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 challenges of treating pregnant and breastfeeding patients, particularly those with atopic dermatitis (AD).

The conversation addresses a crucial yet often unclear topic for dermatologists: balancing safety and efficacy when managing AD in patients during pregnancy and lactation. Dr Shahriari emphasizes the importance of addressing uncontrolled inflammation, which can have potential consequences for both the mother and baby, such as premature birth and maternal sleep disruption. She shares insights into the physiological changes during pregnancy, including the shift from a Th1 to a Th2 immune state, and how this can impact conditions like AD and psoriasis.

The discussion highlights the limited data available for systemic treatments in this population, as pregnant women are excluded from clinical trials. Despite this, therapies like dupilumab and cyclosporine are discussed for their safety profiles, with dupilumab often considered when patients need effective control with minimal risk. Dr Shahriari also addresses strategies to involve partners in treatment decisions, ensuring patients feel supported and informed.

Drs Del Rosso and Shahriari emphasize the importance of open communication with patients, managing risk tolerance, and understanding the nuances of systemic treatment in pregnancy and lactation. Dr Shahriari shares real-world cases, including the use of dupilumab in a pregnant patient with severe AD and counseling a patient with psoriasis who unintentionally administered a biologic injection during the first trimester.

Tune in to the full episode for practical guidance on navigating these complex cases and balancing patient care with available evidence. This episode is a must-listen for dermatologists managing pregnant or breastfeeding patients with inflammatory skin conditions.

In this milestone 100th episode of Derms and Conditions, host James Del Rosso, DO, takes listeners on a year-in-review journey through some of the greatest highlights from 2024. This special solo episode reflects on standout conversations with leading dermatologists and previews exciting plans for 2025.

Dr Del Rosso revisits key insights from some of the most impactful episodes on this 100th Episode of Derms and Conditions Podcasts:

With so many exceptional episodes in 2024 and exciting plans ahead, listeners can look forward to even more cutting-edge insights in 2025. Don’t miss any of these conversations—catch up anytime at dermsquared.com/podcasts/derms-and-conditions

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Brad Glick, DO, dermatologist and residency program director at Larkin Health Center in South Florida, to discuss the complexities of selecting systemic therapies for psoriasis. They share insights on navigating the abundance of treatment options, focusing on patient-centric considerations, with an emphasis on the TYK2 inhibitor deucravacitinib.

They begin by highlighting how treatment selection often depends more on disease location and patient impact than on body surface area alone and discuss the importance of addressing comorbidities, such as metabolic syndrome or inflammatory bowel disease, when determining the best therapy for each patient.

Dr Glick then shares anecdotal examples to illustrate the value of deucravacitinib, including its success in treating an elderly patient with longstanding psoriasis and a younger patient with psoriasis and psoriatic arthritis. Efficacy in difficult-to-treat sites such as the scalp is also important to note.

They then address the importance of collaboration with primary care physicians to address underlying cardiovascular and metabolic risks while encouraging patients to adopt healthy lifestyle changes like smoking cessation and exercise.

They conclude by highlighting the importance of long-term data, citing deucravacitinib’s 4-year efficacy and safety results, and anticipate the arrival of new oral therapies that will further expand treatment choices and improve patient outcomes.

Tune in to the full episode for deeper insights into the challenges and opportunities in systemic therapy selection for psoriasis, including strategies for navigating the expanding treatment landscape, tips for addressing comorbidities, and pearls for integrating therapies like deucravacitinib into practice with a patient-centered approach.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes E. James Song, MD, Chief Medical Officer at Frontier Dermatology, to explore the nuances of systemic therapy selection for atopic dermatitis (AD) and offer practical guidance on tailoring treatment plans to optimize outcomes for these patients.

They begin by discussing the importance of considering patient-specific factors, such as contraindications, access, and age, when selecting among the 3 currently available biologics for AD: dupilumab, tralokinumab, and lebrikizumab. While these therapies share many similarities, nuanced differences—such as dupilumab’s approval for younger patients and asthma comorbidity, or lebrikizumab’s sustained efficacy after discontinuation—can guide treatment decisions.

They also discuss adverse events, including conjunctivitis and dupilumab-associated facial erythema, highlighting strategies for managing these issues. Dr Song notes that switching within the IL-13 pathway can often resolve conjunctivitis and speculates on the possible mechanisms behind facial redness.

They then explore one critical insight: the potential for patients to fail one biologic and still respond to another within the same class. While complete nonresponders may benefit from switching to a different class, such as JAK inhibitors, partial responders often do well with another IL-13 inhibitor.

Tune in to the full episode to explore more insights on optimizing AD management, including how to navigate biologic options, manage adverse events, and approach challenging cases while embracing new therapies and tailoring care to each patient’s unique needs.

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.

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.