Avsnitt
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In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Tina Bhutani, MD, CEO and clinical dermatologist at Synergy Dermatology in San Francisco, to explore the evolving role of topical corticosteroids in psoriasis care and their interplay with newer nonsteroidal agents. With the wide array of treatments available today, they highlight the enduring importance of topicals in dermatology practice, even as systemic therapies become increasingly effective.
They begin by highlighting the role of topical corticosteroids as a cornerstone of psoriasis management. Dr Bhutani explains that she often uses high-potency options like clobetasol for thick plaques and milder steroids like hydrocortisone for sensitive areas. She shares a practical approach: using steroids for acute flares and transitioning to nonsteroidals, such as tapinarof or roflumilast, for maintenance. This approach emphasizes the versatility of topical treatments, allowing dermatologists to tailor treatments, enhance efficacy, and simplify regimens to improve adherence.
They then discuss the unique mechanisms of newer nonsteroidals, particularly tapinarof as an aryl hydrocarbon receptor agonist. This mechanism reduces inflammation through key psoriasis pathways and may even affect memory T cells, contributing to tapinarof’s potential remittive effect.
For challenging areas, Dr Bhutani offers pearls such as occlusion to boost penetration and creative strategies to address palmoplantar psoriasis. She also introduces an effective maintenance strategy, advising patients to scale back topicals to twice a week during remission to reduce side effects while sustaining symptom control.
Tune in to the full episode for actionable insights for dermatologists navigating the balance between traditional and innovative topical therapies in managing psoriasis. -
In this episode of Derms and Conditions, host James Del Rosso, DO, welcomes David Cotter, MD, a dermatologist in clinical practice and assistant clinical professor at the University of Nevada Las Vegas School of Medicine, to discuss the integral role of patch testing in managing atopic dermatitis (AD) and allergic contact dermatitis (ACD), providing practical insights on incorporating patch testing into practice and differentiating between these often-overlapping conditions.
They begin with Dr Cotter highlighting the importance of a holistic approach when evaluating patients with AD and ACD. A thorough history and physical examination, combined with a detailed understanding of allergen exposure, are essential for tailoring patch testing to the patient’s specific needs. He notes that AD and ACD frequently coexist, and identifying an allergen component is particularly valuable in cases of treatment-resistant AD or when new patterns, such as hand or facial dermatitis, emerge.
For patients already on systemic therapies like biologics and JAK inhibitors, interpreting patch test results requires careful consideration. While biologics may control aspects of ACD, breakthrough dermatitis often signals clinically relevant allergens. Patch testing can be performed without discontinuing current biologic or JAK inhibitor therapy, though a washout period and repeat testing may sometimes be needed.
Dr Cotter shares that patch testing can significantly improve outcomes, especially for patients who prefer allergen avoidance over additional systemic therapies. Tools like allergen-detection apps can empower patients to avoid triggers in their daily lives. When avoidance is not feasible, oral JAK inhibitors approved for AD can also help manage both AD and ACD symptoms in many cases.
Tune in to the full episode to explore the value of patch testing in modern dermatology and get actionable strategies to improve care for patients with complex dermatitis cases. -
Saknas det avsnitt?
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In this episode of Derms and Conditions, host James Q. Del Rosso, DO, invites Peter Lio, MD, a clinical professor of dermatology at Northwestern University, to explore the complexities of selecting therapies for atopic dermatitis (AD) with a particular focus on the newly approved IL-13 inhibitor, lebrikizumab. With a growing number of treatment options, Dr Lio and Dr Del Rosso examine how these therapies are enhancing patient management in unique ways.
The discussion opens with a look at the current "embarrassment of riches" in AD treatments. Dermatologists now have multiple biologic options to choose from, each with distinct features. Dr Lio highlights lebrikizumab's flexible dosing, which can shift to once monthly after the initial treatment period, potentially offering patients a more manageable treatment routine. They also explore key differences among IL-13 inhibitors, such as lebrikizumab’s unique binding characteristics that may influence the overall balance of IL-13 in the body. Dr Lio also notes the possibility of achieving relative remission for certain patients on lebrikizumab, as suggested by a long-term extension study where some patients maintained improvement even after stopping the drug.
They also cover the safety and tolerability aspects of AD therapies, including conjunctivitis, arthropathy, and erythematous reactions sometimes seen with these drugs. Dr Lio shares insights on managing these side effects, emphasizing that despite similar mechanisms of action, switching between IL-13 inhibitors may alleviate adverse reactions for certain patients.
Tune in to the full episode for expert insights on differentiating and integrating the latest therapies for AD, strategies for engaging patients in their treatment plans, and valuable guidance on navigating today’s expanding therapeutic landscape. -
In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Adelaide Hebert, MD, chief of pediatric dermatology at McGovern School of Medicine and Children’s Memorial Hermann Hospital in Houston, to discuss the intricacies and challenges of pediatric clinical research.
They begin by noting that past limitations left clinicians with few FDA-approved treatment options for younger patients, often relying on off-label therapies without robust pediatric data. However, legislative changes and incentives, such as patent extensions for drugs studied in pediatric populations, have encouraged pharmaceutical companies to invest in pediatric trials, enabling dermatologists to gain access to more targeted therapies for children.
Despite this progress, enrolling young children in clinical trials remains challenging, partly due to concerns from parents about potential risks. Dr Hebert shares her approach to easing these concerns, often by conducting trials with adult and adolescent populations first so parents have a better understanding of a therapy's safety profile.
Drs Hebert and Del Rosso then address the logistical aspects of pediatric trials, from initial phone screenings to addressing parents’ concerns about risk-benefit profiles, placebo arms, and the long-term safety of therapies. Dr Hebert underscores the need to accommodate the unique schedules and needs of young patients, such as adjusting appointments to fit around school hours.
She also shares tips for administering injections to children, including using ice packs, straightforward explanations, and comforting strategies to make the experience as positive as possible.
Throughout the conversation, Dr Hebert emphasizes the trust placed in dermatologists by parents and highlights the importance of respectful, compassionate communication, which ultimately strengthens the therapeutic alliance.
Tune in to the full episode to learn more about pediatric clinical trials, hear insights on patient and parent communication, and get valuable guidance for dermatologists aiming to expand their expertise in pediatric patient care. -
In this special live episode of Derms and Conditions, recorded at the Fall Clinical Dermatology 2024 Meeting, host Dr James Q. Del Rosso welcomes Dr April Armstrong, chief of dermatology at UCLA, to discuss key highlights from the conference. Together, they cover the latest in psoriasis treatments, promising developments for vitiligo, advances in hidradenitis suppurativa, and much more.
The discussion kicks off with psoriasis, where exciting progress in oral TYK2, IL-23, and IL-17A inhibitors is providing potential for effective, safe options for moderate-to-severe cases. For atopic dermatitis, they review the recent approval of lebrikizumab and the real-world efficacy of tralokinumab for head and neck involvement. They also spotlight OX40/OX40 ligand inhibitors—amlitelimab and rocatinlimab—as promising long-acting treatments currently in development.
In prurigo nodularis, the newly approved nemolizumab, an IL-31 inhibitor, offers antifibrotic benefits and has notably not shown evidence of conjunctivitis risk seen with other biologics. For vitiligo, BET inhibitors are creating new opportunities by targeting epigenomics, and several JAK inhibitors are pending phase 3 data. For hidradenitis suppurativa, focus has shifted from TNF inhibitors to IL-17 inhibitors like secukinumab, with bimekizumab and oral JAK inhibitors, including povarcitinib, in late-stage development.
They round out the episode with chronic hand eczema, where topical ruxolitinib and delgocitinib—a pan-JAK inhibitor recently approved in Europe—show encouraging results.
Tune in to the full episode for a full recap of these developments and other breakthroughs from the Fall Clinical Dermatology 2024 Meeting! -
In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Mona Shahriari, MD, associate director of clinical trials at Central CT Dermatology and assistant clinical professor at Yale University, to discuss the recent FDA approval of lebrikizumab, approved for atopic dermatitis (AD) in patients 12 years of age and up who have failed topical treatments like corticosteroids or calcineurin inhibitors, and its potential impact on treatment strategies.
They begin by explaining the drug's flexibility, with an initial loading dose followed by maintenance dosing that can be extended to once a month for patients who achieve a satisfactory response after 16 weeks. Dr Shahriari emphasizes that determining an adequate response involves more than skin clearance; persistent symptoms like itchiness can indicate the need to continue more frequent dosing.
They then discuss how many patients maintained their treatment response even after tapering dosing, with some experiencing benefits through week 52, suggesting a durable effect even when the treatment was paused.
When discussing real-world use, Dr Shahriari notes lebrikizumab’s convenience for both patients and providers, as it does not require baseline or ongoing lab monitoring and has no drug-drug interactions. Addressing safety, Dr. Shahriari notes that while common side effects like conjunctivitis and injection site reactions were observed, the drug was generally well-tolerated without any major safety concerns.
They conclude by reflecting on the heterogeneity of AD, noting that patients may respond differently to medications even within the same class and that it’s important to have multiple options to personalize treatment for each patient.
Tune in to the full episode to hear more about lebrikizumab’s clinical performance and the growing toolbox for AD management that is allowing dermatologists to offer safer, more targeted treatments that greatly improve patients' quality of life. -
In this episode of Derms and Conditions, host Dr James Q. Del Rosso welcomes Dr Joel M. Gelfand, Professor of Dermatology and Epidemiology at the University of Pennsylvania, to explore the critical issue of comorbidities in dermatology, with a focus on psoriasis, and address why dermatologists should take an active role in recognizing and addressing these risks.
Dr Gelfand reflects on his early observations of patients with psoriasis and their potential internal health issues, noting how in the past, psoriasis was primarily seen as just a skin condition. However, research and a pivotal article on inflammatory pathways in atherosclerosis led to improved understanding that psoriasis is linked to cardiovascular disease.
Dr Gelfand then discusses the groundbreaking use of electronic medical records to track patients with psoriasis over time, revealing higher incidences of cardiovascular events and mortality. This research highlighted that people with moderate to severe psoriasis have a reduced life expectancy by about 5 years, underscoring the need for dermatologists to address comorbidities in their patients.
The conversation then explores practical advice for clinicians, focusing on the role of dermatologists in identifying cardiovascular and diabetes risks in patients with psoriasis. Dr Gelfand suggests a simple yet effective approach: educate patients about their increased health risks, perform basic screenings like cholesterol and blood pressure checks, and collaborate with primary care physicians or cardiologists when needed. By fostering multidisciplinary care, dermatologists can play a crucial role in preventing life-threatening conditions in their patients.
Tune in to the full episode for guidance on addressing the broader health risks associated with psoriasis and the practical steps dermatologists can take to help reduce these risks. From screening for cardiovascular disease to forming strong collaborations with other health care providers, this episode offers valuable insights for improving patient outcomes. -
In this episode of Derms and Conditions, host James Del Rosso, DO, is joined by Jason Hawkes, MD, a dermatologist and investigator at the Medical Research Center of Oregon, to discuss tyrosine kinase 2 (TYK2) inhibitors, particularly deucravacitinib, for plaque psoriasis. They explain how deucravacitinib, which targets the TYK2 pathway, differs from other JAK inhibitors by avoiding the "off-target" effects associated with JAK 1, 2, and 3 inhibitors, offering a more selective and safe treatment option.
They begin by discussing the JAK-STAT pathway, with Dr Hawkes noting that while the science behind it was well known, TYK2's role in psoriasis took time to fully understand. TYK2 regulates key cytokines like IL-12, IL-23, and type 1 interferons, which are critical in psoriasis and psoriatic arthritis. Its more focused role within the immune response reduces the risk of systemic side effects compared to broader-acting JAK inhibitors.
They also explore deucravacitinib’s selectivity, which targets the pseudokinase domain of TYK2, offering greater precision compared to inhibitors that target the ATP-binding domain shared by other JAKs. This selectivity results in deucravacitinib’s cleaner safety profile, reflected in the lack of a boxed warning and minimal monitoring requirements.
Finally, they review long-term data, noting deucravacitinib's superior efficacy to apremilast and a stable safety profile over four years. While some safety signals, like herpetic infections, slightly increased over time, most adverse events were stable or decreased. They conclude by discussing the importance of personalized treatment decisions, emphasizing deucravacitinib’s advantages for patients who prefer oral medications and want to avoid injections.
Tune in to the full episode for a comprehensive discussion on the clinical relevance of TYK2 inhibitors and the role of deucravacitinib in the psoriasis treatment landscape. -
In this episode of Derms and Conditions, host James Del Rosso sits down with Dr Jessica Kaffenberger, an associate professor in dermatology at Ohio State University in Columbus, Ohio, to discuss the latest in hidradenitis suppurativa (HS) management. From navigating treatment challenges to addressing patient concerns, Dr Kaffenberger shares valuable insights on bridging older therapies with biologics, early diagnosis, and the importance of mental health and other forms of support to reduce risk factors for progression of HS, such as smoking cessation and weight reduction.
The discussion begins with a reflection on traditional therapies used for HS, such as antibiotics and intralesional injections, and how they were often insufficient in managing the condition. Dr Kaffenberger emphasizes the importance of being proactive with treatment, especially with the use of biologics earlier in the course of the disease, even for patients with moderate HS.
They also address the limitations of the Hurley staging system for HS, which, as a system based on visible disease severity, often delays biologic treatment until irreversible damage has occurred. Dr Kaffenberger calls for earlier use of biologics to prevent chronic sequelae. She also highlights the difficulty of obtaining insurance approval for biologics at early stages of the disease and recommends using templates from the HS Foundation to support prior authorizations.
Dr Kaffenberger then stresses the importance of early diagnosis, noting that HS is often misdiagnosed as sporadically occurring abscesses or cysts. She encourages health care providers to look for early signs like double-headed comedones and recommends laser hair removal as an early intervention strategy.
Addressing the psychological burden of HS, they highlight the high rates of anxiety, depression, and suicidal ideation among patients. Dr Kaffenberger advises dermatologists to build rapport, connect patients with mental health resources, and consider the impact of weight loss and smoking cessation in managing HS, while approaching conversations nonjudgmentally.
Tune in to the full episode for a comprehensive look at HS management and how dermatologists can improve outcomes for their patients. -
In this episode of Derms and Conditions, host James Del Rosso, DO, speaks with Mark Lebwohl, MD, Dean for Clinical Therapeutics at the Icahn School of Medicine at Mount Sinai, about the role of Janus kinase (JAK) inhibitors, particularly upadacitinib, in treating atopic dermatitis. They provide insights into the benefits of JAK inhibitors compared to monoclonal antibodies, patient selection, and the implications of recent clinical data.
They begin by explaining that while monoclonal antibodies like dupilumab and tralokinumab have been effective for many patients, JAK inhibitors can offer a powerful alternative for those seeking better control of their symptoms. They emphasize the importance of regularly assessing patient satisfaction with their treatment and exploring whether a switch to a JAK inhibitor might be beneficial.
Dr Lebwohl then refers to treat-to-target principles recently established by a consensus conference, where EASI 75 is a moderate goal and EASI 90 is optimal. JAK inhibitors, he suggests, are more likely to help patients reach these higher targets, especially when symptoms persist despite achieving EASI 75.
They continue to discuss data demonstrating that upadacitinib significantly improves outcomes, with 40.8% of patients achieving EASI 90 compared to 22.5% with dupilumab. Additionally, upadacitinib-treated patients are more likely to report minimal impact on their quality of life as measured by the Dermatology Life Quality Index.
Finally, Dr Lebwohl stresses the importance of discussing the risks associated with JAK inhibitors, including boxed warnings, in a clear and contextualized manner to help patients make informed decisions.
Tune in to the full episode to gain a deeper understanding of the nuances of JAK inhibitors in AD treatment, including practical tips for patient management, insights into the latest clinical data, and optimizing patient care. -
In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Omar Noor, MD, co-owner of Rao Dermatology in New York, NY, who shares his expertise on integrating nonsteroidal topical therapies into psoriasis treatment. As systemic therapies continue to advance, Dr Noor emphasizes the enduring importance of topical treatments with a focus on the aryl hydrocarbon receptor agonist, tapinarof.
They begin by discussing the role of newer nonsteroidal options for psoriasis like roflumilast and tapinarof, highlighting their benefits in contrast to corticosteroids, which, despite their effectiveness, can carry significant adverse effects. Dr Noor describes how he incorporates these treatments into his practice, starting with topical steroids in some cases and transitioning to nonsteroidal options as needed. Dr Noor’s approach allows for flexible treatment plans tailored to each patient’s response.
Dr Noor goes on to note that his experience with tapinarof aligns with emerging clinical data, showing effectiveness in challenging areas like the scalp with minimal adverse effects. He highlights that while contact dermatitis was observed in trials, it is rare in his practice, and proper patient education helps mitigate risks.
They then discuss the remittive effect that some patients achieve with tapinarof, thanks to its mechanism of action as an aryl hydrocarbon receptor agonist. This contrasts with corticosteroids, which are often seen as temporary solutions. He encourages health care providers to take the time to engage thoughtfully with patients, recognizing their investment in their care and the value of personalized attention and education.
Tune in to this episode for valuable insights on optimizing psoriasis treatment and improving patient care through effective use of nonsteroidal therapies and enhanced communication strategies. -
In this episode, our host, James Q. Del Rosso, DO, welcomes Dr Adrian Rodriguez, a dermatologist from Nashville, to discuss the exciting advancements in personalized medicine for psoriasis, particularly focusing on the practical use of a dermal biomedical patch to help clinicians optimize selection of biologics agents for patients with psoriasis.
Dr Rodriguez emphasizes that we're moving into an era where personalized patient evaluations are playing a greater role in disease management, not to replace the judgment of the clinician, but to assist the clinician during the process of treatment selection. The Mind.Px patch, which is currently available for use, is designed to predict a patient's response to anti-TNF, anti-IL 17, or anti-IL 23 agents, and epitomizes this shift towards precision medicine. He explains how the patch enables dermatologists to customize psoriasis treatments based on molecular signatures, with evidence supporting improved overall patient outcomes as compared to clinical judgment alone.
He shares his real-world experience of integrating the Mind.Px patch into clinical practice, highlighting its simplicity and the minimal learning curve required for its use. He points out that the real challenge lies in integrating the patch into a busy dermatology practice, ensuring timely results, and coordinating subsequent treatment.
Dr Del Rosso then poses various clinical scenarios to Dr Rodriguez, exploring the practicality of the patch. They acknowledge that data shows better response rates and faster achievement of PASI75 among physicians using the patch.
When selecting the test site, Dr Rodriguez advises choosing an early erythematous plaque, noting that the procedure is painless and well-received by patients who appreciate the use of both for cutting-edge diagnostic technology and treatments. He emphasizes the importance of clear communication with patients about the patch’s benefits and logistics, as it requires a few weeks to get results.
They also cover the practical aspects of obtaining and using the patch, including insurance coverage and patient assistance programs to manage costs.
Tune in to learn how the Mind.Px dermal patch is guiding the future of personalized psoriasis treatment and how you can incorporate this innovative tool into your practice for better clinical outcomes -
In this episode of Derms and Conditions, host James Q. Del Rosso, DO, and guests Michael Cameron, MD, and James Allred, MD, discuss the intersection of GLP-1 agents and dermatology, exploring how these drugs, initially designed for managing type 2 diabetes, are now offering promising benefits for skin conditions associated with obesity.
They begin by providing an overview of glucagon-like peptide-1 (GLP-1) agents and their mechanisms of action. These drugs, which include terzepitide (marketed as Mounjaro and Zepbound) and semaglutide (available as Ozempic and Wegovy), are GLP-1 receptor agonists that enhance insulin secretion, reduce appetite, and promote weight loss.
Dr Allred then shares his personal experience, noting that patients on GLP-1 therapy, prescribed by their primary care physicians, showed remarkable improvements in their hidradenitis suppurativa (HS) symptoms. Observing these benefits, he began prescribing GLP-1 agents himself. Although randomized controlled trials directly linking GLP-1 agents to HS improvement are lacking, clinical observations align with the understanding that obesity-related systemic inflammation impacts dermatologic conditions like HS and psoriasis.
The conversation then shifts to discussing weight management with patients. They stress the importance of empathy and understanding, particularly for patients with HS who may find exercise counterproductive due to flare-ups. By explaining that reducing systemic inflammation through weight loss can significantly improve HS symptoms, they find patients more receptive to GLP-1 therapy.
Finally, they cover the practical aspects of integrating GLP-1 prescribing into dermatologic practice. Drs Allred and Cameron advise on patient assessment, including checking BMI and potential contraindications like a history of thyroid cancer. They highlight the importance of monitoring basic labs, such as glucose, hemoglobin A1c, and lipid profiles, to track the therapy’s impact and support insurance approvals.
Tune in to learn how dermatologists can leverage GLP-1 agents to improve patient outcomes by addressing the inflammatory underpinnings of conditions like HS and enhancing overall quality of life. -
In this special episode of Derms and Conditions, Charlie Dunn, MD, chief resident at Kansas City University, steps in as the host to interview James Del Rosso, DO, offering a fresh perspective for our listeners. Together, they explore the evolution of dermatologic therapies and the understanding of disease states, providing valuable insights for both early-career dermatologists and seasoned practitioners alike.
They begin with rosacea, with Dr Del Rosso explaining the historical perspective and highlighting a landmark article that classified the condition into subtypes. This classification system, although useful, has led to some confusion over the years. He discusses the condition’s complexity and the need to reconsider the traditional subtypes. He stresses the importance of evaluating patients individually, considering the phenotype presented during consultations, and understanding the interplay between erythema, papules, and pustules.
The conversation then shifts to hidradenitis suppurativa (HS) and other disease states, with Dr Del Rosso emphasizing the need for therapies to evolve alongside our understanding of the disease. He points out that package inserts often lag behind current clinical practices, and highlighting the disconnect between FDA-approved prescribing information and real-world application and experience, encourages dermatologists to stay informed about the latest pathophysiological insights and therapeutic options.
Advocating for a personalized approach to dermatologic care, they discuss recognizing that therapies within the same class can behave differently across various disease states and patient populations. They emphasize the value of real-world studies in capturing the practical application of treatments, contrasting with the controlled settings of phase 3 clinical trials.
As the episode draws to a close, Drs Dunn and Del Rosso reflect on the dynamic nature of dermatologic practice, encouraging listeners to stay informed and adaptable. They highlight the importance of reassessing traditional approaches considering evolving evidence. This episode offers a comprehensive overview of the current landscape of dermatologic therapies, providing listeners with actionable insights and a deeper understanding of how to navigate the complexities of modern dermatologic practice. -
In this episode of Derms and Conditions, host James Q Del Rosso, DO, is joined by Clay Cockerell, MD, a practicing dermatopathologist at Cockerell Dermatology in Dallas, TX, whose expertise in dermatopathology and commitment to ongoing education offer listeners practical advice on enhancing patient care and professional fulfillment.
They begin by discussing some common pitfalls that can lead to missed diagnoses. Dr Cockerell emphasizes the importance of proper biopsy techniques, noting issues such as inadequate superficial biopsies that miss diagnostic areas and improper punch biopsies that fail to assess critical features. He also addresses insufficient preset menu options in EMR systems that lack necessary detail, advocating for including clinical photographs with unusual skin biopsies to improve diagnostic accuracy.
They then expand on the topic of the underutilization of EMR systems to send clinical photographs to dermatopathology labs, urging more offices to adopt this practice to provide valuable context for difficult cases.
Dr Cockerell then shares his journey of continuous learning, having pursued multiple MBAs and a law degree. He emphasizes the value of business and legal knowledge in medical practice, noting that his MBA education helped him with personal finance, hiring, leadership, and people skills, while his law degree provided valuable insights into understanding legal documents and advocating for his rights.
Dr Del Rosso and Dr Cockerell then speculate on the increasing rates of burnout among dermatologists and emphasize the importance of hobbies and interests outside of medicine, with both agreeing that diversifying one's interests is crucial to maintaining passion and satisfaction in one's career.
Tune in to the full episode for more valuable insights into improving dermatology practices, the importance of continuous learning, and strategies for maintaining work-life balance to prevent burnout. -
In this episode of Derms and Conditions, host James Q Del Rosso, DO, and James Song, MD, FAAD, co-chief medical officer and director of clinical research at Frontier Dermatology in Mill Creek, WA, explore the complexities of clinical decision-making in dermatology. Dr Song shares his insights on maintaining efficiency in a busy private practice, particularly when dealing with challenging medication approvals.
They begin by highlighting the importance of setting patient expectations early and communicating that initial treatment plans are not binding and can be adjusted based on patient feedback and treatment efficacy.
They explore the challenges of getting systemic treatments approved for conditions affecting areas like the scalp, hands, feet, or nails, which may not respond well to topicals but often require step therapy before systemic agents are approved.
Sharing strategies for streamlining the approval and appeals process, Dr Song explains the value of referencing expert panel guidance to support treatment plans and how using prepopulated templates from organizations like the HS Foundation can streamline approvals and strengthen appeals for off-label usage of drugs like infliximab.
Both doctors stress the importance of thorough documentation, highlighting the need for effective note-taking that includes the key phrases payers look for to reduce denial rates. Dr Song notes the significance of understanding the requirements of major payers and maintaining a log of these requirements to stay current.
The episode also covers the concept of bridge programs, which, while beneficial on paper, can be labor-intensive to maintain. Dr Song advises using them judiciously, opting for reasonable alternatives when possible, so long as it does not compromise patient care.
Tune in to the full episode for a detailed look at the ins and outs of clinical decision-making, medication approval, and the importance of clear communication and conscientious documentation in dermatologic practice. -
In this episode of Derms and Conditions, host James Q Del Rosso, DO, is joined by Alexandra Golant, MD, to discuss taking a holistic approach to diagnosing and managing atopic dermatitis beyond the AAD guidelines, exploring the importance of looking beyond treatment rankings and considering comprehensive patient information.
They begin by discussing the significance of patient history, emphasizing the importance of context clues like family history, seasonal variations in symptoms, and quality of life impacts in forming a comprehensive understanding of the individual.
They also address navigating the challenges of gathering family histories, noting that despite challenges in obtaining accurate details, it's crucial to maintain a broad perspective while making diagnoses, focusing on key features while not losing sight of supportive aspects.
Next, they highlight diagnostic challenges, emphasizing the need to consider atypical presentations and always keep a range of differentials in mind. Dr Golant discusses using therapeutics as both a treatment and diagnostic tool, with an emphasis on reassessment if treatment expectations are not met. Trigger factors are also explored, with both doctors sharing anecdotes that illustrate the impact of environmental triggers on symptoms.
The pair also discusses their differing approaches to making skin care recommendations to their patients, highlighting that this varies among practitioners with some providing liberal suggestions and others providing more specific guidance.
They then move on to discuss how they select treatments for their patients, noting that the integration of topical therapy is patient-dependent, with newer agents gaining traction due to improved tolerability. Systemic therapies, including monoclonal antibodies and JAK inhibitors, offer promising options, with treatment selection tailored to individual patient factors.
Looking ahead, they note that advancements in monoclonal antibodies and targeted therapies hold promise for improving AD management. They conclude their discussion by highlighting evolving guidelines and a shift away from corticosteroids towards more targeted therapies, signaling progress in the field.
Tune in to the full episode to hear more about using guidelines to inform a holistic approach to the management of atopic dermatitis! -
In this episode of Derms and Conditions, host James Q Del Rosso, DO, is joined by Shawn Kwatra, MD, to discuss an intriguing breakthrough in atopic dermatitis (AD) therapeutics: the OX40/OX40 ligand pathway. As advancements in AD treatment continue to unfold rapidly, this pathway has emerged as a novel target, presenting a promising avenue for achieving long-term relief by targeting upstream inflammatory signals. By normalizing disease processes and potentially inducing longer periods of remission, understanding this pathway may offer a paradigm shift in AD management.
They begin with an overview of the OX40/OX40 ligand pathway, a key regulatory mechanism believed to govern type 2 inflammation at its source. The OX40/OX40 ligand serves as a crucial costimulatory molecule, facilitating communication between immune cells. This interaction, occurring upstream in the inflammatory cascade, has become the focus of therapeutic interventions aimed at modulating AD.
They also highlight the impact of the heterogeneity of AD, characterized by various cytokine profiles and immune responses, emphasizing the significance of targeting the OX40/OX40 ligand pathway. By intervening at this early stage, it becomes possible to personalize treatment strategies and address the diverse manifestations of the disease.
They then discuss the potential of OX40/OX40 ligand modulation to influence immune memory, leading to sustained responses even after treatment cessation. Clinical data suggest the possibility of extended remission periods, enabling a shift towards disease modification rather than symptom control alone.
Looking ahead, the pair discusses how the integration of OX40/OX40 ligand-targeted therapies with existing treatments could yield synergistic effects, expanding treatment options for not only AD but also related inflammatory conditions.
Tune in to the full episode to learn more about this novel target and how it may revolutionize the management of a spectrum of immune-mediated diseases.
This episode is supported by Sanofi. The content included in this episode is independently developed by the Derms and Conditions team and their guest speakers, and reflects their own views and opinions. -
In this episode of Derms and Conditions, host James Q Del Rosso, DO, interviews Faranak Kamangar, MD, and April Armstrong, MD, MPH, about the integration of artificial intelligence (AI) in dermatology. They discuss specialized dermatologic models, ethical considerations, and the crucial role of physicians in refining these technologies.
The discussion begins with the host addressing concerns regarding the "authenticity" of AI and how Dr Kamangar developed a strong interest in AI, stemming from her engineering background and interest in health technology, particularly in the development of language-learning models. She explains the significance of ChatGPT opening the door publicly for AI, followed by specialized models revolutionizing AI accuracy. They then discuss the vetting process for AI accuracy, addressing both anticipated and logical errors and the more subtle errors seen in field-specific results. Dr Kamangar emphasizes the importance of using specialized AI models for dermatology to ensure the most precise results.
The discussion with both Dr Kamangar and Dr Armstrong also touches on the ethical considerations surrounding AI use in medical writing, highlighting the necessity of disclosing AI involvement to uphold integrity in academic publishing. Exploring the use of AI in electronic medical records (EMRs), Dr Kamangar and Armstrong underscore the importance of maintaining HIPAA compliance and the need for human oversight when integrating AI into EMRs and publications. They note that when implemented effectively, AI use in EMRs has the potential to reduce human errors, and with both medical record documentation and publication writing, has the potential to alleviate burnout.
The conversation then shifts to the role of residents in integrating AI tools into their practice, with Dr Armstrong noting that residents are often early adopters of new technologies. They also emphasize the importance of physician involvement in the early development of dermatology-specific AI solutions, which is essential for shaping tools that address real-world challenges in dermatologic practice.
Looking forward, they both anticipate continued integration of AI in dermatology practice, emphasizing the need for physicians to familiarize themselves with this technology to determine what models are dependable and ultimately to optimize patient care.
Tune into the episode to further explore the many nuanced challenges and opportunities presented by AI adoption in dermatology! -
In this episode of Derms and Conditions, host James Q Del Rosso, DO, engages in a comprehensive discussion with Jason Hawkes, MD, MS, FAAD, a medical dermatologist in Rocklin, CA, on chronic spontaneous urticaria (CSU). They discuss CSU’s position in the spectrum of urticarial conditions, explore differential diagnoses and treatment strategies, and offer a wealth of valuable insights into this complex disease.
They begin by defining urticaria as a collection of conditions, explaining that this is often not well-delineated in textbooks or literature. Dr Hawkes categorizes urticaria into acute and chronic types, with chronic further divided into chronic inducible urticaria, which results from an identifiable trigger, and chronic spontaneous urticaria, which has no clear cause.
They then explore differential diagnoses for CSU, including drug-induced urticarial reactions and conditions like mastocytosis or urticarial bullous pemphigoid that require thorough consideration.
Transitioning to treatment strategies, they evaluate the use of systemic corticosteroids like prednisone for short-term relief in patients with CSU, taking into account reservations about long-term efficacy and potential side effects. Antihistamines are also highlighted for their rapid action, with Dr Hawkes encouraging prompt dosage adjustments if initial doses are ineffective.
The conversation shifts to omalizumab, an injectable anti-IgE monoclonal antibody that has waned in popularity among dermatologists due to practical limitations and concerns over anaphylaxis risk. However, it is highlighted as a very effective treatment option for many patients with CSU, as it is amenable to office administration with low rates of anaphylaxis in real-world practice and has a broad consensus for use in guidelines.
They conclude by touching on newer therapies in development that target alternative mechanisms, such as BTK and SYK inhibitors, which will broaden the therapeutic alternatives for patients with CSU.
Tune into the full episode to gain a deeper understanding of CSU and glean invaluable insights into the nuances of this multifaceted condition. - Visa fler
