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.

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.