Under Your Skin

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 Under Your Skin, host Nicholas Brownstone, MD, chats with guest Andrew Alexis, MD, MPH, about the public perception of dermatology, therapeutic gaps for challenging pigmentary conditions, and balancing aesthetics and medical dermatology in the clinic. The incomplete public perception of dermatology They begin by discussing the public perception of dermatology, noting that the general public may not fully grasp the extent of dermatologists' contributions. Dr Alexis highlights the diversity of the specialty and its profound impact on individuals' lives. He emphasizes that dermatology encompasses a wide spectrum of care, ranging from aesthetics to inflammatory conditions, infectious diseases, and diagnosing internal diseases through cutaneous manifestations, noting the myriad ways in which dermatologists positively influence patients' well-being. Therapeutic gaps for pigmentary disorders Transitioning to therapeutic considerations, Dr Alexis acknowledges the remarkable recent advancements in dermatology. However, he underscores the persistent need for better therapies, particularly for pigmentary conditions such as lichen planus pigmentosus and erythema dyschromicum perstans, or ashy dermatosis. These challenging conditions pose treatment difficulties due to limited therapeutic options, and Dr Alexis expresses hope for future breakthroughs in identifying new targets and developing effective therapies to address these unmet needs. The intersection of aesthetics and medical dermatology Shifting focus to aesthetic dermatology, Dr Alexis provides insights into the evolving landscape of his practice. He shares that approximately 40% of his time is dedicated to performing aesthetic procedures, such as lasers, peels, and injectables, and that he anticipates a continued increase in the demand for aesthetic services over time. Many of Dr Alexis' aesthetics patients initially sought medical dermatology care but later returned for aesthetic procedures to address additional concerns. This trend underscores the intersection between medical and aesthetic dermatology and highlights the expanding role of dermatologists in meeting patients' diverse needs.

In this episode of Under Your Skin, host Nicholas Brownstone, MD, gets to know renowned dermatologist and social media sensation Sandra Lee, MD, known by her fans as Dr Pimple Popper. Delving beyond dermatology, the duo explores alternative career paths, relaxation techniques after a hectic day in the clinic, and the best part of Dr Pimple Popper's unique role. Exploring alternative career paths When considering alternative career choices beyond dermatology, Dr Lee shares 2 possibilities. Firstly, she entertains the notion of a professional potato chip tester, drawn to the allure of indulging in salty snacks. Secondly, she contemplates a career in marketing, relishing the opportunity to exercise creativity and conceptualize innovative ideas. Finding balance in a busy profession Reflecting on methods to unwind post-clinic, Dr Lee details the significance of finding balance amidst the demands of professional and personal life. For Dr Lee, that means quality time with her family and cats; she also emphasizes the importance of finding time for self-care during a busy schedule. A fulfilling benefit of social media stardom Dr Lee finds fulfillment in her interactions with her young fans. She recounts instances of children visiting her office for birthday celebrations or casual encounters, inspired by the prospect of pursuing dermatology as a future vocation. Dr Lee finds profound gratification in fostering their interest in dermatology, underscoring the enduring impact of her role on future practitioners.

In this episode of Under Your Skin, host Nicholas Brownstone, MD gets to know Doris Day, MD, FAAD, a dermatologist specializing in laser, cosmetic, surgical, and aesthetic dermatology. Dr Day offers tips on guiding conversation with difficult patients, gives her thoughts on an emerging trend in dermatology, and shares her approach to a healthy work-life balance. Understanding the demanding patient and guiding the conversation Dr Day approaches interactions with demanding patients with empathy and understanding. Rather than viewing them as difficult, she recognizes their need to be heard and understood. By empathizing with their anxieties, expectations, and budget constraints, she transforms demanding patients into supportive allies. She also believes in transparent communication and education. Instead of persuading patients into treatments, she informs them about their options and recommends a holistic approach. Starting conversations with compliments helps ease tension and facilitates open dialogue. By striking a balance between meeting patients where they are and being honest about what can be achieved, Dr Day guides conversations with these patients effectively. Sometimes, she acknowledges when she might not be the right fit for a patient, prioritizing ethical practice over profit. A trend towards dermatology’s expanding scope When discussing emerging trends in dermatology, Dr Day says she looks forward to the expanding scope of the field. She emphasizes the importance of recognizing the value of appearance, noting that while many common dermatologic conditions are not life-threatening, they still profoundly impact a patient’s overall well-being and self-confidence. As the population gains a better understanding of general health, Dr Day foresees a future where dermatologists play a crucial role in enhancing healthspan through a holistic approach that integrates skin care, lifestyle modifications, and preventive healthcare. Avoiding burnout with an integrated approach to life To avoid burnout, Dr Day advocates for an integrated approach to life. Balancing her professional commitments with personal interests, such as family, allows her to find fulfillment. She advises against setting goalposts that must be achieved before pursuing the next goal and instead suggests a more balanced approach to the work-life relationship. She emphasizes the need to compartmentalize stress and prioritize self-care. By consciously separating work-related concerns from personal life, Dr Day maintains emotional well-being and prevents burnout.

In this installment of Under Your Skin, host Nicholas Brownstone, MD, sits down with Lisa Swanson, MD, to hear her commentary on what she loves most about being a dermatologist, her tips on dealing with demanding patients, and what conditions we still need better treatments for in dermatology. A passion for dermatology Dr Swanson's journey into dermatology is deeply rooted in childhood experiences growing up with her urologist father. She was exposed to the medical world early through manually organizing and filing her father's research articles and was impacted by his perspectives on medical practice, which became a driving force in her decision to become a doctor. Dr Swanson sees herself practicing in the "golden age of dermatology," driven by the profound impact dermatologists can have on improving patients' lives. Dealing with demanding patients Addressing the challenge of demanding patients, Dr Swanson emphasizes 2 crucial elements: listening and accessibility. As a pediatric dermatologist, she makes sure to allocate ample time for appointments with potentially demanding parents. This ensures that she’s able to listen thoroughly to their concerns without these extended encounters impacting her ability to stay on schedule in clinic. Regarding accessibility, Dr Swanson encourages email communication with her more demanding patients, establishing a connection that helps diffuse tension by offering them an easy way to ask questions. Drs Brownstone and Swanson acknowledge that doctors may be hesitant to share contact information in this way for fear that patients will abuse it; however, they both agree that patients are usually reassured simply by having access to this valuable outlet and thus rarely overuse it. Improving the treatment landscape for challenging conditions Dr Swanson identifies 3 conditions in need of better treatment options in dermatology. Hidradenitis suppurativa presents challenges for many patients despite existing treatments, though she anticipates more solutions in the coming years. She also feels alopecia areata and vitiligo need improved medication options. However, both appear to be on the cusp of a treatment revolution, particularly with the promising developments in JAK inhibitors.

In this episode of Under Your Skin, host Nicholas Brownstone, MD, chats with Muneeb Shah, DO, to explore some valuable advice for residents, effective time management techniques, and strategies for advertising your practice. What advice would you give someone just beginning residency? Dr Shah begins by reflecting on his residency experience, likening it to "drinking from a fire hose" due to the overwhelming influx of information. His key advice to residents is to seize this period as a valuable learning opportunity. He emphasizes the importance of asking questions and seeking insights not only on clinical matters but also on aspects like billing and operations. He encourages residents to attend conferences, network, and absorb as much knowledge as possible, as the intensity of post-residency responsibilities may leave little room for catching up on missed learning opportunities. What are your most useful time management techniques? Acknowledging his own journey to improve time management, Dr Shah underscores the significance of building a supportive team. Delegating tasks that may not be the best use of one's time to qualified team members, whether an office manager or medical assistant, allows for more efficient and strategic use of time. Additionally, he advocates for creating systems within the office to streamline patient interactions, suggesting the implementation of codes to prompt assistance when spending excessive time with a patient. Dr Shah's insights highlight the long-term benefits of optimizing team dynamics and establishing efficient office protocols. How do you advertise your practice? Dr Shah acknowledges the benefit having a large social media following has in attracting patients; however, he notes that patients discovered through social media tend to be more complex. They often seek him out after other dermatologists were unable to solve difficult-to-treat issues and have higher expectations. He also notes that despite having a large social media following, targeting a specific geographic area remains a challenge. Considering that, Dr Shah does not dismiss traditional advertising methods like door-to-door marketing and business card distribution to local family physicians and businesses, noting that he has seen significant success with these tactics.

In this episode of Under Your Skin, host Dr Nicholas Brownstone is joined by Dr Terrence A. Cronin Jr, the president of the American Academy of Dermatology for the 2023-2024 term, to discuss the impact of social media on dermatology, strategies to avoid burnout, and one of the most pressing challenges facing dermatologists today—physician reimbursement. Social media's influence on dermatology One significant topic discussed in the episode is the influence of social media on the field of dermatology. Dr Cronin expresses concern about individuals presenting themselves as skin experts without the necessary background or education, spreading misinformation through platforms like TikTok and Instagram. To counter this, the American Academy of Dermatology (AAD) has initiated the "Your Dermatologist Knows" program, which features ambassadors who actively address public concerns on AAD social media sites with scientifically studied and professional responses. The goal is to combat misinformation and ensure accurate information reaches the public. Additionally, Dr Cronin cautions dermatologists who engage with social media regarding maintaining their professional standing, noting that involvement in social media may be perceived as unprofessional or lead to the inadvertent sharing of information that could be used against dermatologists in their professional future. Combating burnout in dermatology Dr Cronin emphasizes the importance of dermatologists finding outlets beyond their daily work to prevent burnout. Given that dermatologists are visual learners who excel at recognizing patterns, he suggests engaging in activities slightly outside the norm. His recommendations include exploring artistic outlets such as music or creative writing. These activities can serve to stretch creativity and reengage the part of the brain worn down by day-to-day work. The biggest challenge facing dermatology today The central issue highlighted in the episode is the broader challenge facing dermatology and the medical profession in general. Dr Cronin points out that physicians, including dermatologists, are grappling with inflation and physician reimbursement cuts imposed by the government. Physicians are notably the only group within the medical-industrial complex not receiving an inflationary update from the federal government. As inflation rises, hospitals, nursing homes, and inpatient and outpatient facilities receive increased payments, creating a financial gap that physicians struggle to bridge. The episode concludes with a call to action, urging physicians and patients alike to reach out to their congressmen and advocate for change. AAD members can visit https://takeaction.aad.org/ to easily contact their congressmen and can also advocate on social media with the hashtag #fixmedicarenow to add their voices to this vital call for action.

In this episode of Under Your Skin, host Nicholas Brownstone, MD, chats with Gary Goldenberg, MD, about a tip for improving practice efficiency, dealing with demanding patients, upcoming innovations in dermatology, and his unique work-life balance. What change have you made in your practice in the last 5 years that has had the biggest impact on your efficacy? One standout modification Dr Goldenberg made in his practice was introducing private-label skincare. He emphasizes the importance of addressing patients' skin care, considering it a fundamental aspect sometimes overlooked by dermatologists. In his practice, it's now a routine question for every patient, and he’s able to offer them curated regimens available for purchase in the office. He notes that offering private-label skin care can be done relatively inexpensively, enhances patient care, and allows dermatologists to have a clear view of the products their patients are using. How do you deal with demanding patients? When dealing with demanding patients, Dr Goldenberg advocates for setting clear expectations from the start. For instance, managing expectations is crucial in cases like hair loss, where realistic outcomes need to be communicated. He emphasizes the significance of active listening. When patients come to him with many areas of concern, he has them make a list of their priorities and they address them accordingly. By transforming challenging situations into positive interactions, he notes that demanding patients often become some of the most valuable. What innovations in dermatology are you most excited about? Dr Goldenberg predicts that dermatology is on the brink of a regenerative medicine revolution. Beyond just platelet-rich plasma, he anticipates advancements in stem cells and exosomes that hold promise across various aspects of medicine. He notes that these products are still considered experimental, but that the potential for regenerating collagen, elastic fibers, skin cells, and hair opens up new avenues for improving patients' lives. What advice do you have for other husband/wife dermatology couples who practice? Dr Goldenberg, who is in practice with his wife, highlights the advantages of their partnership, noting that they can cover for each other and share common goals of patient care and practice success. He comments that having the same boss at home and in the office promotes harmony and is his preferred way to navigate his professional and personal spheres.

In this episode of Under Your Skin, host Dr Nicholas Brownstone engages in a conversation with Dr Jocelyn Kirby to explore strategies for avoiding burnout, time management techniques in clinic, and advice for dermatology residents. How do you avoid burnout? One key insight from Dr Kirby is the significance of staying connected to the purpose behind her work—the patients. By seeing patients as individuals rather than just by appointment times or medical conditions, she finds a deeper sense of fulfillment. Taking the time to understand her patients on a personal level becomes a meaningful antidote to burnout. What is your favorite time management technique in clinic? When discussing time management techniques in the clinic, Dr Kirby acknowledges the inevitability of occasionally falling behind schedule. Despite this, she stresses the importance of being present in the moment with each patient. By focusing entirely on the individual she is currently counseling, she avoids distractions related to previous or upcoming appointments, ensuring that each patient receives her full attention and care. If you could go back in time to your first day as a dermatology resident, what advice would you give yourself? Reflecting on her own journey as a dermatology resident, Dr Kirby recognizes the prevalence of imposter syndrome among her peers. She collaborated on a project with a colleague, Dr Paul Riegen, and discovered that around 90% of dermatology residents experience imposter syndrome, a phenomenon that often extends beyond residency. Her advice to her younger self is to recognize her worth, acknowledge the hard work that brought her to where she is, and trust in the respect and support of her colleagues. This self-assurance, she believes, is key to sustained success in the field.

In this episode of Under Your Skin, host Dr Nicholas Brownstone chats with Dr Raj Chovatiya about a tip for improving efficacy in your practice, advice for residents on their first day, and exciting innovations in dermatology. What’s one change you’ve made in your practice in the last 5 years that had the biggest effect on your efficacy? Dr Chovatiya remarks that he loves balancing clinical work and research but faces a dilemma of how to combine the 2 while using all hours of his day efficiently. He advises that dermatologists should find a way to make clinic work for them. If there are research questions they’re interested in, they should find a way to relate it to their patients and work those efforts into their clinical time. For Dr Chovatiya, he builds efforts to understand the burden of inflammatory skin disease and issues facing patients with skin of color into each of his encounters, which saves him time and makes him feel as if he is combining 2 things he loves on a day-to-day basis. If you could go back in time to your first day of residency, what advice would you give yourself? Dr Chovatiya advises residents that they never know which direction their future careers may take, so they should be open to exploring opportunities they may not otherwise think about. He reflects on aspects of his career he’s been involved with relating to clinical interest, partners in industry, and research work, and notes that he wouldn’t have been able to predict some of the direction his career has taken. He advises that remaining open to serendipitous opportunities can lead to surprising results. Which innovation in dermatology are you most excited about? Dr Chovatiya is enthusiastic that topical medications are becoming important again. As someone who does a lot of work with inflammatory disease, including psoriasis, hidradenitis suppurativa, and eczema, he notes that while there have been huge developments in systemic and biologic therapies, dermatologists have still been using the same topicals that have been in use for many years. He comments on promising new investments in the last several years in mechanisms of action, vehicles, and issues relating to patient adherence with topicals. He notes that this is exciting because topical treatments are the mainstay of dermatologists; many patients have conditions in the mild-to-moderate range where topicals are the right choice. He hopes to see that investment in topical therapies continue to grow over the next decade.

In this episode of Under Your Skin, host Nicholas Brownstone, MD, gets to know Alexandra Golant, MD, as they discuss her favorite thing about being a dermatologist, her favorite disease to treat, and her best tip for treating patients with inflammatory skin disease. What’s your favorite thing about being a dermatologist? Dr Golant encourages residents who come through her program to remember how lucky they are and to take the drive they have when applying to the program and carry it with them throughout their careers. She feels that dermatology is a very special, relationships-based specialty; she values the ability to take care of so many patients throughout the day and that each of her colleagues can curate their own mixture of patient care, research, and resident education. She also appreciates being able to speak and meet colleagues nationally and internationally and finds that the opportunity to do so makes dermatology particularly meaningful. What’s your favorite disease to treat and why? Dr Golant loves treating inflammatory skin disease, especially atopic dermatitis. She reflects that dermatologists may now take for granted the availability of advanced systemic therapeutics, but that until very recently, patients with atopic dermatitis were ignored from a therapeutic standpoint and had very limited treatment options. She appreciates the ability to positively impact a patient by helping to restore their quality of life; in some cases, patients are enabled to experience life as if they don’t have atopic dermatitis, which for some patients, has been affecting them since childhood. As atopic dermatitis treatments have emerged for younger and younger patients, Dr Golant remarks that the ability to intervene earlier during the stage when children are developing self-esteem and managing school performance makes for a powerful doctor-patient relationship that she greatly values. What is your best tip for treating a patient with inflammatory skin disease? Dr Golant’s best tip for treating patients with these conditions is to actively listen and take time to ask patients what is driving their suffering. By learning each patient’s unique priorities, you can tailor your treatment to suit them and get the best result possible.

In this installment of Under Your Skin, host Nicholas Brownstone, MD, chats with Andrea Murina, MD, to get tips on time management and dealing with demanding patients. Dr Murina also shares her thoughts on what condition dermatology still needs better treatments for. What’s your favorite time management technique in clinic? Dr. Murina finds that getting an early start to her day helps her to best manage her time. She also provides some tips on writing notes. She shares her technique of setting aside a block of time to work on them; if she doesn’t finish her notes within that block, she moves the remainder of that task to the next day. She finds that unfinished work makes her more focused the next day and helps increase her efficiency. How do you deal with demanding patients? Dr. Murina values challenging patients because they teach valuable lessons. One such lesson she has learned from her demanding patients is the importance of listening. She finds that taking the time to sit down and actively listen is the best way to bring down the intensity of a demanding patient. What condition in dermatology do we still need better treatments for? Dr. Murina feels the biggest gap in dermatology currently is treatment for hidradenitis suppurativa. There is currently only one FDA-approved biologic for this condition, and all other treatments for it are off label. She emphasizes that dermatology needs more FDA-approved medications in this area.

In this installment of Under Your Skin, Dr. Nick Brownstone chats with Dr. Mesinkovska about her favorite disease to treat and which innovations in dermatology she’s most excited about. He also gets a helpful tip on one way to increase efficiency in the office. What is your favorite disease to treat and why? Dr. Mesinkovska replies that her favorite disease to treat is alopecia areata because dermatologists finally have a treatment for it. With JAK inhibitors revolutionizing the field, she finds it very satisfying to be able to assure her patients that there is now a treatment available. She also notes the positive effects of dupilumab for children with atopic dermatitis. She comments that with the development of baricitinib, the field of alopecia areata has experienced a game-changing event. She also reflects on the positive developments for other types of alopecia that have benefitted from the development of oral minoxidil. She remarks that she’s hopeful more JAK inhibitors will enter the market. What innovations in dermatology are you most excited about? Dr. Mesinkovska remarks that she’s happy treatment for chronic inflammatory diseases has shifted from injectables to oral treatments taken daily and that dermatologists are able to treat people more effectively with fewer injections. In the realm of aesthetic devices, she is also pleased about the development of micro-coring technology, which uses needles big enough to puncture skin and remove tissue but heal without a scar. She remarks that this technology can likely help tighten not only faces, but bodies as well. In the past 5 years, what is 1 thing you’ve done to increase your efficiency in the office? Dr. Mesinkovska explains that she realizes what she likes to do and how many people she wants to see, and she accomplishes this by recognizing her own worth. She comments on the urge doctors often have to be people-pleasers but recognizes that she can raise her own value by raising her prices and choosing to see 1 patient instead of 3. This allows her to dedicate more time to that patient and leave the exam room feeling less burnt out while not sacrificing any value monetarily.

In this episode of Under Your Skin, Dr. Nick Brownstone chats with Dr. Gabriela Maloney about her journey from Brazil to Wisconsin, her favorite thing about being a dermatologist, tips for staying efficient in the clinic, and how she counsels patients on a common misperception in dermatology.What was your journey like from growing up in Brazil to practicing dermatology in Wisconsin?Dr. Maloney explains that when she was 15, she received a scholarship to become a high school exchange student and later also received a college scholarship. She wanted to pursue medical school but first needed to save some money. After working for 2 years at a biotech company, she saved enough to apply to medical school. After medical school, she had an opportunity to work in Wisconsin, which she describes as a family-friendly place with very nice people.What’s your favorite thing about being a dermatologist?Dr. Maloney explains that she loves the variety of patients dermatologists see, from newborns to the elderly. With a wide array of conditions to treat surgically, cosmetically, and medically, there are no repetitive days in dermatology. With many systemic diseases that can show up in the skin, she feels dermatology especially encourages doctors to retain and use the knowledge they learned in medical school daily. She finds it very rewarding to make a positive impact on patients’ quality of life.How do you stay efficient in clinic?Dr Maloney notes that to stay efficient in clinic, she makes sure to look at her schedule ahead of time, highlight potential derailments, and prepare her staff. She schedules surgeries 10 minutes ahead of when she wants patients to arrive, so if they are late, it doesn’t impact her daily schedule and they have sufficient time to get checked in, prepped, and consented. She also does her large cosmetic procedures right before lunch; with this tactic, if patients have a vasovagal episode or need more recovery time, they can be safely kept in the room without derailing the day.What’s a common misperception you hear from patients, and how do you address it?Dr. Maloney finds that many patients with melasma think they don’t need daily sunscreen because they don’t spend much time outside. She explains to patients that even if they think they don’t go outside, we all inevitably take the trash out, walk our dogs, get the mail, or chat with a neighbor, all of which add to daily sun exposure contributing to melasma. She counsels patients to keep their sunscreen next to their toothbrushes to encourage daily application.

In this episode of Under Your Skin, Dr. Nick Brownstone sits down with Dr. Jane Bellet to hear about a common misperception she hears from her patients, her best tip for treating hemangiomas in pediatric patients, and her opinion on what condition we need better treatments for in dermatology.What is the most common misperception you hear from your patients?The most common misperception Dr. Bellet hears from her patients is that they shouldn’t apply sunscreen to babies under 6 months of age. She advises her patients that while babies should still be shaded and wear protective clothing outside, it’s essential to use a physical blocker with zinc oxide or titanium dioxide to prevent sunburn.What is your best tip for treating pediatric patients with hemangiomas?Dr Bellet advises that the most important thing to do when treating a hemangioma in pediatric patients is to treat early. She emphasizes that doctors should not delay referring patients to a pediatric dermatologist as young as possible since treatments for hemangiomas work better when the patients are younger.Which conditions do we need better therapies for in dermatology?In Dr. Bellet’s opinion, dermatology needs better therapies for nail lichen planus. Dermatologists often struggle to treat it, and she hopes that in the future, better treatment options will develop.

In this episode of Under Your Skin, Dr Nick Brownstone sits down with Dr Ted Lain for a quick Q&A session covering Dr Lain’s favorite thing about being a dermatologist, his perception of the biggest challenge facing dermatology, and his thoughts on how dermatology will evolve in the future.What’s your favorite thing about being a dermatologist? Dr Lain explains that his favorite thing about being a dermatologist is the clinical trials and research. Being a dermatologist allows him to focus on aesthetic, cosmetic, and medical dermatologic research.What’s the biggest challenge facing dermatology?In Dr Lain’s opinion, the biggest challenge currently facing dermatology is the economy and the economic headwinds. He advises dermatologists to focus on core business strategy principles to survive and thrive.How do you think dermatology practice will evolve over the next 10 years?Dr Lain believes that over the next 10 years, artificial intelligence will elevate and augment what dermatologists are able to achieve in terms of diagnosis and treatment.

In this episode of Under Your Skin, Dr Nick Brownstone chats with Dr Brian Kim to ask about the rarest disease he’s seen in his career and hear his thoughts on the future of dermatology.What’s the rarest disease you’ve seen in your career?Dr Kim describes the case of a pediatric patient with eczema who was referred for molluscum in the setting of eczema. Dr Kim suspected an immunodeficiency due to the extent of the patient’s molluscum and discovered the patient had a mutation in the CARD11 protein. The patient was within a cohort of the first patients with a CARD11 deficiency.How will dermatology be practiced 10 years from now?Dr Kim predicts 3 major shifts in the practice of dermatology over the next 10 years. First, he believes more specialization will develop, which will result in more delegation. Second, he anticipates that artificial intelligence will play a role in dermatology. Last, he foresees that randomized trials will lose some significance as targeted therapeutics continue to emerge.Which conditions do we need better treatments for?Dr Kim emphasizes that dermatology needs better treatment for chronic itch. He feels there is a significant misunderstanding about itch being unimportant even though it’s the most common symptom seen in dermatology.

In this episode of Under Your Skin, Dr Nick Brownstone chats with Dr Tina Bhutani to hear about the rarest disease she’s encountered in her career and to get some tips on time management and avoiding burnout.What’s the rarest disease you’ve seen in your career?Dr Bhutani describes a case of Sneddon-Wilkinson disease, or subcorneal pustular dermatosis, a very rare and difficult-to-diagnose condition involving a combination of clinical and pathological diagnoses.What’s your favorite time management technique?Dr Bhutani’s favorite time management tip is to create a list with patients, especially new patients, as soon as a visit begins. She has patients make a checklist of everything they want to discuss and then prioritize the top 2 items. She’ll discuss those 2 topics during the visit and bring patients back for a follow-up visit to discuss the remainder a few weeks later. She explains that this technique helps set expectations while still ensuring the patient feels their needs are being met.How do you avoid burnout?Dr Bhutani avoids burnout by prioritizing and scheduling self-care, whether it’s workout sessions or time with family and friends. She puts these events on her calendar and treats them like any other important meeting. She makes a point not to cancel and holds herself accountable for her own self-care.

In this episode of Under Your Skin, Dr Nick Brownstone sits down with Dr Benjamin Lockshin to get advice on advertising a practice, learn what specialty Dr Lockshin would practice if he couldn’t be a dermatologist, and hear tips on how to avoid burnout.How do you advertise your practice?Dr Lockshin explains that at his practice, they don’t do formal advertising. Rather, he reaches out to community doctors to ensure he develops a relationship with those providers. He believes that taking care of patients effectively and letting the patients do the advertising is the most effective way to grow a successful practice.If you couldn’t be a dermatologist, what other specialty would you practice?Dr Lockshin feels his personality and mindset would work well with urology. He explains that urology shares many similarities with dermatology; you can manage patients with acute problems or over the course of many years. There is also a surgical component as well as a medical component to both specialties.How do you avoid burnout?Dr Lockshin suggests adding variety to your daily and weekly activities to help avoid burnout. He runs a clinical trial center and consults and speaks for several companies, which allows him to vary his weekly schedule.

In this episode of Under Your Skin, Dr Nick Brownstone chats with Dr Neal Bhatia about giving advice to a first-year dermatology resident, innovations in dermatology, and advice on communicating a serious diagnosis to a patient.If you could go back in time, what advice would you give yourself as a first-year dermatology resident?Dr Bhatia explains that he would discuss expectations and emphasize that a first job may not be a last job.He would also advise a first-year dermatology resident to create a niche for themselves. They should aim to learn about everything but also create a specialty and stay in a niche that they can be proud of and dig into deeply.Dr Bhatia also acknowledges that academic demands are high in residency; he would advise a first-year resident to try to find a balance while keeping their foot on the gas and off the brake.What innovations in dermatology are you most excited about?Over the course of his career, Dr Bhatia has enjoyed watching innovations develop around Janus kinase inhibitors, biologics, and strategies and options to manage itch.He recalls being groomed on topical steroids and innovations focused on active ingredients, but comments that now, the vehicles of the topicals are getting attention. He also praises the approach of thinking about the process of disease.Dr Bhatia also encourages dermatologists to put patients’ interests forward, get out from their own shadow, and learn to be aggressive again.How do you communicate a serious diagnosis to your patients?Dr Bhatia emphasizes the importance of communicating serious diagnoses in person. He encourages physical touch and eye contact when discussing the severity of a diagnosis. He advises against relaying a serious diagnosis over the phone, since patients in that scenario may not absorb any information besides the negative news and may begin doing research on their own; he encourages dermatologists to be prepared on how to talk to patients about what’s ahead and the management plan for their diagnosis.He reiterates that putting your hands on patients is vital; he refers to dermatology as 3D and emphasizes the importance of being present with your patients. He has advised residents that they shouldn’t leave the exam room without some physical touch with their patients, even if that means just shaking hands.Dr Bhatia comments that delivering bad news is part of being present with patients and that it’s important to relate that you’re not just delivering the bad news, you are part of the solution as well.