Derms and Conditions

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Lisa Swanson, MD, to explore how acne management continues to evolve and how newer topical therapies can be integrated thoughtfully from the outset. They begin with Dr Swanson highlighting an important clinical reality: acne is presenting at increasingly younger ages, prompting earlier conversations about skin care routines and long-term strategies. At the same time, dermatologists now have several truly novel topical options, an uncommon development in acne therapeutics over the past decade. Using a typical adolescent patient as a reference point, she then outlines the range of options she reviews in clinic: foundational topical regimens (retinoids, benzoyl peroxide combinations, clascoterone, topical minocycline foam, or fixed triple combinations), selective short courses of oral antibiotics, consideration of oral probiotics based on emerging data, and hormonal approaches in appropriate female patients. She emphasizes tailoring mechanisms when combining therapies; for example, pairing hormonal therapy with a topical that offers a complementary pathway. Dr Del Rosso revisits the 4 pillars of acne pathophysiology, highlighting androgen-driven sebum production as an upstream contributor. This leads to a focused discussion on clascoterone as the first topical androgen receptor inhibitor and how targeting sebum early may alter lesion development. Both clinicians stress that clascoterone is best viewed as foundational rather than adjunctive therapy, emphasizing the importance of setting realistic expectations on time to peak efficacy. The conversation also covers tolerability, barrier considerations, twice-daily adherence, and admixture data with common topical agents. Clinical pearls include setting early follow-ups to reinforce adherence, aligning office staff messaging, and using shared decision-making to balance patient priorities like oil control and pore appearance with mechanistic treatment goals. Tune in to the episode to hear real strategies for initiating acne therapy with intention, integrating newer topicals early, and guiding patients toward regimens that are both physiologically sound and sustainable in everyday practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Steven Daveluy, MD, for a wide-ranging conversation that connects oncodermatology, teledermatology, and integrative approaches to patient care. The discussion opens with Dr Daveluy’s work in an oncodermatology clinic and the critical role dermatologists play in managing cutaneous side effects from cancer therapies. He explains that while oncologists may be inclined to pause or discontinue cancer treatment in the face of severe skin reactions, dermatologists are uniquely positioned to identify, manage, and mitigate these effects, often allowing patients to remain on life-saving therapy and achieve better oncologic outcomes. The conversation then shifts to teledermatology, highlighting the Veterans Affairs health system’s leadership in expanding access, particularly for rural patients. Dr Daveluy describes his team-based model in which dermatoscopy is standardized across sites, allowing frontline clinicians to submit high-quality images for rapid dermatologic input. Clinical pearls follow, including management of epidermal growth factor receptor-inhibitor eruptions with tetracyclines and selective use of agents such as isotretinoin or dapsone to keep patients on cancer therapy. Importantly, brisk skin reactions may correlate with positive tumor response, reinforcing the goal of treating through, rather than stopping, therapy. The episode concludes with an exploration of integrative dermatology. Dr Daveluy advocates for consideration of evidence-based supplements, thoughtful discussion of diet and stress, and careful counseling rather than dismissing patient interest. Case examples illustrate both benefit and harm, underscoring the importance of third-party testing and drug–supplement awareness. A final reflection on mind-body medicine through practices like “laughter yoga” highlights tools that can help patients reframe flares and improve quality of life, even when disease activity is beyond their control. Tune in to the episode to hear expert insights on managing cancer-therapy–related skin reactions, expanding access through teledermatology, and thoughtfully integrating complementary approaches into everyday dermatology practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Laura Ferris, MD, to explore the path to, and realities of, serving as a department chair in academic dermatology. They begin with Dr Ferris describing the motivations that led her to consider a leadership role, sharing the self-reflective questions that guided her thinking, including how to continue growing professionally, how care delivery can be improved, and where she could make the greatest long-term impact. The conversation then turns to stepping into the chair role itself. Dr Ferris introduces the idea of a “listening tour,” and the value of meeting with faculty and staff early, understanding what matters most to them, and easing fears that change will disrupt what they value in their work. She stresses that a department’s success depends on shared ownership, not top-down decision-making. They next discuss building productive relationships beyond the academic setting, particularly with community dermatologists. Dr Ferris describes her department’s noncompetitive approach, focusing on clinical excellence, referral partnerships, and aligning care so patients are matched with the right expertise. A key portion of the discussion centers on working effectively with advanced practice providers (APPs). Dr Ferris outlines her department’s physician-to-APP model, highlighting mentorship, collaboration, and thoughtful delegation to ensure high-quality care. The episode concludes with Dr Ferris sharing her goals for the future, including reducing silos, strengthening integration between clinical care and research, expanding translational efforts, and improving access for underserved and rural populations through tools like e-consults. She emphasizes the importance of engaging faculty, residents, and learners in shaping a shared vision and turning ideas into action. Tune in to the episode to hear practical leadership insights, real-world lessons on collaboration, and thoughtful perspectives on guiding a dermatology department through growth and change.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Lauren Madigan, MD, associate professor of dermatology at the University of Utah, for a focused exploration of mast cell disease, an often underrecognized but clinically significant group of disorders that dermatologists may encounter on the front lines. The conversation begins with mast cell biology, including their origin in the bone marrow, tissue-specific phenotypes, and roles beyond classic allergic disease. Dr Madigan explains how mast cells contribute to immune defense and wound healing, with Dr Del Rosso noting how infrequently they are discussed in routine dermatology training despite their relevance across multiple conditions. They then explore mastocytosis across the age spectrum, contrasting pediatric presentations (many of which remit by adolescence) with adult-onset disease, where cutaneous findings often signal systemic involvement. Dr Madigan reviews current National Comprehensive Cancer Network guidance, emphasizing that most adults presenting with cutaneous mastocytosis will have some degree of systemic disease and may warrant more detailed testing for accurate staging, prognostic differentiation, and management choices. The discussion highlights the heterogeneity of systemic mastocytosis, from indolent forms to advanced disease with organ involvement or associated hematologic neoplasms. The episode also covers practical diagnostic and workup considerations, including laboratory evaluation, KIT mutation testing, and biopsy considerations. Dr Madigan stresses the importance of experienced dermatopathology interpretation and thoughtful site selection to optimize diagnostic yield. Treatment strategies are discussed through a pragmatic lens, ranging from symptom-directed therapies to cytoreductive and targeted tyrosine kinase inhibitors, with an emphasis on individualized care based on disease subtype, symptomatology, and prognosis. The episode closes with resources to help dermatologists navigate diagnostic assistance and treatments via specialty centers and clinical trials. Listen to the episode to deepen your understanding of mast cell disease, sharpen your diagnostic approach, and gain practical guidance on evaluation, staging, and management strategies, both for real-world practice and for determining when referral to specialized care is warranted.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Zoe Draelos, MD, for an in-depth discussion of 3 practical questions surrounding topical clascoterone, informed by studies Dr Draelos helped conduct. Together, they translate study findings into real-world considerations for using clascoterone as part of combination acne regimens. The conversation begins with the role of formulation and vehicle design, addressing a common concern in acne management: barrier disruption and application-site irritation. Unlike retinoids or benzoyl peroxide, clascoterone is an androgen receptor inhibitor formulated in a vehicle shown to sustain and slightly increase moisture content in the skin, supporting  barrier function while remaining compatible with other topical acne therapies. Data evaluating transepidermal water loss and corneometry demonstrate that the finished, marketed formulation sustains skin moisturization, reinforcing its barrier-friendly profile. The discussion then turns to real-world use, where clascoterone is frequently combined with other topical agents. An admixture stability study examined whether clascoterone degrades, or causes degradation of, commonly used acne treatments such as benzoyl peroxide, clindamycin, adapalene, and retinoids. Using chromatographic and mass spectrometric analysis, the study confirmed that clascoterone remains stable and compatible when layered with these agents. Finally, Dr Draelos reviews clinical data demonstrating progressive sebum reduction in patients with mild to moderate acne, measured using standardized sebumeter technology. Sebum levels decreased beginning around 12 weeks and continued to decline through 52 weeks, paralleling reductions in acne lesions, oily appearance, and visible pore size. Together, these findings clarify how clascoterone works at the target organ level and why its clinical benefits extend over time. Tune in to the episode to hear how these studies answer key mechanistic and practical questions about clascoterone, and how its barrier-friendly formulation, combination compatibility, and sustained sebum reduction may inform everyday acne management in clinical practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Nicholas Brownstone, MD, practicing dermatologist and host of the Cutaneous Miscellaneous podcast, for a case-based discussion on how dermatologists think through challenging presentations and refine their diagnostic approach. Together, they offer takeaways that residents, early-career dermatologists, and experienced clinicians alike can apply when faced with complex or ambiguous cases. The episode opens with a challenging pustular eruption in a 30-year-old male initially labeled as Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Through a stepwise reassessment, the discussion walks through acute generalized exanthematous pustulosis versus generalized pustular psoriasis, highlighting latency periods, biopsy limitations, recurrence patterns, and the clinical clues that ultimately prompted a shift in diagnosis and management. The case also surfaces practical access barriers, including insurance denial of spesolimab due to tuberculosis testing requirements, and explores how evolving guidance contrasts with current labeling realities. Subsequent cases broaden the scope to mucocutaneous eruptions, clarifying distinctions among erythema multiforme, Mycoplasma-induced rash and mucositis/reactive infectious mucocutaneous eruption, and SJS/TEN. A key takeaway discussed is the importance of prioritizing drug causality when classic triggers and timelines are present, even in the setting of concurrent infection, to avoid potentially catastrophic outcomes. The final case focuses on neonatal lupus and explores how recognizing characteristic cutaneous findings can lead to appropriate evaluation for systemic involvement and timely referral, even when skin disease itself is self-limited. Tune into the episode to follow expert clinicians as they reason through diagnostic uncertainty, rethink initial assumptions, and highlight the small diagnostic details that can meaningfully change disease management.

In this 2025 Year in Review solo episode of Derms and Conditions, host James Q. Del Rosso, DO, reflects on the standout conversations, clinical insights, and new formats that shaped the series over the past year. Dr Del Rosso opens by highlighting the launch of Tea with Dr. D, a sister vodcast that brings expert discussions to video, incorporating slides and procedural footage. He spotlights an episode with HS expert Lauren Lam, MD, who walks through comprehensive hidradenitis suppurativa management from patient check-in through long-term care. He also reviews Spilling the Tea with Dr. D, a hybrid audio-video mailbag format that addresses listener-submitted clinical questions. He then revisits key moments from the core Derms and Conditions series, beginning with Michael Payette, DO, who discussed building a dedicated HS clinic, collaborating with nondermatology providers, and his early adoption of GLP-1 agents for inflammatory disease management. Additional highlights include an episode with E. James Song, MD, on modern nb-UVB phototherapy units and practical guidance for safe implementation, as well as a unique discussion with Clay Cockerell, MD, JD, on estate planning considerations for physicians. Vitiligo emerged as a recurring focus in 2025, with expert insights from Seemal Desai, MD, and Pearl Grimes, MD, covering disease assessment, treatment timelines, topical ruxolitinib, oral therapies, phototherapy, and running a dedicated vitiligo center. Dr Del Rosso also revisits episodes on extended-release minocycline for rosacea, oral JAK inhibitors in older adults, challenging case-based discussions, evolving approaches to photoprotection and skin care counseling, and emerging therapies across alopecia areata, hyperhidrosis, tyrosine kinase 2 inhibition in psoriasis, and chronic hand eczema, including a recent FDA approval. Tune in to the full episode for a look back at a year of clinically relevant education aimed at supporting dermatologists in everyday practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Pearl Grimes, MD, to discuss the latest understanding and management of vitiligo, a field experiencing significant scientific and therapeutic momentum. With the approval of topical ruxolitinib and multiple oral JAK inhibitors on the horizon, these developments are enabling clinicians to better tailor therapy to the diverse needs of their patients. They begin with a discussion on setting patient expectations around treatment duration. With vitiligo therapies requiring long-term commitment, Dr Grimes explains that it is a chronic disease requiring ongoing management, whether using older therapies or newer JAK inhibitors. By establishing realistic expectations early, patients are less likely to abandon therapy prematurely when repigmentation is not yet visible. They also address common misconceptions around skin type. While vitiligo is more noticeable in darker skin, its prevalence is similar across all skin tones. In her clinical experience and in ruxolitinib trials and emerging oral JAK data, Dr Grimes has observed meaningful repigmentation across phototypes, with no major response differences that would warrant altering expectations for lighter-skinned patients. They next discuss practical therapeutic considerations, including typical timelines for assessing response and the role of regimen adjustments during the first year.  When using ruxolitinib, she considers disease extent, anatomic site, and expected repigmentation patterns, noting that the face and neck tend to respond best, with the hands remaining challenging. She also reviews her approach to initial workup, including autoimmune screening, particularly for thyroid disease, as well as her use of supplements to mitigate oxidative stress pathways implicated in melanocyte destruction. Tune in to the full episode to hear Dr Grimes share additional clinical pearls, discuss combination strategies, and offer guidance on setting patients up for long-term success in vitiligo management.

In this special Derms and Conditions episode recorded live at Fall Clinical 2025, host James Q. Del Rosso, DO, is joined by April Armstrong, MD, MPH, and David Cohen, MD, to share highlights and clinical takeaways from this year’s meeting. Dr Armstrong kicks off with updates in hidradenitis suppurativa (HS), noting the field’s rapid progress with 3 FDA-approved therapies (adalimumab, secukinumab, and bimekizumab), emerging 3-year data for bimekizumab, and exciting new agents such as oral povorcitinib and topical ruxolitinib. She shares learnings on the importance of proactive flare management plans and setting realistic patient expectations, particularly regarding scarring and lymphedema. Dr Cohen and Dr Del Rosso echo the importance of reengaging patients with longstanding HS and highlight the promise of JAK inhibition in this complex disease. The discussion shifts to chronic spontaneous urticaria (CSU), where Dr Cohen spotlights remibrutinib, a twice-daily oral Bruton kinase inhibitor delivering rapid results sometimes within 1 to 2 weeks and potentially enabling dermatologists to manage CSU more directly. Dr Armstrong adds that dupilumab now offers another trusted option for CSU, with a head-to-head trial versus remibrutinib on the horizon. For chronic hand eczema (CHE), they discuss the paradigm-shifting approval of delgocitinib cream, a topical pan-JAK inhibitor effective across CHE subtypes and free of boxed warnings. They note strong data for pain and itch reduction and its potential to mitigate chronic steroid reliance. The episode closes with emerging oral psoriasis therapies, including 5-year deucravacitinib safety data and radiographic progression inhibition shown with guselkumab. Looking ahead, they predict major advances by 2026 in TYK2 inhibitors, OX40-targeted therapies, and personalized molecular profiling for atopic dermatitis. Tune in to the full episode for expert perspectives straight from the Fall Clinical stage!

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes David Osborne, PhD, a formulation expert behind several dermatologic topicals, to explore what drives topical performance, using dapsone and roflumilast as case studies. They begin by challenging long-held vehicle dogma rooted in mid-20th-century corticosteroid training: the idea that ointments always outperform creams or lotions. They note that with newer solubilizers, stabilizers, and vehicles, those rules don’t consistently hold for products approved in the modern era. They next revisit propylene glycol (PG) as a classic double-edged tool: its ability to dissolve more drug helped create “super-potent” corticosteroid lotions, yet higher PG levels can irritate skin, induce contact allergy, and compromise barrier function. However, they clarify that small amounts may serve as a humectant and offer antimicrobial benefits. They then discuss topical roflumilast’s development to illustrate modern formulation problem-solving: the roflumilast molecule is difficult to dissolve in water and tends to precipitate when water is present. The formulation approach minimized supersaturation (allowing a small solid fraction), leveraged a high purity grade of diethylene glycol monoethyl ether (DEGEE), known under the commercial name Transcutol, to hold the active ingredient drug (roflumilast) in solution in the presence of water, and delivered a highly moisturizing, propylene glycol-free and ethanol-free cream. Use of a unique emulsification approach ensured physical stability even at elevated temperatures while avoiding lipid extraction and additional barrier damage. For topical dapsone, Osborne incorporated pharmaceutical-grade Transcutol (free of ethylene-glycol contaminants) to partition the drug, slow release, and reduce systemic exposure. He emphasizes “topical product metamorphosis”: as water evaporates on skin, the local Transcutol concentration rises, dissolving residual crystals and enhancing delivery, the opposite of older vehicles that left behind residual visible crystals and under-delivered active. They close by looking ahead towards preservative minimalism, microbiome-aware vehicles, and designing drugs intrinsically optimized for cutaneous delivery so the base can remain as inert as possible. Tune in to the full episode to hear the formulation backstories behind roflumilast and dapsone, why PG can both enhance delivery and damage skin barrier integrity and function, how Transcutol and robust emulsifiers can solve solubility and stability hurdles, and pearls you can use tomorrow when selecting vehicles and counseling on tolerability.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with E. James Song, MD, for a discussion on phototherapy and its place in modern dermatology. While phototherapy has long been a safe and effective treatment for various skin disorders, its use has declined due to limited access, inconsistent residency training, and clinician concerns about dosing. They review why these barriers are more logistical than clinical and how newer technologies are making treatment more accessible than ever. They begin by highlighting one of the most significant advances in phototherapy: home-based narrowband UVB devices. These units feature guided dosing modes that adjust treatments based on patient feedback, minimizing risks and removing guesswork. They review real-world evidence from the LITE study, which demonstrated home-based therapy to be at least as effective as in-office treatment, with strong adherence, particularly among patients of color, while maintaining a favorable safety profile. Dr Song then reviews appropriate patient selection, contraindications, and practical steps for prescribing at-home devices, from enrollment forms to choosing unit sizes for full-body or targeted treatment. He also shares pearls on using phototherapy as an adjunct in conditions like psoriasis with psoriatic arthritis, and highlights approved indications that extend beyond psoriasis, including atopic dermatitis, vitiligo, and cutaneous T-cell lymphoma. The conversation concludes with a look at broader implications: phototherapy’s favorable cost-effectiveness compared to biologics, evidence of improvements in systemic inflammatory markers, and emerging research suggesting potential benefits in autoimmune conditions outside dermatology. Tune in to the full episode for practical guidance on this mainstay of dermatologic practice and a renewed perspective on integrating phototherapy into modern care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Natasha Mesinkovska, MD, associate professor of Dermatology at UC Irvine, to discuss the multifaceted challenges of alopecia areata (AA), an autoimmune condition with complex comorbidities and broad psychosocial implications. The conversation begins with the stigma of hair loss and the importance of addressing the patient’s emotional well-being. Dr Mesinkovska highlights her approach: asking simple but direct questions about how patients are coping and connecting them with mental health resources when needed. Comorbidities and workup are also addressed, with Dr Mesinkovska sharing her pragmatic approach to labs: thyroid-stimulating hormone test as a baseline, selective additional testing for patients with indicators of comorbidities, and requesting consultation with endocrinology when indicated. Prognosis is also discussed, with childhood onset and family history noted as adverse factors. They next explore treatment expectations, beginning with the typical timeline of response seen with oral JAK inhibitors and the importance of allowing several months for optimal hair regrowth. Many patients, once regrowth occurs, ask when they can stop therapy in hopes that results will persist without ongoing treatment; this is an important moment to counsel patients on the chronic nature of AA and emphasize that discontinuing therapy often leads to renewed hair loss. Continuing oral JAK inhibitor therapy offers the greatest likelihood of maintaining regrowth over time.  They review clinical data on the durability of response of the JAK inhibitors for AA, which has shown that relapse of hair loss is common once treatment is discontinued. For those who elect to stop therapy, it is essential to emphasize the need to resume treatment promptly at the first signs of relapse, under supervision of their dermatologist. Ongoing clinical and laboratory monitoring is also highlighted as critical to ensure long-term safety. Dr Mesinkovska then discusses differential diagnoses for AA, covering lichen planopilaris, trichotillomania, and other mimickers, with biopsy reserved for challenging cases. She next reviews the 3 approved JAK inhibitors for AA, baricitinib, ritlecitinib, and deuruxolitinib, highlighting differences in efficacy, dosing, speed of response, and the role of CYP2C9 testing specific to deuruxolitinib. Clinical study data are used to outline the features that distinguish deuruxolitinib, the newest oral JAK inhibitor, from the other agents. These include a potentially faster onset of hair regrowth, enhanced efficacy with twice-daily dosing, and the ability to identify individuals who metabolize the drug more slowly through CYP2C9 testing. Tune in to the full episode to hear how dermatologists can assess comorbidities, select systemic therapies, manage patient expectations, and support the psychosocial needs of those with AA to achieve more comprehensive care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Patti Farris, MD, associate clinical professor of dermatology at Tulane University, for a timely conversation on photoprotection and sunscreen. As new concerns surface among patients, they provide an up-to-date perspective on UV exposure, formulation science, and patient counseling. Dr Farris explains the critical role of UVA radiation, which penetrates deeper into the dermis than UVB and is a major driver of photoaging and skin cancer risk. Unlike UVB, UVA is harder to block because many chemical filters only partially cover this spectrum. She also reviews the controversies surrounding oxybenzone, discussing both endocrine disruption concerns and its debated link to coral reef bleaching, emphasizing the gap between laboratory studies and real-world relevance. The discussion then turns to mineral sunscreens, which have gained popularity amid growing social media skepticism about chemical filters. While they provide strong UVA protection, cosmetic acceptability remains a significant challenge, especially for patients with skin of color due to the persistent issue of white cast. Newer innovations, including the addition of antioxidants, further expand protection by addressing visible light–induced damage. They highlight one example of an advanced formulation that pairs mineral filters with vitamin E to boost UVA defense and improve tolerability across all Fitzpatrick skin types. Finally, they reflect on generational differences in patient counseling. While older patients may prioritize cancer prevention, younger patients often respond more to messaging about photoaging and skin preservation, making it vital to tailor communication strategies. Tune in to the full episode to hear Dr Farris and Dr Del Rosso explore how dermatologists can navigate evolving sunscreen science, address patient concerns with confidence, and make practical recommendations that resonate across age groups and skin types.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Dallas/Fort Worth–based dermatologist Todd Plott, MD, for an in-depth discussion on the first extended-release formulation of minocycline approved for rosacea. The conversation begins with a historical look at tetracyclines, tracing back to tetracycline in 1953, doxycycline in 1968, and minocycline in 1971. While traditionally used as broad-spectrum antibiotics, these agents have shown efficacy in rosacea primarily due to their anti-inflammatory activity rather than antimicrobial effects. They review head-to-head clinical data showing that extended-release minocycline, commercially available as Emrosi, significantly reduced inflammatory lesions and improved Investigator Global Assessment scores in patients with moderate-to-severe rosacea, outperforming both modified-release doxycycline and placebo. The trial population averaged 25 papules per patient, demonstrating the robust improvement required for trial success. A key point of discussion is minocycline’s narrow therapeutic window. While higher doses have raised concerns about adverse effects such as hyperpigmentation and lupus-like drug reactions, pharmacokinetic data show that extended-release dosing achieves lower systemic exposure with fewer safety issues compared to immediate-release formulations. Dr Plott contextualizes this by noting that dermatology indications require far lower doses than in infectious disease, which helps explain the rationale for the extended-release formulation in rosacea. Tune in to the full episode to learn more about how extended-release minocycline and anti-inflammatory dosing fit into current rosacea treatment options, what the latest evidence shows about its efficacy and safety, and how clinicians can gain refreshed perspectives on this long-standing therapy.

Index of Suspicion is the Friend of the Clinician: Great Cases from the Northeast   In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Erik Domingues, MD, a dermatologist in Fall River, MA, to review 3 cases where cutaneous presentations led to unexpected findings or required creative treatment approaches.   The first case involves a 74-year-old man with diffuse granuloma annulare (GA). Although biopsy confirmed GA, the widespread involvement raised concern for an underlying condition. When standard therapy failed, Dr Domingues noted a cervical mass that proved to be an aggressive parotid carcinoma, detected earlier than it might have been without the skin eruption. The case highlights the need for thorough physical exams and clinical judgment when faced with atypical presentations.   They next consider a 34-year-old woman presenting with severe alopecia areata (AA). While her main concern was hair loss, Dr Domingues also observed long-standing facial vitiligo. She was started on ritlecitinib, approved for AA and under study for vitiligo, leading to complete scalp regrowth and substantial repigmentation of her vitiligo. The case highlights how treatment can address both immediate concerns and chronic disease burden, while also reminding clinicians that many patients remain unaware of newer therapeutic options.   The episode closes with a personal case: Dr Domingues’s 5-year-old son, who experienced a severe atopic dermatitis flare that stopped responding to crisaborole. Roflumilast 0.3% cream, approved for atopic dermatitis in patients 6 years and older at a lower concentration, was trialed off-label, producing rapid clearance and ongoing control with seasonal use. This case demonstrates how careful clinical judgment can guide effective off-label treatment.   Tune in to the full episode for practical pearls and real-world examples of clinical reasoning, autoimmune overlap, and innovative strategies for chronic skin disease.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes April Armstrong, MD, MPH, Professor and Chief of Dermatology at UCLA, to discuss chronic hand eczema (CHE) and the introduction of the first FDA-approved treatment developed specifically for this condition. The conversation begins with a review of CHE as a distinct clinical entity, highlighting its subtypes: irritant contact dermatitis, allergic contact dermatitis, atopic hand eczema, and the less common protein contact dermatitis. They highlight occupational exposures and daily “wet work” that increase risk, while Dr Del Rosso notes the challenge of overlapping subtypes in real-world patients. Practical considerations, such as glove selection and improving patient adherence, are also addressed. The discussion then turns to delgocitinib cream, the newly approved topical pan–JAK inhibitor for moderate-to-severe CHE. Dr Armstrong explains its mechanism of action, which targets the JAK-STAT pathway across multiple immune processes involved in different CHE subtypes. They note the significance of its approval without a boxed warning, contrasting it with other topical JAK inhibitors and providing context on evolving perspectives on JAK inhibitor safety. Clinical trial findings are discussed in detail, including meaningful improvements in itch, pain, and quality of life, along with the durability of response over time. Importantly, efficacy was observed across CHE subtypes, reflecting the drug’s utility across real-world patient heterogeneity. Adverse events were minimal, with no systemic safety signals observed. Tune in to the full episode to hear Dr Armstrong and Dr Del Rosso highlight the key factors of diagnosing and treating CHE, the clinical impact of delgocitinib, and how dermatologists are now better positioned to treat this commonly encountered yet difficult to manage condition.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Andy Blauvelt, MD, to explore the mechanism, efficacy, and safety of deucravacitinib, the first FDA-approved tyrosine kinase 2 (TYK2) inhibitor for psoriasis. Dr Blauvelt begins by explaining how TYK2 inhibition differs from traditional JAK inhibition by targeting a more selective signaling pathway downstream of cytokine receptors. Unlike JAK1, JAK2, or JAK3, TYK2 is involved in a narrower range of cytokines, which may explain its distinct safety profile. Dr Del Rosso and Dr Blauvelt also clarify why deucravacitinib lacks the boxed warning seen with other oral JAK inhibitors. With allosteric binding at the TYK2 pseudokinase domain, deucravacitinib avoids cross-inhibition of other JAKs, making it more selective and potentially safer. Long-term data now supports this distinction: 5-year safety results show no increased risk of major adverse cardiac events, malignancy, or serious infections, with only a small, manageable signal for herpesvirus infections. The conversation turns to efficacy, which appears sustained over 5 years without antibody development, a potential advantage over biologics. Dr Blauvelt emphasizes its utility in high-impact areas such as the scalp, palms, soles, genitalia, and nails, and encourages systemic therapy even in patients with limited body surface area involvement when quality of life is severely affected. Tune in to the full episode to learn how deucravacitinib fits into the current psoriasis treatment algorithm, what sets TYK2 inhibition apart from other oral options, and how real-world data is shaping clinical confidence in this novel therapy.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes David Altman, MD, dermatologist at Midwest Center of Dermatology in Warren, MI, to review recent case studies that highlight unexpected presentations, treatment responses, and immune system interplay in dermatology. The first case focuses on a 34-year-old patient with severe, recalcitrant Hailey-Hailey disease. After multiple failed therapies, including antibiotics, corticosteroids, apremilast, and low-dose naltrexone, she achieved near-complete clearance within 12 weeks on dupilumab. Drs Altman and Del Rosso share their thoughts on why a drug targeting type 2 inflammation might be effective in a condition traditionally considered structural, drawing parallels to reports in Darier disease. Next, the conversation shifts to an unusual immune response observed in a patient with well-controlled psoriasis on IL-17 inhibitors who developed widespread atopic dermatitis. Dr Altman describes this as a “cytokine shift,” where suppression of IL-17 may upregulate IL-4 pathways, mirroring the reverse effect sometimes seen with IL-4 inhibition. While uncommon, such effects are now recognized in prescribing information, and the patient improved after transitioning to a broader-acting JAK inhibitor (upadacitinib). In the final case, a patient with Crohn’s disease developed rapidly progressing alopecia areata while on infliximab. Switching to tofacitinib improved hair growth but worsened gastrointestinal symptoms. Following colectomy, both the Crohn’s disease and alopecia resolved, highlighting the role of systemic inflammation in driving skin disease. Tune in to the full episode to hear more about these unique cases, the underlying immunologic mechanisms, and how lessons from complex cases can inform everyday dermatologic practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, speaks with Heather Woolery-Lloyd, MD, dermatologist and director of the Skin of Color division at the University of Miami, about the shifting dynamics of skin care among younger generations and how dermatologists can meet this growing demand for evidence-based “prejuvenation” strategies. The discussion begins with reflections on how skin care priorities have shifted from basic sun protection and moisturization to a more proactive, appearance-driven approach, especially among Gen Z. While this interest is largely aesthetic, Drs Del Rosso and Woolery-Lloyd point out that it also brings health benefits, offering dermatologists a unique opportunity to guide patients toward sound practices for photoprotection and skin longevity. They also explore the influence of social media on how young people consume skin care information. Dr Woolery-Lloyd shares findings from her research showing that most viral skin care content is not produced by medical professionals, increasing the risk of misinformation, but also noting that many young people are increasingly capable of distinguishing influencer marketing from expert guidance. They further discuss how younger patients are seeking neuromodulators and fillers as preventive strategies. Dr Del Rosso highlights the biological rationale behind these concerns, including early collagen loss and environmental skin damage. They conclude with a review of emerging ingredients like acetyl dipeptide-31 amide and bakuchiol, which offer dermal benefits with minimal irritation, potentially impacting how dermatologists counsel younger patients who are hesitant to use traditional retinoids. Tune in to the full episode to hear how dermatologists can thoughtfully engage with this prevention-minded population by acknowledging their concerns, correcting misinformation, and recommending science-backed products that promote both skin health and confidence.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Jason Hawkes, MD, Chief Scientific Officer at Oregon Medical Research Center, to explore the role of dupilumab in chronic spontaneous urticaria (CSU), a condition historically managed outside dermatology. They begin with the immunologic underpinnings of CSU, explaining the role of IL-4 and IL-13 in driving mast cell activation and the role of IL-31 in itch. Since dupilumab blocks these key cytokines, it can disrupt the disease process at multiple levels, from antibody formation to immune cell recruitment. They discuss the growing comfort among dermatologists in treating CSU now that a familiar and accessible agent like dupilumab is available, especially when compared to omalizumab, which has been limited by concerns over anaphylaxis and practice logistics. They next address real-world considerations, including the time dupilumab takes to work, the use of short-term corticosteroids, and the need for personalized treatment approaches. They caution against over-reliance on corticosteroids and discuss alternative bridging therapies like cyclosporine or methotrexate for severe cases. The episode also covers dosing nuances, patient selection, how to distinguish CSU from other urticaria types, and the importance of setting expectations. Dr Hawkes shares his experience with long-term efficacy, noting minimal loss of response among his patients. Listen to this episode for more clinical insights on dupilumab as a key treatment in managing chronic spontaneous urticaria, including considerations around patient selection, duration of therapy, and long-term disease control.