60 Tips in 60 Minutes - Day 1: Acne, Psoriasis, Eczema, Urticaria, Skin Cancer and Office Management
Chief, Division of Dermatology
David Geffen School of Medicine at UCLA
Los Angeles, CA
Our first full day in Hawaii commenced with this favorite multispeaker session covering clinical pearls, novel treatments, and medication side effects. Clay Cockerell, MD, educated us on dermatoses with atypical histologic findings such as photodermatitis with minimal inflammatory infiltrate or a subepidermal blistering disorder in older patients with DIF-negative and cell poor findings often in relation to NSAID usage. He also detailed the shift to grade dysplastic nevi as low- or high-grade, the latter requiring excision and reevaluation.
On all things hair loss, Dr Leavitt reviewed trichoscopy findings of androgenetic alopecia, lichen planopilaris, and CCCA. He recommended trialing minoxidil for at least 6 months for multiple subtypes of alopecia. One small trial (n=89) did not show significant impact on blood pressure. Joslyn Kirby, MD, recommended trialing adapalene 0.1% for acanthosis nigricans and gave us an easy tip for picking patients, including children with atopic dermatitis and adults with acne: hydrocolloid patches. N-acetyl cysteine, though it can cause GI upset, can also be used for picking patients dosed at 600 mg to 2400 mg daily. Dr Green gave us some tips on prescribing antibiotics for acne, including adding a probiotic after dosing, preferably the liquid formulations, and to minimize treatment to 3 months. Spironolactone may also be a viable antibiotic-sparing treatment even for nonhormonal acne.
Dr Lebwohl showed us 2 multicenter RCTs using cantharidin in molluscum contagiosum with superior clearance response in the head/neck and groin regions. He also covered a review of laboratory tests in chronic urticaria and angioedema, which very rarely impact management. All doses of omalizumab significantly improved itch severity score in patients with antihistamine-refractory chronic urticaria and spontaneous urticaria, and the risk of anaphylaxis with this medication is estimated to be 0.2% from reports of about 57000 patients. For those with uremic pruritus or notalgia paresthetica, a new medication, difelikefalin, has dramatically impacted itch scores as soon as one week in multiple RCTs and may be useful in patients with refractory itch in atopic dermatitis.