Starting the morning off with one of the most anticipated sessions of the entire conference, Neal Bhatia, MD, Clay J. Cockerell, MD, Cheri Frey, MD, and Mark Lebwohl, MD, shared the first of 60 tips for daily practice with the audience. Dr Bhatia kicked things off with rosacea treatments for patients looking for “natural” options. Aloe vera and licorice extract are among a long list of natural botanicals that decrease erythema and irritation associated with rosacea. Dr Bhatia discussed a new topical photodynamic agent, SGX301 (topical hypericin gel), that is being investigated in combination with visible light photodynamic therapy (PDT) for cutaneous T-cell lymphoma (CTCL). Multiple studies have shown efficacy for SGX301 + PDT in patch-/plaque-phase CTCL. Dr Bhatia provided tips on how to efficiently schedule patients for PDT in clinic, recommending twice yearly treatments in the fall and spring for all patients with actinic keratoses, and concluded with a brief review of a new immediate-/extended-release minocycline currently in clinical trials for rosacea. 

Dr Cockerell continued the session with dermatopathology pearls for clinicians. Dr Cockerell warned the audience not to rely on shave biopsy margin status as they are not equivalent to margins on elliptical or Mohs excisions. Lesions with supposed “negative margins” on shave biopsies have a 30% or higher recurrence rate. Next, Dr Cockerell spoke about severely dysplastic nevi and the fact that many dysplastic nevi with “severe” atypia are often melanoma. These lesions should be treated with excision with 5-mm margins. Dr Cockerell reiterated a previous call to move away from a 3-tier grading of dysplastic nevi (mild, moderate, severe) to a more actionable “low-grade” and “high-grade” system. Continuing the theme of dysplastic nevi, Dr Cockerell reminded the audience that nevi in special sites, such as the ears, breast, and groin, often have dysplastic features but are not truly dysplastic nevi.

Dr Frey started her portion of this session with a tip on using tranexamic acid to reduce bleeding in dermatologic procedures. Subcutaneous injection of tranexamic acid has been shown to reduce bleeding and improve hemostasis in dermatologic surgeries and procedures such as laser microcoring. Dr Frey provided pearls on intralesional injections for hidradenitis suppurativa and a prescription option for patients who itch without a rash. Dr Frey recommended mixing a 50-mL bottle of clobetasol 0.05% solution into a 1-lb.jar of pramoxine-containing bland moisturizer and letting the patient apply nightly. Moving on, Dr Frey discussed a case of recalcitrant perioral dermatitis that responded to combination metronidazole, azelaic acid, and ivermectin and concluded with a recommendation for affordable over-the-counter sulfur, zinc pyrithione, and hypochlorous acid products.

Dr Lebwohl closed this high-yield session with practical tips for the busy medical dermatologist. After reviewing rates of fungal infections in patients on biologics for psoriasis, Dr Lebwohl presented guidelines for treating oropharyngeal candidiasis and recurrent vulvovaginal candidiasis, focusing on oral fluconazole for both. Dr Lebwohl encouraged clinicians to partner with a local specialty pharmacy to help improve affordability of branded medications for patients. Dr Lebwohl reviewed efficacy data of secukinumab, risankizumab, and bimekizumab for the treatment of palmoplantar psoriasis (PPP) and discussed a case of recalcitrant PPP that improved dramatically following the addition of deucravacitinib to existing therapy. To conclude, Dr Lebwohl presented a case of stubborn granulomatous perioral dermatitis that responded to isotretinoin 10-mg twice daily for 5 months.