Clinical Pearls Panel

Rounding out the second day was a multispeaker session on clinical pearls by Gary Goldenberg, MD, Brad Glick, DO, Edward (Ted) Lain, MD, MBA, Elizabeth (Lisa) Swanson, MD, and Joshua Zeichner, MD. 

Dr Goldenberg opened the session with 5 practical clinical pearls to address common challenges in practice. He emphasized the importance of going beyond simply prescribing medications, urging providers to incorporate advanced tools like platelet-rich plasma for hair loss into their treatment strategies. Dr Goldenberg also posed a thought-provoking question about the future of regenerative medicine, highlighting how regulatory and practical challenges may hinder its progress. Additionally, he stressed the importance of managing patient anxiety and pain during procedures to optimize outcomes. He concluded by encouraging providers to discuss dietary habits with their patients to combat photoaging and manage common skin conditions effectively.

Dr Glick emphasized the importance and criticality of early detection and diagnosis of psoriatic arthritis (PsA). Studies have shown that there is an average delay of 5 years in PsA diagnosis, but even a 6-month delay in diagnosis can have detrimental effects including irreversible joint damage, worse long-term physical function, and decreased quality of life (QoL). There are several QoL measures in PsA, one of which is designated as minimal disease activity (MDA), which consists of 7 criteria—5 of which need to be met to achieve MDA. While MDA primarily assesses clinical disease activity, studies have shown that achieving MDA is strongly associated with slowed or halted radiographic progression of joint damage. Because early detection and diagnosis is critical to patients with PsA, it is important to know that patients with plaque and scalp psoriasis have a 50% or greater chance of having PsA. The 5 major risk factors for development of PsA in association with psoriasis additionally include higher BSA involvement, obesity, intergluteal or perianal lesions, and nail dystrophy. 

Dr Lain continued the discussion by addressing the management of rosacea, focusing on strategies for handling flares in previously controlled cases. He emphasized using low-dose isotretinoin (20–30 mg every other day) as an option for recalcitrant rosacea. For patients experiencing a flare after being well-controlled, Dr Lain suggested evaluating for small intestinal bacterial overgrowth and considering treatment with rifaximin 550 mg twice daily for 10 days. He also highlighted the potential role of probiotics in rosacea management. Additionally, Dr Lain recommended the use of minocycline rather than doxycycline for addressing rosacea-related papules and pustules.

Dr Swanson followed with clinical pearls for pediatric dermatology, sharing practical and innovative approaches to common challenges in this patient population. She highlighted the Aron Regimen as an effective compounded treatment for severe atopic dermatitis, especially in infants and toddlers. Dr Swanson also discussed eclipse nevi, commonly found on children's scalps, emphasizing that these lesions are benign and typically do not require biopsy. For pyogenic granulomas, she discussed the treatment option of topical timolol. She also provided insights into managing warts, advocating for an approach using salicylic acid and 5-fluorouracil, which has shown to be highly effective with minimal pain. Finally, she shared a lighthearted but meaningful tip to always provide a snack to teenage boys after a biopsy, ensuring a positive experience for young patients.

Lastly, Dr Zeichner presented clinical pearls for acne management. Key takeaways included starting with combination therapy such as IDP-126, a fixed-dose triple-combination topical consisting of clindamycin, adapalene, and benzoyl peroxide. Simplifying regimens was highlighted as a way to improve adherence, with once-daily treatments showing higher compliance compared to more complex regimens. Dr Zeichner also underscored the importance of considering acne a chronic condition and continuing treatment beyond 12 weeks, involving patients in shared decision-making to enhance engagement and adjusting isotretinoin doses based on clinical evaluations to ensure effective absorption.