&nbsp;In this new installment of Tea with Dr. D, host James Q. Del Rosso, DO, is joined by Karan Lal, DO, to examine 3 complex cases where clinical reasoning required moving beyond conventional pathways. This episode features visually impactful case images that bring the discussion to life. The first case centers on an elderly patient on PD-L1 immunotherapy who developed erosive plaques on the head and neck. Dr Lal reviews the diagnostic challenges of atypical presentations, the limitations of standard treatments, and his decision to carefully introduce a JAK inhibitor with oncology support, illustrating the importance of balancing risks and benefits in drug-induced BP. Next, they consider a young adult male with diffuse hair loss. A biopsy confirmed androgenetic alopecia without inflammation, prompting Dr Lal to initiate low-dose oral minoxidil with finasteride. He details why combination therapy can be advantageous in younger patients, the need for counseling about shedding phases and time to response, and how to interpret prostate screening in those taking finasteride. The final case highlights a dramatic case of rhinophyma presenting as fibrotic nodules without classic inflammatory features of rosacea. Dr Lal explains his staged management of surgical debulking followed by laser resurfacing, along with the role of isotretinoin for long-term maintenance. For patients unable to pursue surgical options, he shares alternative approaches such as combining isotretinoin with neuromodulators to shrink tissue and improve appearance. Tune in to the full episode to see striking clinical images, learn how expert dermatologists navigate diagnostic uncertainty, and gain insight into creative, patient-centered strategies for challenging presentations

Karen Lal, DO

Tea with Dr D is Back Again! How Would You Have Handled These Cases?

In Part Two of the Tea with Dr. D premiere, James Q. Del Rosso, DO, returns with Lauren Lam, MD, a Canadian dermatologist with a keen interest and extensive experience in managing hidradenitis suppurativa (HS). After covering overall considerations and the medical side of HS management in Part One, they shift gears to focus on important physical approaches, including one of the most effective—and often underutilized—surgical interventions: deroofing. &nbsp;Dr Lam emphasizes the importance of both medical and surgical interventions in order to provide comprehensive management of this multifaceted disease state. She shares her step-by-step approach for identifying which lesions are best suited for deroofing, breaking down key considerations like Hurley staging, scarring assessment, and palpation for sinus tracts. From assessing lesions that have resisted biologic therapy to recognizing when a seemingly mild case may actually benefit from surgical intervention, she explains how deroofing fits seamlessly into a well-rounded HS treatment plan, often working in tandem with biologic agents to address stubborn or recurrent lesions without disrupting systemic control. &nbsp;The conversation then turns to technique. Dr Lam outlines her preferred tools, all which are easily accessible in dermatology practices, and explains how she navigates physically challenging areas like the axilla and groin. The pair emphasize the importance of patient education; Dr Del Rosso raises questions about preventing complications such as biofilm formation and hypergranulation, while Dr Lam addresses these issues and shares her strategies for effective wound management. &nbsp;Together, they reflect on how deroofing can markedly improve comfort and quality of life for HS patients, particularly those who have struggled with focal areas of chronic drainage and recurrent abscesses despite optimized medical therapy. Dr Lam’s enthusiasm for the procedure is readily apparent and contagious, and her practical advice makes the incorporation of deroofing into the management plan feel readily achievable, even for dermatology clinicians who are new to surgical HS management.

Lauren Lam, MD

Another Cup of Tea with Dr. D? Part 2: Closing the Loop on HS

In this premiere episode of Tea with Dr. D, James Q. Del Rosso, DO, welcomes Lauren Lam, MD, a Canadian dermatologist with special interest and strong experience in managing patients affected by hidradenitis suppurativa (HS). They engage in a thoughtful and comprehensive conversation about diagnosing and treating this common yet often elusive skin condition—especially in its early stages—which has been notoriously difficult to treat. Their discussion integrates both medical and surgical approaches to optimize outcomes.Dr Lam shares how she built an efficient, trust-centered model of care at her Calgary clinic, from using intake tools and patient education videos to identifying comorbidities and staging severity. She walks through her approach to treatment selection—focusing on what brings the most value in that moment—and discusses when and how she incorporates patient education, intralesional corticosteroids, biologic therapy, deroofing, laser hair removal, and other approaches into her care strategy.Whether you see HS regularly or only occasionally, this conversation offers practical strategies, clinical nuances, and a fresh perspective on improving care for this complex condition.

Solving The Puzzle of Hidradenitis Suppurativa: Pulling All the Pieces Together for Each Patient

Season 1

Tea with Dr. D is a new video series from the team behind Derms and Conditions. In each episode, host James Q. Del Rosso, DO, pours a cup and sparks candid, visually supported conversations with leading experts about dermatology’s most relevant topics.

<div class="raw-html-embed">Tea with Dr. D is a new video series from the team behind Derms and Conditions. In each episode, host James Q. Del Rosso, DO, pours a cup and sparks candid, visually supported conversations with leading experts about dermatology’s most relevant topics, serving up clinical pearls, personal insights, and a few unexpected takeaways along the way.</div>

Tea with Dr. D

Episode Guide

Tea with Dr D is Back Again! How Would You Have Handled These Cases?

Another Cup of Tea with Dr. D? Part 2: Closing the Loop on HS

Solving The Puzzle of Hidradenitis Suppurativa: Pulling All the Pieces Together for Each Patient