Derms and Conditions

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Cory Rubin, MD, for a candid look at the business of dermatology. Drawing on his experience building an independent practice, Dr Rubin discusses what it takes to move from clinician to practice owner, from the freedom to pursue new opportunities to the responsibility of leading a team, managing finances, and making decisions that extend far beyond patient care. Dr Rubin begins by sharing what motivated him to establish his own practice, including his interest in complex medical dermatology and clinical research and his desire for greater freedom to pursue those interests. He emphasizes that independence comes with significant responsibility: Practice ownership requires commitment, resilience, and a willingness to accept both the benefits and consequences of the decisions you make. The conversation turns to lessons Dr Rubin has learned as a leader. While clinical practice often rewards quickly identifying a problem and acting on it, he found that business decisions sometimes require slowing down, listening, and allowing time before choosing a course of action. He discusses the importance of consistency in setting expectations for staff, developing a strong workplace culture, and training PAs and NPs over time rather than expecting immediate independence. Drs Del Rosso and Rubin also explore the operational considerations of incorporating clinical research into a dermatology practice, including the need for appropriately trained research staff and clear separation of clinical and research functions. They close with Dr Rubin’s approach to structuring interactions with pharmaceutical representatives and his broader perspective on practice ownership as an ongoing process of adaptation and learning. Tune in to the episode for an inside look at the realities of building and running a dermatology practice, the lessons that come with leadership, and why setbacks can become some of the most valuable experiences for a practice owner.

In this episode, host James Q. Del Rosso, DO, welcomes dermatologist and rheumatologist Joseph Merola, MD, to discuss the diagnosis and management of dermatomyositis (DM). From subtle cutaneous clues and systemic involvement to malignancy risk, myositis-specific antibodies, and an expanding treatment pipeline, Dr Merola highlights what dermatologists should recognize when DM enters the differential. DM can present with classic findings such as Gottron papules, heliotrope rash, and the shawl sign, but other clues may be less obvious. Dr Merola discusses pruritic scalp disease, eyelid edema, linear extensor erythema, and nailfold capillary changes, as well as photodistributed eruptions that may be difficult to distinguish from cutaneous lupus. Beyond the skin, he outlines 5 areas to consider when evaluating patients with DM: cutaneous findings, muscle weakness, inflammatory arthritis, lung involvement, and malignancy. The conversation moves from clinical assessment to diagnostic workup, including evaluation of proximal muscle weakness, the importance of asking about dysphagia, and the role of CK and aldolase. Dr Merola also explains when EMG, MRI, or muscle biopsy may add value and when classic skin findings combined with weakness and/or elevated muscle enzymes may provide sufficient diagnostic information. Dr Del Rosso and Dr Merola also discuss malignancy risk and the clinical information provided by myositis-specific antibodies. Anti-TIF1γ and anti-NXP2 can signal greater malignancy risk, while anti-MDA5 is associated with clinically amyopathic disease and heightened concern for interstitial lung disease. Dr Merola considers how these findings can help inform risk assessment, screening, and collaboration with rheumatology and other specialties. Finally, they review the treatment of both cutaneous and muscle disease, from photoprotection and established systemic therapies to JAK inhibition and emerging targeted treatments. Dr Merola reflects on a growing therapeutic pipeline* for a disease in which cutaneous involvement, in particular, has historically been challenging to manage. Tune in to the episode for a clinically focused discussion of recognizing dermatomyositis, assessing systemic and malignancy risk, interpreting antibody profiles, and navigating treatment as new therapeutic options emerge. *This episode was recorded prior to FDA approval of brepocitinib. The FDA has since approved brepocitinib for use in the United States.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Darrell Rigel, MD, MS, for a discussion of photoprotection, sunscreen regulation, and how dermatologists can help patients make informed choices about sun protection. Dr Rigel begins by examining why melanoma prevention requires attention to both primary and secondary prevention. While reducing UV exposure and using sunscreen can help lower risk, early recognition and access to dermatologic care remain critical once a suspicious lesion develops. He discusses geographic differences in melanoma incidence and mortality in the United States and how factors such as UV exposure and access to care can contribute to these patterns. The conversation then traces the complicated regulatory history of sunscreens in the United States. Dr Rigel reviews developments from the emergence of higher-SPF products in the 1980s through subsequent FDA monographs, debates surrounding the safety and systemic absorption of sunscreen filters, and legislation intended to accelerate review of new ingredients. He explains how this history has contributed to the United States having fewer available UV filters than other parts of the world. A significant recent development is bemotrizinol, a broad-spectrum, photostable UV filter that has undergone extensive FDA-requested testing. Dr Rigel discusses its coverage across UVB and UVA wavelengths, cosmetic properties, and potential to expand sunscreen formulation options in the United States.* Drs Del Rosso and Rigel also address how clinicians can evaluate sunscreen products and counsel patients amid persistent misinformation. They discuss the importance of appropriate product testing, selecting products patients will actually use, and providing guidance on application of sprays, sticks, and other formulations. The discussion also considers photoprotection in patients with darker skin tones, including melanoma risk, UVA-associated dyspigmentation, and the importance of cosmetically acceptable formulations that minimize visible residue or white cast. Tune in to the episode to hear Drs Del Rosso and Rigel discuss the science and regulation behind modern sunscreens, strategies for addressing patient misconceptions, and ways to make consistent photoprotection more achievable across a range of skin types and patient preferences. *Editor’s note: This episode was recorded prior to FDA approval of bemotrizinol. The FDA has since approved bemotrizinol for use in the United States.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Andrea Murina, MD, to discuss the early recognition and management of scarring alopecias. Their conversation explores why these conditions can be missed in their earliest stages, the clinical clues that help distinguish scarring from nonscarring alopecias, and approaches to diagnosis and treatment aimed at preventing permanent hair loss. Dr Murina reflects on how outdated perceptions that little could be done once scarring occurred motivated her to focus on these conditions. She explains that recognizing patients earlier in the disease course provides an opportunity to intervene before irreversible follicular destruction develops, setting the stage for a discussion of the timing, patterns, and diagnostic tools that support earlier diagnosis. They review the major categories of cicatricial alopecia, highlighting the relative ease of identifying neutrophilic disorders such as folliculitis decalvans and dissecting cellulitis, while noting that early lymphocytic disorders such as central centrifugal cicatricial alopecia (CCCA) and frontal fibrosing alopecia may initially resemble more common nonscarring conditions. Dr Murina next overviews the value of trichoscopy. She explains how dermatoscopic findings, including perifollicular scale, telangiectasias, follicular plugs, and changes in hair diameter, can help distinguish scarring from nonscarring alopecias, guide biopsy decisions, and improve biopsy yield by identifying the most inflamed follicles for sampling. The episode also reviews treatment strategies for common scarring alopecias. For CCCA, Dr Murina typically begins with topical and intralesional corticosteroids, adding doxycycline and antifungal shampoos when appropriate. For lichen planopilaris, she follows a similar approach while incorporating systemic therapies such as hydroxychloroquine, finasteride, or dutasteride. The discussion concludes with discoid lupus erythematosus, where she emphasizes that early treatment with high-potency topical and intralesional corticosteroids, along with appropriately dosed hydroxychloroquine, can produce meaningful improvement. Tune in to the episode to hear Dr Del Rosso and Dr Murina share diagnostic pearls, trichoscopic clues, biopsy strategies, and treatment approaches that can help clinicians identify scarring alopecias earlier and intervene before permanent hair loss occurs.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Joshua Burshtein, MD, chief dermatology resident at the University of Illinois Chicago, to discuss their recent Journal of Clinical and Aesthetic Dermatology publication, Topical Prescription Therapy for Psoriasis: An Expert Position Paper on Limitations of Published Guidelines and Treatment Selection with Updated Recommendations. Their conversation examines the intended role of clinical practice guidelines, the limitations that emerge as therapeutics evolve, and why clinician judgment remains central to individualized psoriasis care. They begin by defining what treatment guidelines are intended to accomplish: to provide an evidence-based framework for clinicians rather than a rigid set of rules. Dr Burshtein notes that although the paper focuses on topical psoriasis therapies, many of its core principles apply broadly across dermatology, particularly as rapid therapeutic advances challenge the ability of clinical guidelines to remain current. Dr Del Rosso discusses the downstream effects of this disconnect, noting that guidelines are often treated as mandates by third-party payers despite disclaimers stating that they should not replace clinician judgment. The speakers emphasize that treatment decisions should remain patient-centered, with clinicians, insurers, and manufacturers all contributing to timely access to appropriate care. They also explore additional limitations of clinical guidelines, including differences in methodology among organizations and the inability of any single document to encompass every available therapy. The discussion concludes with the importance of recognizing bias in guideline development while reinforcing that treatment selection should be guided by clinical evidence, physician expertise, and shared decision-making with the patient. Tune in to the full episode to hear Drs Del Rosso and Burshtein discuss the evolving role of clinical guidelines, their limitations in everyday practice, and why individualized clinical judgment remains essential to psoriasis care.