Clinical Video Library

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There was a time when treating atopic dermatitis (AD) meant managing the peaks—calming a flare, then waiting for the next one to arrive. But as Elizabeth (Lisa) Swanson, MD, and E James Song, MD, describe, the disease doesn’t really turn off. AD settles, simmers, then resurfaces, more like a smoldering fire than something episodic. And once you start to see it that way, the goal becomes about stabilizing what’s happening over time instead of reacting to the moment.In this conversation, Drs Swanson and Song work through their approaches in clinic: lowering the threshold for biologics, rethinking what “controlled” actually means, and recognizing how much of the disease lives outside of what’s visible. The aim is getting patients off the rollercoaster, reducing the constant negotiation with their skin, and moving toward something steadier, more livable, and more honest to the disease itself.

This video is sponsored by Sun Pharma. Its content is editorially independent of the sponsor. In this episode of Topical Conversations, Aaron Farberg, MD, joins George Monks, MD, to examine the clinical and logistical realities of transitioning patients from general dermatology to Mohs surgery. Their discussion highlights how evolving treatment options, referral timing, and multidisciplinary coordination influence decision-making, particularly when patients present with complex disease or are already receiving systemic therapy. The patient journey: from suspicion to surgical planningThe conversation begins with a practical overview of the typical pathway to Mohs surgery. After identifying a suspicious lesion, dermatologists confirm the diagnosis via biopsy and then guide patients through treatment options, including Mohs when appropriate.A central theme is expectation setting. Patients diagnosed with skin cancer often anticipate rapid surgical intervention; however, real-world scheduling constraints mean wait times of several weeks are common. In many cases of basal cell carcinoma (BCC), a delay of up to approximately 2 months may be clinically acceptable, while higher-risk tumors, such as certain squamous cell carcinomas or melanomas, require more urgent prioritization.Patients are encouraged to remain engaged during this interval, reporting any changes such as growth, bleeding, or pain. This ongoing communication can help dermatologists reassess urgency and facilitate expedited care when needed. Managing complexity: when and how to engage Mohs surgeonsFor borderline or complex cases, early collaboration with Mohs surgeons is emphasized. Prereferral discussions, which can be supported by clinical images and patient history, can help ensure appropriate patient selection and avoid delays associated with suboptimal referrals.This bidirectional communication is increasingly important as treatment decisions become more nuanced. In some cases, Mohs surgeons may refer patients back to dermatologists for consideration of systemic therapy prior to surgery, reinforcing the importance of shared decision-making across specialties. Expanding the toolbox: the role of systemic therapiesThe growing availability of systemic therapies, including immunotherapies and targeted agents, has broadened management strategies for advanced or high-risk skin cancers.Hedgehog inhibitors (HHIs), for example, have become an important option for advanced BCCs that may not be ideal candidates for immediate surgery or radiation. In select cases, systemic therapy may be used in a neoadjuvant approach to reduce tumor burden and improve surgical feasibility.This approach can also help address practical challenges such as surgical wait times. Initiating systemic therapy during this interval may allow for disease control while optimizing the timing and extent of surgery. However, these decisions require careful coordination and individualized assessment.Importantly, clinicians note that response to HHIs is often evident within the first 1 to 2 months, which can help guide ongoing management. In patients who respond well, continued therapy may be appropriate, while nonresponders may be redirected toward surgical management. Addressing clinical uncertainty: skip lesions and treatment timingThe discussion also addresses concerns around “skip lesions,” particularly in the context of preoperative systemic therapy. While discontinuous tumor spread is a theoretical consideration, both clinicians note that it is not commonly observed in their practices and is not a primary deterrent to systemic use.Greater concern is placed on delays in definitive treatment, which may increase the risk of tumor progression or spread. This reinforces the importance of timely referral and meticulous surgical technique, particularly in cases where tumor margins may be less predictable.Careful clinical assessment, including thorough inspection and adjunctive tools when appropriate, remains essential in these scenarios. Looking ahead: integrating new tools with established standardsWhile Mohs surgery remains a cornerstone of cutaneous oncology, the integration of systemic therapies is reshaping how dermatologists approach complex cases. This discussion highlights the importance of flexibility in treatment planning, balanced with a continued emphasis on evidence-based care and procedural precision.Above all, consistent and proactive communication remains central to optimizing patient outcomes in this evolving landscape. Key takeawaysMohs surgery pathways often involve wait times of several weeks; proactive expectation setting is essential for patient management Ongoing communication during the referral interval allows for reassessment of urgency and potential prioritization Early collaboration with Mohs surgeons can improve patient selection and streamline care in complex or borderline cases Systemic therapies, including HHIs and immunotherapies, are expanding options for advanced disease and may be used in select neoadjuvant scenarios Concerns about skip lesions exist, but appear less clinically significant than ensuring timely and definitive treatment Clear, direct communication among care team members remains a critical component of optimal patient outcomes

This video is sponsored by Sun Pharma. Its content is editorially independent of the sponsor. In this episode of Topical Conversations, Vishal Patel, MD, and David Miller, MD, PhD, examine how the management of cutaneous squamous cell carcinoma (cSCC) has shifted from a specialty-specific approach to a truly multidisciplinary model. Their discussion centers on how dermatologists partner with surgeons, radiation oncologists, and medical oncologists to manage increasing disease complexity, while remaining actively involved from diagnosis through long-term surveillance.cSCC as a team-based diseasecSCC is no longer solely a dermatologic or surgical problem. While many tumors remain straightforward to manage, more advanced cases increasingly require coordination across multiple specialties. Drs Patel and Miller emphasize that optimal outcomes, particularly in high-risk or advanced disease, depend on early collaboration and thoughtful sequencing of surgery, radiation, and systemic therapy.A wide and heterogeneous clinical spectrumThey reinforce the broad clinical range of cSCC, spanning low-risk tumors to locally advanced disease, perineural invasion, recurrent tumors, nodal involvement, and metastatic spread. Dermatologists are often the point of entry, responsible for diagnosis, initial risk stratification, and determining when escalation is needed. However, Dr Miller notes that no single specialty holds all the answers and that successful management hinges on assembling the right combination of modalities for each patient.Recognizing complexity and when to expand the teamA central challenge for dermatologists is identifying when a case is becoming more complex. Dr Patel outlines red flags that should prompt earlier multidisciplinary engagement, including rapid tumor growth, recurrence, deep invasion, perineural symptoms, and tumors in anatomically challenging locations. Dr Miller adds immunosuppression, multiple recurrences, and nodal disease as signals that early collaboration may meaningfully alter the treatment trajectory.Both stress the importance of not waiting until options are limited. Early input from surgery, radiation oncology, and medical oncology allows for better planning around margins, adjuvant therapy, and systemic treatment considerations.The dermatologist’s role beyond referralThe conversation challenges the notion that dermatologists step back once oncology becomes involved. Dr Patel highlights the dermatologist’s ongoing role in managing field cancerization, monitoring for secondary primaries, and providing long-term surveillance. Dr Miller adds that patients often place deep trust in their dermatologists, positioning them to reinforce education, address concerns, and help manage skin-related adverse events even when another specialist is leading systemic therapy.Multidisciplinary decision-making in real-world practiceWhile formal tumor boards are ideal, Dr Patel acknowledges that they are not always feasible. Dr Miller describes practical alternatives, such as informal case discussions via email, phone calls, or brief in-person conversations to align on sequencing, goals of care, and follow-up responsibilities. Both note that time constraints and fragmented care can be mitigated by cultivating a reliable network of colleagues and maintaining proactive communication.Where systemic therapy fitsSystemic therapy has become an integral part of modern cSCC management rather than a last-line option. Dr Miller reiterates that timing and sequencing are critical, whether systemic therapy is used before surgery, after radiation, or as a standalone approach. Patel adds that even when dermatologists are not prescribing these agents, understanding when they are appropriate helps guide referrals and set realistic patient expectations.Cosibelimab in the multidisciplinary frameworkThe discussion turns to PD-1 inhibition, now well established in advanced cSCC. Dr Patel notes that response and tolerability vary, particularly in older patients with comorbidities. Dr Miller points to emerging data suggesting cosibelimab, a PD-L1 inhibitor, may offer a favorable tolerability and safety profile, an important consideration in real-world populations.They emphasize that familiarity with where cosibelimab may fit, whether alongside surgery or radiation, or in unresectable or metastatic disease, allows dermatologists to better guide referrals, support shared decision-making, and manage skin-related adverse events. Even when medical oncologists lead systemic therapy, ongoing dermatologic involvement remains essential as the PD-1 and PD-L1 inhibitor landscapes continues to mature.Communication, coordination, and the patient experienceFrom the patient’s perspective, multidisciplinary care can feel either reassuring or overwhelming. Dr Miller stresses that clear handoffs, consistent messaging, and defined follow-up plans are critical to maintaining trust, particularly in advanced disease, where treatment plans may evolve over time.Common pitfalls and practice pearlsDr Patel cautions that dermatologists may underestimate how quickly cSCC can progress once advanced and how impactful early multidisciplinary input can be. Common pitfalls include delayed referrals, unclear ownership of follow-up, and assumptions that another provider is monitoring the patient.Both physicians highlight simple but effective strategies: clear documentation, direct communication with key colleagues, and staying engaged even after referral. These steps can significantly improve care coordination and outcomes.Key takeawayscSCC management has become increasingly multidisciplinary, particularly for high-risk and advanced diseaseDermatologists play a central role across the continuum, from diagnosis and risk stratification to surveillance and adverse event managementEarly recognition of complexity and timely multidisciplinary engagement can expand treatment options and improve outcomesSystemic therapy is now part of integrated cSCC care, with timing and sequencing determined collaborativelyFamiliarity with agents such as cosibelimab helps dermatologists guide referrals and support patient educationClear communication, defined follow-up responsibilities, and ongoing dermatologic involvement are critical to patient experience and care quality

In this episode of Topical Conversations, Dawn Merritt, DO, sits down with Naiem Issa, MD, to explore how dermatologists think about managing atopic dermatitis (AD) over years, not weeks. Their discussion centers on durability, consistency, and the patient experience, and how those factors shape treatment decisions in real-world practice. Using therapies such as tralokinumab as reference points, they examine what sustainable disease control truly looks like for chronic inflammatory disease.Thinking beyond short-term endpointsWhen asked what matters most when choosing a therapy for AD, Dr Issa reflects on the tension between modern expectations for rapid improvement and the long-term nature of chronic inflammatory disease. While regulatory pathways emphasize short-term endpoints to determine whether a drug moves forward, the clinical reality is that patients often require treatment over the long haul.Early improvement is important, but Dr Issa emphasizes that lack of immediate response does not necessarily signal failure. Given the chronicity and complexity of AD, there are situations where allowing more time on therapy is appropriate, particularly when the treatment is well tolerated.Setting expectations for a chronic diseaseDr Merritt highlights the importance of patient education and expectation-setting, particularly for individuals who have previously relied on fast-acting but unsustainable options such as steroids. Both clinicians stress the need to reframe the conversation. AD is not curable; it must be managed. The goal is to identify therapies that are safe and effective over time, rather than those that simply offer rapid but temporary relief.Explaining the biology to support patienceDr Issa notes that bringing biology into the conversation can help patients understand why durability matters. Rather than “setting off an atomic bomb” on the immune system, modern systemic therapies aim to target specific pathways involved in disease pathophysiology.Helping patients understand that targeted immunomodulation works differentlyand can make waiting feel like a purposeful investment rather than a setback.Why IL-13 inhibition may matter for long-term controlThe conversation then turns to treatment selection, with a focus on IL-13 inhibition. Dr Issa explains that while IL-4 has long been recognized as part of AD pathophysiology, growing evidence suggests IL-13 plays a central role in driving disease.With direct IL-13 blockade, clinicians may avoid some of the effects observed with therapies that inhibit both IL-4 and IL-13. Dr Issa references clinical experience and published cases in which patients switching from IL-4 blockade to tralokinumab experienced resolution of arthralgias. He also discusses head and neck dermatitis, including instances of de novo head and neck involvement reported with certain therapies, which can influence treatment choice when considering holistic patient care.Avoiding unnecessary treatment switchingDr Merritt notes that clinicians can sometimes be too quick to switch therapies in response to flares or adverse events. Frequent switching may introduce additional risk and uncertainty without improving long-term outcomes.Dr Issa describes his approach as selecting therapies early that are designed for sustainability. The goal is to reduce risk while optimizing results in a single, cohesive strategy. In his clinical experience, tralokinumab has the potential to support this approach, including for patients who require a switch from another biologic.The role of dosing flexibility in long-term adherenceDrawing from her own practice, Dr Merritt shares that patients who remain on tralokinumab through the initial 16 weeks may transition to once-monthly dosing. While the concept of long-term therapy can initially be difficult for patients to accept, the possibility of reduced dosing frequency can help ease concerns and improve adherence.Dr Issa reinforces this point with clinical trial data, noting that patients who transitioned from every-2-week dosing to every-4-week dosing after 16 weeks maintained similar efficacy. He further highlights data showing that a subset of patients who discontinued therapy maintained clear or almost clear skin, or achieved EASI-75, for the remainder of the year.He frames this as a practical question for patients: if there were a 1-in-4 chance of maintaining control after stopping therapy, would that be worth it? Dr Merritt notes that, in her experience, most patients would accept those odds.Building a plan for the long termThe discussion concludes with a shared emphasis on early selection of therapies that balance efficacy, tolerability, and durability. Lowering the risk of adverse events, minimizing unnecessary switching, and giving patients a realistic path toward long-term control, including the possibility of dose reduction or sustained remission, are central to this approach.The clinicians end by emphasizing that durability is not just a clinical endpoint; it is a strategy that supports better outcomes, better patient relationships, and more sustainable management of chronic inflammatory disease.Key takeawaysAtopic dermatitis requires long-term management, not short-term thinkingEarly efficacy matters, but durability and tolerability often matter more over timeSetting realistic expectations helps patients stay engaged with chronic disease therapyAvoiding unnecessary treatment switching can reduce risk and improve continuity of careDosing flexibility and the potential for sustained control can improve patient acceptance and adherence

This video is Part 2 of a 4-part expert series designed to strengthen clinician confidence in the use of the 31-gene expression profiling (31-GEP) test for prognostic assessment in cutaneous melanoma. Across the series, David Cotter, MD, PhD, addresses common questions and hesitations around molecular prognostic testing to support more consistent and effective integration of 31-GEP into routine dermatologic practice.Expert consensus statementIntegration of 31-GEP testing with traditional staging methods can accurately inform the decision to recommend sentinel lymph node biopsy (SLNB).This consensus statement comes from the expert panel publication “31-Gene expression profiling for cutaneous melanoma: an expert consensus panel” and serves as the foundation for this discussion.SLNB as a critical, but imperfect, decision pointSLNB remains a key step in melanoma staging, but decision-making is not always straightforward in borderline cases. Dr Cotter highlights scenarios frequently encountered in practice, where estimated risk falls near clinical thresholds and management varies.For example:T1B melanomas (0.8–1.0 mm or <0.8 mm with high-risk features): ~5%–10% risk of nodal positivity T2A melanomas (~1.0 mm, nonulcerated): >10% risk of nodal positivityAlthough a ≥10% risk often supports proceeding with SLNB, these estimates are population-based. In practice, patient-specific factors, such as comorbidities or surgical candidacy, introduce additional nuance, contributing to variability in care. The “gray zone” in current guidelinesCurrent guidance generally avoids SLNB in patients with less than a 5% likelihood of nodal positivity. However, this threshold reflects an inherent limitation in the available tools.Among melanomas <1 mm:The average likelihood of nodal positivity is ~5.3% The false-negative rate of SLNB is also ~5% In effect, these values offset one another. Clinically, this means that when SLNB is deferred in this population, a small proportion of patients with occult metastatic melanoma may not be identified at diagnosis. This tradeoff highlights a gap in precision when relying on population-level risk estimates alone. Refining risk stratification with 31-GEP31-GEP testing offers a more individualized approach to risk assessment, particularly in intermediate-risk groups such as T1B melanomas. By incorporating tumor biology, it helps refine which patients may benefit from SLNB.Data discussed in this segment demonstrate that:Use of 31-GEP in T1B patients improves the true-to-false negative ratio to approximately 35:1 When combined with T staging, patients identified as having <5% risk by 31-GEP may safely avoid SLNB without missing node-positive disease These findings suggest that integrating 31-GEP into clinical workflows can improve patient selection and reduce uncertainty in borderline cases. Moving beyond static measures: the role of tumor biologyTraditional staging relies on histopathologic features such as Breslow depth and ulceration; these factors are important, but inherently limited to a single timepoint.31-GEP evaluates gene expression patterns to better characterize tumor behavior. This approach allows clinicians to move beyond population-based estimates and incorporate individualized biologic risk into decision-making.As Dr Cotter describes, the combination of clinicopathologic staging and 31-GEP results supports a more comprehensive and patient-specific framework for care. Key takeawaysSLNB decision-making remains nuanced, particularly in intermediate-risk melanoma Guideline thresholds reflect tradeoffs, including the potential to miss a small subset of node-positive patients31-GEP provides biologic risk stratification, complementing traditional staging measuresIntegration of 31-GEP with T staging can improve patient selection for SLNB and may reduce unnecessary proceduresIndividualized risk assessment is essential, particularly in patients with borderline indications or competing clinical considerations

Psoriasis and psoriatic arthritis are understood as connected but often managed separately. Brad Glick, DO, MPH, walks through why that separation starts to break down in practice. Nearly a third of patients with psoriasis will develop joint involvement, many of whom remain undiagnosed. That reality demands screening become more intentional. Asking about morning stiffness, fatigue, joint swelling, or subtle changes that might otherwise be missed. With an oral TYK2 inhibitor that has demonstrated activity across both skin and joints, the conversation moves from what we treat to how we identify patients, when to intervene, and how we think about psoriasis as a systemic disease from the start.

Omar Noor, MD, focuses on the patients who might otherwise be easy to miss. The small signals that, taken together, start to shift suspicion toward joint disease. It all hinges on asking better questions and asking them consistently. From there, treatment becomes a matter of fit. Oral options don’t replace biologics, and they’re not positioned to outperform other systemic therapies. But they do offer a meaningful option for certain patients, particularly when simplicity, preference, and adherence come into play.

Once you move past mechanism, the question becomes simpler and harder at the same time: where does this actually fit? In this conversation, Benjamin Lockshin, MD, and Michael Cameron, MD, walk through how they’re using TYK2 inhibition in practice—who gets it, when they start, and where it sits alongside biologics and other systemic options. For some patients, it’s a first-line consideration. Those with milder joint involvement alongside psoriasis. Patients who prefer to start with an oral option, or those who don’t quite fit the thresholds that typically push toward biologics. For others, it’s additive—layered onto a biologic in partial responders, used in harder-to-treat areas like palmoplantar disease or in patients where weight may affect response.Running through the discussion is a familiar nuance: when to manage independently and when to refer, how much to act on early or vague joint symptoms, and how to balance simplicity with a growing number of treatment choices. Less about defining a fixed place in the algorithm, more about understanding where it becomes useful across different types of patients.

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

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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.