In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Lawrence Green, MD, clinical professor at George Washington University and practicing dermatologist, to discuss the evolving landscape of hyperhidrosis and the latest FDA-approved therapy, sofpironium bromide gel.

Dr Green highlights that an estimated 16 million people in the US experience clinical hyperhidrosis, with axillary hyperhidrosis being the most frequently reported. However, a significant challenge is patient reluctance to discuss symptoms, often due to embarrassment or frustration with ineffective or irritating treatments. Dr Green suggests raising awareness through social media, office signage, and intake forms to help identify more patients needing care. The discussion then shifts to treatment options, including botulinum toxin, devices such as the Brella SweatControl Patch and the energy-based miraDry, and pharmacologic therapies.  They explore anticholinergic treatments in depth, explaining how sofpironium bromide gel differs from traditional glycopyrrolate wipes. While glycopyrrolate wipes can be messy, highly saturated, and prone to causing systemic absorption from contact with the hands, sofpironium bromide gel is applied via an applicator in a metered dose, reducing unintended exposure and improving application precision. Unlike glycopyrrolate, which affects muscarinic M1 receptors found throughout the body, sofpironium targets muscarinic M3 receptors, which are more specific to sweat glands, reducing the likelihood of systemic side effects. They next review clinical trial methodologies for hyperhidrosis, including the Hyperhidrosis Disease Severity Measure and gravimetric sweat production assessments, noting that they favor patient-reported outcomes over objective sweat measurements, as perceived symptom relief is the most important assessment for this condition. Tune in to the full episode to hear expert insights on identifying and treating hyperhidrosis with new and emerging therapies that improve both efficacy and the patient experience.

In this episode of Derms and Conditions, host James Del Rosso, DO, welcomes Ron Vender, MD, Associate Clinical Professor of Dermatology at McMaster University, to discuss practical strategies for psoriasis treatment and the management of chronic hand dermatitis.

They begin with Dr Vender sharing his 90/70/40 rule, a numeric approach to evaluating biologic efficacy in psoriasis. He explains that across biologic agents, PASI75 responses typically reach 90%, PASI90 responses reach 70%, and PASI100 responses about 40%, providing a useful benchmark for evaluating treatment success. With many biologics showing similar efficacy and strong safety profiles, this method can help guide selection.

They also discuss how comorbidities impact biologic choices, with Dr Vender noting he avoids TNF inhibitors in patients with multiple sclerosis, latent tuberculosis, malignancy, or hepatitis, though they remain a preferred option for women of childbearing potential. He advises caution when using IL-17 inhibitors in patients with a history of inflammatory bowel disease. While tuberculosis screening remains routine, he questions its necessity for anti-IL-17 and IL-23 inhibitors, given their lack of association with latent TB reactivation.

The discussion then moves to chronic hand dermatitis, with Dr Vender stressing thorough history-taking, including identifying occupational exposures, and diagnostic testing, including patch testing and scrapings. He highlights alitretinoin, an oral retinoid specifically approved for chronic hand dermatitis, as an effective and well-tolerated treatment option.

They conclude with a discussion on protective measures for chronic hand dermatitis, including hypoallergenic gloves, cotton liners, and emollient barrier creams.

Tune in to the full episode to hear expert insights on optimizing psoriasis treatment and managing chronic hand dermatitis in clinical practice.

In this episode of Derms and Conditions, James Del Rosso, DO, welcomes Dustin Portela, DO, a private practice dermatologist in Boise, ID, and well-known social media presence, to discuss the challenges and responsibilities of dermatologists engaging online while maintaining professional integrity.

Dr Portela shares how he unintentionally became an influencer, initially using social media to market his new practice without a budget. His following grew as he provided accurate, engaging, and evidence-based dermatologic education, evolving into a broader platform for both patients and clinicians.

They discuss combatting misinformation, as much of the skin care advice online comes from nonmedical sources. Dr Portela emphasizes that his goal is to provide science-backed, accessible information, mirroring the guidance he offers in the clinic. He recommends the AAD website, DermNet, and YouTube’s certified health professionals as trusted resources and uses AI tools like ChatGPT to simplify patient education, though he stresses the importance of reviewing content for accuracy before sharing.

They also address legal considerations, with Dr Portela advising dermatologists to avoid direct medical advice online and instead keep recommendations general and educational. He cautions that malpractice policies typically do not cover social media activity, making it crucial to understand liability risks.

Finally, they discuss brand partnerships, with Dr Portela emphasizing authenticity and trust. He only endorses products he has personally used and recommended in practice, ensuring his audience receives honest, unbiased information.

Tune in to the full episode for insights on navigating social media responsibly, protecting credibility, and effectively leveraging online platforms for dermatologic education.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Michael Payette, MD, a dermatologist in private practice at Central Connecticut Dermatology, to discuss practical approaches to managing hidradenitis suppurativa (HS). Dr Payette shares his experience establishing a dedicated HS clinic and provides insights into addressing diagnostic delays, patient education, and emerging treatments.

They begin by discussing the importance of outreach and education to raise awareness of HS among non-dermatology health care providers, such as OB-GYNs and urgent care practitioners, highlighting how early referral and intervention can prevent long-term complications such as scarring and sinus tract formation.

They then explore the role of GLP-1 therapies and biologics in HS treatment. Dr Payette shares his multimodal approach, explaining how GLP-1s address an underlying cause of inflammation while biologics target active inflammation. He outlines practical tips for managing insurance approvals and counseling patients on the benefits and potential side effects of these therapies.

The episode also covers strategies for discussing lifestyle changes, such as weight loss and smoking cessation, while being sensitive to patient challenges. Dr Payette notes that combining weight reduction with biologics can often yield good outcomes, helping patients achieve better disease control and remission.

Tune in to the full episode to learn how a systematic, patient-centered approach to HS management can improve outcomes for this challenging condition.

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.