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.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Diego Ruiz DaSilva, MD, dermatologist at Forefront Dermatology and assistant professor at Eastern Virginia Medical School. Together, they discuss Dr DaSilva’s recent publications and his journey in building a collaborative research career focused on real-world clinical insights.

 To begin, Dr DaSilva shares the inspiration behind his recent publication that evaluated oral JAK inhibitors in elderly patients with moderate to severe atopic dermatitis. Motivated by the positive feedback from older patients and the perception that JAKs are underutilized due to safety concerns, he conducted a multicenter retrospective study that found strong efficacy and a reassuring safety profile in patients aged 65 to 96.

Next, the discussion turns to nemolizumab, an IL-31 receptor antagonist recently approved for prurigo nodularis and atopic dermatitis. Dr DaSilva highlights a patient case that prompted a broader series: a patient with cancer experiencing recalcitrant itch who saw complete resolution within days of starting nemolizumab. Across 10 cases, 8 showed a rapid and marked itch response, with no adverse events or ocular surface issues.

Finally, they review a case report on palmoplantar psoriasis treated with topical roflumilast 0.3% cream. Used initially as a bridge to systemic therapy, the patient achieved unexpectedly robust results with the topical alone, avoiding the need for a biologic. Dr DaSilva notes the importance of keeping nonsteroidal topicals in mind, especially for steroid-sparing strategies.

Tune in to the full episode for more real-world data and case-based insights to help manage complex dermatologic conditions.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Cheri Frey, MD, residency program director and director of cosmetic dermatology at Howard University, to discuss the clinical nuances of facial hyperpigmentation, with a special focus on melasma and the emerging role of Thiamidol.

 Dr Frey begins by breaking down how she categorizes facial hyperpigmentation that isn't tied to a structural lesion. She explains how the distribution, hue, and depth of pigment—epidermal, dermal, or mixed—guide diagnosis and treatment. They revisit traditional therapies like hydroquinone and oral tranexamic acid, highlighting their ongoing roles in management, while noting concerns around cytotoxicity, ochronosis, and overuse.

 The conversation then turns to Thiamidol, a novel topical agent recently introduced in the US as a potent and selective human tyrosinase inhibitor, unlike many legacy agents developed using mushroom tyrosinase models. Dr Frey shares data showing the superiority of Thiamidol over 2% hydroquinone and comparable efficacy to 4%, with excellent tolerability and quality-of-life benefits. Clinical applications span melasma, acne-induced postinflammatory hyperpigmentation, solar lentigines, and laser-associated hyperpigmentation.

 Dr Frey also discusses an exciting new study where Thiamidol replaced hydroquinone in triple-combination creams, yielding similar efficacy with improved tolerability, offering new options for patients seeking long-term, safer treatments.

 Tune in to the full episode to hear how Dr Frey approaches hyperpigmentation with precision and pragmatism, and how Thiamidol may be poised to reshape the treatment landscape.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by a world expert in pigmentation, Seemal R. Desai, MD, founder of Innovative Dermatology in Dallas, Texas, for a timely, clinically focused discussion on vitiligo.

Dr Desai begins by outlining how to identify unstable vitiligo at the first visit, a crucial step that guides treatment decisions. He describes hallmark features of instability, including trichrome lesions, confetti-like depigmentation, inflammatory borders, pruritus, and signs of Koebnerization—and emphasizes that even one unstable lesion should prompt systemic stabilization. Vitiligo flares can occur unpredictably, even in previously stable patients.

The conversation also explores common comorbidities, including autoimmune thyroid disease, diabetes mellitus, and alopecia areata. Dr Desai shares his standard lab workup at the initial visit, which includes thyroid-stimulating hormone, free thyroxine, thyroid peroxidase antibody, and vitamin D. They discuss when to repeat testing and how to interpret elevated thyroid antibody titers in asymptomatic patients. The pair also touches on psychosocial impact, especially among children and adolescents, and strategies to create space for emotional check-ins during clinical visits.

In the second half of the episode, Dr Desai shares practical insights on using topical ruxolitinib cream 1.5% for nonsegmental vitiligo. Dr Del Rosso and Dr Desai discuss treatment duration, counseling around delayed response, and why BID application is critical for success. They also address combining ruxolitinib with phototherapy, tailoring treatment based on location and follicular density, and how to support patients who may feel discouraged by early speckled repigmentation. Boxed warning concerns are also reviewed, with a focus on safety and real-world reassurance for patients using topical formulations.

Dr Desai closes with an essential message: patients with vitiligo deserve more than a one-line treatment plan. Hope, education, and long-term partnership are key—and new therapeutic options are on the horizon.

In this special mailbag episode of Derms and Conditions, James Q. Del Rosso, DO, takes on your questions from the field, offering expert guidance and real-world tips on some of the most common challenges in dermatology today. 

Dr Del Rosso begins by tackling common challenges with oral apremilast for psoriasis, sharing strategies to manage gastrointestinal side effects and improve patient adherence. He provides tips on starter packs, meal timing, and even reducing caffeine intake to minimize nausea and cramping during therapy initiation. 

Next, he discusses the evaluation of alopecia areata severity and how to determine eligibility for oral Janus kinase (JAK) inhibitors, including baricitinib (Olumiant) and ritlecitinib (Litfulo). Dr Del Rosso outlines a practical approach to scalp assessment using SALT scores, explains how psychosocial impact and eyebrow/eyelash loss can upgrade severity, and reviews important safety considerations for JAK inhibitor therapy. He also previews a recently FDA-approved third option: deuruxolitinib (Leqselvi).  

Finally, Dr Del Rosso covers the newly FDA-approved modified-release oral minocycline 40 mg capsule formulation (Emrosi) for rosacea, highlighting its anti-inflammatory benefits and superior efficacy compared with subantimicrobial-dose doxycycline in a head-to-head controlled-study evaluation. He explains its mechanism of action, favorable safety profile, and how it fits into the modern rosacea treatment landscape. 

Tune in for a fast-paced roundup of pearls, pitfalls, and pro tips that can make all the difference in your day-to-day dermatology practice. 

In this episode of Derms and Conditions, Dr James Q. Del Rosso is joined by Dr Adelaide Hebert, Chief of Pediatric Dermatology at McGovern School of Medicine and Children’s Memorial Hermann Hospital in Houston, Texas. Back by popular demand, Dr Hebert shares her clinical experience managing pediatric atopic dermatitis—particularly in patients who are treatment resistant, injection-averse, or fearful of topical steroids. 

The conversation begins with a discussion of therapeutic decision-making for new patients with moderate to severe atopic dermatitis. Dr Hebert emphasizes the importance of listening closely to both the child and their caregivers to identify emotional barriers, needle phobia, steroid concerns, and gaps in previous care. She explains why patient-centered care requires flexible strategies, and how once-daily, steroid-free topical agents are often more acceptable to families than systemic options or injectable biologics. 

Dr Del Rosso and Dr Hebert focus on topical tapinarof, an aryl hydrocarbon receptor agonist approved for atopic dermatitis down to 2 years of age. Dr Hebert walks through the advantages of its once-daily use, its natural compound origin, and favorable safety profile, particularly for young children and anxious parents. She shares several compelling cases, including a 3-year-old with 85% body surface area involvement who responded dramatically in a clinical trial, and a 7-year-old girl with longstanding disease and prior cyclosporine exposure who found relief with tapinarof. 

Together, the clinicians explore practical pearls for real-world use, including how to apply the cream properly, whether to moisturize before or after, how to avoid waste, and when to reintroduce the medication after a flare. Dr Hebert highlights that many of her patients, and their families, experience life-changing improvements in sleep, school participation, and self-esteem, underscoring the broader impact of effective topical treatment. 

The episode closes with a reminder that personalized care, consistent moisturization, and confidence in the safety of non-steroidal options like tapinarof can help families navigate treatment with less stress—and better results. 

In this episode of Derms and Conditions, Dr James Q. Del Rosso welcomes esteemed dermatologist Dr Henry Lim from Michigan. Together, they explore the evolving science behind photoprotection, the importance of advances in sunscreen formulations and ingredients, and the clinical relevance of sunscreen formulations that both protect against and repair photodamage. 

Dr Lim provides an update on comprehensive photoprotection that includes ultraviolet radiation coverage, recognizes the growing role of visible light protection, and incorporates ingredients with antioxidant activity. He also explains where mineral sunscreens can be particularly helpful in clinical practice. 

A major part of the discussion highlights the progression of science supporting DNA repair through the use of liposomes containing photolyases. These enzymes have been shown to repair cyclobutane pyrimidine dimers—mutagenic DNA lesions induced by UVA and UVB exposure. Incorporating photolyases into sunscreen formulations has been associated with reduced actinic keratosis formation and enhanced skin protection. 

Dr Del Rosso shares his insights on ISDIN's Eryfotona Actinica and Eryfotona Ageless, two mineral sunscreens that include photolyase-containing liposomes, also known as DNA Repairsomes®, to enhance natural DNA repair processes. Each product contains additional active ingredients offering distinct benefits for specific patient needs. Dr Del Rosso and Dr Lim discuss how these formulations fit into both preventive and reparative strategies, particularly for patients with a history of actinic damage or elevated risk for nonmelanoma skin cancers. The conversation then covers the value of broad-spectrum protection, lightweight formulations, and patient education to encourage consistent use. Dr Lim offers practical pearls on counseling patients, improving sunscreen adherence, and integrating these strategies into everyday dermatologic care. 

They also touch on the importance of photoprotection in skin of color, emphasizing the need for inclusive clinical research and personalized recommendations. Dr Lim reinforces the importance of year-round sun protection, even for individuals who perceive themselves to be at lower risk. 

The episode wraps up with forward-looking insights into the future of photoprotection, including emerging technologies and formulation innovations that may reshape dermatologic sun care. From thoughtful commentary to evidence-based guidance, tune in for the latest in photoprotection—just in time for summer. 

In Part Two of the Tea with Dr. D premiere, James Q. Del Rosso, DO, returns with Lauren Lam, MD, a Canadian dermatologist with a keen interest and extensive experience in managing hidradenitis suppurativa (HS). After covering overall considerations and the medical side of HS management in Part One, they shift gears to focus on important physical approaches, including one of the most effective—and often underutilized—surgical interventions: deroofing. 

Dr Lam emphasizes the importance of both medical and surgical interventions in order to provide comprehensive management of this multifaceted disease state. She shares her step-by-step approach for identifying which lesions are best suited for deroofing, breaking down key considerations like Hurley staging, scarring assessment, and palpation for sinus tracts. From assessing lesions that have resisted biologic therapy to recognizing when a seemingly mild case may actually benefit from surgical intervention, she explains how deroofing fits seamlessly into a well-rounded HS treatment plan, often working in tandem with biologic agents to address stubborn or recurrent lesions without disrupting systemic control. 

The conversation then turns to technique. Dr Lam outlines her preferred tools, all which are easily accessible in dermatology practices, and explains how she navigates physically challenging areas like the axilla and groin. The pair emphasize the importance of patient education; Dr Del Rosso raises questions about preventing complications such as biofilm formation and hypergranulation, while Dr Lam addresses these issues and shares her strategies for effective wound management. 

Together, they reflect on how deroofing can markedly improve comfort and quality of life for HS patients, particularly those who have struggled with focal areas of chronic drainage and recurrent abscesses despite optimized medical therapy. Dr Lam’s enthusiasm for the procedure is readily apparent and contagious, and her practical advice makes the incorporation of deroofing into the management plan feel readily achievable, even for dermatology clinicians who are new to surgical HS management. 

In this premiere episode of Tea with Dr D, Dr James Q Del Rosso welcomes Dr Lauren Lam, a Canadian dermatologist with special interest and strong experience in managing patients affected by hidradenitis suppurativa (HS). They engage in a thoughtful and comprehensive conversation about diagnosing and treating this common yet often elusive skin condition—especially in its early stages—which has been notoriously difficult to treat. Their discussion integrates both medical and surgical approaches to optimize outcomes.

Dr Lam shares how she built an efficient, trust-centered model of care at her Calgary clinic, from using intake tools and patient education videos to identifying comorbidities and staging severity. She walks through her approach to treatment selection—focusing on what brings the most value in that moment—and discusses when and how she incorporates patient education, intralesional corticosteroids, biologic therapy, deroofing, laser hair removal, and other approaches into her care strategy.

Whether you see HS regularly or only occasionally, this conversation offers practical strategies, clinical nuances, and a fresh perspective on improving care for this complex condition.

In this first mailbag edition of Derms and Conditions, Dr James Q. Del Rosso flies solo to answer your questions—submitted by clinicians across the country. From potassium monitoring to topical field therapy, it’s a rapid-fire round of guidance grounded in the latest literature, clinical experience, and practical wisdom.

Dr Del Rosso kicks things off with the ever-popular question: Do I really need to monitor blood potassium in healthy patients on spironolactone for acne? He breaks down current guideline perspectives, red flags for high-risk populations, and his own reasoning for when and why he orders labs.

Next, he walks through the expanding world of topical nonsteroidal agents for atopic dermatitis, including:

 Ruxolitinib 1.5% cream (Opzelura) – FDA-approved for mild to moderate AD in patients ≥12 years old and also for vitiligo; Dr Del Rosso discusses addresses black box warnings, despite low systemic absorption in most real-world scenarios.

 Roflumilast 0.15% cream (Zoryve) – Approved down to 6 years of age, well-tolerated with itch reduction data to back it.

 Tapinarof 1% cream (VTAMA) – Approved down to 2 years of age and used effectively in moderate-to-severe disease with favorable skin tolerability.

He explains why these newer agents may be preferred over topical corticosteroids for sensitive areas like the face. In response to questions about actinic keratoses, Dr Del Rosso dives into tirbanibulin 1% ointment (Klisyri), a microtubule inhibitor used once daily for five days. While FDA-approved for face and scalp field treatment up to 100 cm², he shares how he’s successfully using it off-label for forearms and hands, sometimes in combination with cryotherapy.

The episode closes with a discussion of oral antibiotic safety in acne, including:

 Why TMP-SMX (trimethoprim-sulfamethoxazole) works—but must be used selectively due to rare but serious adverse events (TEN, pulmonary toxicity)

 Why azithromycin is not optimal for acne and only used selectively.

 And why mandatory lab monitoring for oral tetracyclines like doxycycline or minocycline isn’t recommended routinely—but clinical vigilance is.

With insights on everything from lab work to lid margins, this is one episode you’ll want to bookmark, replay, and pass along to your dermatology colleagues.