Derms and Conditions

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes back Jason Hawkes, MD, MS, for the second installment of their discussion on the “cytokine soup” underlying inflammatory skin diseases. Building on their previous conversation about type 2 inflammation, they turn their attention to type 1 and type 3 inflammatory pathways, examining how these immune responses contribute to disease manifestations and influence therapeutic approaches.

Dr Hawkes begins by clarifying the terminology surrounding T-helper cell populations and broader inflammatory pathways, including the distinction between Th1, Th2, and Th17 responses and type 1, type 2, and type 3 inflammation. He explains how immune cells develop distinct inflammatory profiles and why understanding the signals that drive these responses is increasingly important as targeted therapies continue to expand.

The conversation then shifts to psoriasis, a prototypical type 3 inflammatory disease, and the complexities that arise when multiple inflammatory pathways contribute to a patient's clinical presentation. Dr Hawkes discusses how the immune mechanisms underlying plaque psoriasis may differ from those involved in psoriatic arthritis, helping explain why skin and joint responses to treatment do not always align. The clinicians also examine how differences in inflammatory pathways contribute to infection susceptibility in psoriasis and atopic dermatitis, as well as certain adverse effects associated with targeted therapies.

Finally, Drs Del Rosso and Hawkes explore the immunologic diversity of psoriasis, from classic plaque disease to guttate, pustular, erythrodermic, and paradoxical presentations. They discuss how a better understanding of the inflammatory mechanisms underlying these distinct phenotypes may help explain variations in clinical presentation and response to treatment, bringing dermatology closer to more individualized therapeutic decision-making.

Tune in to the episode for a clinically grounded discussion of inflammatory pathways, the relationship between immune signaling and disease manifestations, and why understanding the science behind targeted therapies can help dermatologists make sense of what they observe in everyday practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Scott Elman, MD, to examine whether laboratory monitoring requirements for systemic dermatologic therapies reflect current evidence. With some prescribing recommendations rooted in data from more than a decade ago, the clinicians discuss where routine testing remains warranted, where it may be unnecessary, and how dermatologists can balance patient safety with the burden of excessive monitoring.

Dr Elman begins by examining laboratory monitoring practices for atopic dermatitis therapies, highlighting important distinctions between biologics targeting IL-4, IL-13, and IL-31 and Janus kinase (JAK) inhibitors. While routine laboratory monitoring may offer limited clinical value for certain biologics, JAK inhibitors warrant a different approach given their safety profiles. He discusses the rationale for baseline screening and follow-up testing, while questioning the value of repeated testing in patients without changes in risk factors or exposure.

The conversation then shifts to psoriasis, where recommendations for tuberculosis and hepatitis screening have historically been influenced by experience with tumor necrosis factor inhibitors. Dr Elman highlights emerging evidence and recent guidance challenging the need for routine tuberculosis testing with IL-17 and IL-23 inhibitors. The clinicians also clarify the distinction between hepatitis screening and liver function testing, emphasizing the importance of evaluating risk according to therapeutic class rather than applying uniform monitoring requirements.

Beyond laboratory testing, Drs Del Rosso and Elman explore the value of interdisciplinary collaboration when managing patients with complex comorbidities, including inflammatory bowel disease. They discuss how coordination with other specialists can support treatment decisions without unnecessarily limiting therapeutic options.

Tune in to the episode for a practical discussion of evidence-based laboratory monitoring, the potential consequences of unnecessary testing, and how individualized assessment, appropriate co-management, and attention to overall patient health can inform systemic treatment decisions in dermatology.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes E. James Song, MD, to discuss the clinical utility of narrowband UVB (NB-UVB) phototherapy and how advances in home-based devices are addressing longstanding barriers to its use. From psoriasis and vitiligo to atopic dermatitis and other inflammatory skin conditions, they examine where phototherapy fits into modern treatment strategies and how guided home-based treatment can expand access while reducing the burden on patients and practices.

Dr Song begins with an overview of the UV spectrum and why NB-UVB, particularly wavelengths of 311 to 313 nm, offers a favorable balance of therapeutic efficacy and tolerability. The discussion then turns to advances in home phototherapy technology, including a device that uses patient-reported responses to previous treatments to automatically calculate subsequent doses. Referencing findings from the LITE trial, which compared home-based and office-based phototherapy for psoriasis, the clinicians discuss the evidence supporting the safety, effectiveness, and improved treatment adherence associated with home use.

Beyond psoriasis, Dr Song highlights applications in atopic dermatitis, cutaneous T-cell lymphoma, and pruritic conditions, with particular emphasis on the underutilization of NB-UVB in vitiligo. He describes its potential to complement topical and systemic therapies, encouraging clinicians to consider phototherapy as an adjunct rather than an alternative to other treatment modalities.

The conversation also addresses practical considerations for incorporating home phototherapy into clinical care, including prescribing workflows, insurance coverage, and access for patients who live far from treatment centers. Drs Del Rosso and Song review important precautions involving photosensitizing conditions and medications, along with practical strategies for optimizing treatment response, including the use of emollients and adjustments to patient positioning.

Tune in to the episode for a closer look at how home-based NB-UVB phototherapy is changing the logistics of light-based treatment, the clinical scenarios in which it may be particularly valuable, and what dermatologists should know when incorporating it into patient care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Cory Rubin, MD, for a candid look at the business of dermatology. Drawing on his experience building an independent practice, Dr Rubin discusses what it takes to move from clinician to practice owner, from the freedom to pursue new opportunities to the responsibility of leading a team, managing finances, and making decisions that extend far beyond patient care.

Dr Rubin begins by sharing what motivated him to establish his own practice, including his interest in complex medical dermatology and clinical research and his desire for greater freedom to pursue those interests. He emphasizes that independence comes with significant responsibility: Practice ownership requires commitment, resilience, and a willingness to accept both the benefits and consequences of the decisions you make.

The conversation turns to lessons Dr Rubin has learned as a leader. While clinical practice often rewards quickly identifying a problem and acting on it, he found that business decisions sometimes require slowing down, listening, and allowing time before choosing a course of action. He discusses the importance of consistency in setting expectations for staff, developing a strong workplace culture, and training PAs and NPs over time rather than expecting immediate independence.

Drs Del Rosso and Rubin also explore the operational considerations of incorporating clinical research into a dermatology practice, including the need for appropriately trained research staff and clear separation of clinical and research functions. They close with Dr Rubin’s approach to structuring interactions with pharmaceutical representatives and his broader perspective on practice ownership as an ongoing process of adaptation and learning.

Tune in to the episode for an inside look at the realities of building and running a dermatology practice, the lessons that come with leadership, and why setbacks can become some of the most valuable experiences for a practice owner.

In this episode, host James Q. Del Rosso, DO, welcomes dermatologist and rheumatologist Joseph Merola, MD, to discuss the diagnosis and management of dermatomyositis (DM). From subtle cutaneous clues and systemic involvement to malignancy risk, myositis-specific antibodies, and an expanding treatment pipeline, Dr Merola highlights what dermatologists should recognize when DM enters the differential.

DM can present with classic findings such as Gottron papules, heliotrope rash, and the shawl sign, but other clues may be less obvious. Dr Merola discusses pruritic scalp disease, eyelid edema, linear extensor erythema, and nailfold capillary changes, as well as photodistributed eruptions that may be difficult to distinguish from cutaneous lupus. Beyond the skin, he outlines 5 areas to consider when evaluating patients with DM: cutaneous findings, muscle weakness, inflammatory arthritis, lung involvement, and malignancy.

The conversation moves from clinical assessment to diagnostic workup, including evaluation of proximal muscle weakness, the importance of asking about dysphagia, and the role of CK and aldolase. Dr Merola also explains when EMG, MRI, or muscle biopsy may add value and when classic skin findings combined with weakness and/or elevated muscle enzymes may provide sufficient diagnostic information.

Dr Del Rosso and Dr Merola also discuss malignancy risk and the clinical information provided by myositis-specific antibodies. Anti-TIF1γ and anti-NXP2 can signal greater malignancy risk, while anti-MDA5 is associated with clinically amyopathic disease and heightened concern for interstitial lung disease. Dr Merola considers how these findings can help inform risk assessment, screening, and collaboration with rheumatology and other specialties.

Finally, they review the treatment of both cutaneous and muscle disease, from photoprotection and established systemic therapies to JAK inhibition and emerging targeted treatments. Dr Merola reflects on a growing therapeutic pipeline* for a disease in which cutaneous involvement, in particular, has historically been challenging to manage.

Tune in to the episode for a clinically focused discussion of recognizing dermatomyositis, assessing systemic and malignancy risk, interpreting antibody profiles, and navigating treatment as new therapeutic options emerge.

*This episode was recorded prior to FDA approval of brepocitinib. The FDA has since approved brepocitinib for use in the United States.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Darrell Rigel, MD, MS, for a discussion of photoprotection, sunscreen regulation, and how dermatologists can help patients make informed choices about sun protection.

Dr Rigel begins by examining why melanoma prevention requires attention to both primary and secondary prevention. While reducing UV exposure and using sunscreen can help lower risk, early recognition and access to dermatologic care remain critical once a suspicious lesion develops. He discusses geographic differences in melanoma incidence and mortality in the United States and how factors such as UV exposure and access to care can contribute to these patterns.

The conversation then traces the complicated regulatory history of sunscreens in the United States. Dr Rigel reviews developments from the emergence of higher-SPF products in the 1980s through subsequent FDA monographs, debates surrounding the safety and systemic absorption of sunscreen filters, and legislation intended to accelerate review of new ingredients. He explains how this history has contributed to the United States having fewer available UV filters than other parts of the world.

A significant recent development is bemotrizinol, a broad-spectrum, photostable UV filter that has undergone extensive FDA-requested testing. Dr Rigel discusses its coverage across UVB and UVA wavelengths, cosmetic properties, and potential to expand sunscreen formulation options in the United States.*

Drs Del Rosso and Rigel also address how clinicians can evaluate sunscreen products and counsel patients amid persistent misinformation. They discuss the importance of appropriate product testing, selecting products patients will actually use, and providing guidance on application of sprays, sticks, and other formulations.

The discussion also considers photoprotection in patients with darker skin tones, including melanoma risk, UVA-associated dyspigmentation, and the importance of cosmetically acceptable formulations that minimize visible residue or white cast.

Tune in to the episode to hear Drs Del Rosso and Rigel discuss the science and regulation behind modern sunscreens, strategies for addressing patient misconceptions, and ways to make consistent photoprotection more achievable across a range of skin types and patient preferences.

*Editor’s note: This episode was recorded prior to FDA approval of bemotrizinol. The FDA has since approved bemotrizinol for use in the United States.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, delivers a solo “Spilling the Tea” segment exploring clinical observations that may warrant a closer look. He examines dermatomyositis findings that can mimic more common conditions, nuances in prescribing language, the importance of a thorough hidradenitis suppurativa (HS) examination, and an unexpected case of rhabdomyolysis, highlighting details that can change how clinicians approach diagnosis and patient management.

Dr Del Rosso begins with scalp pruritus as a potential manifestation of dermatomyositis. He reviews images showing how scalp involvement may resemble seborrheic dermatitis or psoriasis, with findings such as erythema, scaling, and hair thinning. He also examines nailfold changes, including prominent capillaries, capillary dropout, and abnormal cuticles, that can provide additional diagnostic clues. Recognizing these findings is particularly important given the potential systemic implications of dermatomyositis.

The discussion then turns to limitations of use in prescribing information stating that certain therapies are “not recommended” in combination with other agents. Dr Del Rosso distinguishes this language from a formal contraindication and discusses the importance of understanding the evidence behind labeling when making treatment decisions.

In HS, he emphasizes the value of a complete skin examination, including areas patients may initially be reluctant to expose. Assessing and palpating lesions can help distinguish active inflammatory findings, including abscesses, nodules, and draining tunnels, from established fibrotic or scarred disease.

Finally, Dr Del Rosso shares the case of a 42-year-old woman receiving JAK inhibitor therapy who developed markedly elevated creatine kinase and rhabdomyolysis. Although her medication presented one possible explanation, further investigation revealed that she had gone several weeks without levothyroxine for hypothyroidism, another potential contributor. The case illustrates the importance of considering the full clinical picture when evaluating an unexpected finding or adverse event.

Tune in to the episode for clinical observations that encourage a closer look at what may initially seem straightforward, from recognizing less familiar disease presentations and interpreting prescribing information precisely to conducting a thorough examination and considering multiple explanations for an unexpected finding.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Andrea Murina, MD, to discuss the early recognition and management of scarring alopecias. Their conversation explores why these conditions can be missed in their earliest stages, the clinical clues that help distinguish scarring from nonscarring alopecias, and approaches to diagnosis and treatment aimed at preventing permanent hair loss.

Dr Murina reflects on how outdated perceptions that little could be done once scarring occurred motivated her to focus on these conditions. She explains that recognizing patients earlier in the disease course provides an opportunity to intervene before irreversible follicular destruction develops, setting the stage for a discussion of the timing, patterns, and diagnostic tools that support earlier diagnosis.

They review the major categories of cicatricial alopecia, highlighting the relative ease of identifying neutrophilic disorders such as folliculitis decalvans and dissecting cellulitis, while noting that early lymphocytic disorders such as central centrifugal cicatricial alopecia (CCCA) and frontal fibrosing alopecia may initially resemble more common nonscarring conditions.

Dr Murina next overviews the value of trichoscopy. She explains how dermatoscopic findings, including perifollicular scale, telangiectasias, follicular plugs, and changes in hair diameter, can help distinguish scarring from nonscarring alopecias, guide biopsy decisions, and improve biopsy yield by identifying the most inflamed follicles for sampling.

The episode also reviews treatment strategies for common scarring alopecias. For CCCA, Dr Murina typically begins with topical and intralesional corticosteroids, adding doxycycline and antifungal shampoos when appropriate. For lichen planopilaris, she follows a similar approach while incorporating systemic therapies such as hydroxychloroquine, finasteride, or dutasteride. The discussion concludes with discoid lupus erythematosus, where she emphasizes that early treatment with high-potency topical and intralesional corticosteroids, along with appropriately dosed hydroxychloroquine, can produce meaningful improvement.

Tune in to the episode to hear Dr Del Rosso and Dr Murina share diagnostic pearls, trichoscopic clues, biopsy strategies, and treatment approaches that can help clinicians identify scarring alopecias earlier and intervene before permanent hair loss occurs.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Joshua Burshtein, MD, chief dermatology resident at the University of Illinois Chicago, to discuss their recent Journal of Clinical and Aesthetic Dermatology publication, Topical Prescription Therapy for Psoriasis: An Expert Position Paper on Limitations of Published Guidelines and Treatment Selection with Updated Recommendations. Their conversation examines the intended role of clinical practice guidelines, the limitations that emerge as therapeutics evolve, and why clinician judgment remains central to individualized psoriasis care.

They begin by defining what treatment guidelines are intended to accomplish: to provide an evidence-based framework for clinicians rather than a rigid set of rules. Dr Burshtein notes that although the paper focuses on topical psoriasis therapies, many of its core principles apply broadly across dermatology, particularly as rapid therapeutic advances challenge the ability of clinical guidelines to remain current.

Dr Del Rosso discusses the downstream effects of this disconnect, noting that guidelines are often treated as mandates by third-party payers despite disclaimers stating that they should not replace clinician judgment. The speakers emphasize that treatment decisions should remain patient-centered, with clinicians, insurers, and manufacturers all contributing to timely access to appropriate care.

They also explore additional limitations of clinical guidelines, including differences in methodology among organizations and the inability of any single document to encompass every available therapy. The discussion concludes with the importance of recognizing bias in guideline development while reinforcing that treatment selection should be guided by clinical evidence, physician expertise, and shared decision-making with the patient.

Tune in to the full episode to hear Drs Del Rosso and Burshtein discuss the evolving role of clinical guidelines, their limitations in everyday practice, and why individualized clinical judgment remains essential to psoriasis care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Jason Hawkes, MD, MS, for a special Tea with Dr. D edition exploring the immunology that underpins inflammatory skin disease and how a deeper understanding of cytokine biology can inform clinical decision-making.

The discussion begins by challenging the common tendency to classify diseases according to a single "dominant" cytokine or immune pathway. Drs Del Rosso and Hawkes emphasize that while frameworks such as type 1, type 2, and type 3 inflammation are valuable for organizing complex biology, they should be viewed as conceptual models rather than rigid categories, as immune responses are dynamic, overlapping, and highly interconnected.

Using a series of educational slides, Dr Hawkes reviews how naïve T cells differentiate into distinct immune responses after interacting with antigen-presenting cells within the lymph node. He highlights 3 key cytokines that help clinicians remember the major pathways driving differentiation: IL-12 for type 1 inflammation, IL-4 for type 2 inflammation, and IL-23 for type 3 inflammation. These regulatory cytokines shape downstream immune responses that ultimately contribute to diseases such as atopic dermatitis and psoriasis.

A major focus of the episode is the distinct but complementary roles of IL-4 and IL-13 in type 2 inflammation. Dr Hawkes explains why IL-4 serves as the critical regulator of type 2 immune differentiation, functioning within the lymph node to establish the broader immune response, while IL-13 plays a prominent role within peripheral tissues, particularly the skin. He also addresses the misconception that higher tissue expression necessarily indicates greater biologic importance, noting that cytokines often exert profound effects despite relatively low expression levels.

Throughout the discussion, the speakers reinforce that cytokines should not be viewed in isolation. Their overlapping and synergistic effects help explain why patients can present with different clinical manifestations despite sharing common inflammatory mechanisms. Ultimately, the goal is not to identify a universally superior therapeutic target, but to understand each patient's disease biology well enough to select the therapy that best matches their clinical presentation.

Tune in to the full episode to learn more about the foundations of type 1, type 2, and type 3 inflammation, the distinct roles of key cytokines in immune regulation and tissue disease, common misconceptions surrounding cytokine biology, and how a stronger understanding of immunology can support more personalized treatment decisions in everyday dermatology practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes E. James Song, MD, for a discussion of the IL-23 pathway and its enduring role in psoriasis management. Although therapeutic options continue to expand, IL-23 remains a central target because of its key role in the IL-23/Th17 axis, one of the primary drivers of psoriatic disease.

Dr Song reviews the current IL-23 therapeutic landscape, comparing available agents that target the pathway through different mechanisms. He highlights important distinctions among therapies, including dosing intervals, molecular characteristics, binding affinity, and immunogenicity, while emphasizing that all have demonstrated strong efficacy and favorable safety profiles. The conversation also explores how these pharmacologic differences do—and do not—translate into meaningful clinical differences.

The conversation also explores patient access, with Drs Del Rosso and Song discussing how route of administration and insurance coverage can significantly influence treatment selection, particularly for Medicare beneficiaries. They examine the practical advantages of health care provider-administered therapy, including more reliable treatment delivery, closer patient follow-up, and reduced financial barriers for some patients.

The discussion also addresses expectations for treatment response, emphasizing that IL-23 inhibitors may require more time than other biologic classes to achieve maximal benefit. Dr Song shares practical insights into assessing early improvement, counseling slower responders, and supporting long-term treatment persistence.

The episode concludes with a review of the safety profile of IL-23 inhibitors, including their role in psoriasis with peripheral psoriatic arthritis, while discussing areas where these therapies remain more limited, such as axial disease and uveitis.

Tune in to the full episode to learn more about the IL-23 pathway, the similarities and distinctions among available therapies, practical access considerations, and setting realistic expectations for treatment response in everyday psoriasis care.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Alexandra Golant, MD, for a discussion on the evolving role of topical therapies in atopic dermatitis (AD). While systemic therapies have transformed care for patients with moderate to severe disease, this discussion explores how topical treatments remain essential, not only for managing flares but also for maintaining long-term disease control.

Dr Golant reflects on how the topical treatment landscape has changed over the past several years. After decades in which topical corticosteroids remained the cornerstone of therapy, recent advances have introduced multiple nonsteroidal options with distinct mechanisms of action and improved suitability for chronic, proactive management.

The conversation explores where topical corticosteroids continue to fit in modern AD management. Rather than viewing steroids as obsolete, Dr Golant advocates for a balanced approach that considers efficacy, access, and appropriate stewardship. She emphasizes that corticosteroids remain valuable for short-term use but encourages clinicians to transition thoughtfully to nonsteroidal therapies when appropriate.

Dr Del Rosso and Dr Golant also review the expanding range of nonsteroidal topical therapies, including JAK inhibitors, PDE4 inhibitors, and the first-in-class aryl hydrocarbon receptor (AhR) agonist, tapinarof. Because AhR agonism represents an unfamiliar mechanism for many clinicians, Dr Golant explains how activation of this pathway not only reduces inflammatory signaling but also supports skin barrier function and antioxidant activity, helping address multiple aspects of AD pathophysiology.

The discussion also examines emerging clinical experience with tapinarof in AD, including its once-daily dosing, favorable safety profile, and potential to provide durable disease control in some patients. Dr Golant highlights the importance of challenging outdated assumptions that nonsteroidal therapies are slower or less effective than topical corticosteroids, noting that newer agents can achieve meaningful improvements in itch and skin clearance while providing flexibility for long-term management.

Tune in to the full episode to hear Drs Del Rosso and Golant discuss how they incorporate modern topical therapies into real-world AD management, where corticosteroids still have an important role, and why advances in nonsteroidal treatments are changing the way clinicians approach both acute flares and long-term disease control.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Walter Liszewski, MD, for a discussion on the role of patch testing in patients with atopic dermatitis (AD), from the fundamentals of testing and interpretation to its application in patients with persistent or incomplete responses to therapy.

Dr Liszewski explains why allergic contact dermatitis is frequently overlooked in dermatology practice and how it commonly overlaps with AD and irritant contact dermatitis. Because these conditions often appear clinically similar, Dr Liszewski explains that, unlike AD or irritant contact dermatitis, allergic contact dermatitis has a diagnostic test available, making patch testing an important tool when the underlying cause of eczema is uncertain.

The conversation explores when patch testing should be considered in light of the absence of formal guidelines, with Dr Liszewski sharing his practical approach to identifying patients who may benefit from testing and how it can fit into the management of patients who continue to experience residual eczema despite advanced therapies. He also discusses the different reasons biologic-treated patients may have persistent disease and how patch testing can help distinguish allergic contact dermatitis from a more complex inflammatory phenotype.

Dr Liszewski reviews practical considerations for preparing patients for patch testing, including which medications should be discontinued beforehand and which can generally be continued. He explains why he typically does not stop biologic therapy before testing, while outlining situations in which temporary interruption may be appropriate. The discussion also covers newer molecular testing that may provide additional information in difficult cases and introduces the "paraben paradox," an important concept illustrating how impaired skin barrier function can influence allergic responses.

Tune in to the episode to gain a clearer understanding of when patch testing should be considered in patients with AD, learn how to approach patients with persistent or partial treatment responses, and learn practical considerations for preparing patients and optimizing test accuracy.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, sits down with Melinda Gooderham, MD, for a wide-ranging conversation about the evolution of dermatology, clinical research, and the therapeutic advances that have transformed patient care over the course of her career.

Dr Gooderham reflects on how an early frustration with patient access to emerging biologic therapies led her into clinical research, a decision that not only expanded treatment opportunities for her patients but also shaped her professional focus on inflammatory skin diseases. She discusses how participating in clinical trials deepens understanding of both disease states and therapeutic mechanisms, often accelerating the development of clinical expertise.

The conversation explores some of the most dramatic changes she has witnessed in practice, particularly the impact of JAK inhibitors across multiple dermatologic conditions. Dr Gooderham shares observations from alopecia areata, granulomatous diseases, dermatomyositis, and bullous pemphigoid, highlighting instances where treatment responses exceeded expectations and significantly improved patients’ quality of life.

Dr Del Rosso and Dr Gooderham also discuss areas where therapeutic expectations have been more tempered, including in the role of oral PDE4 inhibitors in psoriasis, before turning to the future of dermatology. Topics include the emergence of highly effective oral therapies, the potential for extended-duration biologics, and how these advances may reshape treatment decision-making and patient preferences.

They conclude with an important discussion on the growing emphasis on early intervention. As treatment options continue to expand, the challenge is increasingly not whether a disease can be treated, but whether patients can be identified and managed early enough to prevent irreversible consequences and optimize long-term outcomes.

Tune in to the episode to hear Dr Gooderham's reflections on the therapies, discoveries, and clinical moments that have most influenced her career, along with her perspective on where dermatology may be headed next.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes back Michael Payette, MD, a dermatologist in private practice in Connecticut, for a wide-ranging discussion on the realities of managing hidradenitis suppurativa (HS) in clinical practice.

Drawing from his experience running a dedicated HS clinic, Dr Payette reflects on what surprised him most after launching the practice, including the number of early-stage referrals and the growing recognition that even patients with relatively mild disease may benefit from more proactive care. The conversation highlights the importance of identifying HS earlier in its course, before patients develop irreversible scarring, sinus tracts, and other long-term sequelae.

Drs Del Rosso and Payette discuss the logistical and emotional complexity of caring for patients with HS, emphasizing that meaningful visits cannot be compressed into a few minutes. Dr Payette shares how he structures conversations around realistic goal-setting, long-term therapeutic partnerships, and individualized treatment “buckets” ranging from topical and systemic therapies to lifestyle considerations, clinical trials, and surgery. The discussion also explores the psychological burden of HS, including how issues such as intimacy, work absenteeism, and social isolation often shape the patient experience as much as the physical disease itself.

They also examines evolving treatment strategies for HS, including the challenges of managing patients in the mild-to-moderate range, the rationale for early intervention, and the growing role of combination therapy. Dr Payette shares insights on combining biologic and JAK inhibitor therapies in select patients, integrating GLP-1 agents into treatment plans, and balancing medical and surgical management to optimize outcomes. Throughout the discussion, both physicians emphasize the importance of empathy, collaboration, and helping dermatologists feel more comfortable initiating treatment for HS, even if they ultimately refer more advanced cases to specialized colleagues.

Tune in to the episode to hear insights on building therapeutic relationships with patients with HS, approaching multifactorial disease management, recognizing opportunities for earlier intervention, and navigating the therapeutic landscape for this historically underserved disease state.

In this episode of Tea with Dr. D, host James Q. Del Rosso delivers a solo “Spilling the Tea” segment that revisits oral isotretinoin through a longitudinal lens, connecting its early clinical foundations to present-day practice.

Framing isotretinoin as a “winding road,” Dr Del Rosso reflects on its 1982 approval, early safety observations, and the evolution of risk management strategies, including the iPLEDGE program. While concerns around psychiatric effects, inflammatory bowel disease, and teratogenicity have shaped prescribing behaviors, he emphasizes that most patients tolerate therapy well when appropriately monitored.

A central theme is the value of foundational knowledge. Dr Del Rosso highlights considerations that remain highly relevant, including dosing flexibility, relapse patterns, treatment duration, and importantly, the impact of absorption on outcomes. Conventional formulations require adequate dietary fat for optimal bioavailability, and suboptimal fat intake may contribute to perceived treatment failure or relapse.

He also reviews evolving data on dosing strategies, noting that a range of daily doses can achieve clearance. The priority, however, is durability of response. Clinicians are encouraged to focus on cumulative exposure and to individualize therapy, extending duration or adjusting dose as needed to maintain clearance. Newer formulations, including lidose and micronized isotretinoin, may help mitigate variability in absorption and improve consistency, though access and cost remain considerations.

Additional insights address relapse risk and the importance of evaluating possible underlying contributors such as androgen excess. Laboratory monitoring practices have also evolved, with a more streamlined approach focusing on key parameters like liver enzymes and triglycerides, alongside strict adherence to pregnancy prevention protocols.

Ultimately, the episode reinforces that while isotretinoin prescribing has modernized in certain respects, many core principles remain unchanged. Thoughtful dosing, attention to absorption, and individualized management are essential to optimizing long-term outcomes.

Tune in to the episode to revisit the clinical foundations of isotretinoin, refine your approach to dosing and duration, and learn practical strategies for improving treatment consistency and long-term acne clearance.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, welcomes Leon Kircik, MD, for a wide-ranging conversation that traces Dr Kircik’s journey from his upbringing in Turkey to building a thriving dermatology practice and research center in Louisville, Kentucky, and ultimately becoming one of the leading educators in the field.

Dr Kircik reflects on the early influence of his father, whose emphasis on discipline and hard work shaped his approach to both medicine and business. After immigrating to the United States and completing dermatology training at the University at Buffalo, he recognized an oversaturated market in New York City and made the strategic decision to establish his practice in Louisville. There, he prioritized including access for Medicaid patients and offered extended hours to better meet patient needs.

The discussion also explores the operational realities of running a high-functioning clinical research center. Dr Kircik shares insights into meeting both the administrative and logistical demands, particularly in the context of clinical studies, highlighting the importance of protocol adherence, consistent investigator presence, and delivering high-quality data to maintain industry trust.

A notable portion of the conversation focuses investigator-initiated studies (ISS). While resource-intensive and carrying greater responsibility, Dr Kircik views ISS as an opportunity to answer clinically meaningful questions that industry-sponsored trials may not be able to address, ultimately contributing to scientific advancement and professional growth.

Tune in to the episode to hear more of Dr Kircik’s reflections on building a multifaceted career as well as personal lessons ranging from real estate investments to maintaining professional commitments while recovering from a serious injury, all grounded in a consistent theme of resilience and sustained effort over time.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO is joined by Stefan Weiss, MD for a focused discussion on compounding in dermatology, an area that often operates with less visibility but carries important clinical implications.

The conversation centers on the regulatory and practical differences between 503A and 503B compounding pharmacies, with particular attention to 503A facilities, where customized medications are prepared based on individual prescriptions. They outline key concerns with this model, including variability in formulation, lack of standardized testing, and limited oversight compared with FDA-approved therapies. Unlike commercially developed medications, compounded products are not required to undergo stability testing, penetration studies, or clinical trials, raising questions about consistency, efficacy, and safety.

A recurring theme is the challenge of knowing exactly what patients receive. Without controls on formulation integrity or bioavailability, clinicians may encounter variability not only between pharmacies, but even between batches from the same source, highlighting how this uncertainty can complicate treatment decisions.

The episode also contrasts compounded therapies with FDA-approved options, using topical clascoterone as an example of a rigorously tested, standardized formulation. While both speakers acknowledge that compounding has a role, particularly in addressing unmet or niche patient needs, they note that its use today has expanded beyond its original intent.

Tune in to the episode to hear how clinicians can approach compounded therapies with greater scrutiny, balance their use against standardized treatments, and make more informed decisions in everyday dermatology practice.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Heather Woolery-Lloyd, MD, for a treatment-focused discussion on acne management in an era where patient expectations, product awareness, and regimen complexity continue to rise.

The conversation opens with a shift many dermatologists are seeing in practice: patients arriving more informed and more influenced by social media, asking detailed questions about ingredients, formulations, and skin care routines. This evolving dynamic requires clinicians to not only select effective therapies but also contextualize an expanding array of over-the-counter and adjunctive options.

Dr Woolery-Lloyd and Dr Del Rosso revisit foundational therapies such as benzoyl peroxide, addressing concerns around benzene and reinforcing its continued role as a reliable, effective agent. They emphasize the importance of formulation and tolerability, noting that lower concentrations (around 4% or less) can offer similar efficacy with reduced irritation when well-formulated.

A central theme is the growing importance of the skin barrier and microbiome in acne management. The speakers highlight how barrier-supportive skin care, including moisturizers and adjunctive products, can improve both tolerability and clinical outcomes. They underscore that regimen success often depends on the full system of care, not just prescription therapies.

The discussion also explores newer over-the-counter formulations, including polyhydroxy acids for gentle exfoliation, multifunctional moisturizers targeting post-inflammatory hyperpigmentation, and emerging adjuncts like hypochlorous acid sprays (particularly useful for truncal acne).

Throughout, the episode reinforces a practical message: effective acne management today requires thoughtful integration of prescription therapies, formulation science, and patient-centered skin care guidance.

Tune in to the episode to hear how clinicians are navigating increasingly informed patients, optimizing tolerability without sacrificing efficacy, and building acne regimens that account for both therapeutic impact and real-world adherence.

In this episode of Derms and Conditions, host James Q. Del Rosso, DO, is joined by Hilary Baldwin, MD, for a treatment-focused discussion on acne management, with particular attention to how newer topical therapies are reshaping treatment approaches.

They begin by reflecting on how patient expectations and therapeutic options have shifted over the past decade. Dr Baldwin highlights improvements in topical formulations that have enhanced both efficacy and tolerability, allowing many patients with mild to moderate and even some severe acne to be managed with topicals alone. This shift has also reduced reliance on prolonged oral antibiotic use.

They next address practical considerations, including access and adherence. Dr Baldwin discusses the role of specialty pharmacies in helping ensure patients receive prescribed therapies without substitution and the importance of providing specific skin care recommendations to minimize irritation and improve outcomes.

A key focus of the conversation is topical clascoterone, a first-in-class androgen receptor inhibitor that targets the androgen-sebum pathway and reduces sebum production progressively over time. They emphasize the benefit of initiating it early and setting appropriate expectations with patients, as its therapeutic effects build over 2 to 3+ months. Both clinicians advocate pairing clascoterone from the outset with a combination of topical agents that addresses other pathophysiologic cascades in acne to provide early visible improvement while supporting longer-term disease control. Other agents, such as benzoyl peroxide, topical retinoids, and clindamycin, are available in combination topical formulations to allow for ease of use, including a triple-combination topical gel.

They also discuss strategies for simplifying complex regimens, especially for younger patients, and review admixture data supporting compatibility between clascoterone and other topical agents.

Tune in to the episode for practical pearls on designing combination topical regimens, setting realistic expectations with patients, and applying these strategies to optimize acne management.

Disclaimer: This podcast is not intended to provide diagnosis, treatment, or medical advice. Content provided in this podcast is for educational purposes only. Please consult with a physician regarding any health-related diagnosis or treatment.