derms and Conditions, our host James Q. Del Rosso, DO talks with Patricia Farris, MD who is in practice in Old Metairie, Louisiana. Dr. Farris talks about building a successful aesthetic dermatology practice, selling skincare products, and offers tips on office dynamics.

In Episode 23 of Derms and Conditions, our host James Q. Del Rosso, DO talks with Patricia Farris, MD who is in practice in Old Metairie, Louisiana. Dr. Farris begins the episode discussing tips on how to build a successful aesthetic dermatology practice. She also offers helpful tips on office dynamics. Dr. Del Rosso asks Dr. Farris to give some advice on how to sell skin care products in a clinical practice setting. The episode ends with Dr. Farris discussing important considerations when selling a dermatology practice to a private equity group.&nbsp; FINANCIAL DISCLOSURES:&nbsp; JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo).&nbsp; PATRICIA FARRIS, MD: Co-founder of RegimenMD and serves as a consultant and/or advisory board member for Neutrogena, Neostrata, Skinceuticals, Fig-1 Skincare, Nutraceutical Wellness, and U.SK Under Skin.

What Type Of Practice Is Right For You?

In Episode 22 of Derms and Conditions, our host James Q. Del Rosso, DO talks to Nicholas Brownstone, MD who is a fellow at the National Society for Cutaneous Medicine and managing editor of SKIN: The Journal of Cutaneous Medicine.

In Episode 22 of Derms and Conditions, our host James Q. Del Rosso, DO talks to Nicholas Brownstone, MD who is a fellow at the National Society for Cutaneous Medicine and managing editor of SKIN: The Journal of Cutaneous Medicine. Dr. Brownstone presents some helpful information about SKIN and highlights the benefits that it can provide to the busy, practicing dermatologist. Dr. Del Rosso asks Dr. Brownstone to review some key articles in the journal's history which includes topics such as "maskne" and the effect of diet on hidradenitis suppurativa. Dr. Brownstone spends the next part of the episode discussing his recent clinical management recommendations article on delusions of parasitosis. He offers some tips and tricks to help dermatologists manage these often difficult patients. Finally, the episode ends with Dr. Brownstone discussing some exciting new updates with the journal. This is an episode you won't want to miss! Resources/Links: Maskne: Exacerbation or Eruption of Acne During the COVID-19 Pandemic <a target="_blank" rel="noopener noreferrer" href="https://jofskin.org/index.php/skin/article/view/953">https://jofskin.org/index.php/skin/article/view/953</a> Nutrition Education Toolbox for Hidradenitis Suppurativa <a target="_blank" rel="noopener noreferrer" href="https://jofskin.org/index.php/skin/article/view/1207">https://jofskin.org/index.php/skin/article/view/1207</a> Best Practices for Management of Delusions of Parasitosis <a target="_blank" rel="noopener noreferrer" href="https://jofskin.org/index.php/skin/article/view/1346">https://jofskin.org/index.php/skin/article/view/1346</a> FINANCIAL DISCLOSURES: JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Nicholas Brownstone, MD None.

How to Win with SKIN

You're listening to the Derms and Conditions podcast. Hello, everyone, and welcome to another great episode of Derms and Conditions. And I have with me just a great guy. Hi. I'd like to say he's a great fellow. His name is Dr. Nick Brownstone. He's based in New York City. He is a melanoma fellow at the National Society of Cutaneous Medicine. And I'll spare you my introduction and get right to talking to, you know, Nick, tell us what you're doing and how you got to this position of melanoma fellow in New York and some of the exciting things you're working on. Thank you, Dr. Delrasso. First of all, it's great to be here. I'm a big fan of the podcast. I listen every week, and it gives me great tips that I can use the next day in the clinic. So thank you for being a great host. Really happy to be here today. I'm currently a melanoma and skin cancer fellow with Dr. Darryl Regal in New York, New York. And I get to do a lot of really neat things, treat skin cancers in clinic, perform clinical research and clinical trials. And one of the most interesting things is serving as the managing editor of Skin, the Journal of Cutaneous Medicine, which you're one of the editors in chief of. So can you talk to us about? Is there anything new that's any breakthrough that we need to know as clinicians that are practical in the clinic with melanoma? Most of the articles that we've been publishing in skin revolve around all different types of disease states, and melanoma is definitely one of them. And there's been a lot of interesting articles talking about genomic testing for melanoma. And, in fact, me and my colleagues will be writing a clinical management recommendations in the upcoming issue, helping clinicians to integrate these tests into their practice. So what that's going to do is the clinicians that aren't necessarily spending every day or a lot of their days on just this area can go to that article and get some practical information on how they can apply it in their clinical practices and when it will be applicable and when it may not be helpful. So that sounds like it's going to be a very welcome article. That's right. One of the best things about skin, and I really want to take this episode for the listeners to really let them know how they could use skin in their practice and how it could help them on a daily basis. And one of the best things about skin is these clinical management recommendations, which is always the first article of each issue, and again, we have a kol in the field write about a couple pages on a very salient topic within the dermatology community. For example, melanom and genetic testing, or the most recent one was treatment of psoriasis. Beyond biologic therapy, which is a very popular topic. It gives some tips on things other than the biologics, because we hear a lot about the biologics. But you mentioned an interesting acronym, KOL, which I believe stands for key opinion leader. But I always thought of it as you could keep them on the list, or if they don't quite cut it, you could kick them off the, you know, they better do a good job when they put that article together. Otherwise, Nick Brownstone, they're going to get the cut, right, Nick? Well, kol to me means keeping them off the list, so you better behave. Otherwise you're off the list. That's right. Exactly. So let's talk about some of the articles in skin. I got an opportunity to review some of them for a presentation. And can you highlight some of the articles that you felt were the most meaningful or very meaningful to clinicians? Yeah, I'd be happy to. The goal of skin is to rapidly disseminate dermatological information, both new information and information that's been taught before. But we want to re highlight one of the most popular articles we had in the history of the journal was an article on mask knee during the Covid-19 pandemic. It was a short article, but it just reviewed some of the salient points regarding the pathophysiology and etiology of acne and some ways to treat it. Really well received. The second article, too, which I thought was really unique and interesting, was entitled Nutrition Education toolbox for hydrogenized suppertiva. And this was in the May 2021 issue. And what the authors did is they provided tools for both physicians and patients to facilitate evidencebased nutrition education in HS through collaboration with dermatologists, registered dietitians, and a culinary specialist. So a really unique collection of individuals. And in this article, they looked at foods to avoid and reviewed the evidence. For example, they discussed that refined carbohydrates could lead to hyperinsulinemia, which may exacerbate a follicular occlusion in hydratinitis. So again, a really practical and highly received article. What I liked about that article was when you have someone come in and a lot of the patients with hydratinitis suprativa are overweight, and it can be somewhat a sensitive issue to be talking to somebody about that without making them feel like you're putting them down or weight is a sensitive subject for a lot of people, and doing it as a clinician as a means of trying to help them get their condition better without making them feel overly sensitive or embarrassed about it. The patient feel embarrassed about it. What I liked about it is there were some excellent handouts in that article that the reader can print out and utilize in their practice, and I found that many of them were very well written. So it was practical from that standpoint. The handouts in that article I thought were fantastic. So I wanted to make sure that you get that information out there, because there was extremely practical article on an area that we and clinicians, we're focusing on. What treatment do we use? What therapies have they had? Should we get them started on a biologic agent? We're thinking about it in that classic medical perspective, but they were practical areas that even our staff can sit down and discuss with these patients. Right. A diet and dermatology is obviously a very big field. Patients come in, they ask about diet and acne, they ask about diet and psoriasis, even diet and atopic dermatitis. So I think these issues are great issues to bring up, and we definitely need more studies for these types of things. So what about some of the other articles? Because you're digging into it and going through them and helping put that journal together, which people see the final copy. But there's so much work behind any of the journals out there in the information that gets in there just to mistypos, little typographical errors when you're trying to proofread something is challenging. And so are there any other articles that really stood out to you? Yeah, there's a lot of articles, a lot of great information being published in this journal. The journal is published bimonthly, which means every other month. One article I'd like to highlight is actually an article that I wrote, and it got really great comments on it. I had done some previous training at UCSF in inflammatory skin disease. One of my mentors was Dr. John Koo, who's board certified in both psychiatry and dermatology. And we did a lot of work together on delusions of parasitosis or Morgellon's disease. So one of the articles that I wrote, and this was in the September 2021 issue, as the clinical management recommendations was best practices for management of delusions of parasitosis. And it really helps physicians in, really, I would say a couple of pages, become more comfortable working with these patients because building rapport and not making them upset is really the most important thing with these types of encounters. I think a lot of clinicians in their mind are thinking, how do I manage this? And you almost want to back away from it, right? You feel badly feeling that way, but that's not the kind of patient that many dermatologists want to see in their practice, admittedly, because they struggle with managing it and they struggle with telling the patient, I think you need to see a psychiatrist and the patient getting angry and that sort of thing. So are there practical recommendations in that article? Can you give me an example of one of the practical recommendations? Absolutely. And it's absolutely correct what you said. The issue is that you turn down the patient, don't want to see the patient, it's fine. But then they're going to end up in your colleague's office, and these patients kind of bounce around in the community. So really, with just a few simple management techniques, we could really improve the care of all these patients. And really with these patients, the key is to just listen to them and be empathetic and tell them that I don't know what's causing this disease. Okay. I can't tell you. If you want to see a parasitologist, entomologist, that's fine, but I have something that can help you. And if you're willing to engage in a trial and error, a medication regimen with me, I'm pretty sure I can cure you. And of course, in the article, we discussed the medications, namely pemizide, which is really effective for this condition. And the most important thing about pemizide is it has no fda us psychiatric indication. So the patients uniquely accept this type of therapy. And in my experience, after seeing these patients every week for about two years, it really leads to a cure. Are there any particular adverse effects or drug interactions? Because it's not a drug that we write often. And myself, if I'm writing a medication or prescribing a medication that I haven't used a lot, I don't want to miss something that's going to harm the patient. So what suggestions do you have about that? Another really good point to bring up. Luckily, Pimazot is a really safe medication. It's technically considered a first generation antipsychotic. But in my experience, in Dr. Ku's over 30 years experience, he's rarely had any significant side effects. You should, in older patients, get an EKG to make sure there's no QT prolongation. And then after you start the medication, there's really, really no major side effects. Maybe a little bit of restlessness, a little bit of tiredness, and you can have them take the medication in the morning or at night because of that. And it's extremely, extremely rare. But the feared complication is tardive dyskinesia, which was thought to be irreversible. This is, of course, uncontrollable movements of the head, neck, arms and legs. Dr. Ku and I performed a worldwide literature search, and we couldn't find one case that was directly caused by pimizide for delusional parasitosis resulting in tartar dyskinesia. In fact, to make clinicians even more comfortable for the first time ever, two new medications have recently come out that are now treatments for tardive dyskinesia, which should help clinicians feel more comfortable prescribing the medication in the first place. Right. So if the patient does happen to develop it, there are some treatments. We don't want the patient to have the problem in the first place, but they have a significant problem that you're treating. And so if you leave that delusions of parasitosis there, how often, let's say, you have a patient with delusions of parasitosis that goes on and on to different clinicians or different. They seek help in different areas, and they don't get that help. What happens to them? They keep going around to different clinicians, to entomologists, parasitologists, infectious disease, until somebody can give them an answer that they want to hear. Sometimes all they want to hear is that their problem is being caused by a parasite. And we, as physicians, obviously can't tell them that's the case, because it's not. But one trick that works really well is to minimize the etiology and maximize the fact that this problem is making their life a living hell. And if we focus on that, we want to get their life back on track, then we can kind of get the patients more on our side and accepting of therapy. Is this the type of patient that is going to get so frustrated they're going to harm themselves or they're going to become suicidal, or do they just keep going on and on and on on this hamster wheel? In very, very rare cases, the patient may feel suicidal, but I have not seen that personally. And Dr. Koop, maybe a couple of times in his career, his 30 year career, seen these patients, have seen a patient who was suicidal from it. But what the patients do do is they will take the time to write to physician governing bodies complaining about the care that they got. And a lot of times, physicians these days are community rated in terms of their reimbursement, where if their scores fall below their colleagues, they may get dinged financially. So it's another reason why, let's say you don't want to take care of these patients, which is fine. You really should know how some basic tips to handle them so not to be penalized financially, right? Yeah. We're getting hit from all different directions. Who's going to take care of us when we go and say, I'm depressed about getting dinged when I didn't deserve it? That's a story for another day. That's a whole nother podcast. That's a whole nother podcast. So I know that you said that I asked some really good questions and made some great observations. Did that surprise you that Jim del Rosso did that, Nick? Not surprised at all. Not surprised at all. So what's next for Nick Brownstone? Before we wrap up today, do you have something you're working on now with Dr. Regal or with someone else? Because you obviously got very motivated to put out some really good information out there for, you know, I want to take these last few minutes to wrap up and just let you know about the exciting stuff we have going on with skin. We introduced two new sections to the journal. One is called skim images, clinical images, and dermatology. And what this is is a picture of a unique, interesting, or rare dermatological disease. And we really want the submitter to really highlight why this is essential to the journal's readership. What can be learned of it? Whether it's a rare disease or a disease that was rare, that's now becoming popular again in today's society. And the next one is dermatological dilemmas, which is an academic style. Grand rounds where someone with a very difficult patient case submits the patient history and asks a couple of questions that we have a key opinion leader answer. And so I think that'll be a really nice part of the journal, too. I don't think any other journal really has a section like that. There are some case studies and things, but we all have those challenging cases that stop us in the course of the day and we all struggle with. So it will be nice to see that you had something else you wanted to wrap up. Yeah. Two more quick things. One is we've really expanded the resident fellow board, the medical student board, and we have an undergraduate student on our board, too, because Skin is really committed to education, and I'm working with the residents and fellows mentoring the medical students and the undergraduate student to teach them how to perform high quality article reviews. And the last thing I'll say before I get wrapped up here is we're going to introduce something called the looking forward to yesterday's series in skin. We have so much great information that's been published in the past, and I want the readers to reengage with these articles. So what we're going to do, starting probably in January, is when the new issue is released. We're going to have about a five question quiz, and the answers will come from the old issues, and the first person who responds correctly will win a gift card. And my hope is that readers will look at the old issues and say, oh, this article is interesting. I didn't see it there. I'm going to go ahead and read this now and learn something new. I think that's fantastic because we have these piles of journals now. We do a lot of things online, obviously, but they sort of sit there, and in those journals there's a lot of great information that's often forgotten. So I think that's great. I think your excitement is actually getting me all excited. I feel like I'm being a little bit too lazy lately. I got to go out there and start reading some of those old journals again. So thanks a lot, Nick. If I can help you in any way, be sure to reach out. And it's very exciting what you're doing with skin and with the other things that you're working on. You really are a good fellow. I'll have to tell Daryl about that. I appreciate that. And yeah, again, really happy to be on the podcast. Thanks for the opportunity. If I have my own podcast one day, I think you'll be the first guest of honor. Well, I would be honored to be part of your podcast series. So anyway, take care. And I want to thank our listeners for listening, and I hope you get an opportunity to look over skin and even contribute to some of the ways that Nick Brownstone's talked about. Thank you. Thank you for listening to this episode of Derms and Conditions. If you have any questions or comments, please email us at podcasts at Fred Health and most importantly, if you like this episode, subscribe to the Derms and Conditions podcast on Apple Podcasts or wherever you get your favorite shows. Thanks for joining us.

In Episode 21 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with Mark Lebwohl, MD, Dean for Clinical Therapeutics and&nbsp;Chairman Emeritus at Icahn School of Medicine at Mount Sinai. Dr. Lebwohl discusses field treatments of actinic keratosis (AK).

In Episode 21 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with Mark Lebwohl, MD, Dean for Clinical Therapeutics and&nbsp;Chairman Emeritus at Icahn School of Medicine at Mount Sinai. Dr. Lebwohl discusses field treatments of actinic keratosis (AK). He also discusses the benefits and disadvantages of imiquimod, 5-FU and tirbanibulin. Specifically, the anticipated reactions of topical AK treatments are highlighted. Advice on medication coverage is discussed next. After the patient receives the medication, Dr. Lebwohl ends the episode by giving some tips on treatment with topical AK therapies. FINANCIAL DISCLOSURES: JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Mark Lebwohl, MD Mark Lebwohl is an employee of Mount Sinai and receives research funds from: Abbvie, Amgen, Arcutis, Boehringer Ingelheim, Dermavant Sciences, Eli Lilly, Incyte, Janssen Research &amp; Development, LLC, Leo Pharmaceuticals, Ortho Dermatologics, Pfizer, and UCB, Inc. Dr. Lebwohl is also a consultant for Aditum Bio, Allergan, Almirall, Arcutis, Inc., Avotres Therapeutics, BirchBioMed lnc. BMD Skincare, Inc., Boehringer-Ingelheim, Bristol-Myers Squibb, Cara Therapeutics, Castle Biosciences, Corrona, Dermavant Sciences, EMD Serono, Evelo Biosciences, Facilitation of International Dermatology Education, Foundation for Research and Education in Dermatology, Helsinn Therapeutics, Inozyme Pharma, Kyowa Kirin, LEO Pharma, Meiji Seika Pharma, Menlo, Mitsubishi, Neuroderm, Pfizer, Promius/Dr. Reddy's Laboratories, Theravance, and Verrica.

When Cryotherapy Alone Gets Too Cold: Topical Field Therapy for Actinic Keratoses

This episode is sponsored by Almerals and Conditions podcast. Hello, everyone, and welcome today to another edition of Derms and Conditions. And I'm very excited. We have a powerhouse in dermatology today, a colleague and great friend, Dr. Mark Leball, who's a leader in dermatology, practicing dermatology, teaching dermatology. So we're going to have a great program today. And Mark is dean for clinical therapeutics at the Icon School of Medicine at Mount Sinai in New York City and chair emeritus of dermatology. So, Mark, emeritus means you're pretty smart, right? So we'll have a good program. Mean, it's the first time I've been introduced as a powerhouse, but that's probably because I'm here in my sweatsuit lifting, you know, you're pumping up. So we're going to talk about actinocaratosis today, Mark, and obviously, I know you've been involved in research over the years. Everybody thinks about you with psoriasis and skin turnal medicine and that sort of thing. But you've done a lot, did a lot of teaching and publications on ectenocytosis. So how do you look at the landscape right now with where we are with field therapies? Because we obviously know we have targeted therapies and directed therapies like cryotherapy, which treats a lesion that we can see. But let's focus more on field therapies for actinocaritosis, how you integrate them and how you see the landscape. Sure. Let me say by way of introduction, even though psoriasis is my main area of research, probably the diagnosis I see most often is actinocaratosis. It's just incredibly common. And, in fact, decades ago, we were the first to treat actinocaratosis with Amikamod. It was one of my early publications, and I vividly remember I was actually the first patient to use it for an actinocaratosis on myself. And I told our dean at the time, who gave me permission to tell the story and use his name, but he know lots of actinocarotosis and many squamous cell carcinomas, and he would have multiple squamous cells a year. And he asked me for some samples. And back then at Mount Sinai, we could give out samples. We still actually can. We figured out how to do that. But I gave him some samples, and he calls me four weeks later and he know, I think you better take a look at that. And he was using it every day as I was as well. And it worked quickly. When you use it every day. But his whole scalp was one boggy, oozing crust and he did not get another squamousil or actinic for five years. And so we knew we were onto something. We then did a bilateral comparison trial, showed dramatic differences, and ultimately published a multicenter trial, which then led to approval for AKS. The pharmaceutical company that made it three m at the time had sales and its use for genital warts had sales of about, I think it was twelve and a half million dollars a year. A year after it got approved for aks, it was 250,000,000. So it was really a boon to them, but really a boon to our patients. Very good treatment for aks. We then published the New England Journal article on picato. Ever since then, we've had a major interest in aks. So you asked me about field therapies, and as you know, the most common field therapy used is not a field therapy, it's a treatment of individual lesions, and that's cryotherapy. And I don't think that it is just because it's reimbursed extra by Medicare. I think it's because it's easy. It's in everybody's office, it takes a few seconds and you focus on a single lesion so you don't have to warn the patient about some bad reaction they're going to get all over. The problem with field therapy is with individual lesion therapy, is that you are getting rid of that lesion temporarily. The recurrence rate is very high and the patient's going to crop up with a new AK right next to it. So I think my use of cryotherapy is perhaps a little more limited than most, but I use cryotherapy like everybody else does. The field therapies that we use are a couple of the ones we just mentioned. Picado is not available anymore because there are a number of reasons, but I think there was a somewhat unfair New England Journal of Medicine article which almost said it didn't work. Compared to Amicomod, PDT and five fu, the treatment used most widely, although not by much more than a Michel mod, is five fu. It's used twice a day, it's approved for four weeks and I use it for four weeks. If you use it for two weeks, you're not going to get as good a response. And what those patients have in common is an awful reaction. And when you get that awful reaction, the patients actually do well. The recurrence rate know, certainly in my experience, not what the New England Journal reported. But they cheated in that article because they allowed the patients to spot treat with cryotherapy and other treatments in the follow up period for that study. But the recurrence rates, in my view, are similar between five fluorior, amiquamod, which also gives a bad reaction. And the two have in common the amiquamod and the five fu, is that they go on for many weeks. So the patients are always kind of irritated and not doing well. Diclofenac, which has the brand name solarase, is much gentler. It's used twice a day for three months, but it's less effective. I think that PDT has a major advantage in that it's given once the patients get a bad reaction, which lasts a week or maybe a little longer than a week, but then that's gone and you're done with it. And it also has a very good response. Many of the people who use it repeat it several times a year to maintain that response. But it is a treatment I use often as well. And most recently we have turbinibulin, which is a treatment I really like because it is much less irritating than, for example, picado, or five fu, actually, than all of the treatments that we have, except diclofenac, which is very gentle but less effective. It has efficacy rates that are as good as any of the treatments I just mentioned, but with much less irritation. So the patients are over it in five days and are pretty happy with it. They use it, they apply it for five days. They have usually milder reactions because it's more of an effect on the apoptosis, not as much cytokine release and stimulating inflammation. I mean, we know with five fu being chemotherapeutic, you expect to get that reaction because of the mechanism, and it tends to be more painful than the other treatments. I agree with you. If you sure change, and there's data to show if they use it for less of a duration, they don't go the full four weeks, their response rate goes down. So I had a patient too, like yours, mark, that when I first saw him, he had such extensive involvement on his scalp with ectinocaratosis, had some thicker areas. I first was going to biopsy, thinking, oh, some of these might be SCC, incitu or something. Then I thought about it and said, what am I going to do with it? Anyway, there's no end to this. I treated them with the michelamod and he came back, and that time it was three times a week. I had him do it. He did it for about a month, and he had such a brisk reaction. It wasn't extremely painful. It was uncomfortable. But once he cleared, he didn't have anything for the few years after that that I saw him. So getting that reaction with a mikamot is helpful. It's just a lot for people to go through, and you have to have the downtime, especially if it's an exposed area. With tuberenobulin, the reactions are seen maybe after about seven days, and they're usually gone within one to two weeks, similar to ingen almebutate picado, which you mentioned. But I think Picado got some more brisk reactions than to Beolin. What's your feeling about that? Yeah, I'm actually giving a lecture on that, where we line up the phase three results of the two drugs. And, in fact, ingenl mebutate, which was a favorite drug of mine, I used it a lot, and the reason I liked it was you got it over with quickly. So a lot of my patients who work in public positions or some of them are on television or they interact with people every day, can't take six weeks off or four weeks off to go through imicomat or five fluorocyl. And so ingeal mebutate was a perfect drug for them. Turbinibulin has even less irritation than ingenl mebutate, and that comes across very clearly when you line up the local skin reactions from the two, phase three pivotal trials. It's a very well tolerated drug and a very effective drug. I've had patients who have been on all the treatments and clearly prefer that. And very recently, I had a patient who, because of the cost of it, asked to be given five fu. He came back to me and he said, I'm never going back to five fu. I'm going to spend the money on turbine abulin. That's another issue, by the way, because you go to one drugstore and it's $1,200, you go to another drugstore and it's $25. So it has some of the Medicare issues where they don't necessarily honor coupons unless the pharmacy has an arrangement with the company that makes it. A lot of the insurance companies don't want to pay for turbanibulin because they have not agreed to get a big discount or rebate. And the company instead makes it to a local pharmacy that will sell it at a huge discount. So specialty pharmacies in that situation, rather than randomly selecting a pharmacy. So, Mark, we're going to take a break at the moment. We're certainly going to get back to this because we're in the heat of the discussion for a word from our sponsor. We would like to thank Almeral for being today's sponsor. So, Mark, now we're at a very important part of our discussion is you get the prescription for the patient. I agree with you. Patients only have to apply the tobanobulin. It comes in the sachets. They could spread easily over the cosmetic unit or the anatomic unit that they're treating, the scalp, the know where the drug is FDA approved once a day for five days, and then they're done with what they have to actively do. And then they just ride it out, usually with not much visible. If it is, it's certainly less than what we see with five fu, typically with a micromod and even with ingenl mebutate. So the downtime is a lot less. But they have to be able to get it. And in my experience, if they just take the prescription, or nowadays we don't have a prescription pad, we have a suggestion that we make, right? We go through the EMR, and it's just randomly to a pharmacy that they want us to send it to. They're often going to run into problems with being told it's not covered, it's out of stock, it's $1,000 or $800 or whatever. But specialty pharmacies make a big difference, especially with access to the banibulin. So can you expound upon that? Because I know you've had some interesting experiences in the New York area. Yeah, I feel very strongly about it. I'll actually never have a patient. The patients will demand, oh, no, send it to my pharmacist. He's my friend. And what happens is the average pharmacist in the US gets a high proportion of their income as a payment from insurance companies to not prescribe medications. And the reason the insurance companies do that is they try to extort payoffs. And I'm not going to use the word discount to rebate. They call it discounts to rebates, but it's really payoffs from the pharmaceutical companies. And for a drug like turbineibulin, for example, they might ask for a payoff of over $1,000 when the drug costs $1,200. And so the pharmaceutical company is not going to agree to that. And instead, what they'll do is make an arrangement where they pay a certain amount of money to a local pharmacy in New York. We have something called Manhattan apothecary. There's another one called apotheco. There's a third one called AMA. And there are many pharmacies around the country that make their own arrangements directly with the pharmaceutical company, and they will always honor the prescription. So if the patient has the right insurance, and there are some Medicares that actually are the right insurance, so we're able to get it a lot of the time from Manhattan apothecary, which is the one I use. I don't have any financial conflict with them. But wherever you live, find that pharmacy. They almost always deliver. So even if my patient lives in, for example, New Jersey or Connecticut, which is miles away from Manhattan, they will deliver within a day to those patients, and they will charge the discounted price, which comes out to $25. So I send all my turbanibulin prescriptions through that particular pharmacy. And we have specialty pharmacies, a few that we use in the area. And we essentially say to the patient, if you're going to force it upon another pharmacy, you're likely not going to be able to get it. And I can't guarantee how quickly we're going to be able to get this resolved for you. It's going to sit on a pile of these kind of situations that just back up our office. So we encourage them. And I could rarely have had a patient been adamant about still send it to their pharmacy of choice. Once you explain it to them, sometimes the patients are looking at you as if you're getting some kind of kickback from it, and I make it clear that that is not the case. I want you to get the best medicine that I want for your situation, that you want also for your situation, and then it's not a problem. But people are suspicious of where the money is going nowadays, and I understand that they hear a lot of bad press out there about things that are going on. So now when you see the patient, you get them treated, and you're down the line. They come back six months later. How often might you repeat a therapy such as this for a patient, or does it depend on the patient? So it depends on the individual patients. So in the clinical trials, two things they did in the clinical trials, they brought patients back at day 57 to see how they were doing. That was their primary endpoint. And if you look at the graph, if you come back at two weeks, you get a reduction in aks. Come back at four weeks, you get more of a reduction in aks. So the day 57 was actually a very wise move. I actually bring my patients back often somewhere in there I might say, come back to me between six and eight weeks, because I'd like them to see that they are much better. And I find that a convenient time. If they have many aks left, then I will bring them back and do it again. You can get the medication refilled as often as once a month. So there's enough in there to treat the better part of a face. There's certainly enough in there to treat the whole scalp, even though in the clinical trials, they were limited to 25 cm². So it's five x five centimeter square, roughly. And I'll tell you why they came up with the five x five, because that was part of the original approval process for amiquamod, when the FDA viewed actinocaratosis as a very serious disease, and they considered one remaining actinocaratosis as a treatment failure because it was a precursor to a squamous cell carcinoma, which could be deadly. And there's actually data supporting that, that it is a precursor to a squamous cell carcinoma. In fact, Scott Denhardt published an article where he showed that metastatic squamous cell carcinomas, if you went back to the primary lesion, two thirds of the time, arose within actinocaritoses. So you can understand the FDA's point of view. Though I think it's flawed. If somebody had 100 aks and you got rid of 99 of them, that was a treatment failure. So in order to overcome the. Because it's unlikely that if someone has 100 aks, you will get rid of 100% of them. To overcome that, we created a scenario where you treated a five x five square centimeter box that had between six and eight aks. And so the chance of getting rid of eight aks now is much higher. And that's why these all come now in little packets, where you treat a small part of the face or scalp, but it turns out there's enough in there, if you spread it thinly, that you can treat a whole face or a whole scalp. When you say treat a small area, talking about the clinical trials, but the approval is to treat the entire. Like, if you're treating the forehead. Treat the entire forehead, right? Yeah. The dilemma is it comes in these packets. So unless you use more than one at a time, which is not approved, you're going to end up doing it five days in a row on a limited area. So often we'll treat the forehead and cheeks for a month, and then a month later, we'll treat the scalp. The same is true for the other therapies that we use, a Michamod five fu is more liberal because it was approved before these rules. So you can treat a large area. The same is true for PDT. The way the machine is constructed, we pretty much can only do face or scalp in one setting, and then a month later we do the other one. Yeah, I find with the packets that you get that each five day treatment session. You can treat that whole cosmetic area as long as the patient's not globbing it on a small area, and then you don't treat it every day for a month. With the branibulin, you're treating it for the five days, and then you see the patients back and you might have a couple of lesions left and you might just freeze those. Or certainly down the line. If patients that we have some patients that are constantly genetically programmed to keep reforming actinocaratosis, they can have another course of treatment when they need it. It's really a lifelong patient once they develop actinocaratosis, you agree? Yes. So I will say the average patient gets it once and then a year later we might give it to them again. There are some patients whom I've done twice a year. I had one patient on a Michelmat who I have not seen since the pandemic, and when he comes back to me, I will be switching him to turbinabulin and have him do the five day thing. And he has actinix all over his arms, all over his legs, all over his face and scalp. And basically we treat one body site at a time and rotate the body sites, and he's done actually very well with that. That's good. Well, Mark, thanks so much for your time today. I know you're busy, I know how busy you are. So we really appreciate your time. Thank you very much. Thanks for having me. Thank you for listening to this episode of Derms and conditions. If you have any questions or comments, please email us at. Podcasts at Fred Health and most importantly, if you like this episode code, subscribe to the Derms and Conditions podcast on Apple Podcasts or wherever you get your favorite shows. Thanks for joining us. We would like to thank Almarol for sponsoring today's episode.

In Episode 20 of&nbsp;Derms and Conditions, host James Q. Del Rosso, DO speaks with Lisa Swanson, MD and has given her the moniker, "The Adele of Dermatology". Dr Swanson spends the episode discussing many high yield and practical tips when treating pediatric dermatology patients.

In Episode 20 of Derms and Conditions, host James Q. Del Rosso, DO speaks with Lisa Swanson, MD and has given her the moniker, "The Adele of Dermatology". Dr Swanson spends the episode discussing many high yield and practical tips when treating pediatric dermatology patients. She first discusses her favorite treatment for warts, including how to treat warts of both the hands and face. Next, Dr. Del Rosso asks Dr. Swanson how she counsels parents about changing&nbsp;nevi in their&nbsp;children.&nbsp; She continues with her tips on counseling parents on sunscreen use in children. She ends the episode with a discussion of the use of propranolol&nbsp;in the treatment&nbsp;of pediatric hemangiomas and emphasizes&nbsp;how clinically safe this treatment is. FINANCIAL DISCLOSURES: JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). LISA SWANSON, MD: SPEAKER &nbsp;• Almirall• Amgen• Janssen• Lilly• Novartis• Ortho Dermatologics• Pfizer• Sanofi RegeneronADVISORY BOARD ATTENDEE• Janssen• Lilly• Ortho Dermatologics• Sanofi Regeneron• Cassiopea

Pertinent Pediatric Pearls That Will Make Your Life Easier

In Episode 19 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with David Cohen, MD, MPH and April Armstrong, MD, MPH in front of a live audience during the 2022 Winter Clinical Dermatology Conference from Koloa, Hawaii. Dr. Del Rosso asks his two guests what they thought were the highlights from the many great lectures delivered at this meeting.

In Episode 19 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with David Cohen, MD, MPH and April Armstrong, MD, MPH in front of a live audience during the 2022 Winter Clinical Dermatology Conference from Koloa, Hawaii. Dr. Del Rosso asks his two guests what they thought were the highlights from the many great lectures delivered at this meeting. Dr. Cohen discusses updates in the treatment of Chronic Spontaneous Urticaria and specifically mentions the use of omalizumab. Dr. Armstrong highlights a new cream based formulation of calcipotriene-betamethasone and two new non-steroidal topical options for the treatment of psoriasis in the pipeline. Dr. Armstrong also highlights pearls from Dr. Kirby's lecture on HS including the use of antibiotics and proper injections techniques for steroids. The episode ends with Dr. Cohen's discussion of the allergen of the year and Dr. Armstrong's discussion on the use of oral minoxidil in the treatment of hair loss. &nbsp;<figure class="image"><img style="display:block;height:auto;margin:5px auto;max-width:80%;" src="https://fchealth-assets.s3.amazonaws.com/dc-recording-wc22.jpg" alt="live recording at WC22 in Hawaii"></figure> FINANCIAL DISCLOSURES: JAMES DEL ROSSO, DO: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). DAVID COHEN, MD, MPH: Consultant and Honorarium:&nbsp; Ferndale Laboratories,&nbsp; Asana Medimetriks [past] Leo UCB Novartis Dermavant FSJ FIDE. (FIDE receives industry sponsorship from AbbVie, Almirall, Amgen, Arcutis, Bausch and Lomb, Bristol-Myers Squibb, Celgene Dermavant, Dermira, Janssen, Kyowa Hakko Kirin, LEO, Lilly, Novartis, Ortho Dermatologics, Pfizer, Sanofi Genzyme, Regeneron, Sun Pharma, UCB, Valeant) Cosmetic Ingredient Review (CIR) Stock or stock options: Dermira [past], Medimetriks [past], Brickell Biotech [past], Kadmon, Evommune, Timber Board of Directors: Kadmon, Timber, Evommune, Dermira-[Past] APRIL ARMSTRONG, MD, MPH: Research investigator and/or scientific advisor to AbbVie, Almirall, Arcutis, ASLAN, BI, BMS, EPI, Incyte, Leo, UCB, Janssen, Lilly, Nimbus, Novartis, Ortho Dermatologics, Sun, Dermavant, Dermira, Sanofi, Regeneron, Pfizer, and Modmed.&nbsp; &nbsp;

Highlights from the 2022 Winter Clinical Dermatology Conference - Hawaii

You're listening to the Derms and Conditions podcast. So we're going to get started with our production here. My name is Jim Dorasso, and it's a pleasure to bring with me today David Cohen, who you all know from New York, and April Armstrong from the other coast down there in Southern California, and that we're now in our second year of Derms and Conditions podcast. We're very proud today to have this live edition. We've started 2022 with episode number 18 with Jason Hawks, and that's already up and running. But I do want to say to take a minute to thank Insight dermatology, the sponsor of Highlights of Winter Clinical 2022, which is this episode. Learn more about Insight's innovative approach to treatment at www. Dot Insight. That's capital incyte.com dermatology. So we're going to get started with highlights of Winterclinical 2022. And I'm going to ask David Cohen, who actually was the lead off hitter of Derms and Conditions podcast with our first two episodes. When we started, David, in listening to the presentations at the meeting, what stuck out in your mind as being something that you felt was really important? So, Jim, as you mentioned a little earlier, this meeting was so packed with pearls and new data, I mean, we could probably do a half a dozen podcasts. I think just from a medical dermatology standpoint, there's a number of lectures there. But Dawn Salmons spoke about chronic area. I think it's one of those areas we don't think a lot about in dermatology, but we deal with daily, and we get distracted by all the advances in psoriasis and eczema. She pointed out a couple of important things, omaluzumab, Zolair, which we know about for years, not something we use in the dermatology office very much because we're concerned about anaphylaxis. But the labels changed, and now, after three supervised doses, patients can self administer at home. I think that's really going to open it up for us a bit more. We also saw over the summer dupilumab issuing data on chronic spontaneous erticaria, the new name for chronic erticaria, chronic spontaneous erticaria, demonstrating sort of two x, the improvement over antihistamines. And then she spoke about some development drugs like ligalizumab, remibbrutinib, which is an oral brutin kinase inhibitor, and tezapellumab, which is being used in asthma. So this area of medical dermatology is expanding really at a great clip. And in dermatology, I think we ought to be taking advantage of that. I think about this a lot when I'm seeing patients in the office. Whatever disease they have, I'm thinking, is there anything new in the last week that I haven't heard about yet because there's expansion of so much information in so many areas. So, April, you're a crowd favorite with your podcast that we had. So I'm going to ask you what stuck out in your mind from this meeting. Yeah, I will say, like David, there were so many things that stood out at the meeting because it was just full and packed with great information. Something that I think you actually, Jim, and as well as Neil simal and I talked about were some of the advancement in topical therapies in psoriasis, including, for example, now we have a calcipo triang betamethasone cream that's quite stable and then, well, tolerating in our patients that we have available for them. In addition to that coming up, we will also hopefully see two nonsteroidal options for patients with plaque psoriasis. One is tipinorov and the other one is roflumolast. Different mechanism, action, but certainly very exciting for patients with psoriasis. One thing that Dr. Bonnie Elewski had highlighted in her talk, for example, for oral therapies for psoriasis, she pointed out that premilast now is approved for psoriasis patients of all disease severity. So we recall that it used to be approved just for moderate to severe disease. Now it also includes mild, moderate, as well as severe disease. So I think that is also quite exciting. And then finally, we'll have a tick two inhibitor that will join our really toolbox, that will offer very efficacious and with good safety profile as an oral option for patients with psoriasis. Is there anything unique about the binding with the tick two inhibitor, the allosteric binding, that it appears it may be different in terms of its profile from the other Janus kinase inhibitors? Yes, absolutely. So this one is quite unique in that the mechanism, action for ducravacitinib, this particular tick two inhibitor, actually binds to the regulatory domain versus the catalytic domain where most of the jack inhibitors bind. And because of that specific binding and that specific mechanism of action, we see it really in the safety profile. When you look at the laboratory work that was done in the patients in the clinical trials, they were very similar to patients who have taken placebo. I just wanted to point out I had similar highlights that April brought out with the tuna topicals. I think all the excitement over the last ten years has been on moderate to severe disease with biologic and systemic drugs. But most of the cases we see in dermatology are mild to moderate. We want to deploy topical therapies and topical steroids mainstay a therapy most of the time. But the two new topicals April mentioned really had consequential efficacy. Real, like checking the steroids at the door for long term use. And then we had topical ruxalidinib this year, which had really impressive results on efficacy. I think it's a real change in our waiting time. We wait ten years for a good topical, and now we might have three amazing ones for pretty broad spectrum of use in the office. Now, I think it's great that we've had roxalitinib approved topically for atopic dermatitis. It offers us a lot of advantages in treating. That's a difficult disease. These patients are fighting this over a prolonged period of time. And even with the best of therapies, we have systemically for psoriasis, and even atopic dermatitis patients still carry some disease with them. The majority of them have carried some disease where we need topical therapy. So, April, I'm going to go back to you and see if you have anything else you want to bring forth or certainly David. David, did you have anything on your plate? Yeah, well, the number of things, but time will limit us. Brian Berman mentioned the tibinibulin known as clyceri, and the package insert has discussed 25. Really liked his very practical approach with the digital imaging, allowing one of those sachets to cover a full scalp. I think it's just a very practical way of looking at it that I can deploy in real life, in real time. Well, you know, you're not just going to put it on 25 cm². That's hardly a field treatment. But the FDA does mandate the protocol be done that way, so you don't have a choice. So we're going to take another quick pause here to thank insight dermatology, the sponsor of today's program, learn more about how insight is changing the face of research in dermatology at ww insight.com forward slash dermatology. So, April, now we'll turn it back to you and see what else you picked up at the meeting, because there are quite a few highlights. Yes. So when we're thinking about hydratinitis separativa, and I think we heard great talks from Dr. Kirby from this meeting. I think we learned a lot in terms of the management. One, in terms of the medical management and the other in terms of some of the procedural management. When we think about the use of oral antibiotics, for example, in our HS patients, we oftentimes think about tetracycline class or beyond that, clindamycin plus rifampin. But I think also considering the use of, for example, agents that are more broad acting in terms of covering both gram negative and gram positive organisms. So things like amoxicillin plus clavulonic acid and potentially some fluoroquinolones can be quite helpful. I'm very encouraged to see in the biological realm for Hs. For example, we have the advent of IL 17 inhibitors and IL one inhibitor in the pipeline that will be additional biologic options, hopefully in the near future, in addition to our TNF inhibitor, adolemab, which is currently the only approved biologic for HS. And then finally, I learned a tip that when you inject these HS lesions, perhaps if you use five milligram per mil concentration, that may be a little too low. So I think Jocelyn was talking about using ten to 20 megs per mil concentration and then inject a good one to two mils into these lesions, into these highly inflammatory nodules or abscesses, to really get those lesions down. So getting into the nitty gritty details, to understand the amount of concentration of the intralesional Kenlock we need to inject, I thought was very helpful, actually. We use evidence based medicine, and my evidence on that was one colleague that I respect a lot, that treats a lot of hydratinitis told me a few years back, he said, inject ten, even 20 milligrams per cc. And I've been using that routinely, evidence based one doctor, but he was right, and it turned out to be very, very helpful. David, any other? I guess, Jim, just parlaying the discussion about the antibiotics, Julie Harper and you were talking about the more limited antibiotic spectrum of seracycline, which we like to be mindful of once we're having patients with acne on antibiotics for three and four months. So it may be a little bit easier decision when you're wanting a little bit longer and not just blasting the broad spectrum of the microbiome. I mean, it's difficult because it's easy to sit in the boardroom and tell people, don't do something more than three or four months. But when you have patience with the realities of what you're experiencing in practice, it's not always that easy to stop things and go to other things, especially when patients are having success. So the decision ultimately has to be a wise one, but we have to respect what antibiotics are doing and respect antibiotic resistance. Anything else, David? I know you, David, took a lot of notes. I'm very proud. I was sitting and taking notes. Obviously very gratuitous, though. The allergen of the year for 2022 was aluminum. I think not the most exciting allergen of the year, but it's one we have to think about. It became an allergen of the year largely because the old fin chambers were aluminum, and kids started to noted reactions to the chambers themselves so people would patch test and see multiple positive reactions. Didn't make any sense. And aluminum is an adjuvant, it's an immune booster in vaccines. And some kids, and I've seen this a number of times, get these exematus plaques over the vaccination site, hot warm areas, and even granulomatous nodule lesions from aluminum hypersensitivity. However, other than this academic interest, I think it doesn't touch us most of the time, and it's just one that'll make it into the record books and move on. I don't see much aluminum allergy under arms from deodorants and antiperspirants. So I was going to say, david, I'm really happy that aluminum was the allergen of the year, because when I first got here, and this is a bad image of Jim del Rosso in the shower, but you taught me at another meeting that always look at what's in there, like the shampoo, and it was cocoa mango. And I'm thinking, gee, I hope cocoa mango is not the allergen. No, that it wasn't. We'd all be in trouble here if cocoa and mango. Cocoa mango allergy. So I feel better now about what they have in the hotel. So, April, we're going to move back to you. Anything else exciting? Oh, first, I would say that your mango smell is quite good here. Yes, I really thought that the tip that was given on oral minoxidil for patients with androgenetic alopecia was wonderful. We think about topical minoxidil for these patients all the time. But also Dr. Eluski alluded to that you can use oral minoxidil, and there are some case reports supporting that. And the dose that for men is 2.5 milligram, and they can come in 2.5 milligram tablets, so they can take that. And for women, it's half of that. So you can get a pill cutter, cut that in half to help treat the androgenic alopecia. And I will say, maybe one of my last tips is from Dr. Abair, which I think I might use on my children as well. She said that a child cannot cry and try to blow out a candle or purse their lip to blow out the candle at the same time. So if you have a crying child in your office and you try to get them to stop crying and tell them to pretend to blow out a birthday candle. So I thought that was a great tip, that I can try it out on my kids and hopefully not my spouse. I think if I tried that at home with my wife or adult daughters, I wind up with a pie in my face, I think, pretty sure, yeah, blow out this candle. Don't yell at me. I think it's important that when we look at topical agents for acne, we actually do have one that has a mechanism of action that we haven't had, and that's the androgen receptor inhibitor with topical closcodarone. And I still have people coming up to me, even at this meeting saying, can we use that in men? And absolutely, it's topical. There's no real concern about systemic activity. And androgens are part of the pathophysiology in everyone, in both males and females. So you don't have to be concerned about using that in males, being a topical agent. Any final words from either of you? I'll start with you, David. Yeah. I just wanted to shout out the lecture I heard from pearl Grimes on hyperpigmentation. Right. She spoke about cystamine, which we kind of knew about for a little while. But what really moved me, she's a luminary in pigmentary disorders, and like all of us, we've seen tinia versa. Colar patients get hypopigmentation from their infections with malassesia. And she's looking at sort of purifying malassesia extracts to parlay that against hyperpigmentation. And I just thought that was a brilliant clinical observation that she's going to try to turn into something that may be useful, akin to minoxidil being used for hypertension and creating hair. Hair growth. Right. I think she's really a great example of using a clinical observation to try to solve a problem. Well, it's interesting because azalaic acid, which can result in some hypopigmentation if you're treating hyperpigmented skin, is actually one of the acids that's produced by malassesia when you have that phase of that infection. So I think that's interesting. Pearl Grimes is the one who taught me way back about using topical retinoids in patients with darker skin, where a lot of people were afraid of doing it. You get your pearls from Pearl, that's for sure. So we'll end up with Dr. Armstrong to give us some final tips. And as I say, Dr. Grimes is a fellow Angelino, so I'm very glad to have her in our area. I will say that another tip that I found was very helpful is from Dr. Colion, who said that in your practice, try to put up a staff bulletin board where staff can put up. You can put brief announcements, but also staff members can put up pictures of their children so that you share a little bit of your life with the other staff. And it can be in an area only that staff can see. But it can really help boost the morale in the office, and I feel like we all need that during this time. That's certainly for sure. So I want to say thanks again to Insight Dermatology, the sponsor of highlights of Winter Clinical 2022. Be sure to drop by their booth here at winter Clinical or check out their website@www.insight.com, dermatology. And remember, you could subscribe to Derms and Conditions podcast at Apple Podcasts or wherever you get your favorite shows. Keep listening because you're going to learn from people like the ones that are to my right here and to my left. Thank you very much.

James Q. Del Rosso, DO speaks with Jason Hawkes, MD, MS, FAAD, Assistant Professor of Dermatology at the University of California, Davis. Dr. Hawkes discusses his unique background and he offers advice to early career and resident dermatologists regarding building a successful career.&nbsp;

In Episode 18, our first episode of Season 2 of Derms and Conditions, our host James Q. Del Rosso, DO speaks with Jason Hawkes, MD, MS, FAAD, who is an&nbsp;Associate Professor of Dermatology at the University of California, Davis. Dr. Hawkes discusses his unique background and he offers advice to early career and resident dermatologists regarding building a successful career. Dr. Hawkes stresses that his basic&nbsp;science and clinical&nbsp;trials background has made him a better clinician. The episode ends with discussion of a difficult dermatology case and Dr. Hawkes highlights the importance of interdisciplinary&nbsp;care.&nbsp; Financial Disclosures JAMES DEL ROSSO, DO FINANCIAL DISCLOSURES: CONSULTANT/ADVISOR Abbvie, Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), BioFrontera, BioPharmX, Bristol-Myers-Squibb, Cassiopea, Dermata, Dermavant, Encore, EPI Health, Evommune, Ferndale, Galderma, Incyte, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), MC2, Novan, Pfizer, Regeneron, Sanofi-Genzyme, SolGel, Sonoma (IntraDerm), Sun Pharma, Trevi, UCB, Verrica, Vyne (Foamix; Menlo) SPEAKER BUREAU Aclaris, Almirall, Amgen, Arcutis, Bausch Health (Ortho Dermatology), EPI Health, Ferndale, Galderma, Genentech, JEM Health, Leo Pharma, La Roche Posay, Lilly (Dermira), Pfizer, Regeneron, Sanofi-Genzyme, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo) RESEARCH INVESTIGATOR Aclaris, Almirall, Amgen, Anaptys Bio, Arcutis, Athenex, Bausch Health (Ortho Dermatology), BioPharmX, Biorasi, Botanix, Brickell, Cara Therapeutics, Cassiopea, Dermavant, EPI Health, Ferndale, Galderma, Incyte, Leo Pharma, Lilly (Dermira), Novan, Pfizer, Ralexar, Regeneron, SolGel, Sun Pharma, UCB, Verrica, Vyne (Foamix; Menlo). Jason E. Hawkes, MD, MS Advisory Boards/Consultant: AbbVie Arcutis Boehringer Ingelheim Janssen LearnSkin LEO Lilly Novartis Pfizer Regeneron-Sanofi Genzyme UCB VisualDx Medical/Scientific Board: National Psoriasis Foundation (NPF) Stock Ownership/Equity: Regeneron Pharmaceuticals (Spouse, employment)

Establishing Connections in Career Development and Patient Care: One Dermatologist's Success Story

You're listening to the Derms and Conditions podcast. So welcome to another exciting episode of Derms and Conditions. And I'm here live in the studio with Dr. Jason Marks, who's an associate professor of dermatology at University of California, Davis. And he has a very interesting background. He spent time at Rockefeller University with Jim Krueger and doing a lot of laboratory work and interesting work in immunology and also working at Mount Sinai with Mark Lewell and colleagues there. And a little less than three years ago has gone out to California. So he spanned across the country, and now he's practicing dermatology and teaching at UC Davis. So welcome, Jason. It's great to have you here this morning. Oh, thanks for having me, Jim. I'm excited to have this conversation today. Well, you should be excited because we have a lot of exciting things to talk about, I think so. I think getting to know you, which I've really enjoyed over the last year or so, you have a very interesting background that I thought it would be good to share with other dermatologists at some point and tell me about how you made this transition, because you're young in dermatology and you have interest in academics and in basic science, but you also have strong interest in being a clinician. And so in speaking, especially to younger dermatologists in the earlier parts of their career, that getting out of their residency, they did all this studying, they have all this background that deciding whether they should go academic or private, as if it's all or none on either side. Can you explain how you've made that transition and combined both? Because I think what you've done is very interesting. Yeah, I think you mentioned it where initially, I think early medicine was that you get in school, you know exactly what you're going to do. You're already differentiated, that you're going to run a lab and everything's clear, and you just follow the path and meet the milestones. And I think what we've learned, I think it's been put on the millennials or Gen Z, et cetera, that that group doesn't really know what they want to do and they bounce around. But I actually think that that fits a lot of where I was, is that there wasn't one thing that just made me so excited that I wanted to do it every single day of my life. And that was true. As I went through undergrad and medical school, I found interest in a lot of different activities, and that included research. It included patient care. I think dermatology for me was a natural fit that way, because we had adult patients, we had pediatrics, we had some procedures, we had pathology. I wouldn't have been a good pathologist every single day because I liked patient interaction. But dermatology brought in multiple aspects, and I think to mirror that interest in dermatology where I had the variety of activities, that's really what I did with the experiences and opportunities I sought after. I spent time at the NIH as a medical student, took a year off in the Howard Hughes program at the NIH, and studied micrornas in non dermatologic conditions because I didn't have the perception I was going to go into dermatology yet. So that was sort of a landmark experience for me, showing sort of that translation between the science and human clinical care. I did mouse model research when I was at the University of Utah, looking at psoriasiform dermatitis and mice and how that might translate to humans and learning the differences between models of disease and humans. And that was very interesting. I did clinical trials when I was in University of Utah, but also in New York City at the Rockefeller University, and to see how that world worked, interact with industry. So all of those experiences might make it look like it's undifferentiated path, but all of those layers have added to my interest, and all of those have value. I think it's okay to not have something that's 100% of your time, because I think overall, it's made me a better clinician, having had those experiences at the basic science level or the clinical trials level. So I think it's okay to have those broad interests, and I encourage young physicians and trainees to actually experience those because they'll add to future activities. So how do you come about getting those opportunities, though? I mean, they just don't fall on you. You had to pursue them. And what you just described sounds like half of someone's career. How much time was that compressed into? Because you're in Utah, you're with Kruger, you're at NIH. I mean, that sounds like years and years of know a lot of them. You're doing two for one, right? So, for me, in medical school, I did take the one year off to do that research fellowship, but for me, I needed to answer an important question, which was that did I want to run a lab or see patients? Because the system really drives you in one direction. It's very difficult to be a successful NIH physician and not do that 100% of the time because the people you're competing with are doing it. 100% of the time. And so while we talk about it being a hybrid, there's really a conflict. So for me, I needed to know early on in my career if I wanted to be in the lab 100% of the time. So that one year off was definitely extra time, but all of the other experiences I really included into my training. So during residency in dermatology, I had, rather than doing a traditional three years of training, I did what we call a two plus two program, which is I did two years of traditional clinical training, but my second two years. So again, one extra year, I spent time doing research, clinical trials, et. So two extra years, when you get to that point, and you might say that the three years I spent in New York City in my master's of clinical investigation was extra time, but it was a paid position. I made money. I lived in New York, had a great experience. And so for me, that was really an advancement of my career, because I was seeing patients at Mount Sinai with Mark Lebwall and his group, and I was learning how to practice dermatology. So to be paid and work and learn, it didn't feel like extra time, because once I was ready to get into the position I'm in now, I had all the tools that I felt like I could manage any patient that walked into the clinic. So to me, it was maybe two years of extra time. There's an opportunity cost there, but I think in the long run, that will be regained. Well, it's time well spent, because if you're setting yourself up for the right choice and that lasts many years, it's like picking the right partner in life. Right. And sometimes it takes a little bit longer, but then when it's the right situation, it works for years, and it gives you a much better life. So tell me about this position you're in now, because I think your patients that you see are very thankful. I've talked to you about cases which we'll get into your knowledge base, and how you manage patients is so comprehensive. So you're in a situation now where you have academics and teaching, but you're basically also in private practice. You're out in the trenches treating patients. You're not just in a center that gets a referral, and you never see the patient back for six months, a year, if ever. So explain how colleagues can find that type of situation. Yeah, and I think to also go back and incorporate a prior question you asked is, how do you find these opportunities? I think some actually do come to your doorstep. You've got to kind of pay attention. You just have to make the decision to accept it or not accept it. And some of them, I think you have to have the conversation with people and explain your interest, right. You have to start to differentiate yourself and say, this is what makes me tick. This doesn't. And a lot of those conversations led my supervisors, leaders, mentors say, hey, you should really think about x, y, or z. Right? So I really think that's important. And I think in answering your second question here, which is, what's my position like here at Ucavis? And it seems to be a hybrid that was also sort of born out of a conversation about what I really wanted to do. I knew very early on, after some of these experiences that I'd had in my training, that I didn't want to see patients every single day in a five day a week practice just wall to wall with patients because that sort of made it difficult to find time to really think and digest the literature and answer important questions. I enjoyed writing, so I needed that time. So this really kind of came out of that conversation of having patient care because I think we need to apply the science that we learn, but we also need that time to think and digest. The, the, you know, practice model I have here is that I'm affiliated with the university, the department of dermatology in Sacramento, and I'm down there one day where I work with residents and fellows, et cetera. But those other days I'm at an outpatient clinic. It's an affiliated clinic with UC Davis, but it's really a multi specialty clinic where there's Ent, there's GI, there's primary care, and I'm the only dermatologist there. So I get those direct referrals. Sometimes same day referrals are within a day or two. And that's been really interesting to see that really, when you say down in the trenches, sometimes at academic centers, we don't see a lot of the basic early presentations because they take a long time to get to us. But out in the community practices, I see these patients that are new diagnoses or just happening, new onset, et cetera, and that's been really interesting. And then I still have a day and a half where I'm not doing any clinical activities. That is just academic time. So I have at least 30% of my time where I can work with industry or as a medical board member of the National Psoriasis foundation. We do a lot of work together. So those are days where I can sort of work on the other side of that brain, for me, that's the creative thinking, learning side. So for me, it really does bring all aspects of what I'd done prior into one position, and it's really satisfying to have the variety for me. Well, you're the architect of that to a significant degree just by how it happens, because you said something very important earlier. You said that people worked with you, and then they started to see this in you, and then they start telling you, hey, have you ever thought about this? Or I know somebody, you should give them a call. And it just builds, but it's you presenting to them your level of interest. So if you just sit there like a bump on a log and you don't express anything to the person you're working with, it's hard to get them motivated about offering some options. So what I'd like to do is ask you about. I know that you talked to me at one time about a very interesting case of a patient that presented with. They had chronic sinusitis with nasal polyps, and they had asthma, and they sort of had a complicated situation. They weren't a classic exemnist dermatitis presentation, they were more of a progenous type of presentation. And can you just end today by explaining how you sorted through that case and managed it? Because I thought that was a very interesting case. Yeah. So there's a case we published, and it was an older gentleman that had had virtually no dermatology history, but had had a long history with multiple specialties for multiple allergic related diseases. So he had suffered with very severe asthma, requiring multiple hospitalizations, er visits. So he was managed by an allergist, he had an Ent that was managing his chronic rhinocitis with nasal polyps. He had had multiple surgeries for the polyps. He had had a severe aspirin induced hypersensitivity, also managed with allergy. And those three conditions together fit with a diagnosis called sampter's triad, which is probably not as common to the dermatology specialty in more ent and or allergy. So this patient, who had had this long allergy history would never interacted with dermatology, was sent to dermatology for these very paridic, sort of red to violacious plaques, mostly on the arms and the trunk. And they were worried that he'd had some infection. He had had a knee surgery that had MRSA, complicated by MRS infection, and they were wondering if this could be related. And so it was his first time to dermatology. When this patient walked in, it was clear that what he was dealing with was parigonodularis. And so what we really wanted to do is think about how we could manage his condition in a way that might also help some of his other conditions. And he was really a magical patient in terms of his treatment response because we were able to get him approved for dupliumab or dupixin, given his other allergy conditions. But what was amazing, within about three weeks, he called me and his skin was completely clear. But what was most interesting to me is that about a month later, I got a call from his ENT surgeon saying, whatever you did to this guy, don't stop because all of his polyps are shrinking. He's off his medications. His allergist talked about how his asthma is well controlled. They stopped all of his oral steroids. What interesting about this patient was that even though he had had these separate diseases, it was clear that he had one common pathway that was shared between all these diseases. That one drug, one targeted, very safe agent, was able to get his skin clear, but then have a huge impact in all of these other conditions. So it really kind of gets us back to thinking about how we can interact with these nondermatology specialties, who might see these patients that have these allergic related conditions, that one treatment that's targeted can really help multiple areas. So it really kind of opened me up to these conversations to have with other specialists about what patients we might share that together we can think of care strategies that will be better for them. Overall, I find that it's very rewarding. I have an allergist, immunologist, the guy's a phenomenal physician, that we share patients and actually also a rheumatologist. When you start getting into psoriasis, psoriatic arthritis in some of these other areas, and I find it very rewarding to share patients with them. So I think that's a great way to end our conversation. And that is an article that is published that people can look up. It was in the journal American Academy of Dermatology, one of the case reports, the Jad case report. So, Jason, I know you have a busy day of patients today. You're probably not in the lab today or doing your academic side work, so I'll let you go. Really, thanks a lot. It was great to talk to you, and I'm sure I'll see you soon. Appreciate it. Thanks, Jamie. It was fun. Thank you for listening to this episode of Derms and Conditions. If you have any questions or comments, please email. Email us at podcasts at Fred Health and most importantly, if you like this episode, subscribe to the Derms and Conditions podcast on Apple Podcasts or wherever you get your favorite shows. Thanks for joining us.

The Smartest One in the Rheum: A Conversation with Joseph Merola, MD, MMSc

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