Clinical Video Library

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Safety, monitoring, and shared decision-making across biologic and adjunctive careIntegrative care in atopic dermatitis (AD) is not only about what clinicians may add to the treatment plan. It’s about how those recommendations are evaluated, monitored, and shaped around the person expected to follow them.In the final installment of this Topical Conversations series, Cynthia Trickett, PA-C, and Peter Lio, MD, turn to the practical responsibilities that come with combining adjunctive strategies and biologic therapy. Dr Lio discusses the long-term safety experience with biologics while emphasizing the importance of continuing to watch emerging signals with appropriate humility. The same caution extends to supplements, where ingredient quality, contamination, counterfeit products, and inconsistent manufacturing can make a seemingly straightforward recommendation far more complicated. When he does recommend a supplement, he tries to be highly specific about the brand and supplier.The conversation then moves from safety to sustainability. Gentle cleansing, regular moisturizing, reducing environmental irritants, sleep, nutrition, and movement may all support care, but only when they fit the patient’s life. A recommendation that is unaffordable, intolerable, inaccessible, or unrealistic is unlikely to succeed, no matter how sound it appears on paper.That reality also shapes follow-up. Dr Lio describes checking in early with patients who have more severe disease and using the Atopic Dermatitis Control Tool to move beyond a general sense of “better” toward a more structured assessment of whether the disease is truly controlled. Those conversations may reveal that a treatment was never received, not covered, caused stinging or burning, or simply did not fit into the patient’s routine.Ultimately, the episode returns to the foundation of integrative care: listening. “The goal is to get you better,” Dr Lio says. That means giving patients options, inviting them to guide the plan, and remaining flexible enough to adjust when one approach does not fit. Integrative care enhances biologic therapy rather than replacing it, creating a broader and more individualized path toward control.

This video is sponsored by Sun Pharma. Its content is editorially independent of the sponsor.In this episode of Topical Conversations, Meena Singh, MD, and Terry Faleye, PA-C, discuss why speed of disease control has become an increasingly important consideration in the management of alopecia areata (AA). As treatment options continue to expand, they explore how earlier signs of response can influence patient confidence, improve treatment persistence, and reshape conversations about what patients can expect during therapy. Using deuruxolitinib as an example, they highlight how evolving efficacy data have changed both provider expectations and the patient experience.The importance of speed in a disease with significant psychosocial impactThe treatment landscape for moderate to severe AA has changed substantially with the availability of multiple FDA-approved Janus kinase (JAK) inhibitors. While efficacy remains the primary goal, Dr Singh and Faleye emphasize that when patients begin to see improvement can be nearly as important as how much improvement they ultimately achieve.For many patients, AA develops suddenly and is accompanied by considerable emotional distress. Faleye notes that many individuals present with little understanding of the disease itself, making education about its chronic nature and treatment course an essential part of the initial visit.The ability to demonstrate visible improvement early in treatment can provide reassurance during what is often an emotionally challenging period. Both speakers describe how even small signs of regrowth can reinforce that treatment is working, helping patients remain engaged and optimistic rather than becoming discouraged after months without visible progress.How earlier responses are changing treatment conversationsHistorically, clinicians often counseled patients that meaningful regrowth might not occur for many months, if at all. Dr Singh notes that this has changed with newer therapies.She discusses how clinical studies of deuruxolitinib demonstrated statistically significant, clinically meaningful hair regrowth as early as 8 weeks, despite the primary efficacy endpoint occurring later in treatment. In her own practice, she has observed patients with extensive scalp involvement experience dramatic improvement within the first few months of therapy, fundamentally changing how she frames expectations at treatment initiation.Faleye similarly points to the secondary efficacy assessments at weeks 8, 12, 16, and 20 as particularly meaningful from a clinical perspective. Seeing evidence of earlier response provides reassurance to both patients and clinicians that therapy is moving in the right direction.She also shares the experience of a patient who had an inadequate response to a different JAK inhibitor but later achieved substantial regrowth after initiating deuruxolitinib, reinforcing her confidence in discussing treatment expectations with appropriate patients.Clinical success and patient-defined success are not always the sameOne of the recurring themes throughout the discussion is that clinicians and patients often define treatment success differently.Dr Singh notes that patients may become excited by the appearance of fine vellus hairs, even though these early changes would not yet represent meaningful terminal hair regrowth from a clinical trial perspective. Nevertheless, these visible signs frequently provide patients with reassurance that treatment is working.Faleye agrees, emphasizing that these seemingly modest improvements often have an outsized effect on treatment adherence. While clinicians recognize that additional regrowth is needed to achieve optimal outcomes, patients may view these early changes as important milestones that motivate them to continue therapy.Recognizing early indicators of responseThe speakers encourage clinicians to look beyond scalp hair counts alone when assessing early treatment response.Dr Singh notes that eyebrow, eyelash, and beard regrowth, even when limited, can represent meaningful early signs that therapy is having an effect. Likewise, a noticeable reduction in hair shedding may precede visible regrowth and can be an encouraging indicator to discuss during follow-up visits.Faleye adds that improvements that may seem minor clinically can carry tremendous significance for individual patients. She recalls an older patient whose primary concern was beard patchiness; seeing early beard regrowth substantially improved the patient's outlook despite relatively modest overall changes.Recognizing and reinforcing these individualized treatment successes can strengthen the therapeutic relationship and support continued adherence while more substantial regrowth develops.Early treatment may help change the long-term trajectoryThe discussion also highlights the importance of identifying and treating AA promptly whenever appropriate.Faleye observes that patients with longstanding disease may be less likely to pursue treatment because of previous disappointments or because they remain unaware that newer therapeutic options are available. At the same time, these individuals can present greater treatment challenges than patients who begin therapy earlier in the disease course.Both speakers emphasize the importance of educating patients about advances in AA management and encouraging timely intervention when indicated.A changing patient experiencePerhaps one of the most meaningful changes, according to Dr Singh, is the transformation she sees in patients between their initial consultation and early follow-up visits. Patients who begin experiencing regrowth within the first few months often return with noticeably greater optimism and confidence, changing the tone of subsequent visits.For both clinicians, the availability of therapies capable of producing earlier, meaningful responses has altered not only treatment strategies but also the overall patient experience. They conclude that recognizing early improvements, setting realistic expectations, and initiating effective therapy promptly can all contribute to better long-term engagement and outcomes for patients with AA.

In this episode of Topical Conversations, Linda Stein Gold, MD, and G. Michael Lewitt, MD, discuss the tolerability profile of tapinarof and how adverse events observed in clinical trials compare with their real-world experience treating patients with plaque psoriasis and atopic dermatitis.Tapinarof, an aryl hydrocarbon receptor (AhR) agonist, was initially approved in 2022 for adults with plaque psoriasis and was subsequently approved for atopic dermatitis in patients as young as 2 years of age. Through modulation of AhR signaling, tapinarof influences multiple pathways relevant to inflammatory skin disease, including cytokine signaling, oxidative stress, and skin barrier function.The discussion focuses on two adverse events that have received particular attention: follicular events and contact dermatitis.Tapinarof and the evolving role of nonsteroidal topical therapyHistorically, nonsteroidal topical therapies have often been incorporated into treatment regimens as adjunctive agents or during topical corticosteroid holidays, helping patients maintain disease control while reducing reliance on corticosteroids.Dr Lewitt notes that tapinarof has been used somewhat differently in clinical practice, serving not only as a maintenance therapy but also as a treatment capable of achieving disease control in appropriate patients. Dr Stein Gold agrees that the availability of newer nonsteroidal topical options has allowed for simpler treatment approaches in some patients, reducing the need for multiple topical medications with different roles within a treatment regimen.Tolerability profile of tapinarofBoth physicians note that application-site stinging and burning have been relatively uncommon in their experience with tapinarof, particularly compared with some earlier nonsteroidal topical therapies.Instead, the adverse events most frequently discussed in relation to tapinarof have been follicular events and contact dermatitis. While these events have been observed in both psoriasis and atopic dermatitis clinical trials, the incidence, severity, and clinical significance warrant closer examination.Folliculitis in plaque psoriasisDr Lewitt reviews findings from the psoriasis clinical trials, where folliculitis was reported in approximately 18% to 24% of patients during the 12-week treatment period.Importantly, the majority of cases were not characterized by inflammatory pustular lesions. Rather, they were more commonly described as hyperkeratotic or keratosis pilaris-like follicular changes. Most events were mild to moderate in severity, and treatment discontinuation due to folliculitis was uncommon.Follicular events in atopic dermatitisThe physicians contrast these findings with those observed in the atopic dermatitis trials, where follicular events were designated as an adverse event of special interest.In the 8-week atopic dermatitis trials, follicular events occurred less frequently than in the psoriasis studies, with reported rates of approximately 9% to 14%. As in the psoriasis trials, most events were mild to moderate in severity; discontinuation rates were below 1%.Dr Lewitt notes that his real-world experience has generally aligned with the clinical trial findings, with follicular events appearing less common among patients with atopic dermatitis than among patients with psoriasis. Dr Stein Gold reports a similar experience, noting that she has not observed folliculitis among her own patients with atopic dermatitis treated with tapinarof.Contact dermatitis: incidence and clinical considerationsContact dermatitis has also been reported during tapinarof treatment.Dr Lewitt notes that in the psoriasis clinical trials, contact dermatitis occurred in approximately 5% to 6% of patients, with discontinuation rates of approximately 1.5%. Based on the clinical characteristics of these reactions, he speculates that at least some cases may have represented irritant rather than allergic contact dermatitis.In the atopic dermatitis trials, rates of contact dermatitis were low, with both event rates and discontinuation rates below 1%. Notably, contact dermatitis was reported more frequently in the vehicle arm than in the tapinarof-treated arm.Dr Stein Gold notes that she has encountered contact dermatitis infrequently in clinical practice, reporting a single case among her patients with psoriasis and none among her patients with atopic dermatitis.Practical considerations for clinical useNeither physician views follicular events or contact dermatitis as a major barrier to prescribing tapinarof. Both note that these adverse events are generally uncommon, typically mild to moderate in severity, and infrequently lead to treatment discontinuation.Dr Lewitt notes that when discussing treatment expectations with patients, he mentions the possibility of these adverse events while emphasizing their generally manageable nature. Practical measures such as applying a thin layer of medication, minimizing application to occluded areas, wearing loose-fitting clothing when appropriate, and applying tapinarof after an emollient may help reduce the likelihood of unwanted drug spread to uninvolved skin.Clinical perspectiveThe discussion highlights that while follicular events and contact dermatitis can occur during tapinarof treatment, both events are typically mild to moderate in severity and rarely result in treatment discontinuation. The incidence of these adverse events appears lower in atopic dermatitis clinical trials than in psoriasis studies, and both physicians report real-world experiences that generally align with those observations.For clinicians considering nonsteroidal topical treatment options for chronic inflammatory skin disease, understanding the nature and clinical relevance of these adverse events may help inform treatment selection and patient discussions.

Skin care, diet, supplements, probiotics, and microbiome-directed strategies in clinical contextAfter establishing why adjunctive strategies matter in atopic dermatitis care, Cynthia Trickett, PA-C, and Peter Lio, MD, turn to the practical questions clinicians hear constantly: Do natural oils have a role? How much does diet really matter? What about probiotics, vitamin D, hypochlorous sprays, or antimicrobial cleansers?For Dr Lio, skin care and barrier repair are so central to the biologic therapy treatment plan that he’s coined the term “Advanced Dermatologic Care,” or ADC, to describe the intentional use of OTC topicals, cleansers, moisturizers, written eczema action plans, and other supportive strategies that help patients and families understand what to do day to day and during flares. The conversation moves through natural oils, black tea compresses, diet myths, the risks of over-restriction, vitamin D supplementation, probiotics, and emerging microbiome-directed approaches, always returning to the same clinical foundation of evidence, safety, practicality, and individualized recommendations that support quality of life.Of the many adjunctive options patients may ask about, Dr Lio says, “part of our job is to try to filter them down into things that have some evidence, that are safe and are practical.” This discussion makes space for it all, and contextualizes what may be overstated, unproven, or potentially harmful. He reminds clinicians not to chase every trend, but to help build an adjunctive plan that protects the barrier, respects the microbiome, and avoids doing harm. Upcoming: In Part 3, Trickett and Dr Lio turn from what clinicians can add to how they can do it safely, with practical guidance on supplement quality, follow-up, treatment monitoring, and patient-led decision-making.

In this episode of Discourses in Dermatology, Ali Shahbaz, MD, reviews the biology of the aryl hydrocarbon receptor (AhR) pathway and its relevance in atopic dermatitis (AD), using tapinarof as an example of a first-in-class topical therapy that targets this mechanism. Rather than focusing solely on the pharmacology of a single agent, the discussion explores why AhR has emerged as an important therapeutic target and how a growing understanding of skin barrier dysfunction is reshaping the management of inflammatory skin disease.Atopic dermatitis: More than inflammation aloneHistorically, atopic dermatitis has been viewed primarily as an inflammatory disease. While inflammation remains a central feature, advances in our understanding of AD have highlighted a second, equally important component: skin barrier dysfunction.Dr Shahbaz explains that effective management of AD requires consideration of both of these interconnected processes. Alongside established therapies such as topical corticosteroids and calcineurin inhibitors, newer nonsteroidal agents have expanded treatment options by targeting additional aspects of disease pathophysiology, including restoration of skin barrier function.The biology of the aryl hydrocarbon receptorThe aryl hydrocarbon receptor is a ligand-activated transcription factor that functions as a molecular sensor within cells. In its inactive state, AhR resides in the cytoplasm. When activated by a ligand, it dissociates from its associated protein complex, translocates into the nucleus, dimerizes with the aryl hydrocarbon receptor nuclear translocator (ARNT), and regulates the transcription of numerous target genes.One of the distinguishing features of AhR is the remarkable diversity of molecules capable of activating it. These ligands originate from a variety of sources, including environmental pollutants, ultraviolet light photoproducts, microbial metabolites, micropeptides, and tryptophan-derived compounds. Because the skin serves as the body's primary interface with the external environment, AhR is continuously exposed to signals from multiple sources.Connecting AhR biology to skin barrier functionFor dermatologists, one of the most clinically relevant aspects of AhR biology is its role in regulating proteins that maintain skin barrier integrity.Dr Shahbaz highlights filaggrin as a particularly important example. Filaggrin plays a critical role in maintaining the epidermal barrier, and alterations in its expression contribute to impaired barrier function and increased transepidermal water loss. He also notes that AhR signaling influences additional structural proteins, including loricrin and involucrin, reinforcing the concept that skin barrier integrity depends on multiple coordinated components.This mechanistic understanding also helps explain observed associations between environmental exposures and AD severity. Rather than viewing AD solely through an immunologic lens, clinicians can also appreciate its structural component, recognizing that barrier dysfunction contributes meaningfully to disease activity.Restoring barrier function as part of disease managementThe skin barrier serves as the body's first line of defense against environmental insults. According to Dr Shahbaz, restoring and maintaining barrier homeostasis represents an important therapeutic objective in inflammatory skin diseases such as AD.Focusing only on inflammatory pathways may overlook opportunities to improve disease control by addressing the structural abnormalities underlying barrier dysfunction. Supporting barrier restoration therefore complements anti-inflammatory treatment and reflects a more comprehensive approach to disease management.AhR within the broader inflammatory networkAhR signaling does not function in isolation. Dr Shahbaz discusses its relationship to the broader network of inflammatory pathways involved in AD and psoriasis, including cytokines such as IL-4, IL-13, and IL-31. Appreciating how these pathways intersect provides additional context for understanding the rationale behind emerging targeted therapies.He notes that tapinarof represents the first topical AhR agonist approved for both atopic dermatitis and plaque psoriasis, introducing a novel therapeutic mechanism into dermatology.Helping patients understand their diseaseBeyond understanding the underlying biology, Dr Shahbaz emphasizes the importance of patient education. Explaining why AD develops and how skin barrier dysfunction contributes to disease can help patients better understand the rationale for treatment selection.As nonsteroidal topical therapies continue to expand, a clearer understanding of disease mechanisms allows clinicians to connect advances in pathophysiology with practical treatment decisions and more meaningful conversations with patients.

In this Expert Therapeutic Update Session, Scott Gottlieb, MD, discusses ILUMYA® for Medicare patients living with moderate to severe plaque psoriasis who are candidates for systemic therapy or phototherapy.The presentation focuses on the practical access considerations that often shape biologic selection in older patients, including Medicare Part B coverage, health care provider administration, and the option to use either buy and bill in the office or an alternate site of care. Dr Gottlieb also reviews clinical data from the reSURFACE trials, including long-term efficacy and safety findings, with attention to outcomes in patients aged 65 years and older.For clinicians managing plaque psoriasis in Medicare populations, the session offers a thorough look at how coverage, administration, adherence, and safety considerations can all factor into treatment decisions.

In this closing recap, Elizabeth (Lisa) Swanson, MD, distills the shift many clinicians are making in practice: thinking beyond body surface area, recognizing AD as a chronic inflammatory disease rather than a series of isolated flares, and knowing when the burden of treatment itself signals it’s time to move beyond topicals. The goal, she argues, is not simply controlling a rash, but giving patients a steadier life outside the constant anticipation of the next flare.

In this segment, Linda Stein Gold, MD, reviews pooled data presented at the 2026 Annual Meeting of the American Academy of Dermatology evaluating the efficacy and safety of tapinarof 1% cream in children and adults with atopic dermatitis (AD). The analysis combined findings from the ADORING 1 and ADORING 2 phase 3 clinical trials, providing a broader look at treatment outcomes across patients with moderate to severe disease.Tapinarof and the aryl hydrocarbon receptor pathwayDr Stein Gold begins by reviewing the background of tapinarof, a nonsteroidal topical therapy initially approved in 2022 for psoriasis in adults and later approved in 2024 for atopic dermatitis in patients as young as 2 years of age.Tapinarof functions as an aryl hydrocarbon receptor agonist, representing a novel mechanism of action among topical therapies for AD. Activation of this pathway helps downregulate proinflammatory cytokines, including Th2 cytokines that play a central role in AD pathophysiology. ADORING 1 and ADORING 2 trial designThe pooled analysis incorporated data from ADORING1 and ADORING 2, two identically designed phase 3 studies conducted across different investigators, sites, and patients.Eligible patients were 2 years of age or older with moderate to severe atopic dermatitis, an Eczema Area and Severity Index (EASI) score of at least 6, and body surface area (BSA) involvement ranging from 5% to 35%. Dr Stein Gold notes that patients at the higher end of the BSA range could reasonably be considered candidates for systemic therapy in routine practice. Average baseline BSA involvement across the studies was approximately 16% to 17%.Participants were randomized in a 2:1 ratio to receive tapinarof 1% cream or vehicle once daily for 8 weeks. Investigators evaluated both efficacy and safety outcomes at the conclusion of treatment.The primary endpoint focused on achieving clear or almost clear skin, defined as at least a 2-grade improvement. Additional endpoints included itch reduction, EASI50/75/90 responses, and other standard efficacy assessments.Early efficacy signals observed by week 1Dr Stein Gold highlights that separation between active treatment and vehicle was observed as early as week 1.By week 8, nearly 46% of patients receiving tapinarof achieved clear or almost clear skin in the pooled analysis. Improvements continued consistently throughout the treatment period, with ongoing separation from vehicle across the 8-week study duration.Itch reduction and low pruritus scoresThe analysis also demonstrated early and sustained improvements in itch.Investigators evaluated the standard ≥4-point reduction in peak pruritus numerical rating scale (NRS) scores and observed statistically significant separation from vehicle beginning at week 1. By week 8, just under 60% of patients achieved this level of itch improvement.Dr Stein Gold also points to an additional itch endpoint that is less commonly evaluated in topical AD studies: achievement of a peak pruritus NRS score of 1 or lower, representing minimal or nearly absent itch. Separation from vehicle again emerged by week 1, and by week 8, nearly one-third of patients achieved this low itch threshold.EASI responses across multiple thresholdsThe pooled data also showed robust EASI responses over the course of treatment.Separation from vehicle was observed as early as week 1 for both EASI50 and EASI75 responses. By week 8:~78% of patients achieved EASI50 ~58% achieved EASI75 ~30% reached EASI90 Safety profile remained consistentFrom a safety standpoint, most treatment-emergent adverse events (TEAEs) were reported as mild to moderate in severity.The most commonly reported adverse events included folliculitis, headache, upper respiratory infection, and nasopharyngitis. Discontinuation rates due to TEAEs remained low throughout the studies.Expanding the topical treatment armamentarium in ADIn closing, Dr Stein Gold emphasizes that the pooled ADORING data demonstrate tapinarof cream to be a safe and effective nonsteroidal topical option for patients with moderate to severe atopic dermatitis, including pediatric patients down to age 2.Key takeawaysPooled data from the ADORING 1 and ADORING 2 trials evaluated tapinarof 1% cream once daily in patients aged 2 years and older with moderate to severe atopic dermatitis Tapinarof is a nonsteroidal aryl hydrocarbon receptor agonist that targets inflammatory pathways involved in AD Separation from vehicle was observed as early as week 1 across multiple efficacy endpoints By week 8, nearly 46% of patients achieved clear or almost clear skin Just under 60% of patients achieved a ≥4-point itch reduction, and nearly one-third reached a peak pruritus NRS score of ≤1 Week 8 EASI responses included approximately 78% achieving EASI50, 58% achieving EASI75, and 30% achieving EASI90 Most treatment-emergent adverse events were mild to moderate, and discontinuation rates due to TEAEs were low

In this episode of Business Unblemished, Erik Domingues, MD, sits down with Mark Kaufmann, MD, to unpack the coding strategies, buy-and-bill models, and overlooked CPT opportunities that can help dermatology practices stay afloat in the face of shrinking reimbursements and rising costs.They discuss how to:Use underutilized codes like G2211 to capture the full scope of careDetermine when buy-and-bill strategies are worth the riskAvoid common pitfalls that lead to lost revenueRecognize how accurate, complete coding can safeguard independent practiceAs Dr Kaufmann puts it: inflation is squeezing physicians, but smarter billing may be the key to better survival.

In this episode of Business Unblemished, Dr Stephen Lewellis, founder of Above & Beyond Dermatology, interviews Jamie Danley, Chief Human Resources Officer at Advanced Dermatology and Cosmetic Surgery, on how best to translate practice principles between small and large dermatology practices.Part one of this two-part episode, Dr Lewellis and Jamie discuss how to achieve employee engagement and establish culture across practice sizes, including the importance of defining culture and its role in creating a thriving practice.

In part two of this episode of Business Unblemished, Dr Stephen Lewellis and Jamie Danley continue their conversation about growing and evolving a small practice into a larger practice. They discuss ways of achieving buy-in from employees, empowering team members, and establishing culture based on a firm conviction in a practice's core values.

In this episode of Business Unblemished, Dr Dawn Merritt and Dr Aaron Farberg discuss how to efficiently implement photodynamic therapy (PDT) for actinic keratosis (AK) in dermatology practices. They address common misconceptions about PDT’s cost, logistical challenges, and practical strategies to maximize both its clinical and financial value.Why use PDT for actinic keratosis?PDT is an effective field therapy for actinic keratosis. While individual lesions can be treated with cryotherapy, many patients require broader treatment, making PDT an excellent in-office option.Dr Merritt, an early adopter of PDT, has integrated the treatment into all 10 of her practice locations, where it is performed daily. Dr Farberg strongly believes every dermatology practice should offer PDT, noting that dermatologists are likely to see multiple patients every day who could benefit from it. While topical therapies remain a viable and effective option, PDT offers greater control over treatment application and adherence, ensuring patients receive consistent and effective care.Optimizing workflow and staffingDr Merritt emphasizes that proper scheduling is key to ensuring PDT does not disrupt clinic flow. Instead of scheduling PDT as a physician-led appointment, she recommends setting it up as a nurse visit:Medical assistants (MAs) handle the setup and patient preparationThe physician only needs to be present for consent, curettage, and product application, allowing them to continue seeing other patients while the PDT session runs in the backgroundDr Farberg adds that while MAs can manage most of the process, physicians should personally apply and initiate PDT for optimal reimbursement and quality of care. A simple way to improve efficiency is to provide patients with a bell to call for assistance while MAs manage other tasks such as prior authorizations or patient paperwork.Space considerations for PDT implementationOne common concern among dermatologists considering PDT is space requirements. However, PDT does not require a dedicated room:Dr Merritt recommends using a nurse visit room or an overflow exam room to allow smooth patient flowDr Farberg has successfully implemented PDT in small rooms, demonstrating that space limitations should not deter practices from considering the serviceAddressing cost concerns and maximizing revenueFor newer or smaller practices, the upfront cost of PDT equipment may feel like a barrier. However, both doctors emphasize that PDT is a long-term revenue generator:Established practices can confidently invest, knowing they will recoup costs over timeNew practices with tighter budgets can explore equipment rental options, which allow them to offer PDT without large upfront costsDr Merritt routinely budgets for PDT when opening a new office because she knows its profitability and value to patients.Educating patients about PDTDr Merritt emphasizes that patient education is crucial for successful PDT integration. She advises new practices to:Create a simple handout explaining what patients can expectAlways schedule 2 PDT treatments upfront, with a third follow-up visit 8 weeks later for evaluation.Dr Farberg finds that offering multiple field therapy options allows patients to choose what works best for them, though many prefer PDT due to its ease of use and convenience.Training staff to promote PDTDr Merritt utilizes rolling screen advertisements in her offices to inform patients about PDT before their appointment. Additionally, she has trained her MAs with instructional videos that cover:PDT setup and applicationHow to explain the procedure to patientsWhen to involve the physician during treatmentThis structured approach ensures the entire team is aligned and helps patients feel more comfortable with the procedure.Identifying ideal candidates for PDTDr Merritt has a simple rule of thumb for determining when to recommend PDT:If she has to freeze more than what fits on one hand, the patient needs field therapy—and PDT is her first choiceDr Farberg also sees PDT as a built-in marketing tool; patients who receive it often remark that they have never had it offered at other dermatology offices. These patients share their positive experiences with friends, bringing in new patients and strengthening practice growth.PDT remains one of the most effective and well-established treatments for AK field therapy. While some dermatologists hesitate due to logistical concerns, both Dr Merritt and Dr Farberg emphasize that with proper implementation, PDT can enhance patient care while becoming a valuable revenue stream.Key takeawaysPDT offers precise, in-office field therapy for patients with AKWith efficient scheduling, PDT can be integrated seamlessly into any practice workflowSpace constraints should not deter practices from offering PDTThe cost of PDT equipment is quickly recouped, and rental options are availableA well-trained team and patient education help maximize PDT’s impact

Hair loss can’t be evaluated well from the scalp alone. In this hair and scalp exam video, Garland James, PA-C, walks through a practical approach to evaluating hair loss in clinic, from taking a focused history and asking about styling practices to looking for signs of inflammatory and noninflammatory alopecia. She also emphasizes the parts of the exam that can easily be missed: asking permission before touching the hair, photographing the scalp for comparison, recognizing when biopsy may be needed, and building a treatment plan with the patient instead of around them. Use the accompanying Hair and Scalp Exam: A Practical Clinical Guide for PAs and NPs as a quick reference for assessing hair practices, tension patterns, density and distribution, dermoscopic clues, and care considerations in textured hair. Question: In the video, James emphasizes that the clinical history can help guide the hair loss exam. Which of the following is most relevant to ask before examining the scalp? Whether the patient prefers prescription or over-the-counter treatment Current and recent hair care practices, including protective styles and duration of wear Whether the patient has used cosmetic hair coloring in the past 10 years Whether the patient is willing to stop all styling during treatment Rationale: Rationale: Hair practices can help explain the pattern of hair loss and should be discussed before the exam. The accompanying guide also notes that hair practices often explain the pattern and recommends asking about recent styling changes, current routine, symptoms, and prior treatments. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; } Question: During the exam, which finding would most strongly support considering biopsy for possible inflammatory or scarring alopecia? Diffuse shedding without scalp symptoms Mixed hair shaft diameters consistent with miniaturization Perifollicular erythema or scaling with concern for scarring disease Mild dandruff without tenderness or visible inflammation Rationale: In the video, James notes that if the exam raises concern for an inflammatory component that could lead to scarring, biopsy should be strongly considered. She also cautions that biopsy location matters; avoid areas that are already fully scarred and sample near active inflammation when possible. document.querySelectorAll('.mcq-block').forEach(function(block) { const correct = block.getAttribute('data-correct'); const form = block.querySelector('.mcq-form'); const feedback = block.querySelector('.mcq-feedback'); const resultText = block.querySelector('.mcq-result'); form.addEventListener('change', function(e) { const selected = e.target.value; // Log to console (optional) console.log("Selected answer:", selected); // Show feedback feedback.style.display = 'block'; if (selected === correct) { resultText.textContent = "Correct!"; resultText.style.color = "green"; } else { resultText.textContent = "Incorrect"; resultText.style.color = "red"; } }); }); .mcq-block { padding: 1rem; border: 1px solid #ddd; border-radius: 10px; margin: 1.5rem 0; background: #fafafa; } .mcq-question { margin-bottom: 0.75rem; } .mcq-feedback p { margin: 0.3rem 0; }

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Register now! Patient Access Management Summit (PAMS) in ChicagoWhere: The Westin Michigan Avenue Chicago909 North Michigan AvenueChicago, IL 60611When: April 25, 2026Earn up to $500 in consulting fees!$200 for completing C-PAM Foundational curriculum$200 for attending the sessions in full$100 for completing a post-conference evaluation

Register now! Patient Access Management Summit (PAMS) in ChicagoWhere: The Westin Michigan Avenue Chicago909 North Michigan AvenueChicago, IL 60611When: April 25, 2026Earn up to $500 in consulting fees!$200 for completing C-PAM Foundational curriculum$200 for attending the sessions in full$100 for completing a post-conference evaluation

Register now! Patient Access Management Summit (PAMS) in ChicagoWhere: The Westin Michigan Avenue Chicago909 North Michigan AvenueChicago, IL 60611When: April 25, 2026Earn up to $500 in consulting fees!$200 for completing C-PAM Foundational curriculum$200 for attending the sessions in full$100 for completing a post-conference evaluation

Register now! Patient Access Management Summit (PAMS) in ChicagoWhere: The Westin Michigan Avenue Chicago909 North Michigan AvenueChicago, IL 60611When: April 25, 2026Earn up to $500 in consulting fees!$200 for completing C-PAM Foundational curriculum$200 for attending the sessions in full$100 for completing a post-conference evaluation

In this episode of Under Your Skin, host Dr Nicholas Brownstone sits down with Dr Susan Taylor to get her perspectives on the evolving field of dermatology. Dr Taylor shares her thoughts on the growing role of teledermatology, the pressing issue of reimbursement that challenges the sustainability of dermatology practices, and how she personally finds balance in her demanding career. The rise of teledermatology Dr Taylor emphasizes the growing significance of teledermatology, particularly since the onset of the COVID-19 pandemic. She highlights that teledermatology has become an essential tool for improving patient access to dermatologic care. For patients who find it challenging to take time off work, teledermatology offers a convenient alternative. They can easily consult with dermatologists during their lunch breaks or even from a private space in their workplace. Dr Taylor stresses that the key benefit of teledermatology is its ability to increase and improve access to dermatologic care, a factor that remains crucial in today's health care landscape. A critical issue facing dermatology Dr Taylor identifies reimbursement as the most critical issue currently confronting dermatology. She points out that while other health care sectors, such as hospitals and skilled nursing centers, have received inflationary updates in their reimbursements, dermatologists have not seen similar adjustments. The lack of updates in Medicare reimbursements has created a significant financial strain on dermatology practices. Dr Taylor warns that this could ultimately affect the quality of care patients receive. The financial pressure makes it increasingly difficult for private practitioners to keep their practices open, pay their staff, and maintain the necessary resources to provide patient care. She underscores that advocating for better reimbursement rates should be the top priority for the American Academy of Dermatology and dermatologists nationwide. Balancing work and relaxation Dr Taylor then shares her personal approach to unwinding after a long day. She enjoys walking to and from work, which helps her process the events of the day and decompress. Additionally, she finds relaxation in spending quality time with her husband, particularly by going out to dinner together. This routine allows her to maintain a healthy work-life balance and recharge for the challenges of the next day.

In this episode of Under Your Skin, host Nicholas Brownstone, MD, gets to know David Pariser, MD, a practicing dermatologist for over 40 years and the senior physician at Pariser Dermatology Specialists. They discuss a valuable tip for improving practice efficiency, Innovations on the horizon for dermatology, and the diverse appeal of the specialty. A strategic addition to the workflow to improve efficiency Dr Pariser has significantly improved his efficiency by incorporating medical scribes into his workflow. These scribes accompany the practitioner into the treatment room for each patient visit. While the doctor engages with the patient, the scribe diligently documents the encounter using macros, ensuring that the note is often completed by the time the doctor leaves the room. This system allows the doctor to electronically sign off on the note, send prescriptions immediately, and complete billing processes before the patient exits the office. This approach has been transformative, enabling Dr Pariser to see more patients without compromising the quality of care. With an EHR system, it typically takes about 3 minutes to document a patient’s chart. For a dermatologist seeing 30 patients, that adds up to 1.5 hours of charting. By utilizing scribes, this time can be redirected towards seeing additional patients, easily offsetting the cost of hiring a scribe and enhancing overall practice efficiency. Outlook on the future of dermatology Dr Pariser is particularly enthusiastic about the advancements in personalized medicine. Precision diagnostic testing and testing to help identify the most effective medications for individual patients, represents the future of dermatologic care. This approach promises to tailor treatments to each patient's unique needs, enhancing outcomes and optimizing therapeutic strategies. The unique rewards of dermatology Dr Pariser's passion for dermatology stems from its diverse and dynamic nature. Dermatology is a "cradle-to-grave" specialty, encompassing surgery, pathology, cosmetics, pediatrics, and adult care. Dermatologists manage a wide spectrum of medical and surgical conditions, ensuring that every day is different and every patient encounter is unique.

In this episode of Under Your Skin, host Dr Nicholas Brownstone explores the future of dermatology with past President of the American Academy of Dermatology Dr Mark Kaufmann, MD, FAAD. Together, they speculate on the integration of telehealth and technology into dermatologic practice and the potential impact on patient care over the next decade. Telehealth: necessity or preference? During the COVID-19 pandemic, telehealth emerged as a necessary tool rather than an optional clinical offering. Dr Kaufmann reflects on this period, acknowledging that while many practitioners and patients may have initially viewed telehealth with skepticism due to technological limitations, its adoption was crucial for the continuity of patient care. Looking ahead, he sees telehealth evolving into a sophisticated triage mechanism, efficiently identifying patients who require urgent in-person consultations while providing virtual care for others. Integrating technology into dermatologic practice Dr Kaufmann acknowledges the increasing role of technology in dermatology. He notes that while some fear that technology and artificial intelligence have the potential to replace jobs, he believes that technology will serve as a valuable assistant, particularly in addressing cognitive challenges that many doctors face rather than replacing procedural aspects of care. He predicts that incorporating technology into clinical activities will become standard practice, enhancing rather than supplanting the role of dermatologists and other medical staff. The future of dermatology: a technological evolution Discussing the next decade, Dr Kaufmann highlights the dynamic nature of health care evolution, noting that while practitioners may not always dictate practice changes, the demand for quality dermatologic care remains constant. Driven by patient preferences and technological advancements, the delivery of care is poised for transformation. Dr. Kaufmann speculates on the influence of patient preferences, noting the inclination of younger generations towards virtual interactions. As technology continues to advance, the landscape of dermatology will evolve, offering exciting prospects for practitioners and patients alike.

In this episode of Under Your Skin, host Nicholas Brownstone, MD, chats with James Q. Del Rosso, DO, who shares anecdotes and insights from his dermatology career on rare diseases, the benefits of being a dermatologist, and the outlook on treatments for challenging conditions. Encounters with a rare disease Dr Del Rosso recounts an anecdote from his internship when he encountered a patient with a rare disease he had never seen before—cytophagic histiocytic panniculitis (CHP). Despite its rarity, Dr Del Rosso encountered CHP again the following year, where, as a first-year resident, he was able to surprise a leading dermatologist by correctly diagnosing this rare condition. The dermatologist’s advantage Dr Del Rosso highlights the autonomy and diversity the field offers. Dermatologists have the flexibility to cater to patients of all ages and can choose to specialize in various areas such as cosmetic, medical, or surgical dermatology. This autonomy extends to their practice setting and scheduling, allowing for a fulfilling and adaptable career. Advancing care for challenging conditions Discussing areas where better medications are needed, Dr Del Rosso reflects on past challenges with conditions like hidradenitis suppurativa, vitiligo, and alopecia areata, where treatment options were limited. However, he expresses optimism about recent advancements in medication development, particularly in JAK inhibitors and monoclonal antibodies. He emphasizes the significant strides being made, providing much-needed additions to the dermatologist’s toolbox when treating patients with these challenging conditions

In this episode of Dermbusters, host Nicholas Brownstone, MD, and guest Dr Gabriela Maloney, DO, tackle common dermatologic myths often heard from their patients. Dr Maloey provides practical advice for clinicians to effectively counsel patients on 2 key topics: the link between diet and acne and the belief that sunscreen applications leads to vitamin D deficiency. Myth 1: Fried foods and chocolate increase the risk of acne Dr Maloney addresses the long-standing belief that diet, particularly fried foods and chocolate, plays a significant role in acne development. Historically, a 1969 study concluded that there was no direct link between acne and diet, which shifted the focus away from dietary factors. However, recent studies have revisited this topic, with some suggesting that foods high in glycemic index and fat content might exacerbate acne. Specifically, interventional studies have indicated that reducing glycemic load can potentially decrease inflammation and acne severity. Tips for counseling patients: Focus on glycemic index: Advise patients to pay attention to their diet’s glycemic index, which may be more relevant to acne management than specific foods like chocolate or fried items. Encourage a healthy diet: Recommend a balanced diet while still allowing flexibility for individual preferences, such as gluten-free or keto diets. Follow treatment plans: Emphasize the importance of adhering to prescribed acne treatments, as dietary changes alone are unlikely to resolve acne completely. Myth 2: Wearing sunscreen leads to vitamin D deficiency A common concern is that sunscreen use can lead to vitamin D deficiency. Dr Maloney explains that this fear should not prevent patients from using sunscreen and highlights that diet plays a crucial role in maintaining adequate vitamin D levels. Tips for counseling patients: Emphasize the role of diet: Explain that vitamin D can be adequately obtained through a balanced diet, eliminating the need to forego sunscreen. Highlight the risks of sun exposure: Stress that the risk of skin cancer from sun exposure outweighs the risk of vitamin D deficiency from using sunscreen. Tune in to the episode to hear Dr Maloney and Dr Brownstone provide valuable insights for dermatologists to guide patients more effectively and counter common misconceptions.

In this episode of Dermbusters, host Nicholas Brownstone, MD, sits down with Brandon Adler, MD, to address some common misperceptions they often hear from their patients. Dr Adler shares how he tackles 2 pressing concerns that dermatologists frequently encounter from their patients: the efficacy and safety of natural products, and the concerns surrounding ingredients in sunscreens. Myth 1: Natural products are always better There is a growing trend among patients towards seeking out natural products, both homemade and store-bought, with the belief that they are inherently better and safer than traditional products. Drawing from his experience running a contact dermatitis clinic, Dr Adler shares that he often sees patients who develop allergic reactions to natural ingredients, such as essential oils. Tips for counseling your patients: Explain that studies demonstrate the rates of contact allergy and irritation are at least comparable between natural and traditional products Mention that while natural products can be effective, each patient is unique and may develop sensitivities or allergies to certain ingredients Dispel the belief that natural always equals good; to illustrate the point effectively, share an analogy relating natural products to poison oak, which, while natural, is not something you want on your skin Myth 2: Harmful ingredients in sunscreens outweigh its benefit Many patients voice concerns about harmful ingredients in sunscreens, with some avoiding sunscreen use altogether to mitigate risks. Dr Adler shares a few tips on how he talks to patients on this issue. Tips for counseling your patients: Explain that while chemical or organic blockers found in many sunscreens have been shown in studies to be systemically absorbed into the body, there is no evidence of any associated adverse effects to date, and these agents have been used safely for decades For patients still concerned about systemic absorption, recommend zinc- and titanium-based physical or mineral sunscreens, which have not shown to be absorbed and therefore don’t carry the same potential implications as chemical blockers For patients with environmental concerns, physical sunscreens can also be recommended Emphasize that the risk of skin cancer is significantly greater than the potential risk of harmful ingredients in sunscreens Tune in to the episode to hear Dr Adler’s approach to individualized patient care and hear his practical solutions for addressing common patient concerns.

In this episode of Dermbusters, host Nicholas Brownstone, MD, chats with acne and rosacea expert Emmy Graber, MD, MBA, about some common misperceptions they often hear from their patients. Dr Graber shares some tips on counseling patients on 2 topics: how diet impacts acne and advising patients on isotretinoin to wait 6 to 12 months before getting cosmetic procedures. Myth 1: Fried and fatty foods cause acne. Dr Graber addresses the widespread belief among patients that fried and fatty foods can induce acne. She acknowledges the challenges of studying diet’s impact on acne but shares a few tips on counseling patients based on published data. Tips for counseling your patients: Explain to patients that while some studies suggest a correlation between high-glycemic foods and acne for some individuals, the association is not universal Emphasize the role of dairy products, particularly skim milk products, in exacerbating acne for some patients For patients who can identify specific dietary triggers, give them the option of avoiding that food Emphasize the uniqueness of individual responses to dietary triggers rather than making blanket statements Myth 2: Patients must wait at least 6 months following the use of isotretinoin before having any cosmetic or surgical procedures. Dr Brownstone and Dr Graber then discuss advising patients on isotretinoin on the often-recommended waiting period before undergoing any cosmetic or surgical procedures. Dr Graber challenges the traditional notion of waiting 6 to 12 months, relating a few discussion points to share with patients. Tips for counseling your patients: Cite a systematic review of over 32 studies and 1400 procedures1 that found no evidence supporting the need for a prolonged delay for cosmetic procedures following isotretinoin use Advise patients that procedures like visible light lasers, hair removal, superficial chemical peels, and fractional and ablative lasers are safe while on isotretinoin Counsel patients to follow the waiting period and delay more intense procedures like nonfractional lasers, deep dermabrasions, and deep chemical peels until there is more data available to support the safety of such procedures while on isotretinoin Mention potential benefits of pulsed dye laser treatments for acne for patients concurrently on isotretinoin, noting not only safety but potentially improved outcomes Tune in to the episode to hear the full details on Dr Graber’s informed approach to counseling patients that embraces evidence-based practices to optimize care. Reference Spring LK, Krakowski AC, Alam M, et al. Isotretinoin and timing of procedural interventions: a systematic review with consensus recommendations. JAMA Dermatol. 2017;153(8):802-809. doi:10.1001/jamadermatol.2017.2077

In this episode of Dermbusters, host Nicholas Brownstone, MD, sits down with Katherine Glaser, MD, a dermatologic surgeon specializing in Mohs surgery, about some common misperceptions heard from both colleagues and patients. Dr Glaser shares some insights on 2 frequently misunderstood topics: the use of lidocaine with epinephrine in the fingers and toes and the role of sunscreen in vitamin D absorption. Myth 1: Dermatologists should not use lidocaine with epinephrine in the fingers and toes. Contrary to a commonly held belief among dermatologists, Dr. Glaser emphasizes that there is robust data supporting the safe use of lidocaine with epinephrine in the fingers and toes. Despite concerns about vascular ischemia and resulting necrosis, studies from both dermatology and plastic surgery literature demonstrate the safety of lidocaine with epinephrine. Tips for advising colleagues: Share the existing data and research findings that support the safe use of lidocaine with epinephrine in the fingers and toes Highlight the lack of reported cases of ischemia with traditional lidocaine with epinephrine and contrast it with cases involving other substances, high concentrations of epinephrine, and improper tourniquet use Emphasize the importance of adhering to safe injection practices, proper dosage, and avoiding direct arterial injection to mitigate any potential risks Myth 2: Sunscreen should not be used because it prevents absorption of vitamin D. Next, Dr Glaser addresses a common myth that dermatologists often hear from their patients: that they shouldn’t use sunscreen because it prevents them from absorbing an adequate amount of vitamin D. While sunscreen does block the UVB rays that aid in vitamin D synthesis, the AAD advises against UV exposure solely for the purpose of absorbing vitamin D. Tips for counseling your patients: Explain that while sunscreen may affect vitamin D absorption, it's not a reason to skip it Highlight alternative sources of vitamin D, such as diet and supplements Encourage wearing sunscreen consistently and correctly Stress the importance of protecting the skin from harmful UV rays to prevent skin damage and reduce the risk of skin cancer

Mona Shahriari, MD and Susan C. Taylor, MD presented a visual and clinically focused guide to diagnosing prurigo nodularis in skin of color, highlighting its neuroimmune pathophysiology, disproportionate disease burden, distinct clinical features in melanin-rich skin, and the rapid, durable efficacy of newly approved targeted biologics.Raj Chovatiya, MD, PhD and Mona Shahriari, MD presented an interactive, case-based session focused on optimizing atopic dermatitis treatment through mechanism-driven biologic selection, individualized dosing strategies, and practical management of real-world clinical challenges.

Steven Daveluy, MD, James Q. Del Rosso, DO and Andrea T. Murina, MD provided a clinically focused update on hidradenitis suppurativa, emphasizing early intervention, integration of biologic and procedural therapies, and emerging targeted treatments.Shawn Kwatra, MD and Dawn Merritt, DO provided a clinically focused update on chronic spontaneous urticaria, reviewing autoimmune mechanisms, stepwise treatment strategies, and emerging biologic and BTK-targeted therapies.

Final day highlights from Miami! Our Day 3 recap video captures the closing masterclasses, final clinical pearls, and the community connections that defined our last day in Miami.

April W. Armstrong, MD, MPH, reviewed major recent developments shaping modern psoriasis management, beginning with the first consensus definition of on-treatment remission established through a Delphi process led by the National Psoriasis Foundation. This consensus defines remission as maintaining BSA 0% or IGA 0 for at least six months, providing a standardized, clinically meaningful target for long-term disease control and a consistent benchmark for evaluating durability across therapies and clinical trials.Dr Armstrong also highlighted emerging oral therapies that are redefining expectations for systemic treatment. Icotrokinra, a novel targeted oral peptide that selectively inhibits IL-23 signaling, demonstrated superior efficacy compared with deucravacitinib in the ICONIC-ADVANCE trials, achieving higher rates of IGA 0/1 and PASI 90 at Weeks 16 and 24. Additional ICONIC data showed robust PASI 90 responses in adults and durable maintenance of PASI 75 and PASI 90 through 52 weeks in adolescents, supporting both potency and durability across age groups. Long-term extension data for the TYK2 inhibitor deucravacitinib demonstrated stable efficacy and a favorable safety profile through five years, including benefit in patients with psoriatic arthritis. Dr Armstrong also reviewed emerging data for highly selective TYK2 inhibitors such as envudeucitinib, which achieved stringent treat-to-target thresholds in a majority of patients at one year. Together, these advances reflect a shift toward precise, durable, and patient-friendly oral therapies that align with newly established remission goals in psoriasis.

Chronic spontaneous urticaria (CSU) affects up to 80% of patients with chronic urticaria and is defined by recurrent hives and/or angioedema lasting longer than six weeks without an identifiable trigger. Naiem Issa, MD, and Dawn Merritt, DO, reviewed key clinical features, including pruritic wheals and angioedema that often burn and may persist for up to 72 hours. They emphasized use of the 7-Day Urticaria Activity Score (UAS7) as the gold standard for assessing disease severity and treatment response. The presenters also highlighted the autoimmune underpinnings of CSU, driven by both IgE-dependent and IgE-independent mechanisms that activate mast cells and basophils.Management was framed as a clear treatment ladder, starting with second-generation H1 antihistamines and rapid up-dosing when control is inadequate. If symptoms persist after 2–4 weeks, escalation to advanced therapies such as omalizumab, dupilumab, or remibrutinib is recommended, with cyclosporine reserved for refractory disease. Emerging data for dupilumab demonstrated meaningful reductions in itch and hives regardless of baseline IgE, while remibrutinib showed rapid onset of action, with more than half of patients achieving well-controlled disease within three weeks. The session closed with practical pearls: escalate early, continue antihistamines when adding biologics, maintain therapy for 6–12 months after complete clearance, and reassure patients that CSU is not allergy-driven despite common triggers like stress or heat.

Lawrence F. Eichenfield, MD, provided an engaging overview of how pediatric dermatology is rapidly evolving, with a focus on improving long-term outcomes through earlier diagnosis and more targeted therapies. In pediatric psoriasis, he emphasized the growing demand for effective oral options beyond traditional immunosuppressants. Promising phase 2 data were presented for icotrokinra, a novel oral IL-23 receptor–blocking peptide that achieved clear or almost clear skin in nearly 90% of adolescents by 24 weeks, with a favorable safety and tolerability profile. These results signal a potential shift toward convenient, noninjectable systemic options for children.Juvenile lichen sclerosus was highlighted as a frequently underrecognized condition with important lifelong implications. Dr Eichenfield underscored that lichen sclerosus rarely resolves at puberty, with most patients continuing to have active disease and structural changes into adolescence and adulthood. He stressed the importance of early recognition and sustained treatment with super–high-potency topical corticosteroids, even in asymptomatic patients, noting that consistent therapy significantly reduces long-term anatomic damage.The session concluded with advances in precision medicine and evolving disease definitions. In atopic dermatitis, the Identity Study was introduced as a novel approach using noninvasive gene expression profiling to predict which children are most likely to respond to JAK inhibitors versus Th2-targeted therapies, allowing for faster clearance and improved itch control. Dr Eichenfield also discussed the shift from Mycoplasma-induced rash and mucositis to reactive infectious mucocutaneous eruption, reflecting the broader range of infectious triggers now recognized. Management focuses on treating the underlying infection and controlling severe mucositis with systemic anti-inflammatory or immunomodulatory therapies, reinforcing the need for timely diagnosis and aggressive intervention in complex pediatric cases.

Susan C. Taylor, MD, presented a comprehensive update on contemporary melasma management, emphasizing evolving concepts in pathogenesis and evidence-based treatment strategies. Dr Taylor reviewed the growing understanding that melasma is a multifactorial disorder driven by ultraviolet and visible light exposure, epidermal melanocyte activation, and clinically relevant vascular component characterized by increased vessel number, density, and angiogenesis. These mechanisms help explain disease chronicity, relapse, and treatment A central focus of the presentation was the international Delphi consensus on melasma management, developed by 38 experts from 11 countries to standardize diagnosis, monitoring, and treatment. The consensus identified Wood’s lamp examination as a favored method for assessing extent and severity, with dermoscopy accepted for differential diagnosis. Photoprotection was emphasized as foundational therapy, with the “ideal” sunscreen providing protection against UVA, UVB, and visible light, and optional inclusion of antioxidants or depigmenting agents to enhance efficacy. For treatment, triple-combination therapy with hydroquinone, tretinoin, and fluocinolone acetonide was reaffirmed as the gold-standard first-line option for moderate-to-severe melasma, while azelaic acid, antioxidants, and non-hydroquinone agents were highlighted as alternatives or maintenance options. Oral tranexamic acid, chemical peels, microneedling, and energy-based devices were reserved for refractory disease within a stepwise algorithm. Dr Taylor also reviewed comparative clinical trial data for newer non-hydroquinone therapies. A randomized non-inferiority trial demonstrated that a 2-Mercaptonicotinoyl Glycine–containing serum achieved similar improvements in mMASI compared with hydroquinone 4%, with fewer local reactions. Additional studies showed that thiamidol and topical metformin produced MASI reductions comparable to hydroquinone-based regimens, supporting their role as effective alternatives in select patients. Collectively, the data reinforce a modern treatment framework that combines standardized photoprotection, targeted topical therapy, and vascular-directed interventions to address both pigment production and relapse risk in melasma.

Take a peek at the atmosphere and buzz in the conference rooms, exhibit hall, and receptions from Fall Clinical 2025 in Las Vegas!

Shawn G. Kwatra, MD, presented a compelling session on the evaluation and management of chronic itch, underscoring its profound impact on patient quality of life. Chronic pruritus, he noted, impairs quality of life to a degree comparable to that of stroke and more than conditions such as heart failure with an implantable defibrillator or patients on hemodialysis. Despite being one of the most common symptoms in dermatology, pruritus often remains diagnostically elusive and therapeutically challenging. Through a series of illustrative cases, Dr Kwatra emphasized that chronic itch can be the first sign of systemic disease and requires careful evaluation beyond the skin. Dr Kwatra discussed emerging insights into the genetic and immunologic underpinnings of chronic itch, including a potential polygenic risk association in prurigo nodularis. He reviewed targeted treatments such as dupilumab, which has shown efficacy for chronic itch of various etiologies, and low-dose naltrexone, which modulates μ-opioid signaling and inflammatory mediators to relieve refractory scalp pruritus and symptoms in conditions such as epidermolysis bullosa. Additionally, he provided a practical framework for laboratory and clinical evaluation, including eosinophil counts and screening for systemic causes when the origin of itch is unclear. Concluding with complex cases of widespread pruritic dermatoses, Dr Kwatra illustrated how integrating immune profiling and genomic analysis can identify dominant cytokine pathways (IL-13, IL-17) and guide rational biologic therapy selection.

Alexandra Golant, MD, Mona Shahriari, MD, and G. Michael Lewitt, MD, presented a session focused on the evolving role of interleukin-13 (IL-13) inhibition in atopic dermatitis, sharing new insights, case experiences, and strategies for optimizing treatment in clinical practice.Dr Golant opened by underscoring the central role of IL-13 in atopic dermatitis pathophysiology. Elevated across age groups and skin tones in patients with atopic dermatitis, IL-13 drives barrier disruption, decreases filaggrin expression, and fuels pruritus and lichenification. She reviewed case examples, including an adolescent with long-standing disease who achieved rapid and sustained improvement on lebrikizumab. Dr Golant emphasized how patient-defined goals such as comfort at school, confidence in social settings, and reduced topical burden align with the responses seen in trials. Early and aggressive targeting of IL-13 was presented as a way to meet both clinical and quality-of-life outcomes.Dr Shahriari expanded on the comparative efficacy of IL-13 biologics, highlighting pivotal data from SOLO, ADvocate, ECZTRA, and long-term extension studies. Both lebrikizumab and tralokinumab demonstrated durable control, with maintenance of EASI90 and pruritus relief extending beyond 2 years. She also addressed switching strategies, noting that patients discontinuing dupilumab for adverse events often achieved better outcomes on lebrikizumab compared with those stopping for inadequate response. Dr Shahriari presented cases of patients with dupilumab-associated ocular surface disease whose symptoms resolved when transitioned to tralokinumab or Janus kinase inhibitors, underscoring the importance of individualized sequencing.Dr Lewitt concluded with a practical perspective on integrating IL-13 inhibitors into daily practice. He illustrated this with a young adult patient who prioritized clearance of hand and facial dermatitis with minimal treatment burden. After 16 weeks of lebrikizumab, both skin clearance and pruritus improved markedly, restoring confidence and function. Dr Lewitt highlighted safety profiles across the IL-13 inhibitor class, emphasizing that adverse events are generally manageable and that selective inhibition may be particularly appealing when patients prefer targeted therapy without systemic immunosuppression. Looking forward, the faculty noted that biologics with extended half-lives, bispecific antibodies, and oral agents may further expand long-term disease control options.

Linda Stein Gold, MD, MS, Cheri Frey, MD, FAAD, Peter Lio, MD, FAAD, and Bruce Strober, MD, PhD, led an expert discussion highlighting cutting-edge advances in topical dermatologic therapy that are transforming treatment safety, efficacy, and patient outcomes across acne, rosacea, atopic dermatitis, and psoriasis.Dr Stein Gold opened with an evidence-based review addressing concerns regarding benzoyl peroxide (BPO) and potential benzene contamination. She summarized recent multicenter studies from 2024–2025 confirming that BPO use does not increase the risk of benzene-related malignancies, emphasizing that product stability depends on formulation chemistry and appropriate storage, specifically refrigeration, avoiding heat, and renewing products every few months. Dr Stein Gold also discussed the FDA approval of low-dose extended-release minocycline (DFD-29, 40 mg) for rosacea, presenting phase 3 data demonstrating strong efficacy, a favorable safety profile, and minimal microbiome disruption, supporting its role as a next-generation oral option for long-term rosacea management.Dr Frey followed with an overview of advances in cosmeceutical science, focusing on novel retinoid analogues, peptides, and regenerative skincare. She explained how new retinoid derivatives such as retinyl retinoate and hydroxypinacolone retinoate enhance collagen and hyaluronic acid production while reducing irritation compared to traditional formulations. Dr Frey also described the therapeutic potential of bioactive peptides, palmitoyl tetrapeptide-7, oligopeptide-68, acetyl hexapeptide-3, and copper tripeptide-1 (GHK-Cu), in promoting skin repair, modulating pigmentation, and attenuating inflammation, though she noted that delivery optimization remains a clinical challenge. She concluded with an introduction to exosome-based regenerative skincare, which can promote wound healing and dermal rejuvenation through the Wnt/β-catenin and VEGF pathways, while underscoring the importance of regulatory oversight and controlled clinical validation.Dr Lio then presented an update on the evolving therapeutic landscape for atopic dermatitis (AD), structuring his discussion around the practical goals of “Get Clear, Keep Clear, Keep It Up.” He reviewed new guideline-supported treatment algorithms incorporating topical corticosteroids, calcineurin inhibitors, and an expanding array of nonsteroidal options such as ruxolitinib, roflumilast, delgocitinib, and tapinarof. Comparative data demonstrated superior patient-reported outcomes with tacrolimus 0.03% versus crisaborole, while ruxolitinib and tapinarof provided durable disease control and favorable safety. Dr Lio emphasized the need for long-term maintenance strategies and barrier repair to sustain remission and improve quality of life.Dr Strober concluded with a discussion of topical innovation in psoriasis and seborrheic dermatitis. He reviewed pivotal trial data showing that roflumilast 0.3% and tapinarof 1% achieve high rates of clearance, durable remission, and excellent tolerability, even in intertriginous and facial regions. Dr Strober highlighted the DERMIS and PSOARING programs, noting the remittive effects of tapinarof and the consistent tolerability of roflumilast across age groups. He positioned both agents as first- and second-line nonsteroidal options that deliver biologic-level efficacy through topical mechanisms. Collectively, the speakers illustrated how formulation science, molecular innovation, and patient-centered design are converging to usher in a new era of precision-driven topical therapy in dermatology.

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Dr Scott Jackson explored how common medications can lead to protean cutaneous morphologies, often mimicking different skin diseases. He highlighted some of the most-talked-about drug-induced cutaneous disorders and provided some classical and some surprising associations. The session began with a discussion of drug-induced dermatomyositis (DM), which has been associated with hydroxyurea, immune checkpoint inhibitors, and statins. Statins received particular attention. Although typically used to lower cholesterol through inhibition of HMG-CoA reductase, statin exposure can trigger an autoimmune response, leading to the production of anti–HMGCR antibodies. These antibodies target muscle tissue, resulting in necrotizing autoimmune myositis and a cutaneous eruption that overlaps with features of DM.Next, Dr Jackson covered drug-induced cutaneous lupus (DI-SCLE). Over the past decade, several medications have been implicated, including anti-TNF alpha agents, immune checkpoint inhibitors, and proton pump inhibitors (PPIs). Notably, PPIs have been increasingly linked to a wide range of cutaneous reactions, from fixed drug eruptions to acute generalized exanthematous pustulosis (AGEP).He then discussed drug-induced asteatosis and eczematous dermatoses, citing associations between statins and diuretics with xerosis cutis, amlodipine with stasis dermatitis, calcium channel blockers with eczema, statins with eczematous dermatitis, and IVIG with dyshidrotic eczema. The lecture continued with an overview of drug associations with psoriasiform dermatitis and drug-induced psoriasis, including lithium, antimalarials, oral and topical beta-blockers, terbinafine, and, more recently, checkpoint inhibitors, TNF–alpha inhibitors, and bupropion. Dr Jackson also addressed drug-induced alopecia areata (DI-AA) associated with some of the most common monoclonal antibody therapies in dermatology. Drug-induced bullous pemphigoid (DI-BP) was another major topic. In one retrospective review, 20% of BP cases were drug-induced. Suspected culprits were dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors), furosemide, monoclonal antibodies used for psoriasis, and immune checkpoint inhibitors. The lecture concluded with a comprehensive review of other drug-related dermatologic conditions, including fixed drug and food eruptions, lichenoid drug eruptions, drug-induced pseudo-lymphoma, pseudo-porphyria, DRESS syndrome, drug-induced vascular disorders, and drug-induced delusional parasitosis. Overall, through his lecture Dr Jackson emphasized the importance of maintaining a high index of suspicion for drug-induced causes when evaluating dermatologic conditions.

Hidradenitis suppurativa (HS) remains one of the most challenging conditions in dermatology—not just clinically, but in its profound impact on patients’ physical, emotional, and social well-being. Curtis Chen, PA-C shared practical strategies for improving care, including how to navigate tough conversations around weight loss, fertility, and the often-asked question of whether HS can be cured. He also showcased impressive clinical outcomes using deroofing, offering both hope and real-world clinical insight.

Acne is a common diagnosis for dermatology providers, yet its management can be surprisingly complex—both in distinguishing it from similar conditions and in tailoring treatment across diverse age groups. Julie Harper, MD, delivered a clear and practical talk on acne management from neonates to adults. She began by covering neonatal (0–6 weeks) and infantile acne (6 weeks–1 year), highlighting a key question: when is isotretinoin appropriate in young children? Dr Harper then addressed another challenging area: acne management during pregnancy and lactation. She walked through the timing and reintroduction of isotretinoin postpartum, and reviewed the risks associated with tetracyclines and spironolactone. To simplify safe prescribing, she shared a helpful mnemonic: “3 for 3 trimesters,” referring to three topical treatments (azelaic acid, benzoyl peroxide, clindamycin—ABC) and three antibiotics (amoxicillin [not in the first trimester], azithromycin, cephalexin, clindamycin, and erythromycin [not estolate, and not in the first trimester]—ACE). Finally, she turned to acne in non-pregnant, non-lactating adults, covering both established and emerging therapies. These included oral contraceptives, spironolactone, and clascoterone cream 1%, with thoughtful discussion of their benefits, drawbacks, and appropriate use.