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 new installment of Tea with Dr D, host James Q. Del Rosso, DO, is joined by Karan Lal, DO, to examine 3 complex cases where clinical reasoning required moving beyond conventional pathways. This episode features visually impactful case images that bring the discussion to life.

The first case centers on an elderly patient on PD-L1 immunotherapy who developed erosive plaques on the head and neck. Dr Lal reviews the diagnostic challenges of atypical presentations, the limitations of standard treatments, and his decision to carefully introduce a JAK inhibitor with oncology support, illustrating the importance of balancing risks and benefits in drug-induced BP.

Next, they consider a young adult male with diffuse hair loss. A biopsy confirmed androgenetic alopecia without inflammation, prompting Dr Lal to initiate low-dose oral minoxidil with finasteride. He details why combination therapy can be advantageous in younger patients, the need for counseling about shedding phases and time to response, and how to interpret prostate screening in those taking finasteride.

The final case highlights a dramatic case of rhinophyma presenting as fibrotic nodules without classic inflammatory features of rosacea. Dr Lal explains his staged management of surgical debulking followed by laser resurfacing, along with the role of isotretinoin for long-term maintenance. For patients unable to pursue surgical options, he shares alternative approaches such as combining isotretinoin with neuromodulators to shrink tissue and improve appearance.

Tune in to the full episode to see striking clinical images, learn how expert dermatologists navigate diagnostic uncertainty, and gain insight into creative, patient-centered strategies for challenging presentations.

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.